1. VNRS B50A-ADVANCED PHARMACOLOGY PART A Stephanie Engler, RN Monday 1:15-2:30pm sengler@bakersfieldcollege.edu

2. WELCOME TO PHARMACOLOGY! Syllabus Content is board approved- some review, but we will be digging deeper! Expectations from this class…. Please do your homework Be ready to participate in class Please bring 3 scantrons to class How can I help you succeed???

3. TO BE SUCCESSFUL IN THIS CLASS……… Come to class with homework prep questions answered- find on website Bring lecture notes to class- print from website Bring a blank concept map to class for additional note taking Study from your lecture notes and additional notes in class- use your text book for clarification of material covered Participate in group “round tables” when available- good time to review exams and ask questions

4. LET’S GET STARTED………… Unit 1- Introduction See class handout Unit 2- Medications Administered for Gastrointestinal Disorders GI review- http://www.youtube.com/watch?v=Z7xKYNz9 AS0&feature=fvsr http://www.youtube.com/watch?v=Z7xKYNz9 AS0&feature=fvsr Liver disease, Pancreatitis & Insulin notes Groups- answer discussion ?’s

5. GI MEDS AND PLAN OF CARE PLAN FOR THE DAY: Quick Notes Review Case Study NCLEX Questions

6. GASTRIC ACID System Esophagus Stomach Liver/gallbladder Pancreas Small/large intestine Gastric acid production Parietal cells- H+ production Receptors- histamine2 Function Stomach pH 1-4 Digestion Defense against infection

7. WHAT DO WE DO WITH THE OVERPRODUCTION OF THIS ACID???? ****Give antacids= to neutralize! Milk of Magnesia (magnesium hydroxide) TUMS (calcium carbonate) Heartburn, gastritis, peptic ulcer disease (PUD) ****Suppress gastric acid! H2 receptor blockers- bind to H2 receptor Pepcid (famotidine) Decrease HCl acid production Decrease heartburn GERD, erosive esophagitis, PUD, H. pylori, gastritis, prevent stress ulcers

8. Gastric barrier- adheres to gastric mucosa/ binds to ulcer Carafate (sucralfate) Decrease heartburn http://www.youtube.com/watch? v=_fa60VhclNo&feature=related http://www.youtube.com/watch? v=_fa60VhclNo&feature=related WHAT DO WE DO WITH THE OVERPRODUCTION OF THIS ACID???? ****Suppress gastric acid! Proton pump inhibitors (PPI)- blocks proton pump, stops HCl production Prevacid (lansoprazole) Prilosec (omeprazole) Protonix (pantoprazole) Decrease HCl production, decrease heartburn Caution with hepatic disease!!!!

9. HOMEWORK QUESTIONS- SELECTED GI DISORDERS= HELICOBACTER PYLORI (H. PYLORI)

10. GASTROESOPHAGEAL REFLUX DISEASE (GERD)

11. PEPTIC ULCER DISEASE

12. GASTROINTESTINAL CASE STUDY History of present illness (HPI): Mr. D- 70 year old male- enters your clinic with a complaint of severe upper abdominal pain that occurs mostly in the evening hours. It is relieved by food, although he vomits his meals several times each week. Wife states intermittent confusion in last month. Past medical history (PMH):  He has a history of peptic ulcers and alcohol abuse  Smoking has been reduced to two packs per week  He is taking no drugs, other than Rolaids for his indigestion Workup: Vital signs- BP- 106/60, HR- 108, RR- 12, Temp- 98.6, O2- 98 on 2L NC, 2/10 pain

13. GASTROINTESTINAL CASE STUDY Lab results: +blood in stool Na 138 K+ 3.2 Glucose 100 Ca 8.0 BUN 12 Creat 1.2 AST 100 ALT 150 Albumin 1.8 Hgb 10.2 Hct 28.6

14. NCLEX 1. Which of the following best describes the mechanism of the action of sucralfate (Carafate)? a.Kill H. pylori b.Reduce the secretion of acid c.Increase the secretion of bicarbonate d.Add a gel-like protective mucus over the ulcer

15. NCLEX 2. The nurse would administer amoxicillin (Amoxil) or clarithromycin (Biaxin) for peptic ulcers in order to: a.Kill H. pylori b.Reduce the secretion of acid c.Increase the secretion of bicarbonate d.Add a gel-like protective mucus over the ulcer

16. NCLEX 3. Which class of drugs acts by neutralizing stomach acid? a.H2-receptor blockers b.Serotonin receptor blockers c.Proton-pump inhibitors d.Antacids

17. NCLEX 4. Which of the following is the most effective class of drugs used to treat diarrhea? a.Phenothiazines b.Antihistamines c.Anticholinergics d.Opioids