NR565 Week 7 & Final Exam Study Outline
Many questions are written to assess your clinical application of the material from the
textbook, in real-world scenarios.
Week 7 Readings:
Chapter 34: Gastroesophageal reflux and peptic ulcer disease
Know the following for each drug class (antacids, antidiarrheals, cytoprotectives,
antiemetics, histamine 2 receptor antagonists, prokinetics, proton pump inhibitors and
laxatives):
Antiacids: neutralize acids in the gastrointestinal (GI) tract. Different combinations have
differing acid neutralizing capacities. Sodium bicarbonate and calcium carbonate have the
highest absolute neutrophil count (ANC)
ALLUMINUM HYDROXIDE (Aluminum Carbonate (Basalgel) AE constipation TX:
Hyperphosphatemia
MAGNESIUM HYDROXIDE AE diarrhea
ALLUMINUM/MAGNESIUM HYDROXIDE Highest ANC
CALCIUM CARBONATE AE constipation TX (TUMS) calcium deficiency in chronic renal
failure, post menopause, osteoporosis
Drug interactions: many affect absorption of most drugs, separate antiacid administration
with other drugs for at least 2 hrs.
Pharmacodynamics: Antiacids neutralize gastric acid in the GI tract. Causing an increase
PH in the stomach and duodenal bulb. Antacids contain various combinations of metallic
cation. * different combinations have different acid neutralizing capacities.
Metallic cation + basic ion, common metallic cation, aluminum, calcium, magnesium, bests
anion, hydroxide, bicarbonate, carbonate.
Clinical use: Hyperacidity: antacids used for relief of heartburn, take QID or more every 30-
60 min until symptoms subside. (discuss maximum doses with pt.) Tx peptic ulcer disease
(triple therapy treatment) used after meals and at bedtime. GERD, antacids are OTC used
before pts seek care. (maintenance after meals and at bedtime). Histamine2 receptor
agonists or proton pump inhibitors are 1st line therapy, Tx Calcium deficiency, chronic renal
failure 1,000 mg calcium carbonate daily, osteoporosis prevention, men and premenopausal
women 1,000 mg daily. Postmenopausal women 1,500 mg daily. Doses higher than 2,000
mg day not recommended!
Pharmacokinetics: Aluminum and magnesium based antacids are not absorbed with
normal routine use. Chronic use increases absorption by 5%-20% renally excreted.
Calcium-containing antiacids require vitamin D for absorption. Excreted in feces.
Precautions/ contraindications: Abdominal pain of unknown cause, Calcium based
antacids contraindicated if pt is hypercalcemic or has renal caliculi. Magnesium-based
antacids should not be used in pts with renal failure on dialysis. Sodium content may affect
patients with hypertension, CHF, or RF.
ARDS: Magnesium-based antacids may cause diarrhea, Aluminum and calcium based
antacids may cause constipation.
Monitoring: abdominal pain of unknown cause, Calcium based antacids contraindicated in
patients with real failure or renal insufficiency. Aluminum-based antacids should not be used
in patients with renal failure on dialysis. Sodium content may affect patients with
hypertension, congestive heart failure, or renal failure.
Patient education: Contact provider if using longer than 2 weeks, experience extreme
pain, cramping, blood in stool (symptoms of GI bleed) Aluminum and calcium based
,antacids cause constipation *need stool softener, magnesium based products cause
diarrhea. (Lifestyle changes)
ANTIDIARRHEALS
Diarrhea is commonly treated with over the counter medications and can be resolved
with or without any treatment. Most diarrhea if seen in the clinical setting is caused by
an infection, food or drug ingestion, or inflammatory bowel disease. Infections are either
from food or a drug that the patient has ingested. Most diarrhea does not require
medication but can be used in acute and chronic diarrhea and inflammatory bowel
disease. Clinicians seek to treat the source of diarrhea.
Pharmacodynamics
There are three main classes of drugs used to treat diarrhea.
Absorbents (kaolin-pectin or bismuth subsalicylate) are administered after each loose
stool.
Opioids are also utilized in the treatment of diarrhea. Maintaining hydration is of utmost
importance in children and the elderly. Electrolyte solutions are used in infants and
young children and flat soda or water in adults.
Absorbent preparations
Preg cat B Kaolin and pectin- Kaolin is a clay-like powder that attracts and holds
onto bacteria. Pectin: thickens stool.
Preg C Bismuth subsalicylate( Pepto Bismol) have antisecretory and
antimicrobial effects. * Also used for eradication of H Pylori
Opiates
Peg C Diphenoxylate with atropine (Lomotil) is an opioid.
Preg C Diphenoxin with atropine (Motofen). Atropine causes decreased bowel
secretions and slows peristalsis.
Preg cat B Loperamide (Imodium)Loperamide binds to opioid receptors and
slows gastric motility. Increases viscosity diminishes loss of fluid and
electrolytes
Crofelemer (Fulyzaq)-New Drug Preg cat C
Approved to treat diarrhea in patients with HIV/AIDS who are
taking antiretrovirals
125 mg twice a day without regard for food
Anticholinergics Only used in IBD
Atropine causes decreased bowel secretions and slows peristalsis.
Propantheline
, Pharmacokinetics
Kaolin and pectin are not absorbed and are eliminated in the stool. Bismuth
subsalicylate dissociates into salicylate that is absorbed (similar to aspirin), metabolized
in the liver, and excreted in the urine with the bismuth that is not absorbed. The opioid
agents are all absorbed and distributed systemically, metabolized in the liver, and
eliminated in urine and/or feces.
Precautions and Contraindications
CI in children <2, rehydration is key in children
Opioids decrease intestinal motility and may cause toxic megacolon.
Atropine component is CI narrow angle glaucoma, caution in prostatic hyperplasia and
children especially down syndrome children.
Bismuth subsalicylate is contraindicated in children with viral or flu-like illness.
Use all cautiously in older adults.
Antidiarrheals are contraindicated in the treatment of diarrhea in most children.
Adverse Drug Reactions
Rebound Constipation
Bismuth causes black tongue and gray-black stools.
Diphenoxylate and difenoxin with atropine have anticholinergic effects.
Opioids have central nervous system (CNS) effects: Dizziness, drowsiness,
sedation, and headaches.
Patient Education
Educate patients regarding rebound constipation. Bismuth can turn the tongue
and stool black. Products with atropine may cause dry mouth and
anticholinergic effects. Opioids may cause CNS effects.
Lifestyle management
Adequate hydration
Clinical Use
Acute diarrhea
Treat the source of diarrhea.
Absorbents (kaolin-pectin or bismuth subsalicylate) used after each loose stool
Maintain hydration.
Electrolyte solution in infants and young children
Flat soda or water in adults
Opioids dosed 3 or 4 times/day or after each stool
Bowel disease
Many questions are written to assess your clinical application of the material from the
textbook, in real-world scenarios.
Week 7 Readings:
Chapter 34: Gastroesophageal reflux and peptic ulcer disease
Know the following for each drug class (antacids, antidiarrheals, cytoprotectives,
antiemetics, histamine 2 receptor antagonists, prokinetics, proton pump inhibitors and
laxatives):
Antiacids: neutralize acids in the gastrointestinal (GI) tract. Different combinations have
differing acid neutralizing capacities. Sodium bicarbonate and calcium carbonate have the
highest absolute neutrophil count (ANC)
ALLUMINUM HYDROXIDE (Aluminum Carbonate (Basalgel) AE constipation TX:
Hyperphosphatemia
MAGNESIUM HYDROXIDE AE diarrhea
ALLUMINUM/MAGNESIUM HYDROXIDE Highest ANC
CALCIUM CARBONATE AE constipation TX (TUMS) calcium deficiency in chronic renal
failure, post menopause, osteoporosis
Drug interactions: many affect absorption of most drugs, separate antiacid administration
with other drugs for at least 2 hrs.
Pharmacodynamics: Antiacids neutralize gastric acid in the GI tract. Causing an increase
PH in the stomach and duodenal bulb. Antacids contain various combinations of metallic
cation. * different combinations have different acid neutralizing capacities.
Metallic cation + basic ion, common metallic cation, aluminum, calcium, magnesium, bests
anion, hydroxide, bicarbonate, carbonate.
Clinical use: Hyperacidity: antacids used for relief of heartburn, take QID or more every 30-
60 min until symptoms subside. (discuss maximum doses with pt.) Tx peptic ulcer disease
(triple therapy treatment) used after meals and at bedtime. GERD, antacids are OTC used
before pts seek care. (maintenance after meals and at bedtime). Histamine2 receptor
agonists or proton pump inhibitors are 1st line therapy, Tx Calcium deficiency, chronic renal
failure 1,000 mg calcium carbonate daily, osteoporosis prevention, men and premenopausal
women 1,000 mg daily. Postmenopausal women 1,500 mg daily. Doses higher than 2,000
mg day not recommended!
Pharmacokinetics: Aluminum and magnesium based antacids are not absorbed with
normal routine use. Chronic use increases absorption by 5%-20% renally excreted.
Calcium-containing antiacids require vitamin D for absorption. Excreted in feces.
Precautions/ contraindications: Abdominal pain of unknown cause, Calcium based
antacids contraindicated if pt is hypercalcemic or has renal caliculi. Magnesium-based
antacids should not be used in pts with renal failure on dialysis. Sodium content may affect
patients with hypertension, CHF, or RF.
ARDS: Magnesium-based antacids may cause diarrhea, Aluminum and calcium based
antacids may cause constipation.
Monitoring: abdominal pain of unknown cause, Calcium based antacids contraindicated in
patients with real failure or renal insufficiency. Aluminum-based antacids should not be used
in patients with renal failure on dialysis. Sodium content may affect patients with
hypertension, congestive heart failure, or renal failure.
Patient education: Contact provider if using longer than 2 weeks, experience extreme
pain, cramping, blood in stool (symptoms of GI bleed) Aluminum and calcium based
,antacids cause constipation *need stool softener, magnesium based products cause
diarrhea. (Lifestyle changes)
ANTIDIARRHEALS
Diarrhea is commonly treated with over the counter medications and can be resolved
with or without any treatment. Most diarrhea if seen in the clinical setting is caused by
an infection, food or drug ingestion, or inflammatory bowel disease. Infections are either
from food or a drug that the patient has ingested. Most diarrhea does not require
medication but can be used in acute and chronic diarrhea and inflammatory bowel
disease. Clinicians seek to treat the source of diarrhea.
Pharmacodynamics
There are three main classes of drugs used to treat diarrhea.
Absorbents (kaolin-pectin or bismuth subsalicylate) are administered after each loose
stool.
Opioids are also utilized in the treatment of diarrhea. Maintaining hydration is of utmost
importance in children and the elderly. Electrolyte solutions are used in infants and
young children and flat soda or water in adults.
Absorbent preparations
Preg cat B Kaolin and pectin- Kaolin is a clay-like powder that attracts and holds
onto bacteria. Pectin: thickens stool.
Preg C Bismuth subsalicylate( Pepto Bismol) have antisecretory and
antimicrobial effects. * Also used for eradication of H Pylori
Opiates
Peg C Diphenoxylate with atropine (Lomotil) is an opioid.
Preg C Diphenoxin with atropine (Motofen). Atropine causes decreased bowel
secretions and slows peristalsis.
Preg cat B Loperamide (Imodium)Loperamide binds to opioid receptors and
slows gastric motility. Increases viscosity diminishes loss of fluid and
electrolytes
Crofelemer (Fulyzaq)-New Drug Preg cat C
Approved to treat diarrhea in patients with HIV/AIDS who are
taking antiretrovirals
125 mg twice a day without regard for food
Anticholinergics Only used in IBD
Atropine causes decreased bowel secretions and slows peristalsis.
Propantheline
, Pharmacokinetics
Kaolin and pectin are not absorbed and are eliminated in the stool. Bismuth
subsalicylate dissociates into salicylate that is absorbed (similar to aspirin), metabolized
in the liver, and excreted in the urine with the bismuth that is not absorbed. The opioid
agents are all absorbed and distributed systemically, metabolized in the liver, and
eliminated in urine and/or feces.
Precautions and Contraindications
CI in children <2, rehydration is key in children
Opioids decrease intestinal motility and may cause toxic megacolon.
Atropine component is CI narrow angle glaucoma, caution in prostatic hyperplasia and
children especially down syndrome children.
Bismuth subsalicylate is contraindicated in children with viral or flu-like illness.
Use all cautiously in older adults.
Antidiarrheals are contraindicated in the treatment of diarrhea in most children.
Adverse Drug Reactions
Rebound Constipation
Bismuth causes black tongue and gray-black stools.
Diphenoxylate and difenoxin with atropine have anticholinergic effects.
Opioids have central nervous system (CNS) effects: Dizziness, drowsiness,
sedation, and headaches.
Patient Education
Educate patients regarding rebound constipation. Bismuth can turn the tongue
and stool black. Products with atropine may cause dry mouth and
anticholinergic effects. Opioids may cause CNS effects.
Lifestyle management
Adequate hydration
Clinical Use
Acute diarrhea
Treat the source of diarrhea.
Absorbents (kaolin-pectin or bismuth subsalicylate) used after each loose stool
Maintain hydration.
Electrolyte solution in infants and young children
Flat soda or water in adults
Opioids dosed 3 or 4 times/day or after each stool
Bowel disease
