Term
|
Definition
Ulcers and chronic gastritis |
|
|
Term
|
Definition
used for motion sickness, N/V and indigestion. Also for pain of arthritis and may help lower cholesterol. Adv rxns rare although heartburn reported in some (me). Use cautiously in HTN or gallstones and during pregnancy or lactation. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
MAGENSIA or MAGNESIUM HYDROXIDE |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
i. Neutralize or reduce acidity of stomach and duodenal contents by combingin with HCL and increasing the pH. Some may increases tone of esoph sphincter to prevent reflux |
|
|
Term
|
Definition
i. Hyperacidity caused by
1. heartburn, acide indigestion, sour stomach
2. gastroesophageal reflux disease (GERD)
3. peptic ulcer
ii. Some are used for no GI conditions like aluminum carbonate a phosphate binding agent used for hyperphosphatemia in renal failure, etc |
|
|
Term
Adverse reactions of antacids |
|
Definition
i. Mag and Na containing may have laxative effect and produce diarrhea
ii. Alum and calcium lead to constipation
iii. Wide margin of safety, though are serious side effects (not common)
1. Alinum containing – constipation, impaction, anorexia, weakness, tremors, bone pain
2. Magnesium containing – severe diarrhea, dehydration, hypermagnesemia (N/V, hypotension and decreased respirations)
3. Calcium containing – rebound hyperacisity, metabolic alkilosis, hypercalcemia, vomiting, confusion, headache, renal calculi, neuro impairement
4. Sodium bicarbonate – systemic alkilosis and rebound hyperacidity |
|
|
Term
Contraindications of antacids |
|
Definition
a.
i. Pts with severe ab pain of unknown cause
ii. Lactation
iii. Sodium containing – CV problems like HTN or HF and those on low Na diets
iv. Calcium containing – pts with renal calculi or hypercalcemia |
|
|
Term
|
Definition
a.
i. Antacids reduce the absorption of the following
1. digoxin
2. isoniazid for infection
3. phenytoin for seizures
4. chlorpromazine
ii. Antacids reduce the effectiveness of the following
1. tetracycline
2. corticosteroids (reduces anti-inflamm)
iii. Antacids with salicylates makes salicylate excreted more rapidly in urine
iv. Antacids with the following cause antacids and following to be excreted more slowly in urine
1. quinidine
2. amphetamines |
|
|
Term
Histamine H2 antagonists all end in.... |
|
Definition
-DINE
cimetedine (Tagament)
famotidine (Pepcid)
nizatidine (Axid)
ranitidine (Zantac)
|
|
|
Term
Proton pump inhibitors
LIST |
|
Definition
a.
a. esomeprazole (Nexium)
b. lansoprazole (Prevacid)
c. omeprazole (Prilosec)
d. pantoprazole (Protonix)
e. rabeprazole |
|
|
Term
CIMETIDINE
FAMOTIDINE
NIZATIDINE
RANITIDINE |
|
Definition
Histamine 2 receptor antagonists
Reduce stomach acid production |
|
|
Term
Actions of H2 antagonists |
|
Definition
Reduce stomach acid by inhibiting H2 receptors in stomach to reduce secretion HCL. Are selective only for H2 receptors in stomach, and not those elsewhere in body, do not cause cholinergic blocking effects. |
|
|
Term
|
Definition
1. prevent ulcers
2. acute upper GI bleeding in critically ill
3. heartburn/acid indigestion/sour stomach
4. GERD
5. Gastric/duodenal ulcer
6. gastric hypersecretory conditions
|
|
|
Term
Adverse reactions of H2 antagonists |
|
Definition
1. usually mild and transient; rare (less than 2%), includes
a. dizziness, somnolence, headache
b. confusion, hallucinations
c. diarrhea
d. reversible impotence |
|
|
Term
Contraindicatinos of H2 antagonists |
|
Definition
Only one listed is those with hypersensitivities |
|
|
Term
Precautionary use of H2 antagonists |
|
Definition
1. renal/hepatic impairment
2. severely ill
3. elderly
4. debilitated
5. preg cats b and c so use with caution |
|
|
Term
Proton Pump Inhibitors (PPIs)
LIST |
|
Definition
a. esomeprazole (Nexium)
b. lansoprazole (Prevacid)
c. omeprazole (Prilosec)
d. pantoprazole (Protonix)
e. rabeprazole |
|
|
Term
ESMOEPRAZOLE
LANSOPRAZOLE
OMEPRAZOLE
PANTOPRAZOLE
RABEPRAZOLE |
|
Definition
Proton pump inhibitors
Decrease stomach acid production |
|
|
Term
|
Definition
1. suppress gastric acid secretion by inhibiting the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system (or acid/proton pump system) of gastric parietal cells at the last step of gastric acid production by gastric mucosa. |
|
|
Term
|
Definition
1. Gastric and duodenal ulcers, especially those assoc with h. pylori
a. For H. pylori infection, are various triple drug regiments that include anti-infectives along with upper GI drugs like proton pump inhibitors, H2 antagonists, bismuth.
2. GERD and erosive esophagitis
3. hypersecretory conditions
|
|
|
Term
|
Definition
1. headache
2. nausea
3. diarrhea
4. abdominal pain
5. prolonged tx may decrease ability of b12 absorption resulting in anemia |
|
|
Term
Contraindications of PPIs |
|
Definition
1. hypersensitivities
2. omerprazole, lansoprazole, rabeprazole, pantoprazole contraindicated in pregnancy and lactation |
|
|
Term
Precautionary use of PPIs |
|
Definition
1. older adults
2. hepatic impairment |
|
|
Term
|
Definition
1. sucralfate for GI distress – decreases absorb of ppi
2. ketocozanole – decreased absorb of ketocozanole
3. ampicillin – decreased absorb of ampicillin
4. oral anticoags – increases risk of bleeding
5. digoxin – increases absorb of digoxin
6. benzos – risk for toxic levels of benzo
7. phenytoin for seizures – risk for toxic level of phenytoin |
|
|
Term
|
Definition
a miscellaneous (uncategorized) acid reducer that is used to reduce the risk of NSAID induced ulcers
- inhibits gastric acid production and mucosal protedction
- can cause abortion and birth defects – contraindicated for pregnant or those who may become pregnant, or lactating.
- Adv rxns are headache, nausea, diarrhea, ab pain
- It’s effects are decreased when given with antacids.
|
|
|
Term
|
Definition
- a misc. acid reducer
- a pepsin inhibitor and mucosal protectant
- binds with proteins to form visous substance to buffer acid and protect mucosa; used for short-term treatment of duod. ulcers.
- Most common ad rx is constipation
- Interactions are similar to the PPIs
|
|
|
Term
ANTICHOLINERGIC ACID REDUCERS |
|
Definition
less used
reduce gastric motility and decrease acid secretion; largely replaced by h2 antagonists bc more effective and less adv rxs.
Both is ch 27:
a. propantheline
b. glycopyrrolate |
|
|
Term
Which acid reducer can cause abortions? |
|
Definition
MISOPROSTOL (CYTOTEC) given to reduce risk of NSAID gastic ulceratino |
|
|
Term
GASTROINTESTINAL STIMULANTS
LIST |
|
Definition
a. metoclopramide (Reglan)
b. dexpanthenol (Ilopan) |
|
|
Term
|
Definition
i. Treat delayed gastric emptying and emesis; increase motility of upper GI w/out increasing secretions
ii. Sensitizes tissue to acetylcholine to increase tone and amplitude of gastric contractions to hasten gastric emptying into small intestine
iii. Inhibition of stimulation of the CHEMORECEPTOR TRIGGER ZONE (CTZ) which is a group of nerve fibers on surface of 4th ventricle of brain that sends signals to vomiting center of medulla |
|
|
Term
|
Definition
i. GERD
ii. GASTRIC STASIS in diabetics, those with N/V assoc with cancer chemo and those in the immediate post-op period.
iii. dexpanthenol may be given IV immediately after abdom surgery to reduce risk of PARALYTIC ILEUM (no peristalsis) |
|
|
Term
Contraindications of GI stimulants |
|
Definition
i. GI obstruction
ii. Gastric perforation or hemorrhage
iii. Pheochromocytoma (an adrenal tumor)
iv. Parkinson’s or seizure disorder who when taking these drugs are likely to have extrapyramidal effects
v. Dexpanthenol should not be used by hemophiliacs |
|
|
Term
Precautionary use of GI stimulants |
|
Definition
i. Diabetes
ii. Cv disease
iii. Use with caution in pregnancy and lactation (b and c categories) |
|
|
Term
|
Definition
1. antidopaminergics
2. cholinergic blocking
3. 5-HT3 receptor antagonists
4. Miscellaneous |
|
|
Term
ANTIDOPAMINERGIC ANTIEMETICS
LIST |
|
Definition
a. chlorpromazine (Thorazine)
b. perphenazine
c. prochlorperazine (Compazine)
d. promethazine
e. thiethylperazine
f. triflupromazine |
|
|
Term
CHLORPROMAZINE
PERPHENAZINE
PROCHLOPERAZINE
PROMETHAZINE
THIETHYLPERAZINE
TRIFLUPROMAZINE |
|
Definition
antidopinergic anti-emetics |
|
|
Term
|
Definition
anticholinergic antiemetic |
|
|
Term
DOLASETRON
GRANISETRON
ONDANSETRON
PALONSETRON
|
|
Definition
5-HT3 receptor antagonist anti-emetics |
|
|
Term
|
Definition
an anti-emetic (miscellaneous) |
|
|
Term
|
Definition
is Marinol
The only medically available cannabinoud for antiemesis
One side effect is euphoria |
|
|
Term
|
Definition
Synthetic cannibinoid used to treat nausea (anti-emetic)
One side effect is euphoria |
|
|
Term
|
Definition
i. Treat of prevent severe N/V, often prophylactically before/after surgery; anticancer drugs and radioation
ii. Also used in infections and adverse drug reactions causing severe N/V. |
|
|
Term
Action of 5-HT3 receptor antagonist anti-emetics |
|
Definition
target serotonin receptors at CTZ and peripherally at nerve endings in stomach; this helps reduce non-GI side effects. Are being tested for irritable bowel. |
|
|
Term
CHEMORECEPTOR TRIGGER ZONE (CTZ) |
|
Definition
group of nerve fibers on surface of 4th ventricle of brain that sends signals to vomiting center of medulla |
|
|
Term
Drugs used for vertigo or motion sickness |
|
Definition
1. buclinzine
2. cyclizine
3. dimenhydrinate (Dramamine)
4. duphendydramine (Benadryl)
5. meclizine
6. scopolamine |
|
|
Term
Adverse reaction of anti-emetics |
|
Definition
i. Mostly varying degrees of drowsiness |
|
|
Term
Contraindications of anti-emetics |
|
Definition
i. Severe CNS depression
ii. 5-HT3 not used by those with heart block or prolonged QT intercals
iii. not recommended furing lactation and pregnancy
iv. uncomplicated vomiting in young children
v. prochlorperazine contro in bone marrow depression, blood dyscrasia, Parkinson’s, severe liver or CV disease
vi. Thiethylperazine is preg cat X |
|
|
Term
Which anti-emetic is a pregnancy category X |
|
Definition
Thiethylperazine (antidopinergic anti-emetic) |
|
|
Term
Precautionary use of anti-emetics |
|
Definition
i. Do not treat severe N/V with antiemetic alone, must understand cause; antiemetics can hamper dx of causes like brain tumors, appecdiciting, drug tox, etc.
ii. Cholinergic blocking antiemetics used with caution in glaucoma, obstructive GI or genitourinary disease, reanal/hep dysfunction, older men with possible prostate hypertrophy
iii. Promethazine used cautiously with HTN, sleep apnea, epilepsy
iv. Trimethobenzamide in children with viral illness bc can increase risk of Reye’s
v. 50HT3 receptor antagonists caution in pts with cardiac conduction problems or electrolyte imbalances
vi. Are classes B and C (except for thiethylperazine is X)
|
|
|
Term
|
Definition
Causes local irritation of stomach and stimulation of medullary vomit center |
|
|
Term
Are all OD/poisoning treated with emetics? |
|
Definition
No, bc can do more harm than good if very caustic |
|
|
Term
|
Definition
i. Not altered mental status and risk of aspiration is high
ii. Pt in convulsions
iii. Substance injected can cause altered mental state or convusions
iv. Sunstance is caustic or corrosive
v. Substance injested is low-viscosity petroleum distillate with potential for pulm aspiration and dvlp of chemical pneumonitis
vi. Pt has medical condition that may be exacerbaeted by vomiting like severe ht, bradycardia, hemorrhagic diathesis |
|
|
Term
What is very important to know before giving and emetic? |
|
Definition
What was injested! When and the symptoms as well. |
|
|
Term
Preassment of admin of upper GI drug |
|
Definition
i. Type and intensity of symptoms like pain, discomfort, nausea, vomiting, etc. for baseline
ii. Document # and times pt has vomited and approx amount of fluid lost
iii. Assess for signs of fluid and electrolyte imbalance
iv. Take vitals
v. For preventative antiemetic, explain why. |
|
|
Term
Ongoing assessment of upper GI drug admin |
|
Definition
i. Monitor continually for continued complaints of pain, sour taste, production of bloody coffe ground emesis.
ii. Keep suction equip available is case a NG tube must be inserted to prevent aspiration
iii. If severe vomiting, observe for signs of electrolye imbalance and monitor BP, pulse, RR q 2-4 hours or as ordered
iv. Carefully monitor I and O includine emesis until vomiting ceases and pt can drink sufficiently
v. Document q time pt vomits\
vi. Notify PCP if blood in emesis or suddenly more severe
vii. May also need to take weight daily if prolonged vomiting
viii. Assess frequently for effectiveness of drug and notify PCP if fails to relieve or diminish symptoms. |
|
|
Term
|
Definition
1. can be given hourly for first 2 weeks for acute peptic ulcer
2. After this, give 1-2 hours after meals and at bedtime
3. PCP may order for self-admin at bedside
a. Ensure enough water and cups for measuing the dose
4. NURSING ALERT – no oral drug should be admin within 1 to 2 hours of an antacid bc of the potential for interactions |
|
|
Term
What must the nurse know re: admin of an antacid? |
|
Definition
Do not give any other oral drug within 1 to 2 hours of the antacid bc of high risk of interaction |
|
|
Term
PaOR for admin of a non-oral upper GI drug |
|
Definition
1. maybe bc are unconscious (surgery eg)
2. many acid-reducing come in IM and IV. IV preferred if has existing line bc these drugs are irritating and IM must be given deep to minimize tissue harmd
3. NURSING ALERT – when “one of these drugs” (acid reducing or all upper GI?) given IV, nurse must monitor rate of infusion at frequent intervals. Too rapid may induce cardiac arrythmias
4. Debilitated pts with NG at risk for gastric ulcer so may be given acid-reducers.
a. Always check med label to see if can be crushed or capsule opened
b. If so, mix with 40mL apple juice, inject and fluch
c. Many come in liquid form; request this if given fvia tub to prevent clogging |
|
|
Term
PaOR when preventing nausea in pts undergoing cancer therapy |
|
Definition
1. Drugs used when for chemotherapy N/V
a. granisetron
b. ondansetron (Zofran)
c. dolasetron
2. given before chemo admin, at first IV
3. always by nurse trained in admin of cancer chemo |
|
|
Term
M/M pt with diarrhea, N/V and admin an upper GI drug |
|
Definition
1. antacids can cause diarrhea or constipation, so keep BM log (ha)
a. if diarrhea, must keep I&O
b. change in antacide usually fixes problem
2. Dehydraton big problem for vomiting pt so observe for sign of dehydration
a. poor skin turgor, dry mucous membranes, low/concentrated urine, restlessness, irritability, up RR and confusion
b. monitor I&O q 8 hrs
c. Offer fluids
d. observe for electrolyte imbalances
e. If elec imb or dehydration, contact PCP bc may need IV fluid/elec.
3. Fluid/electrolyte monitoring esp important in elderly or chronically ill |
|
|
Term
M/M pt having difficulty eating/retaining food/fluids |
|
Definition
1. Provide emesis basin and check; maesure amount
2. can give oral rinse
3. Decraesed appetite from nausea so make environment pleasant without strong odors |
|
|
Term
What must be done to liquid antacids before admin? |
|
Definition
|
|
Term
Patients on high or long term doses of metrolclopramide (Reglan), what should you know? |
|
Definition
watch for CNS adverse reactions and report to PCP before next dose bc may be discontinued. Also report before next dose tardive dyskinesia. These effets (TD and extrapyr.) may be irreversible if continued.
|
|
|
Term
Extrapyramidal symptoms to watch for when administering Reglan at high dose or long-term |
|
Definition
i. difficulty speaking or swallowing, masklike face, shuffling gate, rigidity, tremors, uncontrolled movements of mouth, face, or extremities, uncontrolled chewing or unusual movements of tongue |
|
|
Term
Interactions of CV conditions and antacids |
|
Definition
Some antacids are made with sodium, which can increase BP |
|
|
Term
Directions of effervescents |
|
Definition
Allow to completely dissolve and wait till bubbling stops |
|
|
Term
Antacids that may cause constipation |
|
Definition
those taht contain calcium and aluminum |
|
|
Term
Risks of overuse of antacids |
|
Definition
Can cause more acid production. Do not use for that 2 weeks except if oked |
|
|
Term
When to take motion sickness drug |
|
Definition
|
|
Term
Pt teaching for transdermal scopolamine for motion sickness |
|
Definition
1. behind ear
2. after apply, wash hands well with soap and water to prevent contact of drug with eyes
3. disk will last 3 days, can apply another after
4. after discarding disk, again thorough washing of hands
5. only one disk a time!
6. Adverse reactions are dizziness, dry mouth, and blurred vision
7. stress caution with hazerdous tasks |
|
|
Term
|
Definition
· for digestive upset, ulcers, etc. Generally safe. Antispasmodic effect on GI smooth muscle and protects against ulcers. Can produce mild to severe allergies though. |
|
|
Term
Drugs that may cause constipation |
|
Definition
o Anticholinergics
o Antihistamines
o Phenothiazines
o Tricyclics
o Opioids
o Non-K-sparing diuretics
o Iron preparations
o Barium
o Clonidine
o Antacids containing calcium or aluminum |
|
|
Term
INFLAMMATORY BOWEL DISEASE (IBD) |
|
Definition
·
o about 1.4 million is US
o is both Chron's and ulcerative colitis
o cause inflammation of intestines
o cause unknown, though though is bacteria or virus
o Crohn's
§ ab pain and distension
§ as progresses anorexia, diarrhea, weight loss, dehydraion and nutritional deficiencies
o Ulcerative colitis
§ more abrupt onset
§ sudden need to defecate with severe blood/mucus filled diarrhea or no stool at all.
§ Pain and fatigu
o No evidence that IBD caused by psychological factor
o Drugs for IBD are antibiotics, corticosteroids, biologic agents and aminosalicylates |
|
|
Term
Actions/uses of Aminosalicylates |
|
Definition
i. aspirin like with anti-inflamm
ii. mechanism unknown
iii. topical anti-inflamm in bowel
iv. used for Crohn's and UC and other inflamm disorders (Infammatory Bowel Diseases or IBD) |
|
|
Term
Adverse reactions of aminosalicylates |
|
Definition
ab pain, nausea, diarrhea, fever and weakness |
|
|
Term
Contraindications of aminosalicylates |
|
Definition
i. hypersensitivity to all salicylates
ii. hypersensitivities to sulfanomides and sulfites
iii. intestinal obstruction
iv. children under 2
|
|
|
Term
Precautionary use of aminosalicylates |
|
Definition
i. cats b and c
ii. pregnency and lactation |
|
|
Term
|
Definition
a misc drug for bowel disorder - used for females with IBS and severe diarrhea |
|
|
Term
|
Definition
a misc drug for bowel disorders used for IBD and RArth |
|
|
Term
|
Definition
|
|
Term
|
Definition
an antidiarrheal (Motofen) |
|
|
Term
DIPHENOXYLATE with ATROPINE |
|
Definition
|
|
Term
|
Definition
Immodium
Kaopectate
antidiarrheal
NOT rt opioids
acts on muscles of bowel directly to slow motility |
|
|
Term
|
Definition
is tincture of opium used to treat diarrhea |
|
|
Term
Antidiarrheals rt opioids |
|
Definition
difenoxin (Motofen) anddiphenoxylate (Lomitil)
no analgesia
have sedative and euphoric effects
combined with atropine for negative side effects of sry mouth etc (anticholinergic) |
|
|
Term
Adverse reactions of antidiarrheals |
|
Definition
i. GI - anorexia, N/V, constipation, ab discomfot, pain and distension
ii. CNS- dizziness, drowsiness, headache, sedation, euphoria
iii. Other - rash |
|
|
Term
Contraindications of antidiarrheals |
|
Definition
i. diarrhea cuased by organisms like e.coli and shigella that must be evacuated
ii. psudomembranous colitis
iii. ab pain of unknown urigin
iv. obstructive jaundice
v. children under 2
vi. loperamide prg cat B but not recommended for use during pregnancy and lactation |
|
|
Term
Precautionary use of antidiarrheals |
|
Definition
i. NURSING ALERT - if diarrhea persists more than 2 days when OTCs used, pt dc use and seek treatment
ii. severe hepatic impairment
iii. IBD
iv. preg cat C use with caution pregnancy and lactation |
|
|
Term
If a pt has diarrhea and has been using OTC antidiarrheals, when should they contact PCP |
|
Definition
If no relief after 2 days of use |
|
|
Term
Interactions of antidiarrheals |
|
Definition
i. antihistamines, opiods or hypnotics - increases risk of CNS depression
ii. antihistamines and general antidepressants - increases risk of anti-cholinergic effects
iii. MAOIs - increased risk of hypertensive crisis |
|
|
Term
What are the two ANTIFLATULANTS |
|
Definition
1. charcoal
2. simethicone (Gas-X) |
|
|
Term
Actinos of antiflatulants |
|
Definition
i. do not absorb or remove gag, they only help body release the gas
1. charcoal binds gas for expulsion
2. simethicone has defoaming agent that prevents small gas pockets |
|
|
Term
Adverse rxns of antiflatulants |
|
Definition
|
|
Term
Pregnancy and antiflatulants |
|
Definition
i. preg cat of simethicone not determined, but may be safe bc it is not actually absorbed into body (still consult dr)
ii. Charcoal is preg cat C |
|
|
Term
Interactions of antiflatulants |
|
Definition
i. charcoal may absorp other drugs, decreasing their effectiveness
ii. No known interactions with simethicone
|
|
|
Term
|
Definition
a bulk-producing laxative |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
a stool softener (surfactant) laxative |
|
|
Term
|
Definition
are magnesium preparations like mag cit and MOM |
|
|
Term
|
Definition
are bowel evacuants
polyethylene glycol is Miralax
polyethylene glycol-electrolyte solution if GoLYTELY |
|
|
Term
Action of surfactant stool softeners |
|
Definition
1. lubricate and soften stool
2. Promote water retention in stool |
|
|
Term
action of hyperosmotic laxatives |
|
Definition
dehydrate local tissue, causing irritation to increase peristalsis |
|
|
Term
Action of saline laxative |
|
Definition
pull water into intestine |
|
|
Term
|
Definition
i. To evacuate colon for exams - stimulants, emolliants, saline
ii. prevention of strain after surgery or MI - stool softeners or mineral oil
iii. IBS and diverticular disease - psyllium and polycarbophil
iv. Reduction of blood ammonia levels in hepatic encephalopathy - the hyperosmotic agent lactulose |
|
|
Term
Which laxative is used to decrease blood ammonia levels in hepatic encephalopathy? |
|
Definition
|
|
Term
Adverse reactions of laxatives |
|
Definition
i. Water and electrolyte loss
ii. ab pain discomfort, N/V, perianal irritation, bloating, flatulance, cramps
iii. weakenss, fainting
iv. prolonged use can cause serious electrolyte imblanaces and a lax habit (dependency to have BM)
v. Some contain tartrazine which may cause allergic reactions including bronchial asthma
vi. Can cause abstructions of esophagus, stomach, small intestine, colon if bulk-forming not given with enough water or with pts with intestinal stenosis
vii. Very young or old, or debilitated greatest risk for aspiration of mineral oil into lungs when taken orally. Can lead to lipid pneumonitis. |
|
|
Term
Contraindications of laxatives |
|
Definition
i. persistnat ab pain, N/V of unknown cause
ii. signs of appendicitis
iii. Only used when benefit outweigh risks (preg cat C): cascara, docusate, glycerin, phemolphthalein, magnesium, senna |
|
|
Term
Precautionary use of laxatives |
|
Definition
i. Magnesium admin with caution in any degree of renal impairment
ii. Pts with recatl bleeding
iii. pregnancy and lactation |
|
|
Term
Interactions of laxatives |
|
Definition
i. Mineral oil impairs absorption of fat-souble DAKE vitamins
ii. Laxtives reduce absorptin of other drugs by wither combining with them of hastening their removal
iii. Surfactants wit h mineral oil, may increase mineral oil absorption
iv. Milk, antacids, histamine H2 antagonists, and PPIs should not be administered 1 to 2 hours before bisacodyl bc enteric coating may dissolve early resulting in gastric lining irritation or dyspepsia and deccrease the lax effect of the drug |
|
|
Term
Preassment for pt receiving lower GI drug |
|
Definition
i. what is med diagnosis and reason for admin
ii. review symptoms for baseline
iii. listen to BS and palpate lokoing for guarding/discomfort
iv. May hear hypoactive sounds but have liquidy BM, this could be OBSTIPATION, which mean liquid stool is moving aroung fecal mass |
|
|
Term
|
Definition
Pt is consipated, but liquid feces is moving past fecal mass |
|
|
Term
Ongoing assessment of pt admin of lower GI drug |
|
Definition
i. dx relief? notify PCP if not or if adv rxns
ii. VS more freq if diarrhea severe |
|
|
Term
M/M pt w/ diarrhea and admind lower GI drug |
|
Definition
1. notify PCP if temp high, severe ab pain, ab rigidity/distension, indicates infection orintestinal performation
2. severe diarrhea may req IV fluids, electrolyte replacement, etc
3. Chronic diarrha, encourage to drink extra fluid
4. close I&O
5. Antidiarrheals may cause drowsiness, advise re hazardous tasks and may need assistance
6. For perianal irritation, edu clean w mild soap , dry and apply emolliant like petroleum
7. If diarrhea occurs bc over admin of a laxative, notify PCP |
|
|
Term
When is simethicone taken? |
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Definition
1. simethicone is taken after each meal and at bedtime
2. thoroughly chew bc particle dispersion enhances antiflat action
3. notify PCP if sx not better in several days |
|
|
Term
Pt teaching re: laxatives |
|
Definition
1. avoid long-term use, dependency, unless oked by PCP
2. Constipation can occur as rebound
3. do not use when ab pain, N/V
4. notify PCP if not better or if rectal bleeding and other sxs occur
5. with casara sagrada or senna, pink to red to violet to brown or even black discoloration can occur
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|
|
Term
H2 antagonists and digoxin |
|
Definition
reduces serum digoxin levels |
|
|
Term
|
Definition
use cemetidine (Tagamnet) cautiously with diabetes (higher risk of pneumonia, greater succeptibility to certain virus, which one?)
Apparently, cimetidine also has antiviral activity.... |
|
|
Term
Do H2 antagonists work immediately? |
|
Definition
no, bc they do not neutralize the acid, but prevent production. Best to take preventatively. |
|
|
Term
|
Definition
- anti-infectives
- bismuth
- PPIs lansoprazole (Prevacid) and omerprazole (Prilosec)
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|
|
Term
What is used to treat erosive esophagitis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
Do GI stimulants increase acid production? |
|
Definition
No. They promote gastric emptying without more acid. |
|
|
Term
Drug sometimes used to restart GI motility after surgery? |
|
Definition
Reglan = metroclorpromide |
|
|
Term
GI stimulants and cimetidine |
|
Definition
decreases cimetidine absorption |
|
|
Term
GI stimulants and digoxin |
|
Definition
decreases absorption of digoxin |
|
|
Term
GI stiumlants and levodopa |
|
Definition
decreases effectiveness of levodopa |
|
|
Term
When to take GI stiumulants? |
|
Definition
1/2 hour before eating for better absorption |
|
|
Term
Antiemetics with other CNS depressants |
|
Definition
Increases CNS depressions |
|
|
Term
|
Definition
Decrease antacid absorption |
|
|
Term
Prochlorperazine with lithium |
|
Definition
increases extra-pyramidal effects of lithium |
|
|
Term
Poisons that should not be treated with emetics include |
|
Definition
turpentine, corrosive alkalis, strong acids, petroleum products |
|
|
Term
How can emetics affect the heart/ |
|
Definition
Too mush emesis can cause arrythmias from electrolye imbalances |
|
|
Term
Aminosalicylates and digoxin |
|
Definition
reduces absorption of digoxin |
|
|
Term
Aminosalicylates and warfarin |
|
Definition
|
|
Term
Admin routes of mesalamine (Asacol) |
|
Definition
|
|
Term
|
Definition
|
|
Term
Action of charcoal as an antiflatulant |
|
Definition
|
|
Term
Adverse reactions of antiflatulants |
|
Definition
|
|
Term
2 general categories of laxatives are |
|
Definition
habit-forming and non-habit-forming, i.e. some are stiumlants that make you go and others help you go |
|
|
Term
|
Definition
has very high sugar content, so pulls water into colon
those with renal damage often get this, reduces blood ammonia levels by pulling ammonia into the stool from the blood |
|
|
Term
How laxatives should be administered in relation to other drugs |
|
Definition
Give laxatives separately from other meds, decreases absorption |
|
|
Term
|
Definition
Do no give laxatives with N/V |
|
|
Term
What does metoclopramide (Reglan) affect? |
|
Definition
- A GI stimulant
- Increases gastric emptying (no extra acid production)
- Sensitizes tissue to acetylcholine, inkcreasing gastric tone and contractions
- Also inhibits stimulation of the CTZ, preventing nausea
- Used to treat GERD, gastric stasis in diabetes, cancer N/V and pts after surgery
- Adverse reactions normally mild, but higher or prolonged admin can produce CNS symptoms like drowsiness, restlessness, dizziness, extrapyramidal effects, tremor, invol movements of limbs, rigidity), facial grimacing and depression
|
|
|
Term
What is dexpanthenol, actions, administratino route(s) and adv reactions? |
|
Definition
- a gi stimulant and anti-emetic
- enhances gastric emptying and inhibits CTZ, reducing N/V
- Treats GERD and gastric stasis
- May be adminned IV
- Adv rxns are itching, difficulty breathing, and urticaria
|
|
|
Term
|
Definition
- Give bulk producing with water at admin, and another after
- Mineral oil preferred empty stomach
- Mask flavor somehwo
- Record BMs
- Watch for diarrhea, notify if severe
- Watch for ineffectiveness and notify
- encourage liberal fluid and fiber intake; exercise
- avoid long term use of stimulants; habit forming and rebound constipation
- DO NOT USE IF N/V or ABDOMINAL PAIN
- Edu pt to notify if constipation not releived, rectal bleeding
- Cascara sagrada and senna can cuase urine discoloration
|
|
|
Term
Understanding the nursing role with ipeacac |
|
Definition
- Do not use if alterred mental status, risk aspiration
- so not use if convuslions
- Do not use if substance injested can cuase alterred mental states
- Do not use if substance is caustic or corrosive
- Do not use with petroleum products bc aspiration can cause chemical pneumonitis
- Do not use in pt w/ another condition that can be exacerbated by vomiting, like bradycardia, severe HTN, hemorrhagic diathesis
- MUST KNOW WHAT WAS INJESTED!!!!! ALSO THE TIME and SYMPTOMS. TALKS TO POISON CONTROL IF NECESSARY.
- Assesss fluid lost
- VS frequently, esp bc of fluid and electrolyte imbalances
- Watch for signs of dehydration
|
|
|
Term
Understanding Nursing Role w/ Admin of Antacids |
|
Definition
- May admin hourly for first 2 weeks for acute peptic ulcer, then 1-2 hours after meals and at bedtime
- Can possibly left at bedside for self-admin with order
- Make sure enough water and cups
- No oral drug should be administered within 1 to 2 hours of an antacid
- Antacids may cuase diarrhea or constipationn, so monitor BMs
- If diarrhea, monitor I&O; con be controlled by combining mag with calc or alum antacids, or changing
- Instruct to chew thoroughly and then drink water
- Can order liquid if needed, and flavored; must shake liquid thoroughly
- MAKE SURE PT UNDERSTANDS THAT ANTACIDS, ESP NA CONTAINING, RAISE BP; can interact with other conditionn, so see dr first
- ANTACIDS IMPAIR ABSORPTIONF OF OTHER DRUGS, SO DO NOT TAKE OTHER DRUGS WITHIN 2 HRS OF ANTACIDS
- White streaks in stool fine
- Too many antacidscan cause incraesed acid productin
- Advise of constipation and diarrhea causing antacids
|
|
|
Term
Treatment option (drugs) for GERD |
|
Definition
- GI stimulants
- PPIs
- H2 antagonists
- Antacids
|
|
|
Term
Functional difference b/t H2 antagonists and PPIs |
|
Definition
- H2 antagonists reduce acid production (Tagament, Zantac, Pepcid)
- PPIs can block acid production and allow time for espophagus to heal (Prevacid and Prilosec)
|
|
|
Term
When are cholinergic blocking antiemetics used with caution? |
|
Definition
glaucoma, obstructive GI or genitourinary disease, reanal/hep dysfunction, older men with possible prostate hypertrophy |
|
|
Term
When is the anti-emetic promethazine used with cautiong? |
|
Definition
Hypertension, sleep apneaand epilepsy |
|
|
Term
Which antiemetic is used cautiously in children bc it can increase the risk of Reye's? |
|
Definition
|
|
Term
When are the 5HT3 reseptor antagonist antiemetics used with caution? |
|
Definition
Pts with cardiac conduction problems
Pts with electrolyte imbalances |
|
|
Term
Anti-emetics and pregnancy/lactation |
|
Definition
Use cautiously
Except for thiethylperazine is category X |
|
|
Term
Which antiemetic is pregnancy category X? |
|
Definition
|
|
Term
Can laxatives be given with appendicitis? |
|
Definition
No, infact, don't give if signs of appendicitis. I don't know why. |
|
|
Term
Should stimulant laxatives be given during pregnancy? |
|
Definition
Certain stim laxatives are contraindicated, but used if risk outweighs benefit |
|
|
Term
|
Definition
increases risk for hypertensive episode |
|
|
Term
GI stimulants and cimetedine |
|
Definition
decreases absorption of cimetidine |
|
|
Term
|
Definition
decreases absorption of both |
|
|
Term
GI stimulants general interaction |
|
Definition
In general, causes decreased absorption of certain drugs, except for MAOIs can increase risk of hypertensive episode |
|
|
Term
|
Definition
decreases opioid absorption |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
PPIs and phenytoin for seizures |
|
Definition
Can increase phenytoin to toxic levels |
|
|
Term
|
Definition
Can increase benzos to toxic levels |
|
|
Term
PPIs and oral anticoagulants |
|
Definition
Increases risk of bleeding |
|
|
Term
|
Definition
decreases absorption of ampicillin |
|
|
Term
|
Definition
decreases absorptino fo ketocozanole |
|
|
Term
PPIs and sucralfate for GI distress |
|
Definition
|
|
Term
|
Definition
Increases risk of hypertensive crisis (not sure which antidiarrheals) |
|
|
Term
Antidiarrheals and antihistimines |
|
Definition
increases anti-cholinergic effects; increases CNS depression |
|
|
Term
What is a common side effect of mineral oil laxative? |
|
Definition
Impaired absorptino f fat soluble vitamind KADE |
|
|
Term
What should bisacodyl not be adminned with and why? |
|
Definition
Milk, antacids, H2 receptor antags, PPIs bc may enteric coating may dissolve early and cuase irritation/dyspepsia and decrease effect of drug |
|
|
Term
What are the opioid related antidiarrheals? |
|
Definition
diphenoxylate and difenoxin, both are given with atropine to decrease dependency |
|
|
Term
|
Definition
|
|
Term
Aluminum containing antacid precautionary use |
|
Definition
obstruction
upper GI bleed
decreased kidney function |
|
|
Term
Precautionary use of magnesium containing antacid |
|
Definition
decreased kidney function |
|
|
Term
Precautionary use of calsium containing antacids |
|
Definition
respiratory insufficiency
renal impairment
cardiac disease |
|
|
Term
|
Definition
reduced absorption of digoxin |
|
|
Term
Antacids reduce effectiveness of |
|
Definition
tetracycline and corticosteroids
makes salicylates excreted more rapidly in urine |
|
|
Term
|
Definition
All but esomerprazole (Nexium) are contraindicated in pregnancy/lactation |
|
|
Term
H2 antagonists and pregnancy |
|
Definition
|
|
Term
What class of drugs are the following:
balsalazide
mesalamine
olsaazine
sulfasalaze |
|
Definition
aminosalicylates, GI anti-inflams |
|
|
Term
What is a serious CNS side effect of metrocloripromide (Reglan)? |
|
Definition
Extrapyramidal effects:
Difficulty speaking or swallowing, masklike face, shuffling gate, rigidity, tremors, uncontrolled movements of mouth, face or extremities, uncontrolled chewing or unusual movements of tongue |
|
|
Term
Cautionary use of cholinergic blocking antiemetics |
|
Definition
glaucoma, obstructive GI or genitourinary disease, renal/hep dysfunction, older men with possible prostate hypertrophy
|
|
|
Term
The enti-emetic trimethobenzamide should be used in caution with children with viral illness, why? |
|
Definition
bc greater chance of Reye's |
|
|
Term
Pregnancy and antiemetics |
|
Definition
Cautionary use, except for thiethylperazine class X |
|
|
Term
|
Definition
Increased risk of a hypertensive episode |
|
|
Term
Aminosalicylates and digoxin |
|
Definition
reduces digoxin absorption |
|
|
Term
aminosalicylates and methotrexate (for cancer and autoimmunities) |
|
Definition
increases risk of immunosupression |
|
|
Term
aminosalicylates and oral hyoglycemics |
|
Definition
increases blood glucose levels |
|
|
Term
aminosalicylates and warfarin |
|
Definition
|
|
Term
aminosalicylates and pregnancy/lactation |
|
Definition
|
|
Term
Which class of upper GI drugs can decrease vitimin B absorption? |
|
Definition
|
|
Term
Frequency of admin of antacids |
|
Definition
For 2 weeks for acute ulcer can be given hourly. After tha, 1-2 hours after meals and at bedtime |
|
|
Term
What is the action of loperamide (Immodium) |
|
Definition
Acts of bowel muscles directly to slow motility |
|
|
Term
At what point should a patient seek care when self-administering an OTC antidiarrheal? |
|
Definition
|
|
Term
What is the only PPI that is not contraindicated during pregnancy/lactation? |
|
Definition
|
|