Peptic Ulcers and Medications Overview

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Questions and Answers

What is the primary mechanism of action for antiemetics?

Work on the vomiting center and CTZ (correct)

Decrease urine production

Increase gastric secretions

Reduce peristalsis in the intestines

Which of the following is a contraindication for administering antidiarrheals?

Dehydration

Hypotension

GI obstruction (correct)

Dark stools

What is a common side effect of loop diuretics like furosemide?

Hypokalemia (correct)

Increased gastric secretions

Headache

Nausea and vomiting

What is a primary indication for the use of antidiarrheal medications?

Diarrhea Signup and view all the answers

Which class of medication should be used with caution in older patients due to the risk of confusion?

Antihistamines Signup and view all the answers

Which of the following outcomes is expected with the use of antacids?

Neutralized stomach acid Signup and view all the answers

What is the primary outcome when administering antidiarrheals?

Normal fluid and electrolyte levels Signup and view all the answers

What side effect is associated with prolonged use of antiemetics?

Tardive dyskinesia Signup and view all the answers

What is a common indication for the use of laxatives?

Chronic constipation Signup and view all the answers

Which of the following is not a contraindication for the use of laxatives?

Diabetes mellitus Signup and view all the answers

Which side effect is commonly associated with the use of laxatives?

Electrolyte imbalances Signup and view all the answers

What is the mechanism of action of antacids?

Neutralize stomach acid Signup and view all the answers

Which of the following outcomes is associated with the use of laxatives?

Increased bowel distention Signup and view all the answers

Which of the following is a contraindication for using proton pump inhibitors?

Pregnancy Signup and view all the answers

What is a common indication for the use of antidiarrheals?

Dysentery Signup and view all the answers

Which side effect is associated with H2 antagonists in the elderly?

Confusion and disorientation Signup and view all the answers

What should be avoided when administering iron supplements?

Calcium Signup and view all the answers

What is an important monitoring parameter when using antidysrhythmic drugs?

ECG Signup and view all the answers

Which condition is NOT an indication for the use of ACE inhibitors?

Angina Signup and view all the answers

What side effect is most commonly associated with the use of ACE inhibitors?

Dry, nonproductive cough Signup and view all the answers

Which medication class works by preventing the conversion of angiotensin II from acting?

ARBs Signup and view all the answers

What is a serious contraindication for the use of nitrates?

Erectile dysfunction drugs Signup and view all the answers

What is an expected outcome of using calcium channel blockers?

Decreased frequency of angina attacks Signup and view all the answers

Which of the following is a contraindication for beta blockers?

Asthma Signup and view all the answers

What vital sign must be monitored closely when administering digoxin, a cardiac glycoside?

Heart rate Signup and view all the answers

Which side effect is particularly associated with anticoagulants like heparin?

Increased risk of bleeding Signup and view all the answers

What is the primary mechanism of action for fibrinolytics like alteplase?

Break down existing blood clots Signup and view all the answers

Which of the following outcomes is associated with the use of vasodilators?

Decreased blood pressure Signup and view all the answers

What characteristic is most important when considering the use of a cholesterol absorption inhibitor?

Increased HDL levels Signup and view all the answers

Which medication should not be administered with grapefruit juice due to potential interactions?

Calcium channel blockers Signup and view all the answers

What is a significant risk factor associated with the use of nitroprusside in hypertensive emergencies?

Cyanide toxicity Signup and view all the answers

Which side effect is most likely to indicate an issue with digoxin therapy?

Colored halo vision Signup and view all the answers

Study Notes

Peptic Ulcers

Peptic ulcers are a common GI issue.
Gastritis is inflammation of the stomach lining.
Gastric hyperacidity is a symptom of peptic ulcer disease.
Heartburn is a common symptom of peptic ulcers.

Contraindications for Peptic Ulcer Medications

Renal failure
Electrolyte imbalances
GI obstruction

Side Effects of Peptic Ulcer Medications

Constipation
Diarrhea
Kidney stones
Rebound Hyperacidity
Gas and belching
Metabolic alkalosis

Outcomes of Peptic Ulcer Medications

Neutralized stomach acid

Monitor/Observe for Peptic Ulcer Medications

Vitals
1+0 (referring to intake and output)
Pain levels
Make sure to give with water

Special Considerations for Peptic Ulcer Medications

Should not be given to patients with heart failure or hypertension.

Examples of Peptic Ulcer Medications

Aluminum salts (Basaljel)
Magnesium salts (Milk of magnesia)
Calcium salts (Tums)
Sodium bicarbonate

Antidiarrheals

Indications: Diarrhea
Contraindications: GI obstruction, narrow angle glaucoma, paralytic ileus, toxic megacolon, allergy and drug interactions.
Side Effects: Increased bleeding time, constipation, dark stools, confusion, hypotension, flushing.
Outcomes: Reduced pain, decreased peristalsis, normal fluid and electrolyte labs, reduced gastric secretions.
Monitor/Observe: Vitals, fluid volume, 1+0, color, consistency and frequency of stools.
Special: Be careful with older patients as this may cause confusion.
Examples: Pepto-bismol (absorbent, mild), Anticholinergics (antimotility, moderate), Opiates, Probiotics (antibiotic induced: BACID).

Antiemetic/Antinausea

Indications: Nausea and vomiting
Contraindications: Allergy, pregnancy.
Side Effects: "Drying" effect, headache, dizziness.
Outcomes: Decreased nausea and vomiting.
MOA: These medications work on the vomiting center and CTZ (chemoreceptor trigger zone) to reduce nausea and vomiting.
Monitor/Observe: Frequency of nausea and vomiting, vitals, fluid and electrolytes.
Special: Given 30-60 minutes before chemotherapy, long-term use can lead to tardive dyskinesia.
Examples: Anticholinergics, antihistamines, serotonin blockers, tetra-hydrocannabis.

Diuretics

Fluid/HTN(HF) Up Regulation Asterload

Loop: Loop of Henle. Example: Furosemide.
Furosemide Side Effects: Hypokalemia, dehydration, ototoxicity (ringing in the ears).
Furosemide Administration: IV push slowly, must be compatible with blood types.

Anemia Drugs

Indications:
- Epoetin alfa stimulates RBC production
- Iron deficiencies (give iron)
- Folic acid deficiencies (give folic acid)
- Pernicious anemia (give vitamin B12)
Contraindications:
- Allergies
- Surgeries
- Alcohol abuse
- Some antacids
- Calcium with iron administration
Side Effects:
- Constipation
- Stomach cramps
- Hypertension
- Diarrhea
- Headache
- Rash
- Bone pain
- Injection site irritation
- Fatigue
Outcomes:
- Increased blood production
- Increased fetal development
- Decreased fatigue and headache
- Increased well-being and nutrition
Examples:
- Erythropoieses (stimulating agent)
  - Iron, folic acid, epoetin alfa
- Vitamin B12, cyanocobalamin
Monitor/Observe:
- Iron levels
- Fetal development
- H&H labs
- 1+0
- Neurological status
Special:
- Vitamin B12 has to be given IM
- Iron mimics GI bleeds (black tarry stools)
- Epoetin alfa is given with iron
- Take Vitamin C to increase effects
- Avoid Calcium at med time
- Take iron with food
- Eat iron-rich foods
Iron:
- Vitamin C = YES
- Calcium = NO

Antidysrhythmic Drugs

Indications: Dysrhythmias, A-fib, V-fib, Tachyddysrhythmias
Contraindications: 2nd or 3rd degree AV block, acute MI, pulmonary congestion
Side Effects: Dizziness, headache, blurred vision, prolonged QT interval, dysrhythmias (can cause other dysrhythmias)
Outcomes: Return of normal sinus rhythm
Monitor/Observe: ECG, BP, HR, INR when talking amiodarone and warfarin (how long it takes to clot)
Special: No grapefruit juice, have to be on a heart monitor, may feel discomfort
Examples: Amiodarone (Class 3), Procainamide (Class IA), Ditiazem (Class IV), Adenosine (stops the heart)

H2 Antagonists

Indications: GERD, PUD, erosive esophagitis, adjunct therapy, control GI bleed, Zollinger-Ellison syndrome
Contraindications: Allergy, smoking, renal/liver disease
Side Effects: Confusion and disorientation (elderly), impotence, gynecomastia, thrombocytopenia
Outcomes: Suppresses acid secretion in the stomach, relieves GERD, PUD, and heartburn
Monitor/Observe: Vitals, liver function, renal function, 1+0 observation, GI discomfort, administer 1-2 hours before antacids
Special: Administer 1-2 hours before antacids, encourage patients to not smoke
Examples: Cimetidine (Tagamet), Famotidine (Pepcid), Ranitidine (Zantac)

Proton Pump Inhibitors

Indications: Ulcers (stress, short term, NSAID induced), H pylori induced, GERD, erosive esophagitis, Zollinger-Ellison syndrome
Contraindications: Warfarin, allergy, pregnancy, digoxin use (interaction)
Side Effects: C diff, osteoporosis, pneumonia
Outcomes: Less ulcers (decreased pain), less GI bleeding, less heartburn
Monitor/Observe Special: Liver labs, bowel sounds and bleeding, can be given through an NG tube (make sure it's not clogged), increased risk of C diff, take with an antibiotic if for H pylori
Examples: Lansoprazole (Prevacid), Omeprazole (Prilosec), Pantoprazole (Protonix), Esomeprazole (Nexium)

Laxatives

Indications: IBS, Chronic constipation, acute constipation, surgical & diagnostic prep
Contraindications: Gl block, Renal insufficiency, Electrolyte imbalances, Dehydration, Chronic GI issues
Side Effects: Electrolyte imbalances, Impaction, Skin rashes, Esophageal blockage, Lipid pneumonia, Abdominal bloating, Diarrhea, Nutritional malabsorption
Outcomes: Increased water absorption, Bowel distention, increased peristalsis, and evacuation, Lubricate the fecal material and intestinal walls
Monitor/Observe: Electrolytes, 1+0
Special: Should be taken with water, not juice or milk
Examples:
- Bulk forming: Psyllium (Metamucil)
- Emollient: Colace, Surfak
- Hyperosmotic: Lactulose
- Saline: Magnesium hydroxide, Milk of Mag
- Stimulant: Bisacodyl

Antacids

Indications: Acute symptom relief of ...

Ace Inhibitors (-Pril)

Indications: Hypertension, heart failure, MI, diabetic neuropathy
Side Effects: Hypotension, hyperkalemia, dry, nonproductive cough, angioedema, first dose hypotension
Contraindications: Pregnancy, hypotension, hx of angioedema
Side Effects acc.: Angioedema, cough, hyperkalemia
Outcomes: Decreased BP, decreases SVR, decreases preload, decreases afterload as well
Monitor/Observe: Electrolytes, blood pressure, respirations, cough
MOA: Stops the conversion of angiotensin I to angiotensin II, which increases BP. Cardio drug of choice for patients with diabetes.

ARBs (-Sartin)

MOA: Stops the conversion of angiotensin II from working (Works Later)
Side Effects: Hypoglycemia, chest pain, hypotension, hypertension
Indications: HTN, heart failure, given with a cough and hyperkalemia
Contraindications: Hypotension, hypoglycemia
Outcomes: Decreases BP, decreases HR

Nitrates

Indications: Treatment of angina, Prevention of angina, Given for active MI
Side Effects: Headaches, Hypotension, Orthostatic hypotension, Reflex tachycardia
Outcomes: Decrease frequency and severity of angina, Treatment of heart failure with acute MI, Decrease preload, Decrease afterload
Contraindications: Erectile dysfunction drugs, Severe angina, Hypotension, Severe head injury
Special:
- Patch: Take off every 8 hours or at night to prevent tolerance
- Sublingual: Tingling is normal, Headache is normal
Monitor/Observe: Blood pressure, hold if systolic is less than 100 systolic, S/S of tolerance

Calcium Channel Blockers (-Pine)

Examples: Nifedipine, Felodipine, Amlodipine
Indications: Angina, Hypertension, Coronary artery spasms, Post brain aneurysm spasms
Contraindications: Acute MI, 2nd or 3rd degree AV block, Hypotension (SBP<100)
Side Effects: Hypotension (SBP<100), Tachy/bradycardia, Dyspnea, Constipation, Increased risk of stroke, arrhythmias, and stroke
MOA: Prevents calcium from going to the channels in the heart. This decreases the heart rate and vasodilates the blood vessels. Improves blood flow to the heart. Decreases force of contraction
Outcomes: Decreased BP, Decreased frequency and severity of angina attacks
Special: Don't give with grapefruit juice, Hold if HR<60, Hold if SBP<100
Chromotrope: Decreases HR
Dromotrope: Decreases conductivity
Ionotrope: Decreases contractility

Beta Blockers (-Olol)

Examples: Metoprolol (cardio-selective), Atenolol (cardio-selective), Propranolol
Indications: Angina, Hypertension, Dysrhythmias, Cardio-protection, Heart failure
Contraindications: HR<60, Broncial asthma, Systolic heart failure, Hypoglycemia (can mask hypoglycemic symptoms)
Side Effects: Decreased HR, Decreased BP, Dizziness, Impotence, Hyper/hypoglycemia
Monitor/Observe: Blood sugar, BP, hold if SBP<100, HR, hold if <60
Special: Get up slowly, don't stop taking abruptly, long-term angina treatment, check vitals
Outcomes: Decrease HR (primary), Decrease BP (secondary), Decrease frequency of angina, Prevention of MI
MOA: Decrease heart rate resulting in a decreased myocardial oxygen demand; increased oxygen to the heart. Decrease myocardial contractility, which helps to conserve energy, or decreasing demand/workload on the heart.

Vasodilators

Indications: Hypertension, Hypertensive emergencies
Contraindications: Severe renal/hepatic disease, Low BP, Decreased cerebral perfusion
Side Effects: Hypotension, Decrease SVR, Peripheral vasodilation, GI upset, Sudden BP drop
Outcomes: Decreased BP, Control HTN crises, Decrease preload, Decrease afterload
MOA: Directly relaxes the arterial and venous smooth muscle
Examples: Hydralazine (common), Nitroprusside (HTN emergency), Diazoxide (rarely used)
Monitor/Observe: Blood pressure, Heart rate, S/S of toxicity (nitroprusside)
Special: Cyanide toxicity can occur with nitroprusside, Fall risk due to hypotension, Avoid alcohol use
Main Goal: To increase the supply of blood and decrease the demand on the heart

Cardiac Glycosides

Indications: Heart failure, A-fib, Used with other drugs
Contraindications: Uncontrolled A-fib, AV block, Known alcohol intolerance
Side Effects: Brady/tachycardia, Vision changes (Colored, halo vision), Hypotension, Fatigue
Outcomes: Decrease severity of heart failure, Increase cardiac output, Inotropic Effect, Chronotropic Effect, Dromotropic Effect
MOA: Induces an increase in intracellular sodium. This will drive an influx of calcium in the heart and cause an increase in contractility. Cardiac output increases with a subsequent decrease in ventricular filling pressures.
Examples: Lanoxin (Digoxin) is the prototype
Monitor/Observe: Potassium levels (Low potassium levels increase its toxicity), Vitals (Hold if HR<60), Vision changes, S/S of toxicity, Creatinine in the elderly (increased toxicity risk)
Special: Purple, yellow, green halos in vision, Very narrow therapeutic window (0.5-2 ng/mL), Take at the same time every day, Used with other drugs (ACE, ARBs, beta blockers)

Anticoagulants - Heparin

Indications: DVT, PE, A-fib, MI, Stroke, Indwelling devices
Contraindications: Epidural catheter, Bleeding disorder
Side Effects: Increased bleeding risk, Petechiae/Bruising easier, Vomiting, Shortness of breath, Chills
Outcomes: Decreased risk for clotting, Prophylaxis
Examples: Heparin IV
Monitor/Observe: S/S of bleeding, PTT, Blood where it shouldn't be
Special: Rotate subQ injection sites, Don't massage the site, Antidote: Protamine sulfate
MOA: Inhibits specific clotting factors in the blood to reduce the risk of clotting

Fibrinolytics - Plasminogen Activator (TPA)

Indications: Acute MI (active), Ischemic Stroke (active), DVT, PE
Contraindications: Prior intracranial hemorrhage, Ischemic stroke within 3 months
Examples: Alteplase, Reteplase
Monitor/Observe: Neuro changes, S/S of bleeding, Adverse effects
Special: Timely administration, Bleeding in gums and blood in stool can be a sign of a bleeding, TPA must be administered within 3 hours, Must be administered in a controlled setting
Side Effects: Increased risk of bleeding (including intracranial hemorrhage), Reperfusion injury risk (potential damage to tissues due to sudden reperfusion)
Outcomes: Breakdown of existing blood clots
MOA: Thrombolytics break down existing blood clots by activating the body's natural fibrinolytic system, which involves the conversion of plasminogen to plasmin (a substance that breaks down fibrin (a component of clots) to reestablish blood flow.

Cholesterol Absorption Inhibitor (Antilipidemic)

Indications: Increased LDL
Contraindications: Liver disease
Side Effects: Diarrhea, abdominal pain, headache, muscle pain
Outcomes: Increase in HDL and a decrease in LDL
MOA: Cholesterol absorption inhibitors, such as ezetimibe (Zetia), work by inhibiting the absorption of dietary cholesterol in the small intestine.

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Description

Explore the critical aspects of peptic ulcers, including symptoms, medications, and contraindications. This quiz covers the side effects of various peptic ulcer medications and important monitoring considerations. Learn about the implications of treatment to ensure effective management of this common gastrointestinal issue.