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antiulcer emetic q's
Question about nursing management of antiulcer, antiemetic, antidiarrheal, lax
| Question | Answer |
|---|---|
| bismuth subsalicylate; black stool and possibly tongue | harmless side effect; tongue w/ sulfa drugs; it is not GI bleeding |
| H2 receptor antagonist and confusion in older adult | dangerous side effect; discontinue and contact hcp |
| H2 receptor antagonist and cardiac dysrhythmias | dangerous side effect; discontinue and contact hcp |
| H2 receptor antagonist and symptoms: fatigue, weakness, pale, increased infection, bleeding | agranulocytosis or aplastic anemia; dangerous side effect; discontinue and contact hcp |
| apple cider vinegar as antacid | not much info supporting/refuting; may have to do with reflux? |
| magnesium antacids with chronic use or renal impairment | hypermagnesemia: effects are diminshed/absent deep tendon reflexes; flushing, nausea, headache, drowsiness, hypocalcemia, lethargy, hypotension, bradycardia, somnolence |
| sodium bicarbonate antacids may cause... | metabolic alkalosis: effects are belligerence, confusion, lethargy, paresthesias, muscle twitching, cramping, slow, shallow respirations |
| aluminum antacids with chronic use | hypophosphatemia; binds phosphate in GI tract and prevents absorption |
| what specific drug interactions occur with increasing gastric and duodenal pH? What type of drug does this? | drugs that need an acid pH, digoxin and itraconazole; premature dissolution of enteric coated drugs; the antiulcer agents H2 receptor antagonists, proton pump inhibitors, and antacids |
| What antiulcer agents bind other drugs? Why is this a problem? | antacids (incl with H2 receptor anatagonists) and sucralfate; prevents the drugs from absorbing |
| how can we avoid the problems of antiulcer agents that decrease pH or bind other drugs? | space drugs by a couple of hours |
| what antiulcer agent should a person avoid if they have history of cardiac dysrhythmias? Why? | H2 receptor antagonists; side effect |
| how does omeprazole interact with CYP 450 enzymes? | competes for active sites on CYP450 enzymes; decreases metabolism of those drugs so increases risk for toxicity |
| what are examples of drugs metabolized by CYP450 enzymes? | diazepam and antianxiety drugs; phenytoin (anticonvulsant); warfarin |
| how does cimetidine interact with CYP450 enzymes (and to lesser extent H2 receptor antagonists) | inhibits CYP450 enzymes, increasing toxicity of many other drugs, incl diazepam, phenytoin, warfarin |
| What drugs or foods can counteract the therapeutic effect of antiulcer agents? | those that irritate the GI tract; alcohol, aspirin, NSAIDS, corticoseroids, antibiotics |
| Why do some drugs cause severe constipation when used with certain antiulcer drugs? | combine two drugs that cause constipation worsens the effects. anticholinergics, and those with anticholinergic effects |
| Why do some drugs cause severe diarrhea when taken with certain antiulcer drugs? | combine two drugs that cause diarrhea worsens the effects. Antibiotics |
| What drugs should you avoid when taking H2 receptor antagonists and proton pump inhibitors to avoid severe drowsiness? | central nervous system effects; alcohol, NSAIDS, antihistamines, anticonvulsants, psychotropic |
| What laxative and antiulcer agents should you not combine, otherwise you will have hypermagnesemia? | magnesium sulfate (lax), magnesium hydroxide (ulc) |
| What assessment would I use to determine if antiulcer therapy is successful? | absence of symptoms; none returning after d/c medication |
| What assessment would I use to determine if proton pump inhibitor is successful? | absence of heartburn, indigestion due to reflux |
| who should not take an antiemetic? | food poisoning, something that you've ingested |
| What are reasons to suppress nausea and vomiting | chemotherapy, radiation, surgery, anesthetics; motion sickness or any situation where there is not a toxic substance in the stomach |
| non-pharmacological means for relieving nausea | rest, relaxation, fluid intake |
| which antiemetic may cause dizziness, headache, diarrhea/constipation? | 5-HT3 receptor antagonists side effects |
| what kind of antiemetic should one not take when using hormonal birth control? | NK1 receptor antagonist -- alternatively, use non-hormonal birth control |
| what should you teach people who take dopamine receptor antagonists and spend time outside? | wear sun screen and protective clothing (photosensitivity) |
| What should you tell those who take dopamine receptor antagonist about getting out of bed or a chair? | Move slowly; if lying down, reach a sitting position and wait (orthostatic hypotension) |
| Which antiemetic may cause constipation and dry mouth? | side effects of dopamine 2 receptor antagonists |
| What should you do if a patient taking dopamine receptor antagonists start having extreme restlessness, involuntary movements, and uncontrollable speech | extrapyramidal symptoms are a side effect of dopamine receptor antagonists |
| What antiemetic would cause a patient to experience drowziness, hallucinations, and feeling of being outside your body? | dronabinol, a cannabinoid |
| why are dry mouth, blurred vision, drowsiness, sweating side effects of antiemetics such as scopolamine? | anticholinergic, due to blocking of cholinergic receptors throughout the body |
| how does a laxative differ from a cathartic? | lax: mild, production of soft formed stool over a day or so; cath: propt, flud bowel evacuation, fast and intense |
| What part of a healthy diet most benefits proper bowel function? | dietary fiber; absorbs water to soften feces and increase size; digested by colonic bacteria which increases mass |
| constipation definition | hard stools, infrequent, excessive straining, prolonged effort, sense of incomplete evacuation, unsuccessful defecation |
| Name four clinical uses for laxatives other than relief of constipation | obtain fresh stool sample; prior to treatment (procedure prep); expelling dead parasite after treatment; prevent fecal impaction in bedridden patients |
| Why is it contraindicated to use laxatives if experiencing abdominal pain? | same for nausea, cramps, symptoms of appendicitis, regional enteritis, diverticulitis, ulcerative colitis |
| What problems can occur with laxative overuse/abuse? | chronic diarrhea, which can cause dec absorption of drugs, hypokalemia, hypocalcemia, hypo OR hypermagnesemia, extracellular fluid volume deficit; laxative dependence |
| What kind of laxative will produce what kind of stool in 2-6 hr? | watery stool; osmotic laxatives (high dose), castor oil, polyethylene glycol w/ electrolyte solution |
| What kind of laxative will produce what kind of stool in 6-12 hrs? | semifluid stool; osmotic laxative (low dose), stimulant laxatives (except castor oil) |
| What kind of laxative wil produce what kind of stool in 1-3 days? | soft stool; bulk-forming laxatives, surfactant laxatives, lactulose, lubiprostone |
| How should surfactant laxative agents be taken? | With a full glass of water |
| What complication can occur if bulk-forming laxatives are not takine with a full glass of liquid (then followed by an additional glass)? | esophageal obstruction |
| Who should not take bulk-forming laxatives? | Contraindicated for those with narrowing of intestinal lumen; risk of intestinal obstruction and impaction. Should not be used if difficulty swallowing, as it could swell in the esophagus. |
| What drugs should be spaced out from taking bulk-forming laxatives? | thyroid hormones and digoxin; may decrease absorption |
| How should a patient taking a surfactant laxative take other laxatives? | separated by 2 hours to prevent absorption into body |
| How should you react to diarrhea and abdominal cramping with use of stimulant laxative? | Common side effect |
| How can you avoid severe cramping when taking bisacodyl? | they are enteric coated; no crushing, shewing, milk or antacids |
| What harmless color change will occure when taking senna? | urine colored pink or brown |
| What effects might stimulant laxatives have in older adults? | fecal incontinence, especially those less mobile |
| Under what condition could use of osmotic laxatives increase risk for falls? | People who are weak or dehydrated, due to absorption of sodium and phosphate |
| How should you react to diarrhea and abdominal cramping with use of osmotic laxative? | Common side effect |
| What effects might osmotic laxatives have in older adults? | fecal incontinence, especially those less mobile |
| what osmoic laxative might result in hypermagnesemia? | magnesium salts |
| Why must a patient sit upright when taking mineral oil laxative? | if aspirated, may cause pneumonia |
| Why is it best to separate mineral oil laxative from meals and vitamins by 2 hours? | Can cause malabsorption of fat soluble vitamins with chronic use |
| Why is it useful to take lubiprostone with food and water? | to relieve or prevent nausea, a common side effect |
| what kind of constipation is lubiprostone (chloride channel activator) used for? | chronic idiopathic constipation; also irritable bowel syndrome |
| Why are peripheral opioid receptor antagonists used with opioid therapy? | constipation is common with opioid therapy. Since these drugs can inhibit opioid receptors selectively in the intestine, the constipating effects can be reduced without inhibiting intended CNS effects |
| How do effects of peripheral opioid receptor antagonists increase risk for falls? | Cause orthostatic (postural) hypotension; stand up slowly from sitting; sit up first if lying down |
| What effects should be monitored if taking opioid antidiarrheal? | urinary retention, dry mouth, impaired heat regulation, drowsiness, dizziness |
| Increased risk for falls with opioid antidiarrheal is due to... | drowsiness and lightheadedness |
| What would make drowsiness worse with opioid antidiarrheal? | alcohol, CNS depressants |
| What very important teaching should accompany use of bismuth subsalicylate? | do not use if allergic to aspirin, or child/adolescent with chickenpox or viral illness. |
| Guidelines for use of antibiotics for diarrhea | use only if severe; use all prescribed and don't save for later use. Fluoroquinolones may be used for severe E. coli |
Created by:
hezasan
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