PC707 Module 3 – Exam with 100% Verified and Updated Solutions

PC707 Module 3 – Exam with 100% Verified and Updated Solutions Anti-Ulcer drugs help by: - answer-altering gastric pH by decreasing acid secretion -protecting the stomach wall lining by increasing mucosal protection -eradicating harmful bacteria Ex: H. Pylori What are the main pharmacologic categories of drugs we used to manage gastric acid secretion and the effects: - answer-antacids -H2 receptor antagonists -proton pump inhibitors (PPIs) -prostoglandin analogs -mucosal protectant sulcrafate (Carafate) What is the first OTC medication tried by patients with dyspepsia? - answer-Antacids -->these are typically not effective for persistant GERD and PUD What are antacids? How do they work? - answer-organic salts -neutralize the hydrochloric acid in the stomach -raises the gastric pH above 4.0 What are the main side effects of antacids? - answer-diarrhea -constipation What are the different categories of antacids? - answer-calcium carbonate -sodium bicarbonate -aluminum based -magnesium based -aluminum hydroxide What is important teaching for patients taking antacids? - answer-decreasing the stomach pH can cause the decrease absorption of drugs that rely on acidic conditions -if taking enteric coated medications--reducing stomach acid can cause the medication to dissolve and absorb in the stomach instead of the intestine **always separate antacids from other medications by 2 hours** Calcium carbonate antacids: - answer-Tums -can cause CONSTIPATION -require adequate fluid intake to dissolve -can be used in patients needing to take an antacid who also could benefit from extra calcium intake. -potential for milk "alkali" syndrome, metabolic alkalosis Sodium Bicarbonate antacids: - answer-Alka Seltzer -contains aspirin (ASA) -potential to WORSEN GI distress. -increased risk for water retention and fluid overload -potential to cause hypertension -Contraindicated in pregnancy, children, patient with CVD* Aluminum based antacids: - answer-Amphogel -can cause CONSTIPATION -requires adequate fluid intake to dissolve -Contraindicated in patients with renal insufficiency* Magnesium based antacids: - answer-Milk of magnesia -suspension mixture is more effective -can cause DIARRHEA -Contraindicated in renal insufficiency* Aluminum hydroxide antacids: - answer-may decrease the absorption of warfarin*. -can cause a chelating affect with drugs such as tetracyclines, warfarin, and digoxin—potentially decreasing their absorption & effectiveness -high affinity for phosphate—may cause hypophasphatemia What can cause heartburn in pregnancy? - answer-hormonal fluctuations -anatomic changes Are antacids safe in pregnancy? - answer-Yes, due to poor absorption -EXCEPT sodium bicarbonate (AlkaSeltzer) due to aspirin content, risk for fetal and maternal metabolic alkalosis, and fluid retention and overload* What are the typical order of interventions for pregnancy heartburn? - answer-lifestyle changes then try antacids -Milk of magnesia is first line* --category B -Tums--category C -make sure to consider if she has diarrhea or constipation -if antacids fail to work--H2 receptor antagonists are next -Zantac is the most studied and deemed the safest H2 blocker in pregnancy*—however, Zantac currently is being investigated to have a carcinogen—Pepcid is a great alternative What are H2 receptor antagonists? How is it different from H1 receptor antagonists? - answer-H2 receptors are primarily in the parietal cells of the stomach and when stimulated increase the secretion of gastric acid -H2 blockers help to competitively block the binding to these receptors--therefore decreasing acid secretion* -this is different from H1 blockers--which primarily blocks the histamine that is involved in allergic reactions What are the different types of H2 receptor antagonists? - answer-cimetidine (Tagamet) -famotidine (Pepcid) -ranitidine (Zantac) -nizatidine (Axid) Why should cimetidine (Tagamet) be avoided whenever possible? - answer-it is a potent CYP enzyme inhibitor causing deceased metabolism of many drugs--increasing drug levels* -many drug to drug interactions: warfarin, phenytoin, propanolol, nifidepine, chlondiapoxide, diazepam, lidocaine, tricyclic antidepressants, theophylline, metronidazole* Why is famotidine (Pepcid) a good go to drug for H2 antagonist? - answer-least CYP inhibitor effect -fewer drug to drug interactio