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Upper and Lower GI Drugs
Roach 41 & 42
209
Pharmacology
Undergraduate 1
10/15/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
H. Pylori causes what?
Definition
Ulcers and chronic gastritis
Term
Ginger
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
ALUMINUM CARBONATE
Definition
antacid
Term
ALUMINUM HYDROXIDE
Definition
antacid
Term
CALCIUM CARBONATE
Definition

antacid

 

Term
MAGENSIA or MAGNESIUM HYDROXIDE
Definition
antacid
Term
MAGNESIUM OXIDE
Definition
antacid
Term
SODIUM BICARBONATE
Definition
antacid (baking soda?)
Term
Actions of antacids
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
Uses of antacids
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
Interactions of antacids
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
Uses of H2 antagonists
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
Actinos of PPIs
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
Uses of PPIs
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
Adverse Rxns of PPIs
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
Interactinos of PPIs
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
MISOPROSTOL
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
SUCRALFATE
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
Action of GI stimulants
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
Uses of GI simulants
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
Classes of antiemetics
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
TRIMETHOBENZAMIDE
Definition
anticholinergic antiemetic
Term

DOLASETRON

GRANISETRON

ONDANSETRON

PALONSETRON

 

Definition
5-HT3 receptor antagonist anti-emetics
Term
APRITANT
Definition
an anti-emetic (miscellaneous)
Term
DRONABINOL
Definition

is Marinol

The only medically available cannabinoud for antiemesis

One side effect is euphoria

Term
NABILONE
Definition

Synthetic cannibinoid used to treat nausea (anti-emetic)

One side effect is euphoria

Term
Uses of the anti-emetics
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
Action of emetics
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
When not to use emetics
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
PaOR to Antacids
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
Shake 
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
1 hour before needed
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
CHAMOMILE
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
ALOSETRON
Definition
a misc drug for bowel disorder - used for females with IBS and severe diarrhea
Term
INFLIXIMAB (Remicade)
Definition
a misc drug for bowel disorders used for IBD and RArth
Term
BISMUTH
Definition
antidiarrheal
Term
DIFENOXIN w/ ATROPINE
Definition
an antidiarrheal (Motofen) 
Term
DIPHENOXYLATE with ATROPINE
Definition
an antidiarrheal
Term
LOPERAMIDE
Definition

Immodium

Kaopectate

antidiarrheal

NOT rt opioids

acts on muscles of bowel directly to slow motility

Term
Paregoric
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
none reported
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
METHYLCELLULOSE
Definition
a bulk-producing laxative
Term
POLYCARBOPHIL
Definition
a bulk-forming laxative
Term
GLYCERIN (re GI)
Definition
a hyperosmotic laxative
Term
LACTULOSE
Definition
a hyperosmotic laxative
Term
LUBIPROSTONE
Definition
a hyperosmotic laxative
Term
CASCARA SAGRADA
Definition
a stimulant laxative
Term
BISACODYL
Definition
stim lax
Term
DOCUSATE
Definition
a stool softener (surfactant) laxative
Term
SALINE LAXATIVES
Definition
are magnesium preparations like mag cit and MOM
Term
PEG and PEG-ES
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
Uses of laxatives
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
LACTULOSE
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
OBSTIPATION
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?
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

 

Term
H2 antagonists and digoxin
Definition
reduces serum digoxin levels
Term
Cimetedine and diabetes
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
H. Pylori Treatment
Definition
  • anti-infectives
  • bismuth
  • PPIs lansoprazole (Prevacid) and omerprazole (Prilosec)
Term
What is used to treat erosive esophagitis?
Definition
PPIs
Term
When to take PPIs
Definition
1 hour before eating
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
Antiemetics and antacids
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
increases bleeding risk
Term
Admin routes of mesalamine (Asacol)
Definition
oral or enema
Term
Action of simethicone
Definition
disperses gas
Term
Action of charcoal as an antiflatulant
Definition
binds gas for expulsion
Term
Adverse reactions of antiflatulants
Definition
none reported
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
How lactulose works
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
Laxative and N/V
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
Nursing Role Laxatives
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
Trimethobenzamide
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
Thiethylperazine
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
GI stimulant and MAOIs
Definition
increases risk for hypertensive episode
Term
GI stimulants and cimetedine
Definition
decreases absorption of cimetidine
Term
Reglan and levodopa
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
Reglan and opioids
Definition
decreases opioid absorption
Term
Reglan and digoxin
Definition
decreases digoxin absorb
Term
PPIs and digoxin
Definition
increases digoxin levels
Term
PPIs and phenytoin for seizures
Definition
Can increase phenytoin to toxic levels
Term
PPIs and benzodiazepines
Definition
Can increase benzos to toxic levels
Term
PPIs and oral anticoagulants
Definition
Increases risk of bleeding
Term
PPIs and ampicillin
Definition
decreases absorption of ampicillin
Term
PPIs and ketocozanole
Definition
decreases absorptino fo ketocozanole
Term
PPIs and sucralfate for GI distress
Definition
decreases absorb of ppi
Term
Antidiarrheals and MAOIs
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
Antacids and pregnancy
Definition
Use with caution
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
Antacids and digoxin
Definition
reduced absorption of digoxin
Term
Antacids reduce effectiveness of
Definition

tetracycline and corticosteroids

makes salicylates excreted more rapidly in urine

Term
PPIs and pregnancy
Definition
All but esomerprazole (Nexium) are contraindicated in pregnancy/lactation
Term
H2 antagonists and pregnancy
Definition
Use cautiously
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
GI Stimulants and MAOIs
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
increases bleeding riak
Term
aminosalicylates and pregnancy/lactation
Definition
use cautiously
Term
Which class of upper GI drugs can decrease vitimin B absorption?
Definition
PPIs
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
2 days
Term
What is the only PPI that is not contraindicated during pregnancy/lactation?
Definition
esomprazole (Nexium)
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