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NURS202 ExamII Pt1
Pharmacology for Clients with Altered Nutrition and Elimination Needs
| Question | Answer |
|---|---|
| What are types of anti-ulcer meds? | antacids, H2 receptor antagonists, proton pump inhibitors (PPI), cyto-protective agents |
| What are some indications for anti-ulcer meds? | too much stomach acid remains in stomach destroying the lining. hyperacidity, peptic ulcer disease (PUD)- gastric/duodenal, stress ulcer, GERD, gastritis |
| What are types of antacids? | sodium bicarbonate (oldest), aluminum containing (Amphojel), magnesium containing (MOM), calcium containing (Tums), combo (Maalox- both Ca/Al) |
| What is the mechanism of action of antacids? | work to neutralize acid by raising the pH of the stomach which also: decreases pain, inhibits digesting ability of pepsin, increases resistance of stomach lining, increases tone in lower esophageal sphincter |
| What are adverse side effects associated with antacids? | GI: MOM can cause diarrhea, Al and Ca can cause constipation, F/E: can cause metabolic alkalosis, ACID rebound (becomes ineffective) with frequent use |
| What are interactions associated with antacids? | absorption (chelation) of other drugs to antacids- chemically alter other drugs, alters/increases stomach and urinary pH |
| What are types of H2 receptor antagonists? | "tidine", cimetidine (Tagamet), rantidine (Zantac), famotidine(Pepcid), nizatidine (Axid) |
| What is the mechanism of action of H2 receptor antagonists? | prevents histamine from stimulating H2 receptors on the gastric parietal cells |
| What are indications for H2 receptor antagonists? | Shown to be effective:gastric/duodenal ulcers, GERD, hypersecretory conditions- Zollinger-Ellison, upper GI bleeding May be effective:stress ulcers, allergic conditions when used with H2 blockers- urticaria, anaphylactic, peptic esophagitis |
| What are adverse effects associated with H2 receptor antagonists? | INTEG:rash, alopecia, dermatitis ENDO:gynecomastia & impotence (cimetidine) CNS:headache, lethargy GI/GU:diarrhea, cramping |
| What are interactions associated with H2 receptor antagonists? | reduced absorption of some drugs,cimetidine raises blood concentration of meds metabolized thru liver,may reduce effects of skin allergy tests,give 1hr before or 2hrs after antacids,meds narrow therapeutic window-theophylline,warfarin,dilantin,lidocaine |
| What are types of proton pump inhibitors (PPI)? | "prazole", lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), esomeprazole (Nexium) |
| What are adverse effects associated with PPI's? | CNS:headache,dizzy GI:diarrhea,abd.pain,vomiting,anorexia GU:protein/hemat/glycos-uria HEMA:pancyto/thrombocyto/neutro-penia,leukocytosis,anemia INTEG:rash,dry skin,urticaria,pruritis,alopecia RESP:upper resp infection,cough OTHR:back pain,fever,fatigue |
| What are interactions associated with PPI's? | increased levels of certain drugs- diazepam, phenotoin, decreased absorption of drugs requiring acid, don't give with protective agents- Carafate, Cytotec |
| What are types of cytoprotective agents and their uses? | also called anti-peptic agents. sucralfate (Carafate)-used to treat stress ulcers, misoprostol (Cytotec)- prevent NSAID induced ulcers |
| What is the mechanism of action of cytoprotective agents? | reacts with gastric acid to form thick paste to selectively adhere to the ulcer surface (molecules of sulfated sucrose are attracted to and bind with base of ulcers, decrease gastric acid, "coats the tummy" |
| What are adverse effects and interactions associated with cytoprotective agents? | GU: miscarriage (Cytotec), menstrual disordersd interaction- decreased absorption of meds- tetracycline |
| What are contraindications/"use cautions" assessment concerns for anti-ulcer meds? | abdominal pain (can masks serious issue), elderly (slower metabolism, more possible drug interactions), children, pregnancy/lactation (Cytotec), renal/liver impairment (decreased metabolism, risk for toxicity), cardiac disease (many antacids contain salt) |
| What are some anti-ulcer nursing actions? | hematest stools, check blood work, watch for side effects and interaction with other meds |
| What are education concerns of anti-ulcer patients/family? | continue treatment 4-6wks even if feeling better, limit OTC use and call physician, don't crush granules, shake suspensions, avoid GI irritants, may cause drowsiness-don't drive until repsonse is known, report melena or hematemesis, eliminate smoking |
| What are types of laxatives? | laxatives- bulk-forming, hyperosmotic agents, saline cathartics, stimulants, emollients- stool softeners and lubricants |
| What are indications associated with laxatives? | constipation, bowel cleansing, remove parasites, obtain stool specimen |
| What are types of bulk-forming laxative? | psyllium (Metamucil)- natural, methycellulose (Citrucel)- synthetic OTHER: lactulose (Chronulac), polycarbophil (Fiber Con), polyethylene glycol (Miralax) |
| What are adverse effects associated with bulk-forming laxatives? | Metamucil may increase blood glucose, Citrucel contraindicated in GI obstruction and hepatitis |
| What is the onset time for bulk-forming laxatives? | 12-36 hours, long/slow acting |
| What is the mechanism of action of bulk-forming laxatives? | stimulates peristalsis by absorbing H20 increasing bulk of feces to form emollient gel and causes dilation of intestine initiating reflex bowel activity promoting bowel movement, used for chronic diarrhea |
| What are types of hyperosmotic agents? | polyethylene glycol-electrolyte solution (Golytely), lactulose (Enulose), glycerin (fleet suppository/enema) OTHER: polyethylene glycol (Miralax)- short term for constipation in peds |
| What is the mechanism of action of hyperosmotic agents? | draws H2O into the GI tract increasing fecal H2O content resulting in distention, increased peristalsis and evacuation |
| What are adverse effects associated with hyperosmotic agents? | Golytely: contraindicated in GI obstruction and bowel perforation Lactulose: low galactose diet Glycerin: no contraidications, very mild, used on children, all can cause diarrhea-->kidneys dump Na+-->loss of F/E |
| What are the onset times for the different hyperosmotic agents? | Golytely= 1 hr Lactulose= 24 hrs Glycerin= 16-36 mins |
| What are types of salines/cathartics? | magnesium citrate (Citrate of Magnesia), magnesium hydroxide (MOM) |
| What is the mechanism of action and uses of salines/cathartics? | draws H2O into the small intestine (are salts), commonly used for rapid evacuation of bowel in prep for some GI diagnostic tests- colonoscopy |
| What are adverse effects and contraintications of salines/cathartics? | contraindicated in renal insufficiency, abdominal pain, nausea, vomiting, intestinal obstruction, rectal bleeding GI: diarrhea F/E: imbalances |
| What is the onset time of salines/cathartics? | 1/2- 3 hrs |
| What are types of stimulants? | castor oil, cascara sagrada, senna/sennosids (Senokot, Ex-lax Gentile Nature), bisacodyl (Dulcolax)- moderate |
| What is the mechanism of action of stimulants? | can affect entire GI tract, action is in proportion to dose, irritate lining of intestine and stimulates peristalsis |
| What are adverse effects associated with stimulants? | most likely of all laxatives to cause dependence, diarrhea, abdominal cramping (increased peristalsis), F/E: disturbances from diarrhea |
| What is the onset time for stimulants? | 6-24 hrs |
| What are types of emollients? | stool softeners, lubricants |
| What are types of stool softeners? | docusate potassium (Kasof), docusate calcium (Surfak), docusate sodium (Colace, Correctol) |
| What is the mechanism of action of stool softeners? | soften fecal impaction through the passage of H2O and lipids into fecal matter, facilitate easy bowel movements for patients with anorectal conditions (hemorrhoids), may be used to prevent constipation in high risk patients |
| What are adverse effects and contraindications associated with stool softeners? | diarrhea, contraindicated in bowel obstruction, nausea and vomiting |
| What is the onset time for stool softeners? | 6-8 hrs |
| What is a type of lubricant and how is it administered? | mineral oil- orally or by enema |
| What are adverse effects and contraindications for lubricants? | diarrhea, contraindicated in bowel obstruction, abdominal pain, nausea and vomiting |
| What is the mechanism of action of lubricants? | eases passage of stool by preventing H2O from leaving the stool, lubricates the intestines |
| What is the onset time for lubricants? | 12-24 hrs |
| What are contraindications/"use cautions" assessment concerns for laxatives? | abdominal pain, patients with limited fluid intake (bulk-forming), monitor blood sugar with diabetics, renal disease |
| What are education concerns of patients/family for patients using laxatives? | take with lots of H2O, ways to prevent constipation:exercise,increase fluids,increase bran products, know onset time is, dependency, best on empty stomach, suppository works, refrig citrate, mix castor oil with juice, senna products can discolor urine |
| What are types of anti-diarrheals? | absorbents, anticholinergics, synthetic opiates, intestinal flora modifiers |
| What are types of absorbents? | bismuth subsalicylate (Pepto-Bismol), attapulgite (Kaopectate), activated charcoal |
| What is the mechanism of action of absorbents? | coats the walls of the GI tract absorbing the bacteria or toxins causing diarrhea, promotes intestinal absorption of fluid and electrolytes |
| What is a contraindication of Pepto-Bismol? | do not give to infants/children. contains salicylate- Reye's syndrome |
| What are types of anticholinergics? | atropine, belladonna alkaloids (Donnatal) |
| What is the mechanism of action and uses of anticholinergics? | anti-motility- decreases peristalsis and muscle tone, used in combo with absorbents and opiates |
| What are types of synthetic opiates? | codeine, loperamide (Immodium AD), diphenoxylate/atropine (Lomotil) |
| What is the mechanism of action of synthetic opiates? | decreases bowel motility, secondary- reduces pain related to diarrhea and abdominal cramping, allows for H20 absorption due to decreased peristalsis |
| What is a type of intestinal flora modifier? | lactobacillus acidophilus (Bacid, Lactinex) |
| What is the mechanism of action and uses of intestinal flora modifiers? | suppresses growth of bacteria by restoring the natural flora of the bowel, natural organisms obtained from bacterial cultures, may need to be given post antibiotic therapy |
| What are contraindications/"use cautions" assessment concerns for antidiarrheals? | geriatric patients with fecal impaction, children <2yrs, abdominal pain |
| What are adverse effects associated with absorbents (bismuth salicylates)? | HEMA: increased bleeding time GI: constipation, dark stools CNS: confusion, twitching OTHER: hearing loss, tinnitus, metallic taste, blue gums |
| What are adverse effects associated with anticholinergics? | GU: urinary retention and hesitancy, impotence CNS: headache, dizziness, confusion, anxiety, drowsiness CV: hypotension, hypertension, bradycardia, tachycardia INTEG: dry skin, rash, flushing EENT: blurred vision, photophobia, increased pressure in eye |
| What are adverse effects associated with opiates? | CNS: drowsiness, sedation, dizziness, lethargy GI: nausea, vomiting, anorexia, constipation RESP: resp. depression CV: bradycardia, palpitations, hypotension GU: urinary retention INTEG: flushing, rash, urticaria |
| What are nursing actions associated with antidiarrheals? | interactions,Pepto effects absorption digoxin/tetracycline,increases effects oral anticoagulants,Pepto-child/teens with chicken pox/flu-like illness may temp turn stools/tongue gray-black->salicylate toxicity,constipation,addictive effect CNS depressants |
| What are education concerns of patients/family for patients using antidiarrheals? | shake liquid,inform of aspirin in med, notify if diarrhea >2 days or if accompanied by high fever,dizziness,added CNS depression with alcohol/antihistamines/sedatives/etc,dry mouth,notify immed. if blood is passed,fluid replacement,may darken stool |
| What is traveler's diarrhea and how is it prevented and treated? | caused by a strain of E. coli, prevention is best (don't drink the water!), preventatives- Pepto QID and TMZ-SMZ (Bactrim/Septra), once Dx is made- rifaximin (Xilfaxan) 200mg TID x48 hrs |
Created by:
kgrabo99
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