Gastroesophageal reflux disease (GERD) "Acid Reflux"

Chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus

Transient or permanent changes in the barrier between the esophagus and the stomach, may be due to incompetence of the cardia, transient cardia relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatus hernia.


Symptoms

Heartburn is the major symptom of acid in the esophagus, characterized by burning discomfort behind the breastbone (sternum)

- Esophagitis (reflux esophagitis) — inflammatory changes in the esophageal lining (mucosa)
- Difficulty swallowing (dysphagia)
- Chronic chest pain
- Cough, hoarseness, voice changes, chronic ear ache, nausea
- Sinusitis



H2-receptor Antagonists

- H2-receptor antagonists reduce secretion of gastric acid by blocking H2-receptors.

- Used in short-term treatment of active duodenal ulcers and prevention of ulcer recurrence.

- Also used for heartburn.

Examples of H2 Receptor Antagonist
Pepcid AC, Zantac, Axid

H2-receptor Antagonists: Adverse Effects

Common Adverse Effects: GI disturbances, headache, drowsiness, confusion, agitation, hallucinations, and reversible impotence

Serious Adverse Effects: cardiac arrhythmias and cardiac arrest after IV bolus dose


Proton Pump Inhibitors

Act by blocking hydrochloric acid production

Used to heal stomach and duodenal ulcers and relieve symptoms of GERD and esophagitis

Examples
Prevacid

Peptic Ulcers

Ulcer in an area of the gastrointestinal tract that is usually acidic and thus extremely painful

~80% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach, however only 20% of those cases go to a doctor

Caused by hyperacidity and excessive pepsin activity

Alcohol, caffeine, and smoking have been linked to peptic ulcers



Helicobacter Pylori(Bacteria that causes Ulcers)

1 H. pylori penetrate the mucus layer of host stomach and adhere the surface of gastric mucosal epithelial cells.

2 Produce ammonia from urea by the urease, and the ammonia netralize the gastric acid to escape from elimination.

3 Proliferate, migrate, and finally form the infectious focus.

4 The gastric ulcerization is developed by destruction of mucosa, inflammation and mucosal cell death.


(Click to enlarge)


Signs & Symptoms

Symptoms of a peptic ulcer can be:
Abdominal pain, classically epigastric with severity relating to mealtimes, after around 3 hours of taking a meal
Bloating and abdominal fullness
Nausea, and lots of vomiting
Loss of appetite and weight loss;
Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.

Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

Antacids: Uses
Alkaline compounds that neutralize hydrochloric acid

Most commons contain aluminum hydroxide and magnesium carbonate

Common: diarrhea or constipation, anorexia, weakness, bone pain, tremors

Hypermagnesemia may produce nausea, vomiting, confusion, renal calculi, metabolic alkalosis, headache.

Example of Medications that treat Peptic Ulcer
Tums(Calcium Carbonate)
Milk of Magnesia (Magnesium Hydroxide)
Maalox Plus (Aluminum Hydroxide)

Drugs on the Gastrointestinal Disorders

This week, I will be discussing Medications for Gastrointestinal Medications.

Ulcers
Heartburn
GERD
Diarrhea
Constipation
Vomiting

Administration of Medications Con't

Routes of Administration

Enteral: absorbed through GI tract
- Oral
- Nasogastric or gastrostomy tube
- Sublingual drugs diffuse into the blood through tissues under the tongue
- Buccal- in cheek; shown buccal swab commonly used to obtain DNA sample (CSI!)




Nasogastric (NG) tube: inserted through nasopharynx and into stomach



Gastrostomy tube: surgically placed directly into stomach




Sublingual

Sublingual: placed under tongue for dissolving

Used when rapid action is desired

Examples include nitroglycerin (for angina pectoris) and ergotamine tartrate (for migraines)

Buccal
Placed between gum and cheek for dissolving

Forms include tablets, capsules, lozenges, and troches

Should not be swallowed

Often used over sublingual route for sustained-release delivery




Parenteral Route of Administration
Parenteral: injected
Intravenous (IV), intramuscular (IM), subcutaneous, intradermal


Parenteral
+More quickly absorbed than oral route

+Irretrievable once injected

+Require invasive procedure

+Aseptic (sterile) technique must be used to avoid infection.

Equipment
Needles: pierce the skin to allow injection.

Syringes: contain and then transfer the medication into the body through needle.
Hypodermic, insulin, tuberculin

Ampules and vials: contain medication that is then drawn into syringe for injection.

Ampules: made of clear glass; usually contain single dose of drug; usually have pre-scored neck that is cut open; medication is then aspirated into syringe using filter needle

Vials: small glass bottles sealed with rubber cap; pierced with needle to withdraw medication







Intradermal Injection (ID) - Needle enters at 15° angle
Usually given in inner forearm or upper back just below epidermis into dermis

Commonly used for tuberculin or allergy tests, or to administer local anesthetics

Injection produces small wheal on skin’s outer surface

Subcutaneous Injection - 45º angle usually used, based on patient’s body weight

Usually given into upper arms, back, or abdomen

Commonly used for heparin and insulin

Small volumes of medication (0.5 to 1 mL) are given subcutaneous.


Intramuscular (IM) Injections - 90º injection into the muscular tissue

Usually given into upper arm, thigh, or hip muscles

Commonly used for drugs that irritate subcutaneous tissue

1 to 3 mL of medication can be given IM.

Intravenous (IV)
Injected directly into veins, usually in arms

May be administered:
Slowly
rapidly (IV push)
piggyback infusion- adding a second
drug to the same line, ie. antibiotics
into existing IV line (IV port)
into intermittent access device (heparin lock), or added to IV solution

IV needles are inserted into veins at a short angle to the skin.

Transdermal Route

Transdermal patches provide sustained-release administration.
Examples include: Nicotine, Nitroglycerin, Estrogen



Ophthalmic Route

Medications are administered to the eyes using instillations or irrigations with liquids or ointments.

Sterile technique is required.

Prescribed liquids are usually diluted to less than 1% strength.

Eye irrigations are used to wash out conjuctival sac.


Otic Route

Localized infection or inflammation of the ears is treated by dropping a small amount of sterilized medication into ear.

Patient should remain lying on one side for 5 minutes to allow coating of inner ear canal with medication.


Nasal Route
Nasal decongestants are most common nasal instillations.
Many of these medications are OTC drugs.
Administered with dropper or via sprays; usually while patient is supine with head tilted back

Inhalation Route
Inhalation therapy may involve the administration of medicines, water vapor, and gases such as oxygen, carbon dioxide, and helium.

Local effects are achieved within the respiratory tract through aerosols, nebulizers, or metered-dose inhalers.

Commonly administered by nebulizer
Delivers fine fog or mist using atomization or aerosolization

Atomization: larger droplets are inhaled

Aerosolization: droplets are suspended in gas such as oxygen (the smaller the droplets, the further they can be inhaled into the respiratory system)





Vaginal Route


Vaginal medications, or instillations, include creams, jellies, foams, or suppositories

Suppositories are inserted with the finger of a gloved hand; they melt at body temperature.

Vaginal creams may be instilled by using an applicator.

Rectal Route
Rectal medications are usually suppositories.

This route is useful for patients who are nauseated, vomiting, or unconscious.

Other rectal medications are available as solutions that are administered in the form of enemas.

Administration of Medications

You as a patient should know that medications have the potential to cause serious harm to you. All medication orders must come from the Doctor or an authorized health care professional. Health care professionals need to ensure CONSTANT VIGILANCE(Prof. Alastor Moody), to prevent errors and ensure quality of patient care.


Principles of Drug Administration

- Physicians should assess the patients health, obtain their medication history to check vitamin, herbs, supplements use before giving them their medications.

- Also, assess their socioeconomic status, and their ability to self administer.

- Lastly, determine the most suitable route of administration.

Seven Rights of Drug Administration

Right patient
Right drug
Right dose
Right route
Right time
Right technique
Right documentation

Errors can occur at the manufacturing stage, the prescription stage, the dispensing stage, or the administrating stage.

Constant Vigilance!

Reactions to Medication

Drugs can often alter the effects of another drug and vice verca. The interaction between the drugs can often cause adverse reactions or beneficial reactions.

There are different ways as how the body can react to these medications.

Normal Reactions: Nothing unusual occurs, and the body is reacting positively to the medication administered.

Idiosyncratic reaction: a unique, strange, or unpredicted reaction to a drug

Allergic reaction: hypersensitivity to drug that occurs after previous exposure to similar or same drug, and develops rapidly after re-exposure

Anaphylactic shock: idiosyncratic, sudden, and life-threatening allergic reaction


Other Effects
Cumulative effect: occurs when body cannot completely metabolize and excrete one drug dose before next dose is given

Synergism: occurs when combined action of two or more agents produces a greater effect than expected from agents acting separately

Potentiation: a greater effect than expected caused from additive properties of two or more drugs

Drug Names

Chemical name: chemical makeup of a drug; often very complicated
ex) N-acetyl-para-aminophenol (APAP)


Generic name: also official, approved, or nonproprietary name; not protected by copyright
ex)Acetaminophen



Proprietary name: also brand or trade name; assigned by manufacturers and protected by copyright
ex)Tylenol

Introduction To Pharmacology

Pharmacology: the study of drugs and their actions and effects in body systems

Pharmacodynamics: the study of biochemical and physiologic drug effects, and the mechanisms of drug action

Pharmacokinetics: the study of drug absorption, distribution, metabolism, and excretion

Pharmacognosy: the study of drugs derived from herbal or natural sources

Pharmacotherapeutics: the study of how drugs are best used and which drug is appropriate for a specific disease

Toxicology: the study of poisons and poisonings