Transcript Pharmacology and Pathophysiology II

Pharmacology and
Pathophysiology II
Gastrointestinal and Genitourinal Anatomy,
Pathophysiology and Pharmacology
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Tagamet (cimetidine) is what classification?
Proton Pump Inhibitor
Histamine H2 Antagonist
Acid Neutralizer
GI Stimulant
Compazine is what classification?
GI Stimulant
Acid Reducer
Antiemetic
Combined-Product Acid Neutralizer
What generic name is Pepcid?
Famotidine
Ranitidine
Esomeprazole
Promethazine
This medication is used for
constipation and encephalopathy.
Docusate Sodium
Lactulose
MiraLax
Psyllium
Which of the following is a potassium
sparing diuretic?
Bumex
Lasix
Diamox
Aldactone
Which of the following is the
functional unit of the kidneys?
Nephron
Loop of Henley
Proximal Tube
Glomerulus
Pyridium is prescribed for what?
Overactive Bladder
Treatment of UTI
Relief of UTI pain
Cystitis
Anatomy and
Physiology
Gastrointestinal System
The Esophagus
The Stomach
O Temporary food storage
O Control the rate at which food enters the
duodenum
O Acid secretion and antibacterial action
O Fluidisation of stomach contents
O Preliminary digestion with pepsin, lipases
etc.
Duodenum
O neutralize the acidic gastric contents (called
'chyme')
O initiate further digestion
O Brunner's glands
O secrete an alkaline mucus which neutralizes
the chyme and protects the surface of the
duodenum.
Jejunum and Ileum
O greatly coiled parts of the small intestine
O 4-6 meters long
O The mucosa of these sections is highly
folded (the folds are called plicae),
O Increases the surface area
available for absorption dramatically.
Pancreas
O consists mainly of exocrine glands that
secrete enzymes to aid in the digestion of
food in the small intestine in addition to its
regulation of glucose
O lipases (fat)
O peptidases (protein)
O amylases (carbohydrates)
Large Intestine
O removes water
O passing semi-solid feces into the rectum to be
expelled from the body through the anus.
O The mucosa is arranged into tightly-packed straight
tubular glands
O consist of cells specialized for water absorption and
mucus-secreting goblet cells to aid the passage of
feces.
O areas of lymphoid tissue
O found in the ileum (Peyer's patches),
O provide local immunological protection of
potential weak-spots in the body's defenses.
Liver
O normally about 1.5kg (although this can increase to over
O
O
O
O
O
O
10kg in chronic cirrhosis).
The liver is the main organ of metabolism and energy
production;
Bile production
Storage of iron, vitamins and trace elements
detoxification
conversion of waste products for excretion by the
kidneys
The liver is functionally divided into two lobes, right and
left. The external division is marked on the front of the
liver by the falciform ligament, which joins the coronary
ligament at the superior margin of the liver.
Liver
O double blood supply
O the right and left hepatic arteries
O portal vein carries venous blood from the GI tract to the liver.
O Drains into the superior and inferior mesenteric veins and joined by
the splenic vein
O blood drains into the hepatic sinusoids,
O screened by specialized macrophages (Kupffer cells)
O plasma is filtered through the endothelial lining of the sinusoids
and bathes the hepatocytes;
O contain vast numbers of enzymes capable of braking down and
metabolizing most of what has been absorbed.
O portal venous blood contains all of the products of digestion
absorbed from the GI tract,
O
processed in the liver before being either released back into the
hepatic veins or stored in the liver for later use.
Appendix
Gallbladder
Which of the following is not a function
of the stomach?
Temporary Food Storage
Primary Digestion
Acid Secretion
Control the rate at which food enters the
duodenum
This organ stores bile.
Liver
Small Intestine
Stomach
Gallbladder
This is the purpose of plicae
Increases surface area for increased
absorption
Stores good bacteria for the large
intestine
Facilitates peristalsis
Absorbs water in the large intestine
Esophageal Pathophysiology
O Symptoms
O Dysphagia
O Odynophagia
O Pyrosis (Heartburn)
O Chest Pain
O Regurgitation
Esophageal Pathophysiology
O Diagnostics
O Barium Swallow
O Esophageal Manometry
O pH Monitor Test
O Endoscopy
Esophageal Pathophysiology
O Motility Disorders
O Achalasia
O Absent peristaltic activity
O Increased resting tone of LES
O Absent or incomplete relaxation of LES with
swallowing
Esophageal Pathophysiology
O Motility Disorders
O Diffuse Esophageal Spasm (DES)
O Rare disorder only involving smooth muscle
portion
O DES is distinguished from achalasia by the
normal function of the LES
Esophageal Pathophysiology
O Hiatus Hernia
O Herniation of stomach through the
esophageal hiatus in diaphragm and into the
chest
Esophageal Pathophysiology
O Carcinoma
O Squamous cell carcinoma and
adenocarcinoma
Esophageal Pathophysiology
O GERD
O Esophageal Varices
Esophageal Pathophysiology
O Reflux esophagitis and Peptic Strictures
O Reflux esophagitis
O Esophageal injury r/t gastric acid reflux
O Peptic stricture
O End stage of reflux esophagitis
O Ongoing reflux – mucosal damage – healing
O Fibrosis, spasm and edema
Esophageal Pathophysiology
O Barrett’s Esophagus
O Patches of metaplastic columnar epithelium
in lower esophagus
O Due to severe reflux esophagitis
O Increased risk of adenocarcinoma
Stomach Pathophysiology
O Gastritis
O Inflammation of stomach lining
O Ulcers
O Nausea
O decreased gastric motility and increased tone in the small intestine
O reverse peristalsis in the proximal small intestine.
O Retching (dry heaves)
O spasmodic respiratory movements conducted with a closed glottis.
O antrum of the stomach contracts and the fundus and cardia relax
O Emesis
O H Pylori
O common cause of peptic ulcers
O present in about half the people in the world.
O passed from person to person through direct contact with saliva,
vomit or fecal matter.
O contaminated food or water.
H. Pylori
O Blood test.
O usually collected by pricking your finger.
O Breath test.
O Swallow a pill, liquid or pudding that contains radioactive carbon
molecules.
O Radioactive carbon is released when the solution is broken down
in your stomach.
O Body absorbs the radioactive carbon and expels it when you
exhale.
O Exhale into a bag and your doctor uses a special device to detect
the radioactive carbon.
O Stool test.
O A laboratory test called a stool antigen test looks for foreign
proteins (antigens) associated with H. pylori infection in your stool.
O Endoscopy
Liver Pathophysiology
O Hepatitis
O Inflammation
O results in compression obstruction of the internal bile ducts
preventing bile flow along them
O Crystalline stones can occur in the gallbladder and obstruct
the cystic or common bile duct.
O bile duct obstruction (in either case)
“obstructive jaundice”
results in “clay colored” feces from the lack of bile pigments.
blocked bile spills over into circulating blood and accumulates in
light tissues giving them a yellow coloration (“yellow” jaundice).
O bile pigments are excreted by the kidneys producing an amber or
darker “coffee” urine.
O
O
O
Intestinal Pathophysiology
O Small intestine does not have a protective mucus layer
O suspended and attached to the dorsal body wall by sheets of
O mesentery,
O Herniation can cause bowel obstruction and can occlude the blood
supply to the herniated portion resulting in death of a portion of
the intestine.
O Abdominal surgery can cause problems
O Loop of the intestine can adhere to the abdominal wall or scar
tissue
O Adhesions of the small intestine can cause the unattached, motile
portions on each side of the adhesion to twist and turn
O A volvulus (knot) may form
O not only obstructs the bowel but can twist the mesenteric blood
vessels (strangulation) and result in death of intestinal tissue.
Intestinal Pathophysiology
O Diverticula
O small, bulging pouches that can form anywhere in
O
O
O
O
your digestive system, including your esophagus,
stomach and small intestine.
most commonly found in the large intestine.
common, especially after age 40.
When you have diverticula, the condition is known as
diverticulosis.
May never know you have these pouches because
they seldom cause any problems
O Diverticulitis
O one or more diverticula in your digestive tract
become inflamed or infected.
Intestinal Pathophysiology
O Common signs and symptoms of diverticulitis include:
O Pain that's often sudden, severe and located in the lower
O
O
O
O
O
O
O
O
O
left side of the abdomen
Less commonly, abdominal pain that may be mild at first
and become worse over several days, possibly fluctuating
in intensity
Change in bowel habits
Abdominal tenderness
Fever
Nausea and vomiting
Constipation
Diarrhea
Bloating
Bleeding from your rectum (less common)
Intestinal Pathophysiology
O
Colon polyp
O
O
O
O
O
Anyone can develop colon polyps.
Higher risk if
O
O
O
O
O
O
O
O
small clump of cells (abnormal cell growth)
forms on the lining of the colon.
some become cancerous over time.
50 or older,
are overweight
Smoker
eat a high-fat
low-fiber diet
personal or family history of colon polyps or colon cancer.
Usually don't cause symptoms.
If symptoms are present
O
O
O
O
O
Rectal Bleeding
Constipation
Narrowing of stool
Pain
Obstruction
Intestinal Pathophysiology
O
Polyp Formation
O
O
O
O
O
O
In general, the larger a polyp, the greater the likelihood of cancer.
There are three main types of colon polyps:
Adenomatous.
O
O
O
O
About two-thirds of all polyps fall into this category.
only a small percentage of these polyps actually become cancerous
nearly all malignant polyps are adenomatous.
Hyperplastic.
O
O
O
O
O
can develop anywhere in your large intestine.
flat (sessile)
mushroom shaped and attached to a stalk (pedunculated).
Most of the remaining polyps are hyperplastic.
occur most often in your descending colon and rectum.
Usually less 5 millimeters in size
Very rarely malignant.
Inflammatory.
O
may follow a bout of ulcerative colitis or Crohn's disease of the colon.
Colon Polyps
Colon Caner
Intestinal Pathophysiology
O Hemorrhoids
O also called piles,
O swollen and inflamed veins in your anus and
O
O
O
O
lower rectum
straining during bowel movements
increased pressure on these veins during
pregnancy,
Internal or External
Common
O About half of all adults over 50 have a hx. Of
hemorrhoids
To remove a hemorrhoid using rubber band ligation, your doctor inserts a small tool
called a ligator through a lighted tube (scope) in the anal canal and grasps the
hemorrhoid with forceps. Sliding the ligator's cylinder upward releases rubber bands
around the base of the hemorrhoid. Rubber bands cut off the hemorrhoid's blood
supply, causing it to wither and drop off.
Colonoscopy
O https://www.youtube.com/watch?v=Cr3cX6I
_2sU
Intestinal Pathophysiology
O Small Bowel Obstruction
O
O
O
O
O
O
O
O
O
O
O
O
Fibrous bands
Diverticulitis
Volvulus
Impaction
Stricture
Paralytic Ileus
Hernias
Tumors
N/V/D
Constipation
Distention
High Pitch Tinkling upon auscultation
Liver Pathophysiology
O Cirrhosis
O Scarring of the liver
O Hepatitis and ETOH Abuse
O Cannot be undone
O Treat underlying cause
O
O
O
O
O
O
O
Fatigue
Bleed and Bruise Easily
Ascites (fluid accumulation in abdomen)
Jaundice
Edema
Nausea
Loss of Appetite
Liver Pathophysiology
O Complications
O Portal HTN
O Edema
O Infections (increased risk)
O Bacterial peritonitis (secondary to ascites)
O Bleeding
O Hepatic Encephalopathy
O Malnutrition
The small intestine is susceptible to ulceration because it lacks
the protective mucous layer like the stomach has.
Yes
No
Esophageal varices are engorged veins in the
esophagus and are usually non life threatening if
the rupture.
Yes
No
Genitourinary Anatomy
Urinary Tract Infection
O infection in any part of your urinary system —
O
O
O
O
your kidneys, ureters, bladder and urethra.
Most infections involve the lower urinary
tract
Women are at greater risk of developing a
UTI than men are.
Serious if it spreads to the kidneys
Antibiotics
Urinary Tract Infection
Part of urinary tract affected
Signs and symptoms
Kidneys (acute pyelonephritis)
•Upper back and side (flank)
pain
•High fever
•Shaking and chills
•Nausea
•Vomiting
Bladder (cystitis)
•Pelvic pressure
•Lower abdomen discomfort
•Frequent, painful urination
•Blood in urine
Urethra (urethritis)
•Burning with urination
Urinary Tract Infection
O Cystitis)
O usually caused by Escherichia coli (E. coli)
O Urethritis
O GI bacteria
O STDs
Urinary Tract Infection
O
O
O
O
Risk Factors
Being female (anatomy)
Being sexually active
Using certain types of birth control.
O Diaphragms, Spermicide
O
O
O
O
O
O
Douching
Completing menopause.
Having urinary tract abnormalities.
Having blockages in the urinary tract.
Having a suppressed immune system.
Using a catheter to urinate.
Polycystic Kidney Disease
O
Polycycystic kidney disease (PKD)
O
O
O
Isn't limited to your kidneys
O
O
Can cause cysts to develop in your liver and elsewhere in your body.
Complications
O
O
O
O
O
O
O
O
clusters of cysts develop primarily within your kidneys.
Cysts are noncancerous round sacs containing water-like fluid.
Results in HTN, Aneurysm and Renal Failure
Back or side pain
Headache
Increase in the size of your abdomen
Blood in your urine
Frequent urination
Kidney stones
Urinary tract or kidney infections
CT Scans and Renal
Function
Laboratory results should be checked for the most recent serum
creatinine on ALL patients If serum creatinine is not available, it should
be performed if
• Age over 60
• History of “kidney disease” as an adult, including tumor and
transplant
• Family history of kidney failure
• Diabetes treated with insulin or other prescribed medications
• Hypertension (high blood pressure)
• Paraproteinemia syndromes or diseases (e.g., myeloma)
• Collagen vascular disease (e.g., SLE, scleroderma, rheumatoid
arthritis)
• Solid organ transplant.
O If creatinine testing is required, a creatinine level within the prior 6
weeks is sufficient in most clinical settings.
O Metformin is predominantly eliminated by renal excretion. Contrastinduced nephropathy can result in metformin accumulation and
precipitate metformin-related lactacidosis
O
Kidney Stones
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
small, hard deposits that form inside your kidneys.
made of mineral and acid salts.
Passing kidney stones can be quite painful,
usually cause no permanent damage.
Severe pain in the side and back, below the ribs
Pain that spreads to the lower abdomen and groin
Pain that comes in waves and fluctuates in intensity
Pain on urination
Pink, red or brown urine
Cloudy or foul-smelling urine
Nausea and vomiting
Persistent urge to urinate
Urinating more often than usual
Fever and chills if an infection is present
Pain caused by a kidney stone may change — for instance, shifting to a different
location or increasing in intensity — as the stone moves through your urinary tract.
Kidney Stones
O
O
Types of kidney stones
Calcium stones.
O
O
O
O
O
Struvite stones.
O
O
O
Form in response to an infection, such as a urinary tract infection.
These stones can grow quickly and become quite large, sometimes with few
symptoms or little warning.
Uric acid stones.
O
O
O
O
Most kidney stones are calcium stones, usually in the form of calcium oxalate.
Oxalate is a naturally occurring substance found in food.
Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels.
Your liver also produces oxalate.
Those who don't drink enough fluids or who lose too much fluid,
those who eat a high-protein diet,
those who have gout
Cystine stones.
O
These stones form in people with a hereditary disorder that causes the kidneys to
excrete too much of certain amino acids (cystinuria).
Kidney Stones
O Renal Calculi Risk Factors
O Family History
O Being Male
O Dietary Habits
O Obesity
Kidney Stones
O Blood tests
O Calcium or Uric Acid
O Renal Function
O 24 Hour Urine Test
O Determine levels of stone forming elements
O CT
O Analysis of Passed Stone
Renal Failure
O Chronic Kidney Failure
O gradual loss of kidney function
O In the early stages of chronic kidney disease,
you may have few signs or symptoms. Chronic
kidney disease may not become apparent until
your kidney function is significantly impaired.
O Treatment for chronic kidney disease focuses on
slowing the progression of the kidney damage,
usually by controlling the underlying cause.
Kidney Failure
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Nausea
Vomiting
Loss of appetite
Fatigue and weakness
Sleep problems
Changes in urine output
Decreased mental sharpness
Muscle twitches and cramps
Hiccups
Swelling of feet and ankles
Persistent itching
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath, if fluid builds up in the lungs
High blood pressure (hypertension) that's difficult to control
Signs and symptoms of kidney disease are often nonspecific,
Kidney Failure
O Diseases and conditions that commonly cause
chronic kidney disease include:
O
O
O
O
O
O
Type 1 or type 2 diabetes
HTN
Glomerulonephritis
Interstitial nephritis
Polycystic kidney disease
Prolonged obstruction of the urinary tract,
O Enlarged prostate, cancer
O Vesicoureteral reflux, a condition that causes urine
to back up into your kidneys
O pyelonephritis
Kidney Failure
O Risk Factors
Diabetes
High blood pressure
Heart disease
Smoking
Obesity
High cholesterol
Being African-American, Native American or AsianAmerican
O Family history of kidney disease
O Age 65 or older
O
O
O
O
O
O
O
Kidney Failure
O Potential complications may include:
O Fluid retention
O Hyperkalemia
O Cardiovascular Diseas
O Weak bones and an increased risk of bone fractures
O Anemia
O Decreased sex drive or impotence
O Damage to your central nervous system, which can cause difficulty
concentrating, personality changes or seizures
O Decreased Immune response
O Pericarditis
O Risks for the mother and the developing fetus
O Irreversible damage to your kidneys (end-stage kidney disease),
eventually requiring either dialysis or a kidney transplant for
survival
Kidney Failure
O Treatment for end-stage kidney disease
O Dialysis.
O Kidney transplant
Peritoneal dialysis uses the lining of your abdominal cavity, called the
peritoneal membrane, to clean waste from your blood. Your peritoneal cavity
is filled with dialysis solution via a catheter. Over several hours, the solution
draws waste out of the lining's blood vessels. The fluid is then drained and
replaced, starting the process over again.
Dialysis Video
O https://www.youtube.com/watch?v=IQKQ4e
oKfTg
Gynecological
Pathophysiology
O Uterine fibroids
O Noncancerous growths of the uterus that often
O
O
O
O
O
O
appear during childbearing years.
Also called leiomyomas or myomas,
develop from the smooth muscular tissue of the
uterus (myometrium).
A single cell divides repeatedly, eventually creating a
firm, rubbery mass distinct from nearby tissue.
Fibroids range in size.
As many as 3 out of 4 women have uterine fibroids
sometime during their lives
May be caused by genetics or horomones
Gynecological
Pathophysiology
O If women have symptoms
O Heavy menstrual bleeding
O Prolonged menstrual periods — seven days or
O
O
O
O
O
more of menstrual bleeding
Pelvic pressure or pain
Frequent urination
Difficulty emptying your bladder
Constipation
Backache or leg pains
Gynecological
Pathophysiology
O Uterine polyps
O Growths attached to the inner wall of the uterus
that extend into the uterine cavity.
O Overgrowth of cells in the lining of the uterus
(endometrium) leads to the formation of uterine
polyps, also known as endometrial polyps.
O usually noncancerous (benign)
O some can be cancerous or can eventually turn
into cancer (precancerous polyps).
O The sizes of uterine polyps vary
Gynecological
Pathophysiology
O Signs of uterine polyps include:
O Irregular menstrual bleeding — for example,
O
O
O
O
O
having frequent, unpredictable periods of
variable length and heaviness
Bleeding between menstrual periods
Excessively heavy menstrual periods
Vaginal bleeding after menopause
Infertility
Some women may experience only light bleeding
or spotting or may even be symptom-free.
Gynecological
Pathophysiology
O Risk factors for developing uterine polyps
O
O
O
O
include:
Peri- or postmenopausal age
High blood pressure (hypertension)
Obesity
Tamoxifen, a drug therapy for breast cancer
Gynecological
Pathophysiology
O Uterine polyps may be associated with
infertility.
O Uterine polyps also may present an
increased risk of miscarriage in women who
undergo in vitro fertilization (IVF)
Gynecological
Pathophysiology
O Ovarian cysts
O Fluid-filled sacs or pockets within or on the
O
O
O
O
surface of an ovary.
Many women have ovarian cysts at some
time during their lives.
Most are harmless.
Majority disappear without treatment within a
few months.
May rupture
Gynecological
Pathophysiology
O
O
O
O
O
O
O
O
O
O
O
Symptoms of ovarian cysts, if present, may include:
Menstrual irregularities
Pelvic pain — a constant or intermittent dull ache that may radiate to
your lower back and thighs
Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse (dyspareunia)
Pain during bowel movements or pressure on your bowels
Nausea, vomiting or breast tenderness similar to that experienced
during pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder that causes a need to urinate more
frequently or difficulty emptying your bladder completely
Ovarian Torsion
Bleeding
Male Reproductive
Pathophysiology
O Hydrocele
O fluid-filled sac surrounding a testicle that results in swelling
O
O
O
O
O
O
of the scrotum
common in newborns,
most disappear without treatment within the first year of
life.
Older boys and adult men can develop a hydrocele due to
inflammation or injury within the scrotum.
usually isn't painful.
may not need any treatment
Transillumination
O Fluid should be clear
O Ultrasound
O Hydrocelectomy or Needle Aspiration
Male Reproductive
Pathophysiology
O Epididymitis
O inflammation of the coiled tube (epididymis)
O
O
O
O
at the back of the testicle that stores and
carries sperm.
most common in men between the ages of
14 and 35.
Epididymitis is most often caused by a
bacterial infection or STI
Amiodarone
Chemical epididymitis (urine backup)
Male Reproductive
Pathophysiology
O Symptoms
O A tender, swollen, red or warm scrotum
O Testicle pain and tenderness, usually on one side — the pain
O
O
O
O
O
O
O
O
may get worse when you have a bowel movement
Painful urination or an urgent or frequent need to urinate
Painful intercourse or ejaculation
Chills and a fever
A lump on the testicle
Enlarged lymph nodes in the groin (inguinal nodes)
Pain or discomfort in the lower abdomen or pelvic area
Discharge from the penis
Blood in the semen
Male Reproductive
Pathophysiology
O
Benign prostatic hyperplasia (BPH)
O
O
O
O
O
O
O
O
O
O
O
O
O
AKA prostatic hypertrophy
Blocks flow of urine out of the bladder and can cause bladder, urinary
tract or kidney problems.
Weak urine stream
Difficulty starting urination
Stopping and starting while urinating
Dribbling at the end of urination
Frequent or urgent need to urinate
Increased frequency of urination at night (nocturia)
Straining while urinating
Not being able to completely empty the bladder
Urinary tract infection
Formation of stones in the bladder
Reduced kidney function
GI System Pharmacology
Antiemetics
O
O
O
O
O
O
O
O
O
O
O
O
Decadron (dexamethasone)
Emend (aprepitant)
Zofran (ondansteron)
Compazine (prochlorperazine)
Reglan (metoclopramide)
Phenergan (promethazine)
Marinol (dronadinol)
Dramamine (dimenhydrinate)
Vistaril (hydroxyzine)
Ativan (lorazepam)
Valium (diazepam)
Scopolamine
Antiemetics
O Common Side Effects
O Headache, Diarrhea, Dizziness
O Emend
O Fatigue
O Compazine, Reglan, Phenergan
O Dopamine Antagonists
O Extrapyramidal Symptoms
O Stop medication and administer Benadryl
O Anticholinergic effects
O Dry mouth, urinary hesitancy, retention and constipation
O Hypotension
O Sedation
O Anticholinergic Effects
Antiemetics
O Common Side Effects
O Marinol
O Hypotension
O Tachycardia
O Drowsiness
O Do not combine with CNS depressants, ETOH or
sedatives
O Potential for dissociation and dysphoria
O Do not use with mental health patients
Antiemetics
O Common Side Effects
O Scopalamine and Dramamine
O Sedation
O Anticholinergic Effects
Laxatives
O Psyllium (Metamucil)
O Bulk Forming
O Docusate Sodium (Colace)
O Surfactant Laxative
O Bisacodyl (Dulcolax)
O Stimulant Laxative
O Magnesium Hydroxide (MOM)
O Osmotic Laxative
O Senokot (Senna)
O Lactulose
Laxatives
O Common Side Effects
O GI Irritation
O Rectal Burning Sensation
O Procitis
O Especially with long term use bisacodyl
O Magnesium
O Hypermagnesium
O Renal patients need to avoid
O Dehydration
O Osmotic Diuretics
O Milk and antacids can destroy enteric coating of
bisacodyl
Laxatives (colonoscopy prep)
O Miralax (polyethylene glycol solution)
O Also used for constipation
O GoLYTELEY
O Polyethylene glycolelectrolyte solution
Antidiarrheals
O Lomotil (diphenoxylate and atropine)
O Immodium (Loperamide)
O Motofen (difenoxin)
O Activate Opioid receptors in GI Tract
O Decrease motility
O Increase Absorption of fluid and sodium
Antidiarrheals
O Common Side Effects
O Opioid effects
O CNS Depression
O Atropine
O Blurred vision
O Dry mouth
O Urinary retention
O Constipation
O Tachycardia
O Increased risk of megacolon in patients with
inflammatory bowel disorders
O Can lead to perforation
Acid Reducers
O H2 Antagonists
O Tagamet (cimetidine)
O Pepcid (famotidine)
O Zantac (ranitidine)
O Common Side Effects
O Headache
O Diarrhea
Acid Reduces
O Proton Pump Inhibitors
O Nexium (esomeprazole)
O Lansoprazole (Prevacid)
O Prilosec (omeprazole)
O Protonix (pantoprazole)
GU System Pharmacology
Loop Diuretics
O Lasix (furosemide)
O Bumex (bumetanide)
O Work in ascending limb of loop of Henley
O Block reabsorption of Na- and ClO Prevent reabsorption of water
O Cause extensive diuresis even with severe
renal impairment
Loop Diuretics
O Common Side Effects
O Dehydration
O Hyponatremia
O Hypochloremia
O Hypotension
O Otoxicity
O Avoid use with other ototoxic medications
(gentamycin)
O Hypokalemia
Loop Diuretics
O Interactions
O Digoxin toxicity
O Occurs with hypokalemia
O Antihypertensive
O Increased hypotensive effect
O Lithium
O Toxicity resulting from hyponatremia and
decreased lithium excretion
Thiazide Diuretics
O Hydrochlorothiazide (HCTZ)
O Chlorothiazide (Diuril)
O Block reabsorption of sodium and chloride
and prevent reabsorption of water in early
distal convoluted tubule
O Promotes diuresis when renal function is not
impaired
Thiazide Diuretics
O Common Side Effects
O Dehydration
O Hypokalemia
O Hyperglycemia
O Interactions
O Digoxin
O With hypokalemia
O Antihypertensives
O Lithium Toxicity
O NSAIDS
O Decrease diuretic effect
Potassium Sparing Diuretics
O Aldactone (spironolactone)
O Midamor (amiloride)
O Works in distal nephron
O Block action of aldosterone (water and
sodium retention)
O Results in potassium retention
O Secretion of sodium and water
Potassium Sparing Diuretics
O Common Side Effects
O Hyperkalemia
O Endocrine Effects
O Impotence, irregular menstrual cycle
O Contraindicated with severe renal failure
patients and anuria
Potassium Sparing Diuretics
O Interactions
O ACE Inhibitors and Angiotensin II Blockers
O Potassium Supplements
O Increase risk of hyperkalemia
Urinary Analgesics
O Pyridium (phenazopyridine)
O Side Effects
O Headache
O Rash
O GI Disturbances
O Urine Color Changes
Urinary Antispasmodics
O Enablex (darifenacin)
O Ditropan (oxybutinin)
O Also used for neurogenic bladder
O Vesicare (solifenacin)
O Detrol (tolterodine)
O Common Side Effects
O
O
O
O
O
Dry mouth
Nausea
Headache
Urinary retention (Ditropan)
Blurred Vision
BPH and Renal Calculi
Medications
O Flomax (tamsulosin)
O Alpha1A Antagonist
O Relaxes muscles in bladder and prostate
O Common Side Effects
O Dizziness
O HA
O Nausea
Post Lecture Quiz
Your patient has stage 3 renal failure and CHF. Which
medication do you anticipate the physician to prescribe?
Lasix
Aldactone
HCTZ
Amiloride
You will question which medication for a
patient in renal failure?
Bisicodyl
Colace
Milk of Magnesia
Metamucil
You are discharging a patient from an urgent care center who has
been diagnosed with renal calculi. What instruction will you provide
to him?
Notify the doctor immediately if you have
pink tinged urine
Use pyridium to control the pain
Strain your urine and save any stones in a
specimen container for the urologist
You do not to see the urologist as your
stone will pass on its own
Your patient has the following labs: BUN 20, Creat. 1.6 , K+ 4.5, Mg
.7, Cl- 100. Which order will you question
Lasix 40 mg PO Daily
CT Angio
Milk of Magnesia 30 mL PO Daily
Protonix 40 mg IV Daily
A patient presents to the ED complaining of flak pain, nausea, vomiting,
increased pain with urination, and fever. You identify this as probably
Cystitis
Urethritis
Pyelonephritis
Renal Calculi
Demonstration
Enemas
Suppositories
Set up for GYN / Pelvic Exam
Cultures
Urine Collection
Glucagon from last lecture
H. Pylori Test
Videos
Vaginal Examination and Swab
https://www.youtube.com/watch?v=DE6sb3yp5HA
Penis Examination and Swab
https://www.youtube.com/watch?v=_RcGBb4GW8U&oref=https%3A%2F%2F
www.youtube.com%2Fwatch%3Fv%3D_RcGBb4GW8U&has_verified=1
H. Pylori Breath Test (machine)
https://www.youtube.com/watch?v=JBQSb3S-y6Y
24 Hour Urine
https://www.youtube.com/watch?v=T_eJY0cxLBc
Barium Swallow
https://www.youtube.com/watch?v=sM6uxd1uS6M
Barium Enema
https://www.youtube.com/watch?v=JFXSw1CbXoU