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How does the sympathetic system effect the GI:
can slow it down when "fight or flight" system is triggered.
decreases muscle tone, secretions, and contractions in the nerve plexus layer of the GI.
Four major activities of the GI system:
Chief cells secrete ______.
Gastrin and the parasympathetic system stimulate what in the stomach?
Histamine- 2 receptors
What do the histamine -2 receptors cause in the stomach?
HCI - hydrochloric acid
Cause of a peptic ulcer?
Bacterial infection of Helicobacter pylori
The vomiting reflex is controlled by what ?
two receptors in the Medulla
the emetic and the CTZ
THE chemoreceptor trigger zone (CTZ) does what?
located in medulla, responsible for vomiting, this is the more mature
How do Histamine-2 antagonists work?
Block the release of hydrochloric acid in response to gastrin
How do proton pump inhibitors work?
suppress the secretion of Hydrochloric acid into the lumen of the stomach
How do antacids work?
interact with acids at the chemical level to neutralize them
Most common terms for over production of HCI by the parietal cells?
- sour stomach
- acid stomach
Symptoms of peptic ulcer :
- Burning pain the often occurs after meals
How do Antipeptic agents work?
Coast the stomach to prevent further injury from acid
What do prostaglandins do to treat the stomach ?
- inhibit the secretion of gastrin
- increase the secretion of mucous lining of the stomach, providing a buffer
What three cells in the stomach make acids?
- Chief - Pepsinogin breaks down proteins
- Parietal- HCI secreted by the proton cells
- Mucous- protective mucus
Prostaglandins do what?
- 1- protects heart
- 2- protects stomach pain/ inflammation
Antacids can alter the _____ balances in the body.
Aluminum Salts in antacids can cause:
Magnesium in antacids can cause
Gaviscon, Maalox, and Mylanta are what type of antacids?
Combination of aluminum and magnesium
- AL & MAG Family:
- AL has constipation
- MAG has diarrhea
How would you take a combination aluminum/magnesium antacid?
1 -2 hours before or after a meal, not with a meal.
Renal failure is a contra indication for use of what type of antacid?
Magnesium salts - the kidneys can't excrete the extra magnesium, resulting acumulation
Antacids with Calcium can cause what side effects?
- Kidney stones
- Hypercalcemia - increase calcium levels
Antacids with Sodium Bicarbonate can cause what side effects?
- Increase water retention / bad for hypertension or CHF patients
- Gas/ belching
- Metabolic acidosis / changes to pH
Hyperacidity rebound =
increase gastric acid secretion - side effect of many GI drugs
Sodium Bicarbonate antacids have a ___ onset.
- Quick onset, short term duration
- Highly soluble
Antacid drug -Drug interations:
- Inactivation (chelation) of another drug
- Reduced ability of other drugs to be absorbed
Assess for with use of antacids:
- Renal disease
- GI obstruction
- Fluid imbalance
Antacids may cause premature dissolving of ___________ medications.
enteric-coated, resulting in stomach upset
What should you avoid when taking antacids?
- harsh spices (black pepper)
Sodium bicarbonate antacids are highly contraindicated in patients with what impairment?
- Renal impairment
- sodium bicarbonate is excreted in the urine and can cause severe electrolyte imbalance in patients that can not effectively excrete it.
Tagament, Pepcid, and Zantac are what type of antacids?
- H2 Antagonists
- they reduce HCI acid secretion
All H2 antagonists end in what?
H2 antagonists will _______ production of acid in the stomach.
- CHANGE production by selectively blocking the H2 receptor sites.
- This is before the proton pumps
H2 antagonists are used to treat what ?
- prevention of ulcers
- combination for treatment of H. pylori
Contraindications for H2 antagonists:
- Pregnancy / lactation
- Hepatic/ Renal dysfunction
- They us the CYP 450 enzyme
Adverse effects of H2 Antagonists:
- Narrow therapeutic index drugs
- Cardiac arrhythymias
- Not in combination with other antacids
- NO WINE - JUST DINE
- NO smoking (decrease effectiveness)
- NO NSAIDS - block good prostaglandins
Side Effects of Opiates:
- Respiratory depression
Side Effects of Anticholinergics:
- Urinary retention
- Dry skin
- Blurred vision
Pepto-Bismol is what type of drug?
Absorbent anti diarrhea
Kaopectate may cause __________.
Dark chalky stool
How long does acute diarrhea last?
2 days - 2 weeks
How long does Chronic diarrhea last?
How do absorbents work?
coat the wall the walls of the GI tract & Bind to the causative agent for elimination
How do Anticholinergics work?
- slow the movement of feces though the GI tract
- decrease intestinal muscle tone and peristalsis
Can't Pee, SEE, SPIT, SHIT are all realated to what?
Atropine is an ________ .
How do opiates work?
Decrease bowel motility (contractions/spasms) & transit time allowing for more electrolytes to be absorbed
Interactions with Absorbents:
- May decrease absorption of many agents
Antacids will decrease the effect of ______________.
Do not give bismuth subsalylates to what age group?
- Children under 16
- Reyes Syndrome
Do not give anticholergics with a history of:
- Recent bladder surgery
Nursing Implications for anticholinergics:
- Fluid volume status
- Monitor therapeutic effects
Treatment for constipation that will increase bulk:
Psyllium (metamucil) - take with 8-10 ounces of water
How does Psyllium work?
Distends bowel to initiate bowel reflex activity
How do Emollients work?
- Softening/ lubricating stool
- Promotes more H2O and fat in stool
Example of a stool softener?
- Colace (ducosate)
- Mineral Oil
What does COLACE stand for?
- Cause of constipation (immobility/FVD)
- ducOlax common drug
- fLuid increase
- tAstes bitter
- Cardiac / Surgical
- Electrolyte changes
How do Hyperosmotic work?
Increase fecal water content, causing bowel distention, increased peristalsis & evacuation
goLytely, Sorbital, Lactulose, and glycerine are examples of what?
Hyperosmotic drugs used to treat constipation
Epsom salt is an example of ...
Saline / Hyperosmotic treatments for constipation
How does Saline work?
- causes more water to enter intestines
- Magnesium Sulfate
How do Stimulants work?
increase peristalsis via intestinal nerve stimulation
May cause Cramps
Castor Oil, Senna & Cascara are examples of :
All laxatives can cause:
Electrolyte Imbalances !!
Patients should not take laxatives or cathartic if they are experiencing:
nausea, vomiting, or abdominal pain with unknown etiology
What should you asses before giving a laxative?
Vomiting is a ____ ____ ____ to various stimuli.
Complex Reflex Reaction
is often not beneficial in clinical conditions
Emetics cause what?
No longer recommended for at-home use
Antiemetics are used for what?
Decrease/ prevent nausea or vomiting
Centrally Acting Antiemetics:
- Anticholinergics / antihistamines (sea sick)
How do Phenothiazines work?
Depress carious areas of CNS for treatment of nausea/vomiting
Adverse effect of pheonthiazines?
How do ANTIpheonothiazines work?
reduce responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting
Anticholinergics / antihistamines how do they work as antiemetic?
block the transmission of the impulses to the CTZ
Adverse effects of Anticholinergics / antihistamines:
Adverse reaction to Serotonin receptor blockers?
Zophran is an example of a _____ antiemetic?
Serotonin Receptor blocker
Serotonin Receptor blocker adverse effect?
- Urinary Retention
Nursing implications for CNS depressants for antiemetics:
Asses for Hydration, electrolytes, safety, allergies, Fluid volume status - oral hygiene - daily weights
Anabolic effects include:
Tissue building / mass
Anabolic testosterone is _______.
Male steroid hormones or _______ act like testosterone.
Indications for Androgens:
- Breast cancer in women by blocking release of FHS / block estrogen
- Sever weight loss
Androgens work by increasing the retention of what?
Androgens increase protein _______.
anabolism - make more redblood cells, and make more protein and not break it down
Androgens are indicated for use in males for:
Cautions with use of androgens:
- Liver Function (cause small holes in the liver)
- Cardiovascular disease (enlarged heart/ Cardiomyopothy)
Adverse effects of Androgens:
- Hirsutism (hair growth)
- Deepening of voice
- Oily skin & hair
- Testicular atrophy
- Weight gain
Alfa blockers are used for :
Mini "sins" =
- adverse effects of Alfa blockers that end in "sins"
- orthostatic hypotension
- increased heart rate / drowsiness
- need to recumbent for 3-4 after initial dose
Finasteride & Dutasteride are used to treat what ?
- help block androgens to decrease the size of the prostate
- Block production of testosterone
- CAN NOT donate blood for 6 months
- be handles by pregnant women