pharm 4 GI

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mthompson17
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225399
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pharm 4 GI
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2013-06-30 12:25:39
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pharmacology gastrointestinal drugs nursing
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pharm test 4 GI: Vickers
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  1. Disorders of the upper GI?
    • 1. GERD
    • 2. PUD
    • 3. H. Pylori Infection
    • 4. NV
  2. 4 s/s of GERD?
    • 1. heartburn
    • 2. regurgitation
    • 3. dysphagia
    • 4. waterbrush
  3. Waterbrush?
    salivary gland secretes salty/sour secretion due to reflux
  4. 4 Tx options for GERD?
    • 1. antacids
    • 2. promotility agents
    • 3. antisecretory agents
    • 4. mucosal protective agents
  5. H. Pylor Tx?
    Legacy triple therapy:  2 ABX and a proton pump inhibitor (PPI)
  6. 4 ABX that may be used in legacy triple therapy for H. pylori?
    • 1. clarithromycin
    • 2. amoxicillin
    • 3. metronidazole
    • 4. tetracycline
  7. Proton pump inhibitors end with ____.
    zole
  8. Prototype PPI?
    omeperazole/Prilosec
  9. Action of PPI?
    blocks the final step of gastric acid production
  10. Why are PPI's enteric coated?
    so can get passed gastric acid to work
  11. Route of PPI?
    PO

    nexium & protonix can be given IV
  12. Dosing of PPI?
    once per day
  13. Which stomach med is a preg. cat. X?
    cytotec
  14. Effect of PPI besides decreasing acid?
    have some antimicrobial affect against H. pylori
  15. Most common AE of PPI?

    Other AE that may occur?
    HA & diarrhea

    • 1. dizziness
    • 2. constipation
    • 3. abd pain
    • 4. NV
    • 5. URI
    • 6. pneumonia
  16. Serious AE of PPI?

    Why may these occur?
    • 1. URI- upper resp infection
    • 2. pneumonia

    decreased gastric acid can cause increased bacteria in GI & resp tracts
  17. When should PPI be taken?
    1 hour before meals
  18. 3 nursing considerations with PPI?
    • 1. cannot crush - enteric coated
    • 2. may need Ca supplement b/c PPI decreases absorption of Ca
    • 3. antacids can be taken for additional management
  19. 3 uses for PPI?
    • 1. peptic ulcers resulting from H. pylori
    • 2. GERD
    • 3. erosive esophagitis
    • 4. hypersecretory conditions (Zollinger-Ellison Syndrome)
  20. Peptic Ulcer Disease is usually caused by?
    H. pylor
  21. 6 factors that can make PUD worse?
    • 1. NSAIDS
    • 2. ASA
    • 3. glucocorticosteroids
    • 4. stress
    • 5. caffeine
    • 6. smoking
    • 7. alcohol
  22. 3 Tx of PUD?
    • 1. PPI
    • 2. histamine-2 receptor antagonists
    • 3. antacids
  23. Histamine-2 receptor antagonists end with ____.
    ine
  24. Prototype H-2 blocker?
    ranitidine/Zantac
  25. Action of H-2 blockers?
    inhibit all phases of gastric acid secretion
  26. H-2 blockers used to Tx what 5 conditions?
    • 1. s/s of active duodenal ulcers
    • 2. benign gastric ulcers
    • 3. GERD
    • 4. hypersecretory conditions
    • 5. erosive esophagitis
  27. AE of H-2 blockers?
    • 1. dizziness
    • 2. NVD
  28. 2 routes for H-2 blockers?
    • 1. PO
    • 2. IV
  29. Drug interactions with H-2 blockers?
    cimetidine/Tagamet interacts with multiple meds
  30. Tarry stools is an indication of what?

    What may this be caused by?
    upper GI bleed

    bleeding ulcer
  31. Admin of IV ranitidine/Zantac?
    admin slowly to prevent hypotension & cardiac arrhythmias
  32. Why is it important for pt to take oral H-2 blockers u.t.?
    s/s disappear before the ulcer will totally heal
  33. Taking antacids with H-2 blockers?
    give at least 2 hours apart from antacids
  34. Antacid drug interactions?
    antacids interact with a lot of meds - decrease effects of most meds
  35. Taking OTC stomach med with H-2 blockers?
    should not substitute or add OTC b/c risk for interaction
  36. If a pt has arthritis they will be taking a lot of ____.

    What drug will they take to prevent ulcers?
    NSAIDs

    cytotec
  37. Cytotec uses?
    1. prevent NSAID- induced gastric ulcers in high risk pt

    2. therapeutic abortions
  38. Action of cytotec?
    increases the production of protective mucous and decreases the secretion of gastric acid

    also causes uterine contractions
  39. Consideration for interactions with any GI med?
    many GI meds mess with other med abortion
  40. What is required prior to the admin of cytotec?
    negative pregnancy test
  41. When will cytotec therapy be begun?
    on 2nd or 3rd day of mentrual period
  42. 2 things to teach cytotec pt?
    • 1. use contraception throughout therapy (in women)
    • 2. take with food
  43. Most common AE of cytotec?
    • 1. diarrhea
    • 2. abd pain
  44. Uses for sucralfate/Carafate?
    Tx duodenal ulcers & accelerate ulcer healing

    also prevention & long-term Tx of ulcers
  45. What is sucralfate?
    aluminum salt with anti-peptic activity
  46. Action of sucralfate?
    non-abosrobent paste forms & adheres to ulcer lesions
  47. AE of sucralfate?
    constipation
  48. When should sucralfate be taken?
    1 h before meals & 1 h before or after other meds - can affect absorption of other meds
  49. 4 bases for antacids?
    • 1. aluminum
    • 2. magnesium
    • 3. calcium
    • 4. sodium
  50. AE of aluminum based antacids?

    Magnesium?
    aluminum - constipation

    magnesium diarrhea

    together - none
  51. Magnesium & aluminum based antacids in kidney failure/ESRD?
    magnesium cannot be excreted and will build up

    aluminum can help with phosphorous excretion
  52. What needs to be monitored when pt is taking antacids?
    electrolyte levels
  53. When should antacids be taken?
    2 h after other drugs and 1 h after meals
  54. Why should pt not substitute antacid for Rx meds to treat peptic ulcer?
    can affect absorption of other meds or mess up electrolytes
  55. Do not take max dose of antacid for more than _____.
    2 weeks
  56. What should pt report to MD of taking antacids?
    • 1. constipation/diarrhea
    • 2. abd pain
    • 3. black tarry stools/coffee ground emesis
  57. Prototype prokinetic agent?
    metocopramide
  58. What is metoclopramide?
    gastric stimulant
  59. 4 uses for metoclopramide?
    • 1. delayed gastric emptying
    • 2. GERD
    • 3. NV
    • 4. diabetic gastroparesis
  60. How does metoclopramide help with NV?
    increases the effect of Ach on GI system
  61. 4 AE of metoclopramide?
    • 1. extrapyramidal reactions
    • 2. depression
    • 3. parkinson-like s/s
    • 4. decreases seizure threshold
  62. 4 s/s of extrapyramidal reaction?
    • 1. muscle rigidity
    • 2. tremor
    • 3. bradykinesia
    • 4. tardive dyskinesia
  63. Who may receive metoclopramide for NV?
    chemo pt
  64. What GI med may be given to MI pt to prevent vagal response?
    stool softeners
  65. When should metoclopramide be given?
    30 minutes before meals or chemo
  66. IV admin of metoclopramide?
    give slow IV push to prevent exgtrapyramidal effects
  67. Pt teaching for metoclopramide?
    s/s of AE
  68. Why may metoclopramide be given to pt getting a GI procedure/exam?
    b/c they get GoLytely & it makes them nauseated
  69. Prototype digestive enzyme med?
    pancrelipase - synthetic pancreatic enzymes
  70. What condition requires the use of pancrelipase?
    cystic fibrosis
  71. 3 AE of pancrelipase?
    • 1. N
    • 2. abd cramps
    • 3. diarrhea
  72. When should pancrelipase be taken?
    before or with meals
  73. Pt teaching for pancrelipase?
    • 1. do not crush or chew tablets
    • 2. avoid breathing powder & skin contact
  74. Why should pt avoid breathing powder & skin contact with pancrelipase powder?
    can cause asthma attack
  75. Contraindications with pancrelipase?
    hypersensitivity to pork
  76. Prototype med for weight management?
    xenical
  77. AE of xenical?
    • 1. oily spotting
    • 2. flatus with stool
    • 3. fecal urgency
  78. Contraindications for xenical?
    malabsorption syndrome
  79. Pt education with xenical?
    • 1. limit dietary fat to 30% of calories
    • 2. may need multivitamin for fat soluble vitamins
  80. 3 classifications of anti-emetics?
    • 1. selective serotonin receptor antagonists
    • 2. antidopaminergic
    • 3. anticholinergic
  81. Prototype selective serotonin receptro antagonist?
    ondansetron/Zofran
  82. 2 uses for zofran?
    • 1. chemo
    • 2. post op
  83. 3 common AE of zofran?
    • 1. HA
    • 2. constipation
    • 3. malaise
  84. 3 serious AE of zofran?
    • 1. arrhythmias
    • 2. hypotension
    • 3. extrapyramidal effects
  85. When should zofran be admin?
    15 to 30 min. before chemo repeating q 8 h for 1 to 2 days post chemo or radiation

    OR

    prior to anesthesia for post-op NV
  86. Pt teaching with zofran/
    possible AE to notify
  87. 4 meds used for lower GI probs?
    • 1. antidiarrheals
    • 2. IBS
    • 3. IBD
    • 4. laxatives
  88. Prototype antidiarrheal?
    diphenoxylate/atropine Lomotil
  89. Important consideration with lomotil?
    it is similar to demerol - schedule V med

    has no pain effects

    atropine is in it to prevent its abuse
  90. Action of lomotil?
    reduces intestinal motility and slows peristalsis
  91. Use for lomotil?
    treats diarrhea not responsive to symptomatic supportive TX
  92. Contraindication for lomotil?
    diarrhea ass. with organisms that penetrate intestinal mucosa
  93. Common AE of lomotil?
    • 1. drowsiness
    • 2. dizziness
    • 3. dry mouth
  94. 2 serious AE of lomotil?
    • 1. atropine overdose
    • 2. toxic megacolon
  95. 3 nursing considerations with lomotil?
    • 1. decrease dose when diarrhea becomes less frequent
    • 2. monitor for s/s of atropine overdose
    • 3. do not exceeed the prescribed dose
  96. Teaching for lomotil?
    • 1. don't drive until know effects
    • 2. don't take too much med
  97. Why is it important not to take too much lomotil?
    • 1. can form dependence on it
    • 2. can get atropine overdose
  98. 6 major groups of laxatives?
    • 1. saline
    • 2. hyperosmotic
    • 3. stimulant/irritant
    • 4. bulk-forming
    • 5. stool softeners/surfactants
    • 6. emollient
  99. Prototype saline laxative?
    magnesium hydroxide/Milk of Magnesia
  100. Action of saline laxatives
    retain water in the intestinal lumen - stimulates peristalsis
  101. Why should magnesium hydroxide only be used short-term?
    can form physial dependene with all laxatives except bulk-forming
  102. Common AE of magnesium hydroxide?
    • 1. overactive GI activity
    • 2. dependence
  103. Serious AE with magnesium hydroxide?
    fluid and electrolyte imbalances
  104. Pt teaching for magnesium hydroxide?
    • 1. take with a full glass of water
    • 2. avoid long-term use
  105. Prototype hyperosmotic laxative?
    lactulose
  106. Action of hyperosmotic laxatives like lactulose?
    pulls water and ammonia into the stool for evacuation
  107. Uses for hyperosmotic laxatives like lactulose?
    • 1. constipation
    • 2. hepatic coma
    • 3. hepatic encephalopathy
  108. Why are hyperosmotic laxatives like lactulose used for hepatic coma & hepatic encephalopathy?
    ammonia levels built up in these conditions and these laxatives help excrete it
  109. 2 routes of admin for lactulose?
    PO & enema
  110. Prototype stimulant/irritant laxative?
    bisacodyl/Dulcolax
  111. Action of stimulant/irritant laxatives?
    increases peristalsis via nerve stimulation in the colon
  112. Contraindication for use of stimulant/irritant laxatives?
    fecal impaction
  113. 2 routes of admin for stimulant/irritant laxatives?
    PO & suppository
  114. Teaching for stimulant/irritant laxatives?
    can't use too much - can cause loss of bowel function & dependency
  115. Prototype bulk-forming laxative?
    psyllium/Metamucil
  116. Action of bulk-forming laxatives?
    fiber pulls water to lg & sm int. to form soft bulky stool increasing peristalsis

    can also help pull out cholesterol
  117. Bulk-forming laxatives should be used with caution in what pt?
    pt with HTN, CHF, or edema b/c some contain Na & have to increase fluids with admin
  118. Pt teaching with bulk-forming laxatives?
    must increase fluid intake
  119. Prototype stool softener?
    docusate sodium/Colace
  120. Action of stool softeners?
    coats surface of feces and colon to ease passage of stool
  121. Use for stool softeners?
    prophylactically to prevent constipation
  122. 4 pt that may be using stool softeners?
    • 1. elderly
    • 2. post-op]
    • 3. MI
    • 4. opiate use
  123. Prototype emollient laxative?
    mineral oil
  124. Action of emollient laxatives?
    lubricates the intestine
  125. AE of mineral oil?
    decreased absorption of fat-soluble vitamins
  126. Drug interaction with mineral oil?
    pt on coumadin would have increased med effects because of decreased vitamin K
  127. Contraindications for all laxatives?
    • 1. s/s of acute abd prob:  abd pain, nausea, cramps
    • 2. diverticulitis
    • 3. IBD
    • 4. bowel obstruction
    • 5. fecal impaction except colace
  128. Which laxatives are safest and only one recommended for long-term use?
    bulk laxatives
  129. Nursing consideration for admin of bulk laxative?
    full glass of water or juice with admin
  130. Long term use of laxatives (except bulk) can lead to ______ ______.
    laxative dependency
  131. ______ based laxatives are contraindicated with renal dysfunction.
    magnesium
  132. ______ based laxatives are contraindicated with CHF, HTN, & edema
    sodium
  133. Med used for IBS diarrhea type?
    alosetron/Lotronex
  134. Action of lotronex/
    decreases bowel motility, secretions, and abd pain
  135. Lotronex contraindication?
    constipation
  136. Lotronex common AE?
    constipation
  137. Lotromex serious AE?
    ischemic colitis & severe constipation
  138. Education with lotromex?
    • 1. possible AE of constipation & to report to MD
    • 2. s/s of ischemic colitis
  139. S/S of ischemic colitis?
    • 1. rectal bleeding
    • 2. blood diarrhea
    • 3. new or worsening abd pain
  140. IBS drug for constipation type?
    tegaserod/Zelnorm
  141. Action of zelnorm?
    stimulates the peristaltic reflex & decreases visceral sensitivity (decreases pain & bloating)
  142. CI for zelnorm?
    • severe renal impairment
    • hepatic impairment
    • Hx of bowel obstruction
    • gallbladder disease
  143. AE of Zelnorm?
    diarrhea
  144. Education about zelnorm?
    diarrhea that does not resolve or is accompanied by severe cramping abd pain or dizziness should notify MD
  145. IBS med used to Tx bowel spasms?
    dicyclomine/Bentyl
  146. Action of Bentyl?
    anticholinergic agent, antispasmotic
  147. Bentyl is contraindicated in what conditions?
    • 1. obstructive uropathy
    • 2. myasthenia gravis
    • 3. glaucoma
    • 4. bowel obsturction
    • 5. paralytic ileus
    • 6. toxic megacolon
  148. IBS AE?
    • anticholinergic effects: 
    • 1. sedation
    • 2. constipation
    • 3. urinary retention
    • 4. tachycardia
    • 5. dry mouth
    • 6. blurred vision
    • 7. dizziness
  149. Education for Bentyl?
    can cause sedation.....
  150. When should Bentyl be taken?
    before meals to alleviate pain ass. with ingestion of food
  151. 2 types of IBD?
    • 1. ulcerative colitis
    • 2. crohn's disease
  152. What type of med may be used to Tx IBD?
    aminosalicylates (5-ASA)
  153. Prototype aminosalicylate?
    mesalamine/Asacol
  154. Action of aminosalicylates?
    dcreases prostaglandins & leukotrienes
  155. Route of asacol>
    po

    suppository

    rectal suspensions
  156. CI for asacol?
    salicylates and sulfite sensitivity

    children r/t Reye syndrome
  157. Common AE of asacol?
    • 1. GI effects
    • 2. HA
  158. Serious AE of asacol?
    • 1. blood dyscrasias
    • 2. exacerbation of colitis
    • 3. pericarditis
    • 4. renal impairment
    • 5. hepatotoxicity
  159. Teaching for asacol>
    • 1. swallow oral med whole
    • 2. contact MD if rash or fever occurs
  160. Important consideration with pepto-bismol?
    can cause Reye syndrome in CH

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