ATI Proctored Pharmacology 2019

BMI - higher BMI - higher doses age - liver and kidney function could be immature or impaired gender - females have increased body fat, leading to changes in medication absorbtion med tolerance - could come from long term use, or IV drug use. med accumulation - results in decrease renal function, therefore excretion/absorption psychological factors - the placebo effect inadequate gastric function - decreased GI absorption, diarrhea vascular insufficiency - arterial insufficiency, med doesn't get where it needs to go. liver/kidney disease - reduces medication metabolism pediatric dosing - bsa or weight based geriatric dosing - Increased gastric pH, Decreased GI motility, Decreased protein binding sites, Impaired memory , Changes in vision and hearing, Polypharmacy interventions for geriatric patients - Clear and concise instructions, verbally and in writing. Help the patient set up a daily calendar. Pill containers. pregnancy concerns with med therapy - Most meds should be considered harmful don't just assume, talk to doctor Avoid live virus vaccines: MMR, polio, but inactive flu vaccine is recommended. Benzodiazepines - -pams + chlordiazepoxide. Treats Anxiety, seizures, muscle spasms, alcohol withdrawal, induce or maintain anesthesia Buspirone - Anxiety, PTSD, panic, OCD Benzos pharmacodynamics - Increase the effects of GABA, GABA reduces the activity of neurons. Side effects: Sedation, amnesia, dependency, withdrawal. Do not abruptly discontinue. Flumazenil: antidote! Buspirone pharmacodynamics - SE: GI upset, dizziness, headache, nausea. Can be used long term, Sedation not a problem, Number of weeks for effects to be felt Eat food with them if GI upset. SSRI's - -ine treats Anxiety, depression, OCD, PTSD SSRI pharmacodynamics - How you ask? Inhibit serotonin reuptake SE: Nausea, wgt gain, fatigue, decreased sexual function. Insomnia for paroxetine Serotonin syndrome: Agitation, tremors, diaphoresis, fever Buproprion (Wellbutrin, Zyban) - antidepressant, helps quit smoking Buproprion pharmacodynamics - SE: Insomnia, weight loss, GI distress Trazadone: Sedation Trycyclic antidepressants - - Imipramine, amitriptyline - Blocks reuptake of Serotonin & norepinephrine - But also blocks other NTs postsynaptically (Ach, EPI) Depression, insomnia, fibromyalgia, neuropathy MAOIs - Phenelzine - for yo depression Trycyclics pharmacodynamics - Anticholinergic SE: Urinary retention, constipation, blurry vision, photophobia, dry mouth, tachycardia. Sedation, sweating, seizures. Chew gum, wear sunglasses, drink lots of fluids, high fiber diet. Most serious anticholinergic SE: URINARY RETENTION MAOI - Pharmacodynamics - SE: HTN crisis, agitation, anxiety, orthostatic hypotension Interact with almost everything. Eat foods with tyramine (Salami, aged cheese, avocado, red wine, chocolate, basically all yummy foods, can trigger HTN crisis. Lithium - treats bipolar disorder Lithium Pharmacodynamics - SE: GI upset, fine hand tremors (expected,) coarse hand tremors (toxicity,) polyuria, kidney toxicity, electrolyte imbalances (Na) Toxicity: Over 1.5, monitor lithium and sodium levels Symptoms of Toxicity: Coarse tremors, hypotension, seizures, tinnitus, coma, death No diuretics, eat enough salt, no NSAIDs, no anticholinergic meds, adequate fluid Carbamazepine - + valproic avid treats: BPD, seizures Carbamazepine pharmacodynamics - SE of Carbamazepine: blood levels down: leukopenia, thrombocytopenia, nystagmus, hypoosmolality, rash SE of Valproic acid: hepatoxicity First gen antipsychotics - First Generation (Conventional): Control positive side effects. Chlorpromazine, haloperidol - dopamine antagonists Treat Psychotic disorders such as schizophrenia First Gen Pharmacodynamics - EPS: Dystonia: spasm of neck, face, back, tongue Parkinson symptoms: drooling, shuffling, tremors Akathisia: inability to sit still Tardive dyskinesia: involuntary movement of tongue and face Neuroleptic malignant syndrome: fever, dysrhythmia, muscle rigidity VIA: IM injections every 2-4 weeks EPS: anticholinergic meds second generation antipsychotics - Risperidone, clozapine treats: Schizophrenia (positive and negative symptoms) second gen pharmacodynamics - SE: Diabetes, weight gain, increased cholesterol Anticholinergic effects Important: • IM option • Avoid alcohol Medications that end in -sone - PUD, Fluid retention, weight gain, bone loss. herbal supplements - any that start with a G potentiate bleeding Meds ending in -nab/-nib - are cancer drugs - increase risk for infection Oral Pharmacokinetics - 30min - 1hr onset, absorbed in GI, can be limited food, PH, or extended release Sublingual Pharmacokinetics - fast onset (maybe 5 min) because of highly vascular tissue. Limited by water or food, or if it is accidentally swallowed. inhalation pharmacokinetics - Rapid onset, highly vascular Topical/Intradermal Pharmacokinetics - slow absorption. Subcutaneous and IM Pharmacokinetics - intermediate absorption rate, depends on perfusion and med solubility IV Pharmacokinetics - immediate absorption. Medication distribution - medications bind to albumin, therefore it is needed to distribute the medication Medication Metabolism - kidney's, liver, and blood. increased metabolism in infants, decreased metabolism in older adults. First Pass Effect - found in oral medications, higher doses might be needed as a result. Medication Excretion - Via the kidney's MEC - minimum effective concentration. Therapeutic Index - can be low or high, check peak and trough levels (VANCO) Half-life - the amount of time it takes for only have of the drug to remain in the pt's system Agonist - potentiates and action: morphine is an opiod agonist Antagonist - blocks an action: narcan blocks receptors to prevent overdose Intradermal Administration - Low volume, under 0.1 mL 5-15 deg angle, bevel up SQ Administration - 3/8-5/8 inch needle, 25-27G, 45-90 deg IM Administration - 1-1 1/2 inches long, 22-25 G, 90 degrees IV administration - 20G, trauma 16G, Surgery: 18G, Child or old people: 22 to 24G 6 rights of administration - Right patient: 2 identifiers: name, birthday, MRN. Right med, Right dose, Right time, Right route, Right documentation, Patient has the right to refuse. Occurrence report for med errors - within 24 hours, should not be reference in patient's record, do not put it in the pt's chart Risks of IV med administration: - Heart failure = circulatory overload, Wrong medication: absorbed right away, Certain meds irritate lining of the veins: vesicant, Failure to maintain surgical asepsis: infection IVF: - typical rate: 100ml/hr, bolus: larger amount/less time Infiltration: - Pallor, cool to touch. What to do: Stop, remove, elevate, cold or warm compresses depending on solution. Extravasion (this sucks) - Infiltration of a vesicant solution. Pain burning redness swelling, Stop and notify, May want to infuse an antidote hematoma - put a warm compress on it. Catheter Embolus (this also sucks) - Missing catheter tip - Inspect the tip Can travel to the lungs and cause a pulmonary embolus, place a tourniquet to prevent travelling. Phlebitis (this really hurts) - Edema, throbbing, burning, increase temperature, palpable band, warm compress Cellulitis - Pain, warm, edema, induration (hardness,) fever, chills, malaise. to fix it: DC infusion, warm compress, elevate extremity to treat it: Abx, antipyretics Fluid Overload - s/s: JVD, tachycardia, SOB, edema, crackles. to fix it: Slow rate raise HOB (easier to breathe). to treat it: Diuretics ADHD/ADD Meds - Methylphenidate, amphetamine ADHD Meds Pharmacodynamics - SE: Insomnia, weight loss, appetite loss Do not administer at night, Administer immediately before or after meal, Monitor weight ETOH W/D - Withdrawal begins 4-12 hrs after last drink, peak 24-48 hours, finish 5-7 days. S/S of W/D: N/V, tremors, increased HR, RR, BP, seizures (can be fatal) ETOH W/D treatment - Benzodiazepines: Lorazepam, diazepam, chlordiazepoxide. Decrease VS, prevent seizures Hypertension: Clonidine, propranolol Antiepileptics: Carbamazepine ETOH Abstinence meds - Disulfiram: If they drink, will cause, N/V, hypertension, headache Naltrexone: Suppresses cravings Acamprosate: Decrease anxiety, restlessness Opiod Abstinence meds - Methadone Nicotene Abstinence Meds - Bupropion, Replacement (Gum, patch, nasal spray), Varenicline: Suppress cravings,Monitor for depression and suicidal tendencies myasthenia gravis - a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles decreased ACH MG meds - Neostigmine, edrophonium MG meds pharmacodynamics - Increase ACH by inhibiting the enzyme cholinesterase at the synapses, increase strength and mobility + Reverse neuromuscular blocking agents SE: Related to too much ACH, Increased salivation, bradycardia, sweating Other: Edrophonium - Used to diagnose MG, If given and improves- MG, If given and worsens- cholinergic crisis Give antidote: atropine Parkinson's disease - not enough dopamine, too much ACH Carbidopa/Levedopa (PD) - Increases dopamine, decreases tremors SE: Nausea, vomiting, drowsiness, dyskinesia, darkening of urine and sweat, psychosis Important: High protein meals will decrease the effectiveness of this medication, eat more carbs! Benztropine (PD) - Decreases ACH SE: Anticholinergic side effects Important: Chew gum, wear sunglasses, high fiber diet, 2-3L water per day Antiepileptic - Phenytoin (Dilantin) Phenytoin (Dilantin) (AED) Pharmacodynamics - SE: Gingival hyperplasia, nystagmus, diplopia, Ataxia, hypotension, rash Important: plasma levels, narrow therapeutic range Decreases effectiveness of oral contraceptives Timolol - Treats: Open angle glaucoma SE: Stinging of eye Important: Don't touch tip of bottle to eye, hold pressure at tear duct Acetylzolamide - Carbonic-anhydrase inhibitor - treats: Glaucoma, heart failure, altitude sickness Decreases aqueous humor production via diuresis SE: Flu-like symptoms, electrolyte imbalances (Na, K) ciprofloxacin/hydrocortisone - Treats: Otitis externa Admin: Position on unaffected side, roll container gently, gently shake (if in suspension) after admin stay on that side for a bit nueromuscular blocking agents - Succinylcholine, panchyronium : Paralysis for intubation NBA pharmacodynamics - How? Blocking Ach receptors, causes paralysis, Two trouble makers blocking Ach receptors SE: Respiratory arrest, apnea, Malignant hyperthermia, Muscle rigidity, fever, muscle pain MH treatment: Iced IVF, cooling blanket, 100% O2, admin dantrolene Dantrolene (muscle relaxant) - treats: Muscle spasticity, CP, MS, treat, prevent MH Via: Preventing release of Ca, reducing spasticity SE: GI upset, hepatotoxicity, drowsy, muscle weakness Push Hard and Fast just the way we like it Baclofen (muscle relaxant) - treats: Muscle spasticity r/t spinal cord injury, CP, MS, MH Via: Enhances effect of GABA in CNS SE: Drowsiness, nausea, constipation, GI upset Bethanechol (muscarinic agonist) - treats: Nonobstructive urinary retention via: Stimulating cholinergic receptors in bladder muscle SE: Bradycardia, hypoTN, flushing, sweating, N/V 1hr before, 2 hrs after r/t GI oxybutynin (antispasmodic) - treats: Incontinence, frequency via: Blocking ACH in bladder SE: Anticholenergic Ambien - Insomnia Ambien Pharmacodynamics - Increases effect of GABA SE: Daytime sleepiness Dedicate 8 hours of sleep Melatonin Agonist - treats insomnia IV anesthetics - Pentobarbital, Midazolam, Propofol Conscious sedation, intubation, anesthesia IV anesthetics pharmacodynamics - Depress CNS, promote LOC SE: Respiratory depression Propofol: infection at IV site, use bottle within 6 hours after opening Beta 2 adrenergic agonists - Albuterol short acting, solumeterol long acting B2 adrenergic agonists pharmacology - Bronchodilation by effecting the Beta-2 receptors SE: Tachycardia, anxiety, use this drug 5 min before glucocorticoid (dilate before medicate) Xanthines - Theophylline - long term control of respiratory conditions Theophylline: Pharmacodynamics - SE: GI upset, dysrhythmias, seizures Narrow therapeutic index Ipratropium - treats asthma and COPD Ipratropium Pharmacodynamics - Block Ach in airway smooth muscle, causes bronchodilation SE: Anticholinergic, Local, not as many systemic effects Beclomethasone - steroidal, treats asthma Beclomethasone pharmacodynamics - Decrease inflammation SE: Candidiasis, hoarseness Rinse yo mouth you dirty ho Prednisone - treats Asthma, autoimmune, inflammatory Prednisone pharmacodynamics - SE: Bone loss, weight gain, fluid retention, hypoglycemia, hypocalemia, infection, muscle weakness, PUD, adrenal gland suppression high stress = high doses Taper off slowly Monitor for infection Avoid NSAIDs Montelukast - Asthma, exercise induced bronchoconstriction Montelukast pharmacodynamics - Zafir-: monitor liver enzymes Take 2 hours before exercise or at night Codiene - Cough Suppressant = Reduces cough reflex SE: Sedation, respiratory depression, dependency, orthostatic hypotension Increase fiber, fluid, change positions slowly Dextromethorphan - Antitussive Guaifensesin - treats: Non-productive cough with respiratory infection via: Thins secretions, makes cough more productive SE: GI upset, rash Drink yo water bish Acetylcysteine - Pulmonary dx with thick secretions (CF) = Improve flow of secretions in respiratory tract SE: Bronchospasm, rash, nausea Can smell like rotten eggs Antidote for acetaminophen Decongestants - Phenylephrine, pseudoephedrine - treat rhinitis Decongestants Pharmacodynamics - Cause vasoconstriction of vasculature and mucosa of respiratory tract SE: Agitated, nervous, palpitations Rebound congestion possible first gen antihistamines - Diphenhydramine - Nasal congestion, mild allx reactions, motion sickness Block histamine release, reduce mucus secretions SE: Anticholinergic effects, Sedation Second gen antihistamines - Loratadine Mometasone - Stuffy nose, rhinitis Decreased inflammation in nasal passages SE: HA, nasal burning, pharyngitis Furosemide - HTN, fluid overload, edema, pulmonary edema Via: Blocks reabsorption of Na, Cl, and water SE: Hypotension, hyponatremia, hypokalemia, Ototoxicity, Dehydration, hyperglycemia Administer during the day, will cause massive diuresis. Infuse IV @ 20 mg/minute. Weight daily, monitor I/O, monitor electrolytes (K levels) Thiazide diuretics - Hydrochlorothiazide Treats: HTN, edema Via: Na, Cl, water diuresis SE: Dehydration, hypoK in AM the day, monitor i/O, weight, electrolytes Spironolactone - HF, HTN, contraindicated in patients with severe kidney failure Via: Blocks aldosterone, promotes secretion of Na, and water SE: hyperK r/t potassium sparing, amenorrhea, gynecomastia, importence Monitor K, avoid salt substitutes that contain K Mannitol - Increased ICP, increased IOP, edema via: Increase serum osmol, draws fluid back into plasma SE: HF, electrolyte imbalances, pulmonary edema Filter in IV tubing, filter needle when drawing up Renin + Angiotensinogen = - Kidneys release renin Renin activates angiotensin 1 ACE converts angiotensin 1 to 2 Angiotensin 2 causes widespread vasoconstriction to increase BP Adrenal cortex released aldosterone Aldosterone causes kidneys to absorb more sodium and water Losartan - treats: HTN, HF, MI, diabetic nephropathy SE: Angioedema, GI upset, hypotension Spironolactone - block aldosterone Captopril - HTN, HF, MI, diabetic nephropathy Blocks angio 1 to 2, causes vasodilation SE: A: angioedema C: cough E: elevated potassium (Hyperkalemia) Rash Hypotension Verapamil, Diltiazem, Nifedipine (CCB) - HTN, angina Block calcium channels in the heart, cause vasodilation, decrease in heart rate SE: Hypotension, decreased HR, dysrhythmia, constipation, peripheral edema Do not take in any PO grapefruit juice, monitor BP and HR frequently and carefully Alpha/Beta Review - Alpha 1: blood vessels, activation cause vasoconstriction, increase in blood pressure Alpha 2: activation cause vasodilation, decrease in heart rate Beta 1: activation cause increase in heart rate and contraction Beta 2: lungs, activation causes bronchodilation Alpha 1 blocker - prazosin Alpha 2 agonists - Clonidine for HTN SE: Drowsiness, dry mouth Beta 1 blockers - Metoprolol, atenolol treat HTN, angina, HF, MI Via Block beta-1 receptors, decrease in HR, BP SE: Bradycardia, decrease CO, ED, hypotension Change position slowly (orthostatic HPN), take BP and pulse daily Non-selective beta blockers - Propranolol, carvedilol, labetalol Via: Block beta-1 and -2 SE: Bronchoconstriction, contraindicated in asthma patients, hypotension Do not use in patients who have asthma HTN CRISIS BISH - Nitroprusside - Impact both preload (veins) and afterload (arteries) SE: Hypotension, cyanide poisoning Digoxin - HF, AFIB Digoxin Pharmacodynamics - via: Positive inotropic effect, Increase in force and efficiency in contractions, Decrease HR SE: Dysrhythmia, bradycardia Toxicity: GI upset, Fatigue, weakness, Vision changes (halos) Admin: Check pulse rate for full minute before admin, do not admin if pulse under 60 Monitor levels: 0.5-2. Hypokalemia can increase the risk of dig toxicity. Treat bradycardia with atropine Treat overdose with digibind Epinephrine, dopamine, dobutamine - Cardiac arrest, asthma Epi - cardiac arrest, asthma Dopamine - Shock, HF, increase renal blood flow, HR, and CO Dobutamine - HF, increase CO SE: Dysrhythmia, hypertension, angina Nitroglycerin - Treats angina and CP Nitroglycerin PhD - Causes vasodilation, decreases myocardial O2 demand SE: Headache, orthostatic hypotension, rebound tachycardia Admin: Stop activity, sit down, let nitro dissolve under, wait 5 minutes, still have chest pain? Call 911, take another, then wait 5 minutes, take a 3rd. Max 3 Patch Admin: Hairless area, rotate sites, clean area with soap and water and dry thoroughly. Wear gloves when administering. Procainamide and Lidocaine - treats Aflutter, Afib, SVT, Vtach Procainamide + Lidocaine PhD - Sodium channel blocker SE: Hypotension, leukopenia, lupus, thrombocytopenia Propranolol - treats: Paroxysmal SVT, HTN, angina, Afib, Aflutter Propranolol PhD - Beta-1 and beta-2 receptor SE: Bronchospasm (never use in asthma patients,) bradycardia, fatigue, weakness, hypotension Amniodarone - treats: Vtach, Afib, Vfib Amniodarone PhD - Potassium channel blockers SE: Hypotension, bradycardia, pulmonary toxicity, visual disturbances, liver toxicity, thyroid dysfunction, GI upset Verapamil + Diltiazem - CCB, Afib, Aflutter, SBT, HTN, angina Verapamil + Diltiazem PhD - Block calcium SE: Hypotension, bradycardia, GI upset -statins - Treat: High cholesterol (hypercholesterolemia), Decrease Mi incidence Via: Increase HDL, decrease LDL SE: Hepatoxicity, muscle pain, GI upset, rhabdomyolysis Risks: Damage to liver is common across all anti-lipidemic meds Admin: -statin in the evening with a meal bc Cholesterol is synthesized at night Also: Monitor LFT, CK levels, educate on avoidance of alcohol Ezetimibe/Simvastatin - treats: High cholesterol Via: Inhibits absorption of cholesterol in small intestine SE: Hepatoxicity, muscle pain Monitor: LFT, CK Colsevelam - treats: High cholesterol via: Binds bile acids in intestine which causes excretion of cholesterol, lowers LDL SE: Constipation = Increase fiber and fluid, take with food and full glass of water Other: Med can interfere with fat solbuble vitamin absorption : A, D, E, K Interfere with oral contraceptives, so wrap yo biscuit when you get jiggle with it ladies. Nyosin - Nicotinic acid - treats: High cholesterol via: Decreased lipoprotein and triglyceride synthesis SE: Flushing of face, GI distress, hepatotoxicity, hyperglycemia Monitor: Liver function, BG levels Gemfibrozil - treats: High cholesterol via: Decreased triglyceride production and transport SE: Gall stones, hepatoxicity Administer: 30 minutes before breakfast and dinner Parenteral Anticoagulants - Heparin Enoxaparin (Lovenox) Oral anticoagulants - Warfarin (Coumadin) Parenteral AntiCoags Pharmacodynamics - Treat: Stroke, PE, Prevent new clots from forming, will not break up old clots. SE: Bleeding, HIT: decrease in platelet count, formation of clots across the body, immune reaction to heparin, Hypersensitivity Monitor: PTT, Monitor for s/s bleeding Therapeutic: 1.5-2x patient's baseline (baseline between 30-40 seconds), Max should be about 80 Antidote: protamine sulfate Important: Coffee ground emesis, black tarry stools Soft toothbrush, electric razor Oral AntiCoags Pharmacodynamics - Venous thrombus, Afib, prevention of MI, TIA, PE, DVT Via: Antagonize vit K SE: Bleeding, GI upset, hepatitis Monitor: PT/INR, INR: 2-3, Normal PT: 11-13, Therapeutic: 18-24 Takes 3-5 days for coumadin to get therapeutic Start on heparin, once coumadin levels normalize, d/c heparin Antidote: vitamin K Maintain consistent intake of vitamin K Monitor Signs of bleeding, education on bleeding precautions Direct thrombin inhibitors - delbuteron Rivaroxaban (Xarelto) - Prevent DVT, PE, stoke (Afib) Via: Selectively inhibits factor XA SE: Bleeding, elevated liver enzymes Monitor: Hbt, Hct, liver enzymes Antiplatelets - Aspirin, abcyxamib, clopidogrel Antiplatelets pharmacodynamics - Inhibit platelet aggregation, prevent MI or stroke SE: GI upset, bleeding Aspirin: tinnitus Other: No aspirin to children with a fever (Reyes syndrome)+ Contraindicated in patients with bleeding disorders Alteplase - Treats: Previously formed clots can be broken down, MI, PE, stoke, occluded PICC Via: Converts plasminogen to plasmin SE: Bleeding, Contraindicated to patient who have hemorrhagic stroke, internal bleeding, recent trauma, surgery, or severe hypertension Admin: Given to patient within 3 hours of onset of symptoms (MI or stroke) Monitor: labs, VS Limit venipunctures or IM injections epoetin alfa - Treats: Anemia Via: Increase production of RBCs by stimulating bone marrow SE: Increased Hct leads to HTN, DVT, stroke, MI Monitor: BP, Monitor Hgb, Hct 2x per week, Monitor iron levels Admin: do not shake her sister Filgrastim (Neupogen) - Increase neutrophils by stimulating bone marrow, Decrease risk for infection SE: Enlarged spleen, bone pain, leukocytosis do not agitate vial Monitor: CBC levels 2x per week Whole Blood Products - Blood loss d/t surgery, trauma; dehydration, shock RBCs - treat anemia platelets - treat thrombocytopenia Fresh frozen plasma - treats clotting factor deficiencies Blood Administration - Baseline laboratory values (all of it)/Patient signs consent/Assess for risk of FVO/Baseline vital signs Stay with client, monitor for first 15-30 minutes/ Take vitals hourly before blood transfusion is complete/ 20G catheter/ 0.9% Normal Saline ONLY/ Always have 2 nurses to confirm blood is right type, AVO, factor, band/ Document number, total volume infused, time it started, time it finished, adverse effects If giving whole blood or packed RBCs • Infuse over 2-4-hour period Platelets • 15-30 minutes per unit FFP • 30-60 minutes per unit Complications of Blood - Any time you suspect a reaction, stop infusion immediately Disconnect that tubing sis Hook them up to straight normal saline infuse that, call provider Send it - blood bag, IV tubing for analysis Obtain urine specimen • For RBC hemolysis Hemolytic reaction to blood transfusion S/S - Fever, low back pain, tachycardia, tachypnea, hypotension Febrile reaction to blood transfusion - Fever, chills, possible headache Temp increases >1 degree from baseline Anaphlactic reaction to blood - Wheezing, shock, cardiac arrest Mild Allergic Reaction to Blood - Flushing, itching, urticaria Stop the infusion, drop some antihistamines, and roll that blood back to the bank sister Circulatory overload related to blood - Cough, SOB, crackles, HTN, tachycardia, distended neck veins Infuse blood slowly (closer to 4 hours) Multiple units? Wait about 2 hours before administering second unit Sit upright with feet down Diuretics and oxygen admin as appropriate H2 receptor antagonists - Cimetidine Ranitidine Famotidine Nizatidine H2 receptor antagonists pharmacodynamics - treat: Duodenal, gastric ulcer, GERD, ZE syndrome Via: Block H2 receptors in stomach, decrease gastric acid secretion SE: Colonization of bacteria in GI tract Avoid aspirin, NSAIDs, smoking Omeprazole (Prilosec) - Treats: Duodenal, gastric ulcer, ZE syndrome, GERD Via: Inhibits enzyme for gastric acid secretion SE: GI upset, increased risk of osteoporosis Sucralfate (Carafate) - Treats: Duodenal ulcers Via: Reacts with stomach acid, forms thick paste that adheres to ulcers SE: Constipation Admin: 1 hour before meals, at bed time Increase intake of fiber, fluids Antacids - Magnesium hydroxide, aluminum hydroxide, calcium