Week 10

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  1. H pylori causes PUD likely d/t (4)
    • enzymatic degradation of mucus layer
    • cytotoxin that injures mucosal cells
    • infilitration of neutrophils
    • produces urease which forms CO2 and ammonia
  2. H pylori promotes
    gastric cancer
  3. Zollinger-ellison syndrome is
    • a rare disorder
    • caused by a tumor that secretes gastrin
  4. Goal of therapy in PUD is to (4)
    • alleviate symptoms
    • promote healing
    • prevent complications
    • prevent recurrence
    • *drugs do not alter disease process (except abx)
  5. 5 major groups of antiulcer
    • abx
    • antisecretory
    • mucosal protectant
    • antisecretory w/ enhancement
    • antacids
  6. Tx for NSAID-induced ulcers? (2)
    • PPI
    • H2 antagonist
  7. Drugs that reduce acidity should be admin in doses enough to
    raise pH at 5 and above
  8. Tests for H pylori (5)
    • invasive: endoscopy and bx
    • noninvasive: breath, stool, blood
  9. Abx used to tx H pyrlori
    • clarithromycin (inhibit protein synthesis)
    • amoxicillin (disrupt cell wall)
    • bismuth (disrupt cell wall; inhibit urease activity)
    • metronidazole
    • tetracycline (inhibit protein synthesis)
  10. Bismuth SE
    harmless black coloration of tongue and stool
  11. Metronidazole can cause
    disulfiram-like reaction when used with ETOH
  12. Antibiotic regimens for H pylori
    • if resistance to clarithromycin is low: chlarithromycin-based triple therapy: chlarit + amox + PPI
    • if resistance to clarithromycin is high:
    • bismuth-based quadruple therapy: bismuth + flagyl + tetracycline + PPI/H2RA
    • sequential therapy: PPI + amox x 5 days; then PPI + clarithromycin + tinidazole x 5 days
  13. H2RA promote; examples
    • ulcer healing by suppressing gastric acid secretion
    • ranitidine
    • cimetidine
    • famotidine
    • nizatidine
  14. Cimetidine absorption; therapeutic effects
    • decreased by food
    • 4-6 weeks of therapy
    • may be given prophylactically
  15. Cimetidine is drug of choice for tx
    • preventing aspiration pneumonitis
    • given 60-90 mins before anesthesia
  16. AE of Cimetidine (5)
    • gynecomastia
    • reduced libido
    • impotence
    • CNS effects
    • pneumonia
  17. Cimetidine can increase levels of
    • warfarin
    • phenytoin
    • theophylline
    • lidocaine
  18. Compared to cimetidine, ranitidine (3)
    • more potent
    • has fewer SE
    • has fewer drug interactions
  19. Most effective drug for suppressing gastric acid secretion
    PPIs (omeprazole, pantoprazole, -prazole)
  20. Omeprazole (Prilosec) MOA
    irreversible inhibition of H K ATPase (enzyme that generates gastric acid)
  21. Omeprazole tx should be
    limited to 4-8 weeks
  22. Omeprazole is used for (5)
    • duodenal ulcers
    • gastric ulcers
    • erosive esophagitis
    • GERD
    • long term zollinger-ellison syndrome
  23. ulcer prophylaxis should only be done (4)
    • in ICU pts
    • multiple trauma
    • spinal cord injury
    • prolonged mech ventilation
  24. AE of omeprazole (4)
    • pneumonia
    • fxs
    • rebound acid hypersecretion
    • hypomagnesemia (tremors, muscle cramps, SZ, dysrhythmias)
  25. PPIs have been associated with
    dose-related C diff
  26. Omeprazole decreases the effects of
    • Plavix
    • for pts with risk factors for GI bleeding, combining the drugs is OK
  27. Esomeprazole is used for
    prophylaxis of NSAID-induced ulcers
  28. Sucralfate inidication; AE
    • duodenal ulcers
    • create protective barrier against acid and pepsin
    • constipation
  29. Misoprostol is; therapeutic use; MOA; pregnancy category
    • an analog of prostaglandin E
    • prevention of gastric ulcers cause by NSAIDs
    • replaces endogenous prostaglandins
    • Cat X
  30. Pts about to start Misoprostol
    • comply with birth control measures
    • given oral and written warnings
    • negative serum pregnancy
    • start therapy 2-3 day of menstrual cycle
  31. ondansetron MOA; SE (3)
    • blocks 5HT (serotonin) receptors
    • headache, diarrhea, dizziness
  32. Most effective antiemetic caused by cisplatin and other antiCA drugs
    serotonin antagonists (zofran)
  33. Serious AE of ondansetron?
    • QT prolongation
    • caution: electrolyte abnormalities, heart failure, bradydysrhythmias
  34. Dose of zofran for post op n/v
    16 mg PO 1 hr before anesthesia
  35. Dolasetron AE
    fatal dysrhythmias when given in high doses
  36. Palonosetron compared to other serotonin antagonists
    • has longer half life
    • effected against both acute and delayed emesis
    • IV only
  37. Which 2 glucocorticoids are used to suppress CINV?
    • solu-medrol
    • dexamethasone
    • IV, short term, intermittent
  38. Aprepitant (Emend) is approved for? MOA? instruction?
    • preventing postop N/V and CINV
    • it blocks neurokinin1-type receptors
    • must be combined with other antiemetics (ie glucocorticoid, serotonin antagonist)
  39. Fosapretitant (Emend) is? indication?
    • prodrug convert to aprepitant in the body
    • indicated only for CINV
  40. Which benzo is used in combination with other antiemetics? benefits? (4)
    • lorazepam
    • sedation
    • suppression of anticipatory emesis
    • production of anterograde amnesia
    • control EPS
  41. Dopamine antagonist (phenothiazine) MOA; SE? (4)
    • block dopamine2 receptors
    • EPS
    • anticholinergic effects
    • hypotension
    • sedation
  42. Promethazine can cause
    • respiratory depression
    • tissue injury
  43. Promethazine is CI in
    children < 2 yrs
  44. Which route is preferred for promethazine?
    • IM
    • IV route: 25mg/mL rate of 25mg/min
  45. Butyrophenones drugs used for anti NV? MOA? SE?
    • haloperidol; droperidol
    • block dopamine2 receptors
    • EPS, sedation, hypotension, QT prolongation
  46. Which 2 cannbinoids are used to prevent CINV?
    • dronabinol (Marinol)
    • nabilone (Cesamet)
    • considered 2nd line d/t potential for abuse
  47. Dronabinol is also used to
    increase appetite in pts with AIDS
  48. Cannabinoids SE
    • temportal disintegration
    • dissociation
    • depersonalization
    • dysphoria
    • CI for pts w/ psych issues
  49. Dronabinol is classified as
    Schedule III d/t its slow onset and no interest in streets
  50. Regimens for CINV
    • High risk: aprepitant + dexamethasone + ondansetron
    • Moderate: dexamethasone + palonosetron
    • Low: Dexamethasone
  51. First-line therapy for NV in pregnancy
    • doxylamine + vit B6 (pyridoxine)
    • trade name: Dicletin, Diclegis
    • start with 2 tabs at bedtime
  52. Most effective drug for motion sickness; SE? (3)
    • scopolamine
    • dry mouth, blurred vision, drowsiness
  53. Most effective antidiarrheal agents (5)
    • opioids
    • dcrease intestinal motility
    • allow more time for absorption of fluid and electrolytes
  54. Opioids used for diarrhea
    • diphenoxylate (+atropine)
    • difenoxin (+ atropine)
    • loperamide
    • paregoric
    • opium tincture
  55. Infectious diarrhea is
    usually self-limiting and requires no treatment
  56. tx for infectious diarrhea
    • cipro or norfloxacin
    • children and pregnant women: azithromycin
  57. Prohyplaxis vaccine for diarrhea
  58. nonspecific drugs for IBS include
    • antispasmodics
    • bulf-forming agents
    • antidiarrheals
    • TCAs
  59. IBS-specific drugs include
    • alosetron (IBS-D)
    • lubiprostone (IBS-C)
    • tegaserod (IBS-C)
  60. Alosetron is indicated
    • ONLY for women with IBS-D lasting 6 mos
    • selectively blocks 5HT receptors
    • improvement should be seen in 4 weeks
  61. Alosetron should be discontinued when
    constipation occurs and ischemic colitis
  62. Tegaserod is CI
    in women with known CV disease
  63. 2 IBD are
    Crohn's and ulcerative colitis
  64. 5 drugs for IBDs are
    • 5-aminosalicylates
    • glucocorticoids
    • immunosuppressants
    • immunomodulators
    • antibiotics
    • these drugs are NOT curative
  65. Sulfasalazine is indicated for; AE?
    • IBD (mild to mod) and RA
    • hematologic disorders (CBC needed)
  66. Indications for Mesalamine, olsalazine, balasalazide
    • mesalamine: mild to mod IBD
    • olsalazine: maintenance therapy of ulcerative colitis
    • balsalazide: mild to mod active ulcerative colitis
  67. immunosuppressants used for IBD and crohn's
    • azathioprine & mercaptopurine
    • cyclosporine
    • methotrexate
    • used for LONG term therapy
  68. Immunomodulators used for IBD and crohn's
    • infliximab (remicade) TNF inhib
    • certolizumab
    • adalimumab (humira) TNF inhib
    • natalizumab (tysabri) interfere with alpha4 integrin
  69. Infliximabd (remicade) AE
    • infection (TB, opportunistic)
    • infusion reactions
  70. Abx (Flagyl and Cipro) are only effective against
    • Crohn's
    • it is not helpful in ulcerative colitis
  71. Reglan has 2 actions
    • suppress emesis
    • increase upper GI motility
    • AE: sedation, diarrhea, tardive dyskinesia
    • CI: GI obstruction, perforation, hemorrhage
  72. Pralifermin is indicated for
    • oral mucositis of pts with hematologic malignancies
    • AE: rashe, erythema, edema, discoloration of tongue
    • should be stopped 24 hrs before chemo and should not resume until after 24 hours
  73. A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer?
  74. The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record?
  75. An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication?
  76. A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective?
    aprepitant & zofran
  77. A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine [Azulfidine]. Which statement by the patient would indicate understanding of the information?
    report any fatigue or sore throat
  78. Laxatives arre contraindicated in pts with
    • abd pain, nausea, cramps
    • symptoms of appendecitis
    • fecal impaction or obstructions of bowel d/t risk of perforation
  79. 4 classifications of laxatives based on MOA
    • bulk-forming
    • surfactant
    • stimulant
    • osmotic
  80. classification of laxatives based on therapeutic effect
    • Group I: within 2-6 hours; watery stool
    • Group II: intermediate; 6-12 hours; semifluid
    • Group III: slow 1-3 days; soft but formed
  81. Metamucil; methylcellulose (bulk-forming agent) should be taken
    with full glass of H2) to prevent esophageal obstruction
  82. Colace is a ? MOA?
    • surfactant laxative
    • lowers surface tension; inhibit fluid absorption
  83. example of stimulant laxatives?
    • bisacodyl: group II
    • senna: group II
    • castor oil: group I
  84. stimulant laxatives are indicated only for
    • opioid induced constipation
    • constipation d/t slow intestinal transit
  85. castor oil is indicated for rapid and thorough evacuation of bowels (prep for procedures)
  86. Osmotic laxative (mg salts) are CI in
    pts with kidney disease
  87. sodium phos is a? CI?
    • osmotic laxative
    • HF, HTN, edema
  88. what are the fat-soluble vits?
    A D E K
  89. what is the first indication of vit A deficiency?
    night blindness
  90. Vit A deficiency can lead to
    xeropthalmia and keratomalacia
  91. Vit A toxicity is referred to as? it can lead to?
    • hypervitaminosis A
    • birth defects
    • liver injury
    • bone-related disorders
  92. Vit A (retinol) therapeutic use?
    vit a deficiency
  93. What is the UL of vit A?
    3000 mcg/day
  94. classic effects of vit d deficiency
    • rickets (children)
    • osteomalacia (adults)
  95. Vit E helps
    protect against peroxidation of lipids
  96. High-dose vit E increases risk of
    • hemorrhagic stroke
    • doses above 200 IU/day should be avoided
  97. Vit K is required
    for synthesis of clotting factors and prothrombin
  98. Vit K deficiency can cause
    bleeding tendencies and spontaneous hemorrhage
  99. In order to prevent neonatal hemorrhage,
    Vit K (.5-1 mg) is given after delivery
  100. Ther uses for Vit K
    • thrombinemia
    • bleeding caused by Vit K deficiency
    • control of hemorrhage causes by warfarin
  101. Vit C deficiency leads to
    scurvy: faulty bone and tooth devt; loosening of teethc; gingivitis; poor wound healing; heamorrhage
  102. the UL for vit C is
    2 gm/day
  103. niacin deficiency is called
    pellagra "rough skin"
  104. riboflavin (B2) deficiency results in
    • sore throat
    • angular stomatitis
    • cheilosis
    • glossitis
  105. thiamine (b1) deficiency has two forms
    • wet beriberi (primary symptom is leg edema
    • dry beriberi (neuro and motor deficits)
  106. Pyridoxine (B6) deficiency results from
    • poor diet
    • isoniazid therapy
    • inborn errors of metabolism
  107. Pyridoxine UL is
    100 mg/day
  108. Which vit B interferes with levodopa?
    B6 (pyridoxine)
  109. folic acid deficiency results in
    • neural tube defects
    • anencephaly
    • spina bifida
  110. recommendation to ensure sufficient folate
    all women capable of being pregnant should take 400-800 mcg of folic acid each day
  111. orlistat is used to? MOA? AE? CI? DI?
    • promote and maintain weight loss
    • acts in GI tract to reduce absorption of fat by inhibiting gastric and pancreatic lipase
    • AE: oily rectal leakage, flatulence, fecal urgency, fatty/oily stools
    • can be reduced by minimizing fat intake or taking metamucil
    • CI: malabsorption syndrome or cholestasis
    • should be taken 4 hrs apart of levothyroxine
  112. Locaserin (Belviq) is used for? MOA? AE? CI? DI?
    • chronic wt loss
    • suppressed appetite and creates sense of satiety
    • headaches, back pain, decrease in lymphocytes, URI
    • pregnancy
    • serotonin syndrome w/ serotonergic drugs
  113. Which 2 sympathomimetic amines are uses for wt loss?
    • diethylpropion
    • phentermine
    • only used short term (3 mos or less)
  114. A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient?
    smooth intact skin
  115. Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism?
    hold the vitamin
  116. Which of the following administration techniques would be appropriate when giving a sucralfate [Carafate] tablet to a patient with a duodenal ulcer?
    • Administer the tablet with sips of water 1 hour before meals. Correct
    • Allow the tablet to dissolve in water before administering it. Correct
    • Break the tablet in half so it is easier to swallow. Correct
  117. The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in 2 doses. The nurse knows that this medication is used for which indication?
    Preparation before a colonoscopy
  118. A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy?
  119. A nurse should teach a patient who takes alosetron [Lotronex] for diarrhea-prominent irritable bowel syndrome (IBS-D) to stop the medication immediately if the patient develops which condition?
  120. A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient?
    Smooth, intact skin in sun-exposed areas Correct
  121. In a patient with a thiamine deficiency, which finding would indicate the development of Wernicke-Korsakoff syndrome?
    nystagmus, diplopia, ataxia
  122. Which statement about lorcaserin [Belviq] is correct
    It is classified as a Schedule IV controlled substance. Correct
  123. A female patient is given a prescription for lorcaserin [Belviq]. The nurse ensures that the patient schedules an appointment with which healthcare provider?
    OB GYn
  124. The nurse teaches the patient to monitor for which adverse effect when taking phentermine?
    tachycardia, anginal pain, and hypertension
Card Set:
Week 10
2015-10-24 20:16:36
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