Block II - Test 1: Medications Kee: Chapters 3, 4, 16, 47, and 48

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sisterbarley
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Block II - Test 1: Medications Kee: Chapters 3, 4, 16, 47, and 48
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2013-01-27 22:14:25
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Medications Fluid Electrolyte Imbalances GI Problems
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Block II Medications for Test 1: Fluid/Electrolyte Imbalances and GI Problems Kee: Chapters 3, 4, 16, 47, and 48
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  1. Omeprazole (OTC, Rx), Prilosec
    • Functional Class: Antiulcer, proton pump inhibitor
    • Chem. Class: Benzimidazole

    • 1. Blocks final step of acid production by inhibiting the hydrogen/potassium ATPase enzyme in the parietal cells 
    • 2. Works to inhibit gastric secretion
    • 90% greater than H2 blockers
    • 3. Take before meals (97% protein
    • bound)
    • Dosage: Once daily vs. before meals based on indication
    • Enhances actions of: warfarin, digoxin, and benzodiazepines (diazepam/Valium)
    • Side effects: many (see drug book)
    • Nursing considerations: assess GI system, Hepatic enzymes
  2. Nexium
    PPI
  3. Prevacid
    PPI
  4. Aciphex
    PPI
  5. Protonix
    PPI
  6. Famotidine (Rx), Pepsid
    • h2 blocker
    • Small gun
    • Dosage: Once daily vs. before meals based on indication
    • Administer: PO/IV 
    • Side Effects: Headaches, dizziness, constipation, thrombocytopenia, dysthrythmias
  7. Axid
    h2 blocker
  8. Zantac
    h2 blocker
  9. Aluminum
    hydroxide - AlOH (Amphogel)
    Antacid
  10. Magnesium hydroxide - MGOH (Milk of Magnesia)
    Antacid
  11. Maalox
    • Combination antacid: MaAlox
    • Aluminum hydroxide - AlOH (Amphogel)
    • Magnesium hydroxide - MGOH (Milk of Magnesia)
  12. Metoclopramide (Reglan)
    GI stimulant

    —Enhances acetylcholine response to increases upper GI peristalsis (motility) without stimulating gastric secretions

    —Blocks dopamine receptors in central and peripheral nervous system resulting in antiemetic properties.
  13. Sulcrafate (Carafate)
    • Pepsin Inhibitor
    • 1. Mucosal Protective Agent
    • 2. Forms a viscous cover for ulcer & protects from acid and pepsin
    • Dose: Take 1 hr. AC, avoid antacids for ½ hr.
    • Side effect: constipation
    • NOTE:  Decreases action of some drugs
  14. Oral
    5-aminosalicylates Sulfasalazine (Azulfidine or Mesalamine etc.)
    give antidiarrheals with these

    Given for IBD 

    Acts locally in the colon to decrease the inflammatory response and systemically interfered with secretion by inhibiting prostoglandin synthesis
  15. Corticosteroids
    —slide 41
  16. Flagyl
    Antibiotics
  17. Cipro
    Antibiotics
  18. Methotrexate
    Immune modulators

    • folate antimetabolite that inhibits DNA
    • synthesis. In Crohn’s disease, it may have
    • immune modulator and anti-inflammatory activity
  19. Prednisone
    • Glucocorticoid-Cortisol
    • 1. Anti-inflammatory, Anti-allergy and Anti-stress, Liberates energy stores, Hold Na and Water (spills k+ = BE CAUTIOUS OF LASIX WHICH ALSO SPILLS k+)
    • 2. Must be tapered to discontinue (or risk Addison’s crisis)
    • Side Effects:
    • Increased blood sugar,
    • N/V, Diarrhea, Increased appetite,
    • Headache, Mood changes
    • Adverse Effects: Petechiae,
    • Ecchymosis, Hypertension, Osteoporosis, Muscle wasting
    • Life threatening: GI hemorrhage, Pancreatitis, Embolism
    • Use with caution in Diabetes Mellitus, Increases blood sugar
    • If used with diuretics like Lasix, may potentiate Hypokalemia
    • May cause transient Hyperglycemia
    • Increased susceptibility to infections, Masks infection, Adrenal atrophy
    • Impaired wound healing
    • Increases action of Aspirin and NSAID’s Ý risk
    • of GI Bleed
    • —Decreases action of oral anticoagulant
    • Watch the side effects!! Especially the blood sugar, when dealing with a diabetic.
    • Masking an infection: Decreases inflammation, thus, the bodies response to fight an infection is reduced.
    • Increased appetite
  20. Ondansetron (Zofran)
    • Antiemetic
    • Blocks Serotonin receptors in the Chemoreceptor Trigger Zone (CTZ)
    • Side Effects: Headache, Diarrhea, Dizziness, Fatigue
  21. —Promethazine (Phenergan)
    • Blocks Serotonin receptors
    • May cause Drowsiness, Confusion
  22. Prochloraperazine (Compazine
    • Antihistamine and anticholinergic properties
    • Action: Blocks Dopamine2
    • receptors in CTZ
    • Routes: PO, Deep IM, IV, PR
    • Anticholinergic and extrapyramidal symptoms (EPS)
  23. OTC Anti-emetics
    • Antihistamines: 
    • 1. Dramamine (dimenhydrinate)
    • 2. Benadryl (diphenhydramine hydrochloride)
    • 3. Antivert (meclizine hydrochloride)
    • Additional: 
    • —Bismuth subsalicylate (Pepto-Bismol)
  24. Loperamide HCL (Immodium)
    • Antidiarrheal
    • 1. Slows GI Motility
    • 2. Increase fecal bulk
    • 3. Decreases fluid loss
    • PO dose: 4mg initally, 2mg after each loose stool
    • Maintenance dose: 4-8mg/day in divided
    • doses
    • Side Effects: Drowsiness
  25. Diphenoxylate with Atropine
    (Lomotil)
    • Opiate style and Anticholinergic
    • 1. Slows GI Motility
    • 2. Can be addictive
    • PO dosage: 2.5 – 5 mg bid-qid PRN
    • Not used for daily maintenance of
    • diarrhea
    • Side Effects: Drowsiness, dizziness,
    • constipation, urinary retention (anticholinergic effects)
    • Contraindicated in patients with what
    • conditions? 
    • Contraindicated for: Inflammatory
    • Bowel Diseases (Ulcerative Colitis and Crohn’s Disease) that cause diarrhea
    • WARNING:This is a narcotic.
  26. Laxatives
    • 1. Bulk-producing
    • 2. —Emollient - Lubricants
    • 3. Emollient - Stool softeners 
    • 4. Irritants
    • 5. Saline/Osmotic
  27. (Psyllium/Metamucil)
    • Bulk producing 
    • 1. Increases bulk and absorbs water
    • 2. Nonabsorbable, Requires sufficient fluid intake
    • 3. Works in 8-24 hours up to 3 days
    • 4. Decreases absorption of oral anticoagulants, ASA, digoxin 

    —Inadequate fluids + Psyllium = Bowel Obstruction

    —Side Effects: Anorexia, N/V, Cramps, Diarrhea
  28. Mineral Oil
    • Emollient - lubricants
    • 1. Increases water retention in stool
    • 2. Decrease straining 

    —Avoid prolonged use because Fat soluble vitamins may be lost: A, D, E, K

    • —Adult 15-45 ml HS
    • Child 5-20ml HS
  29. Docusate Sodium (Colace)
    • Emollient - Stool softener
    • 1. Decreases surface tension and holds water
    • 2. Acts on small and large bowel (may take 1-5 days for result).
    • 3. Often used to prevent straining, Post-MI, Post-TURP, Post-Cataract surgery, etc.
    • NOTE: Given in combo with other laxatives
    • Contraindicated in CHF because of Na+
  30. Bisacodyl (Dulcolax)
    • Irritant
    • 1. Increases —peristalsis by irritating the mucosa
    • 2. Minimal absorption

    • NOTE: Decreased effect with antacids, H2 Blockers, and milk
    • Side Effects: Anorexia, N/V, Cramps, Diarrhea
  31. Saline/Osmotic
    • Saline products contain Na+ or Mg+
    • 1. Fleets  PO or PR, often a bowel prep
    •  - Contraindicated/Caution in CHF
    • 2. Golytely bowel prep 
    •  - Isotonic and safe for renal failure and CHF
    • 3. Lactulose 
    •  - For constipation or treatment of liver failure as it binds ammonia in the gut
    • 4. Milk of magnesia
    •  - Requires adequate renal function
  32. Simethicone (Mylicon)
    • Antiflatulant
    • 1. Changes surface tension of gas bubbles 
    • —2. Evacuate gas through belching and flatulence
    • Dosage: 1 tablet (80 mg) pc and hs x 6 doses Chew tablet before swallowing, drink water Interferes with guiac results

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