Term
| Which antiemetics can cause extrapyramidal symptoms (EPS)? |
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Definition
| Dopamine antagonists ex: Prochlorperazine (Compazine), haloperidol (Haldol), droperidol (Inapsine) and metoclopramide (Reglan) |
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Term
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Definition
| used for postoperative nausea/vomiting and emesis caused by cancer chemotherapy; Cause extrapyramidal symptoms(muscle spasms), as well as hypotension |
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Term
| What actions are expected when lorazepam (Ativan) is given with another antiemetic such as metoclopramide (Reglan)? |
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Definition
| Lorazepam (Ativan) is a benzodiazepine; it works in combination with other medications to prevent nausea and vomiting from chemotherapy: depresses central nervous system. Produces sedation, amnesia, and suppression of emesis helps control the EPS caused by drugs like metoclopramide (Reglan) |
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Term
| Which antiemetics relieve nausea and vomiting, but also stimulate the appetite and can help patients gain weight? |
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Definition
| Cannabinoids: active ingredient in marijuana are used to suppress chemotherapy-induced nausea and vomiting (CINV) also stimulate appetite which can help patients prevent or reverse weight loss. |
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Term
| Cannabinoid side effects and name brands |
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Definition
| Side effects include: mod changes, euphoria, drowsiness, nightmares, confusion, memory lapse, and incoordination, alcohol, sedatives and other CNS depressants can induce drowsiness, can also cause tachycardia and hypotension; contraindicated for psychiatric disorders, and used w/ caution in patients w/ cardiovascular disease ex: dronabinal (Marinol)& nabilone (Cesamet) |
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Term
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Definition
| emetic (induces vomiting); used when ingested substance is not caustic or a petroleum product. Pt. must be alert and the ingestion must have occurred within the last 60 minutes; given w/ water NOT milk or carbonated beverages. Emesis should occur within 15-30 minutes. If it does not activated charcoal can be given. |
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Term
| activated charcoal (CharcoAid) |
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Definition
| taken orally w/ a glass of water, attaches to the poison to prevent its absorption in to the body. Activated charcoal is not absorbed systemically. Used when certain toxic substances have been ingested before absorption can occur. |
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Term
| When is vomiting NOT induced? |
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Definition
| If caustic substances such as ammonia, chlorine bleach, lye, battery acid, or toilet cleaners are ingested. Also petroleum products such as gasoline, kerosene, paint thinner, or lighter fluid are contraindicated for emesis as they can cause aspiration with a resultant severe pneumonia. |
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Term
| Which opioid antidiarrheal drug causes the least CNS depression? |
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Definition
| Loperamide (Imodium) - causes less CNS depression than diphenoxylate and difenoxin because it is poorly absorbed and does not readily cross the blood brain barrier |
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Term
| When are laxatives beneficial and indicated? |
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Definition
| In specific situations such as in patients with hemorrhoids or anorectal lesions to ease pain of elimination, also in patients w/ cardiovascular disease, those scheduled for surgery of a diagnostic procedure of the colon need to empty the bowel completely. Also used to prevent fecal impaction in bedridden patients, remove ingested poisons and correct constipation associated w/ pregnancy or certain drugs |
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Term
| When are laxatives contraindicated? |
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Definition
| in patients w/ certain disorders of the bowel; if a patient has abdominal pain, nausea, cramps or other symptoms of appendicitis, or regional enteritis, diverticulitis or ulcerative colitis. Should also be avoided in patients w/ fecal impaction or bowel obstruction |
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Term
| Which laxatives should be avoided in patients with kidney dysfunction? |
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Definition
| magnesium salts; some osmotic laxatives include these magnesium salts: (magnesium hydroxide, magnesium citrate, and magnesium sulfate)Magnesium is mainly excreted by the kidney and patients w/ poor renal function can develop toxicity. Sodium phosphate can cause fluid retention so sodium salt drugs (sodium phosphate & polyethylene glycol or Miralax) should be avoided in patients w/ heart failure, hypertension, edema, and renal dysfunction or those that are taking drugs that affect kidney function such as diuretics |
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Term
| What instructions should be given to a patient taking bisacodyl (Dulcolax) tablets for constipation? |
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Definition
| Oral tabs are enteric coated to prevent gastric irritation so they should not be crushed or chewed. Milk and antacids dissolve the enteric coating so tabs should be administered at least on hour after ingestion of these substances. |
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Term
| Which patient should not take castor oil for constipation? |
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Definition
| Pregnant women should not take castor oil because it can stimulate uterine contractions and spontaneous abortion my result |
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Term
| What instructions should be given to a patient who is taking polycarbophil (Fibercon) everyday? |
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Definition
| Take with a full glass of water or juice and maintain good fluid intake daily |
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Term
| Which laxatives are commonly used to prevent straining after surgery or after a myocardial infarction? |
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Definition
| Surfactant laxatives - docusate calcium (Surfak) & docusate sodium (Colace); act by lowering surface tension and promoting water accumulation in the intestine and penetration of water into the stool |
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Term
| What causes gastric ulcers? |
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Definition
| The breakdown of the gastric mucosal barrier because of inadequate mucous to form a barrier, inadequate bicarbonate to neutralize the acid and pepsin, or insufficient blood flow to the mucosa. |
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Term
| What is the most common cause of peptic ulcers? |
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Definition
| Heliobacter pylori (H. pylori) infection is the most common cause and is present in 60-75% of patients with peptic ulcer disease |
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Term
| What drug regimen is used to treat an H. pylori infection? |
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Definition
| Antiulcer drug therapy includes 2-3 antibacterial agents, plus histamine 2 receptor antagonists, OR proton pump inhibitors |
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Term
| What adverse effects can be caused by all H2 blockers (-tidiness)? |
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Definition
| cimetidine (Tagmamet), ranitidine (Zantac), famotidine (Pepcid) & nizatidine (Axid); Cimetidine has more side effects than the other H2 blockers, it binds to androgen receptors causing blockade of these receptors. This causes gynecomastia, reduced libido, and impotence; all of which are reversed when the drug is discontinued. The other three H2 blockers do not bind to androgen receptors; therefore they do not cause the side effects seen w/ cimetidine. All H2 blockers increase the risk of pneumonia because when gastric acidity is reduced more bacteria will grow including bacterial in the respiratory tract. |
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Term
| Drug interactions of Cimetidine (Tagament) |
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Definition
| Cimetidine interacts with various drugs due to its ability to inhibit liver enzyme function which causes the blood level of these other drugs to rise: Warfarin (anticoagulant), phenytoin (antiepileptic), theophylline (bronchodilator0, or lidocaine (antidysrhythimic agent) |
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Term
| Which adverse effects can be caused by proton pump inhibitors (-prazoles)? |
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Definition
| ex: omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), raberprazole (Aciphex) & pantoprazole (Protonix); these are the five available proton pump inhibitors. They like H2 blockers also increase gastric pH increasing the risk for pneumonia. Long term therapy in high doses may increase risk of osteoporosis and fractures. Drug interactions may occur due to elevation of gastric pH Atazanavir (HIV drug) and two antifungal agents (ketoconazole and itraconazole) are poorly absorbed if given with a proton pump inhibitor. Other drug levels may increase due to interference with liver metabolism, including digoxin, warfarin, and phenytoin |
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Term
| Which antacid can change the pH causing alkalosis? |
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Definition
| Sodium bicarbonate; it is systemically absorbed, and can alter systemic pH causing alkalosis (excessive bicarbonate) |
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Term
| Why are aluminum antacids commonly combined with magnesium antacids? |
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Definition
| Aluminum antacids commonly cause constipation where magnesium causes diarrhea; together they reduce the chances of changing bowel habits |
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Term
| Why is aluminum given to patients with renal failure? |
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Definition
| it binds to substances including tetracyclines (antibacterial agents), warfarin and digoxin; reducing their effects. It will also bind phosphate which can result in low blood phosphate levels (hypophosphatemia); however it can be used to treat hyperphosphatemia which commonly occurs in patients with renal failure |
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Term
| What are common anticholinergic effects caused by glycopyrrolate (Robinul)? |
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Definition
| most common is dry mouth. Other anticholinergics may cause constipation, visual disturbances, or urinary retention |
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Term
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Definition
| glycopyrrolate (Robinul), propatheline bromine (Pro-Banthine) and pirenzepine (Gastrozepine) |
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Term
| What teaching should be given to a patient with sulcralfate (Carafate) for an ulcer? |
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Definition
| The most common side effect is constipation. Drug interactions can occur including decreased absoption of some drugs: phenytoin, theophylline, digoxin, warfarin, and flourquinolones (antibacterial agents). These interactions can be minimized by administering sucralfate 2 hours apart from these other drugs. Antacids interfere with sucralfate's effects and should be given at least 30 minutes apart. this drug works by covering ulcer and protecting it from acid |
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Term
| What drug is used to prevent gastric ulcers caused by NSAIDs? |
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Definition
| Misoprostol (Cytotec) serves as a replacement for prostaglandins, since prostaglandin synthesis is inhibited by the NSAIDs. Most common side effects are diarrhea and abdominal pain; contraindicated during pregnancy [pregnancy Risk Category X], prostaglandins cause uterine contractions and spontaneous abortion may occur. |
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Term
| What is the approved used of alosteron (Lotronex)? |
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Definition
| Alosetron (Lotronex) is for women w/ Irritable bowel syndrome w/ diarrhea who have had symptoms for at least 6 months that have not responded to conventional drugs. It is a serotonin receptor antagonist blocking type 3 serotonin receptors in the colon; relieving abdominal pain, slowing colon transit time, reducing intestinal secretions and increasing sodium and water absorption. |
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Term
| How does budesonide (Entocort) work to improve symptoms of inflammatory bowel disease? |
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Definition
| It is a glucocorticoid used to relive symptoms of ulcerative colitis and Crohn's disease through its anti-inflammatory effects. Approved for crohn's disease because the drug is released when it reaches the ileum and ascending colon. |
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Term
| What should the patient taking infliximab (Remicade) be told to report? |
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Definition
| Immunomodulators increase the risk of serious infections including tuberculosis, patients should report signs of infection such as fever or pain |
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Term
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Definition
| infliximab (Remicade), certolizumab (Cimzia) & adalimumab (Humira) |
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Term
| What are the daily water needs? |
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Definition
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Term
| A fever adds what percent of water requirement? |
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Definition
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Term
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Definition
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Term
| What causes hyperosmolality? |
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Definition
| severe diarrhea, increased salt intake, inadequate water intake, diabetes or sweating |
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Term
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Definition
| IV solutions that contain electrolytes and other substances that closely resemble the body's extracellular fluid |
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Term
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Definition
| Isotonic: D5W, 0.9% NaCl, D5/0.2% NaCl, LR ; Hyptotonic: D5W (rapid or continuous) 0.45% NaCl ; Hypertonic: D10W, D5/ 0.9% NaCl,D5LR |
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Term
| Where does the fluid go with each type? |
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Definition
| Hypotonic - water moves from the plasma to the interstitial space and the cells; Isotonic - no net fluid shift; Hypertonic - plasma gains more solute than the interstitial fluid and water moves from the interstitial space to the intravascular space |
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Term
| What situation is a hypotonic solution used for? |
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Definition
| Used to treat cellular dehydration |
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Term
| What situation would you use an Isotonic solution? |
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Definition
| Used to treat fluid loss due to vomiting, diarrhea, or surgical procedures, especially when BP is low |
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Term
| What situation would you use a Hypertonic solution? |
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Definition
| Used to treat cellular edema such as cerebral edema or increased intraocular pressure |
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Term
| What adverse effects can occur with a Hypotonic solution? |
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Definition
| Can result in hypotension because of movement of water out of the intravascular space |
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Term
| What adverse effects can occur with an Isotonic solution? |
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Definition
| Care must be taken to avoid fluid overload because they can expand the blood volume rapidly |
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Term
| What adverse effects can occur with a Hypertonic solution? |
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Definition
| Water also leaves the cells and moves into the plasma compartment which can result in dehydration |
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Term
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Definition
| solutions that expand the blood volume and replace plasma proteins |
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Term
| What adverse effects can occur with hetastarch? |
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Definition
| Has an extended duration action, lasting more than 24 hours, can persist in the body for weeks causing decreased platelet and hematocrit counts; contraindicated in patients with bleeding disorders, heart failure, and renal dysfunction |
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Term
| Which blood product will most benefit a patient with low oxygen levels, low plasma protein levels, and low clotting factors? |
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Definition
| Whole blood because it contains oxygen carrying rbc's, plasma with all its proteins and clotting factors |
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