NR565 Exam Final Study Guide

NR565 Exam Final Study Guide Week 7 & 8 Antacids: weak bases that react with hydrochloric acid to form salt & water. -Neutralize Gastric Acidity (causes ^pH of the stomach and duodenal bulb) -Inhibit proteolytic activity of pepsin -Increase lower esophageal sphincter tone -ALL antacids are contraindicated in the presence of severe abdominal pain of unknown cause, especially if accompanied by fever -HIGH SODIUM content: pts w/ HTN. CHF need to use low sodium preparation -Concurrent administration with enteric-coated drugs, destroys the coating= alters absorption, ^ the risk for adverse effects -Administrations should be separated by at least 2 hours to decrease interactions 1. Calcium based antacids: TUMS, Caltrate, Calcarb • Require Vitamin D for absorption from the GI tract • Prescribed to treat calcium deficient states, i.e. chronic renal failure, post-menopause, and osteoporosis • Contraindicated in the presence of hypercalcemia and renal calculi • Can cause constipation- increase bulk, fluids and mobility, stool softener • Administered 30min- 1hr on empty stomach or 3hr after meals • Should not be administered with food containing large amounts of oxalic acid (spinach, rhubarb), or phytic acid (bran, cereals), they decrease the absorption of calcium • Taking w/ foods containing phosphorus (milk, dairy) can lead to milk-alkali syndrome (N/V, confusion, headache). • Taking with acidic fruit juice improve absorption 2. Aluminum based: AlternaGEL, Amphojel, Mylanta • Inhibit smooth muscle contraction and slow gastric emptying • Aluminum concentrated in the CNS • Prolonged use in patients with renal failure may result in dialysis osteomalacia • Elevated aluminum tissues levels contribute to the development of dialysis encephalopathy • Used to treat hyperphosphatemia in pts w/ renal failure & phosphate renal stone prevention • Can cause constipation- increase bulk, fluids and mobility, stool softener 3. Magnesium based: Milk of mag, Maalox, Mylanta • Can be used to treat magnesium deficiencies from malnutrition, alcoholism, or mag- depleting drugs • Contraindicated in patients with renal failure & used with caution in pts with renal insufficiency • Can cause diarrhea- increase fiber intake Antidiarrheals: • Diarrhea that lasts for less than 2 weeks is considered acute; if it lasts more than 2 weeks, it is considered chronic. • Not recommended for children under 12, none of the antidiarrheals are safe for children under 2 years old • Rebound constipation is the main adverse effect • Contraindications: Drugs that decrease gastric motility or delay intestinal transit time have induced toxic megacolon, especially in those with inflammatory bowel disease -Bismuth subsalicylate (Pepto bismol): Acute diarrhea, travelers’ diarrhea ▪ For bismuth subsalicylate, additional reactions that all patients should be warned about are gray/black stools and black tongue, the results of the bismuth. Patients should be told to expect this reaction and that it does not indicate GI bleeding. ▪ Bismuth subsalicylate may potentiate the risk for toxicity if taken w/ aspirin ▪ Is contraindicated in children with flu-like symptoms ▪ Has antimicrobial effects against bacterial and viral enteropathogens -Crofelemer (fulyzaq): Symptomatic relief of noninfectious diarrhea in adult pts w/ HIV/AIDS on antiretroviral therapy -diphenoxylate w/atropine (Lomotil): Acute diarrhea ▪ Anticholinergics are useful only with inflammatory bowel disease ▪ The atropine component of diphenoxylate and difenoxin contraindicates their use in narrow-angle glaucoma and requires cautious use in prostatic hyperplasia. -Difenoxin w/atropine (Motofen): Acute diarrhea ▪ Anticholinergics are useful only with inflammatory bowel disease ▪ The atropine component of diphenoxylate and difenoxin contraindicates their use in narrow-angle glaucoma and requires cautious use in prostatic hyperplasia. -Kaolin-pectin (kapectolin): Acute diarrhea -Loperamide (Imodium): Acute diarrhea, travelers’ diarrhea, chronic diarrhea associated w/inflammatory bowel disease Cytoprotective Agents: Pt should report onset of black tarry stools or severe abdominal pain, which may indicate treatment failure and GI bleeding - Sucralafate (Carafate): MOA-Aluminum salt that binds to necrotic ulcer tissue where it acts as a barrier to acid, pepsin, and bile salts. Action is largely topical. • Separate administration of interacting drugs by 2 hours • Take on an empty stomach • Causes constipation- increased fluids, dietary bulk and exercise • Do not use with digoxin or warfarin= decreases effectiveness • Indication for active duodenal ulcer x8wks and maintenance after healing x2wks -Misoprostol (Cytotec): MOA-Inhibition of acid secretion in response to stimuli such as meals, histamine, and coffee by binding to prostaglandin E receptors, mucosal protective qualities. • Pregnancy X: Can produce uterine contractions endangering pregnancy causing spontaneous abortion, premature birth, or birth defects. Women of childbearing age should have a negative pregnancy test before prescribed and start misoprostol on day 2 or 3 of menstrual period. If pregnancy is suspected, drug should be stopped immediately. • Take with food • Can cause diarrhea, if persists x1WK notify provider • Indicated for prophylaxis and treatment of duodenal ulcers associated with NSAID use