N365 Final Exam

antihistamine (H2- blocking agent)

it blocks H2 receptors as a competitive antagonist and doesn’t allow stimulation to happen on the parietal cells, it decreases gastric acid secretion

• uncommon

• pneumonia

• constipation

it decreases the acid production, so pH is raised, which might allow for the survival of organisms in that environment, leading to respiratory aspiration

GERD

proton-pump inhibitor (PPI), gastric acid secretion

it inhibits H+K+ATPase, the enzymes that produces gastric acid; suppresses the last phase of gastric acid production

• with short term use (4-8 weeks) = headache, N/V/D

• long-term use = higher incidence of CKD, dementia, magnesium deficiency, pneumonia and weakened bones

there’s interference with calcium absorption occurring since some acidity in the stomach was lost

omeprazole (Prilosec)

• no tobacco use

• increases gastric acid production

• no lying down for at least 2 hours after eating

• raise HOB

• weight loss

proton pump inhibitor

anti-ulcer

acts locally within the GI tract to “patch” an ulcerated area in the stomach mucosa in order to protect it against further attack by acid, pepsin, or bile salts

• constipation — most common
  VERY well tolerated

• dizziness

• vertigo

it needs to be given on an empty stomach, it will not get to where it needs if given with food

antacid and fat soluble vitamins

antacid, nonsystemic

neutralizes gastric acid by chemical reaction, leading to a higher pH

Al products = constipation
Mg products = diarrhea
This medication tries to balance the 2 effects

after meals when the acid has already been produced

it can reduce absorption of various drugs and bind with a lot of other medications

antiflatulent

alters surface tension of gas bubbles, causing them to coalesce and free the gas, which is then eliminated by belching or passing flatus

none; very well tolerated drug

via drops

in combination with antacids

antiemetic, anticholinergic, antihistamine

it is used to prevent motion sickness, so you can’t use it once you’re already feeling motion sick

decreases GI motility and GI spasms (which leads to vomiting)

anticholinergic effects:

• sedation

• dry mouth

• blurred vision

• urinary retention

• do not use if patient has glaucoma since it can increase intraocular pressure

• may mask symptoms of ototoxicity

antiemetic

used to treat vomiting or decrease vomiting

acts directly on CTZ and vomiting center by suppressing their response

there is a high risk of necrosis of the surrounding tissues and blood vessels

• sedation

• hypotension

• dystonias

• peripheral anticholinergic effects (dry mouth, blurred vision, constipation)

• not effective for motion sickness

• synergistic for analgesia with narcotic and non narcotics - pain relief is better

antiemetic

can be used as a promotility agent when there is no N/V, helps things move forward in GI tract and can be used for people who have diabetic gastroparesis

• blocks dopaminergic receptors in the CTZ

• stimulates acetylcholine effect which enhances motility of smooth muscle

• drowsiness

• restlessness

• extrapyramidal symptoms esp w/ high IV doses = nystagmus, tongue thrusting

• gynecomastia

metoclopramide

• obstruction

• hemorrhage

• perforation of GI tract

30 minutes

antiemetic

selective serotonin antagonist that works in the CTZ to prevent nausea and vomiting

prevention of N/V, also used post-op

• constipation

• rashes

• transient blurred vision

to assist those receiving chemo

false; it does not

30 minutes before chemo

false, it does NOT prevent delayed CINV

cathartic, saline (laxative)

it causes diarrhea, that’s why it’s a mixture

reacts with HCl in the stomach —> MgCl = saline/salt effect pulls water into the intestinal lumen; if theres enough it increases peristalsis. this produces bowel movement

can work in half an hour to 3 hours

• occasionally diarrhea (if taken too often)

• hypermagnesemia if you have renal failure

about 20% of magnesium may be absorbed, which is a problem in patients w/ CRF due to magnesium toxicity

polyethylene glycol and electrolytes

miralax

to avoid fluid imbalance

cathartic, stimulant (laxative)

stimulates peristalsis by irritating mucosa

• intestinal cramps

• diarrhea

• suppositories may produce mild burning sensation in rectum

to not crush, cut or chew tablets

laxative, bulk-forming

it absorbs water which enlarges bulk of fecal mass and mechanically stimulates bowel

rare

it should be stirred in 8 oz. glass of liquid and drunk immediately while in suspension

it decreases cholesterol

Emollient agent (stool softener)

acts like a detergent and penetrates fecal material with water and fatty substances to soften it; it has NO effect on intestine and peristalsis, just fecal mass

negligible, occasional diarrhea

for its prophylactic effect (constipation)

antidiarrheal

it suppresses bowel motility / slows down or stops diarrhea

when you’re exposed to foreign microbes from another country

• traveller’s diarrhea

• any sudden onset of diarrhea

• black box: torsades de point — VERY chaotic VENTRICULAR rhythm

• constipation

• abdominal cramps

8mg, 24g if being supervised

it is an opioid used ONLY to tread diarrhea, atropine is put in there to discourage abuse as it can cause unpleasant side effects

hormone, anterior pituitary

it stimulates cortex of adrenal gland to produce cortisol

used to detect adrenal insufficiency, now used for more diagnostic purposes

same as cortisone:

• edema in LE

• HTN

• mood swings, memory, behavior

• confusion

• delirium

if cortisol levels rise after giving a shot of cosyntropin (corticotropin) then adrenal gland is working, if it fails to rise = dx is made

hormone, post-pituitary

• used to treat diabetes insipidus

• causes contraction of the smooth muscle of vascular bed

• promotes renal conservation of water

• excessive vasoconstriction

• decreased cardiac output

• water retention and intoxication

• to treat diabetes insipidus

• gaseous distention

desmopressin

posterior pituitary hormone

• stimulate uterine smooth muscle

• constricts vascular muscle

• limited ADH effect

• water intoxication can occur with large doses

• hyponatremia

• injudicious use can cause uterine rupture, hypertensive crisis and cerebral hemorrhage

• induction of labor

• post partum bleeding

vitamin D

• stimulates intestinal Ca absorption

• decreases Ca excretion

• bone Ca mobilization

when you have renal disease, you can’t activate vit D, so it causes a change in the bones

• hypercalcemia

• weakness

• lethargy

• ataxia