NURSB-261 1st EditionExam # 3 Study Guide Omeprazole-Proton Pump InhibitorPT: heartburn, GERD, peptic ulcer diseasePK: oralAbsorption—small intestine (enteric coated in order to pass through the stomach and reach the small intestine…omeprazole is unstable in an acidic environment)Metabolism—liver by the P450 systemExcretion—urine and fecesPD: suppresses last phase of gastric acid production by suppressing the ATPase system (proton pump, which is responsible for acidification of stomach contents)GOAL: control signs and symptoms and promote healingContraindications: hypersensitivityBe cautious when used preventively b/c it can mask signs and symptoms of gastric cancer -Pain-Hematemesis-Black, tarry stools-Chest pain-Unexplained weight loss-Nausea and vomitingAE: headachesDiarrheaPneumonia (# of bacteria increase when acidity decreases)Interactions: other drugs metabolized by the P450 systemDrugs that need an acidic environment in stomachLifespan: decreases absorption of calcium—elderly are at increased risk for fracturesSafety has not been established in children—do not give to childrenPt education: acidic, spicy diets, smoking, and chewing can increase the acidity in stomachTake omeprazole 30 minutes before meal to prevent signs and symptomsFor best results take daily—not just when you are feeling symptomaticIt patient experiences diarrhea—call doctor—leads to fluid and electrolyte imbalanceDo not crush or chew (can be opened and sprinkled into apple sauce)Elderly patients should take calcium supplement*The Asian population—longer duration of action (results in higher serum levels) so the may need a decreased dose*Ranitidine-Histamine 2 Receptor AntagonistPT: mitigate effects of GERD, active or benign ulcers, maintenance therapy for ulcer treatmentPK: oral at home/ IV in hospitalAbsorption—systemically Metabolism—liverExcretion—kidneys PD: Inhibits day and night gastric secretions by inhibiting histamine 2 receptors on parietal cells(Reduces volume and concentration of gastric acid secretion)Contraindications: hypersensitivityHepatic/renal impairmentBe cautious when used preventively b/c it can mask signs and symptoms of gastric cancer -Pain-Hematemesis-Black, tarry stools-Chest pain-Unexplained weight loss-Nausea and vomitingAE: headachesBlood count changes-Leukopenia-Thrombocytopenia-GranulocytopeniaConstipation/diarrhea (depends on the patient)Nausea and vomitingExacerbates forms of HepatitisInteractions: NSAIDs can cause gastric distressLabs: renal, liver, CBCLifespan: elderly have decreased liver and kidney functionPregnancy: BPt education: may need diet alterationsGive 2 hrs apart from antacids (antacids decrease ranitidine absorption)IV ranitidine is given slowly to reduce hypotension and cardiac arrhythmiasSmoking—stagger time with antacidsContact provider if patient experiences sharp stomach painP450: NO. Does not use the P450 systemOndansetron—Selective Serotonin Receptor AntagonistPT: nausea and vomiting (food poisoning, chemotherapy, pregnancy morning sickness, etc.)PK: IV or oralMetabolism—liverExcretion—kidneys *Kidney problems does NOT require a dosage change*PD: Blocks serotonin from chemoreceptor trigger zone to prevent nausea and vomitingContraindications: allergies to drugAE: headachesMalaiseConstipationsTremorsIV can cause hypotension and cardiac arrhythmiasInteractions: other drugs metabolized by the liver and excreted in the kidneysLabs: BMP, liver, renal, dehydration and electrolytesLifespan: NOT for children under 3 (reaction is unknown)Pregnancy: B (safe for pregnancy)Pt education: fall riskReport tremors—they are not permanent*IV—dilute with normal saline (15 minutes to go in). For a straight push (undiluted) takes 2-5 minutes and patient will report a burning sensation*Aluminum Hydroxide with Magnesium Hydroxide-AntacidPT: reflux that leads to heartburnUpper GI disorders—GERD, gastritis, PUD, heartburnPK: oral Rapid onsetExcretion—feces PD: Raises gastric pH (makes stomach more basic)Inhibits pepsin activity and increases tone of lower esophageal sphincter which helps keep stomach acid from passing up into the esophagusContraindications: low phosphate levelsRecent GI bleed HypermagnesemiaRenal Insufficiency AE: aluminum by it’s self—constipationMagnesium by it’s self—diarrhea Together this combo drug causes—osteomalagia (bone softening), encephalopathy, reboundgastric acid productionInteractions: if another drugs needs an acidic environment…be aware that this drug will raise pH and change absorption of some drugsIncreases the urine alkalinity which decreases excretion of basic drugs and increases the excretion of acidic drugsLabs/assessments: assess signs and symptoms (could be gastric cancer), any recent GI bleeds, renal, OTC drugs can cause interactions, diet, alcohol, and smoking effect stomach pHPt education: shake suspensions (mix well before use)Chew tablets thoroughly and rinse mouth out after takingGive 2 hours after giving other drugsEffective if GI pain goes away and electrolytes/bowel remain in normal limitsContact provider if patient experiences sharp stomach painMetoclopramide—Prokinetic AgentPT: helps with nausea and vomitingChildren—failure to thriveEncourage GI movementFor diabetics--gastroparesisPK: oralAbsorption—GIMetabolism—liverExcretion—kidneys…renal impaired patients might need dosage adjustmentPD: stimulates ACh sensitivity which increases GI motilityBlocks dopamine/serotonin to help with nausea and vomitingContraindications: abdominal surgerydiarrheaBowel obstruction—can lead to bowel perforation GI bleedSeizuresParkinson’s DiseaseAE: drowsinessDizzinessDepressionHeadacheAnxietyTardive dyskinesia (tremors)—PERMANENT—Report Immediately!Interactions: narcotics, Levodopa, AnticholinergicsLabs/assess: renal, bowel sounds, mental statusLifespan: NOT for children under 2 or elderly with poor renal functionPregnancy: B (safe for pregnant and lactating)Pt education: watch for tremors and report immediately Assess for fall riskTake 30 mins before mealsDiphenoxylate with Atropine Sulfate--AntidiarrhealPT: diarrhea, overactive bowelsPK: oral Metabolism—liverExcretion—fecesPD: acts on smooth muscle to slow down motility (gives time fore more water absorption)Contraindications: viral/bacterial infection—you need the diarrhea to flush out pathogensKids under 2—masks dehydrationOlder adults—masks dehydration AE: drowsinessDizzinessHeadacheDepressionsNumbness