Palonosetron compared to other serotonin antagonists
has longer half life
effected against both acute and delayed emesis
Which 2 glucocorticoids are used to suppress CINV?
IV, short term, intermittent
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)
Fosapretitant (Emend) is? indication?
prodrug convert to aprepitant in the body
indicated only for CINV
Which benzo is used in combination with other antiemetics? benefits? (4)
suppression of anticipatory emesis
production of anterograde amnesia
Dopamine antagonist (phenothiazine) MOA; SE? (4)
block dopamine2 receptors
Promethazine can cause
Promethazine is CI in
children < 2 yrs
Which route is preferred for promethazine?
IV route: 25mg/mL rate of 25mg/min
Butyrophenones drugs used for anti NV? MOA? SE?
block dopamine2 receptors
EPS, sedation, hypotension, QT prolongation
Which 2 cannbinoids are used to prevent CINV?
considered 2nd line d/t potential for abuse
Dronabinol is also used to
increase appetite in pts with AIDS
CI for pts w/ psych issues
Dronabinol is classified as
Schedule III d/t its slow onset and no interest in streets
Regimens for CINV
High risk: aprepitant + dexamethasone + ondansetron
Moderate: dexamethasone + palonosetron
First-line therapy for NV in pregnancy
doxylamine + vit B6 (pyridoxine)
trade name: Dicletin, Diclegis
start with 2 tabs at bedtime
Most effective drug for motion sickness; SE? (3)
dry mouth, blurred vision, drowsiness
Most effective antidiarrheal agents (5)
dcrease intestinal motility
allow more time for absorption of fluid and electrolytes
Opioids used for diarrhea
difenoxin (+ atropine)
Infectious diarrhea is
usually self-limiting and requires no treatment
tx for infectious diarrhea
cipro or norfloxacin
children and pregnant women: azithromycin
Prohyplaxis vaccine for diarrhea
nonspecific drugs for IBS include
IBS-specific drugs include
Alosetron is indicated
ONLY for women with IBS-D lasting 6 mos
selectively blocks 5HT receptors
improvement should be seen in 4 weeks
Alosetron should be discontinued when
constipation occurs and ischemic colitis
Tegaserod is CI
in women with known CV disease
2 IBD are
Crohn's and ulcerative colitis
5 drugs for IBDs are
these drugs are NOT curative
Sulfasalazine is indicated for; AE?
IBD (mild to mod) and RA
hematologic disorders (CBC needed)
Indications for Mesalamine, olsalazine, balasalazide
mesalamine: mild to mod IBD
olsalazine: maintenance therapy of ulcerative colitis
balsalazide: mild to mod active ulcerative colitis
immunosuppressants used for IBD and crohn's
azathioprine & mercaptopurine
used for LONG term therapy
Immunomodulators used for IBD and crohn's
infliximab (remicade) TNF inhib
adalimumab (humira) TNF inhib
natalizumab (tysabri) interfere with alpha4 integrin
Infliximabd (remicade) AE
infection (TB, opportunistic)
Abx (Flagyl and Cipro) are only effective against
it is not helpful in ulcerative colitis
Reglan has 2 actions
increase upper GI motility
AE: sedation, diarrhea, tardive dyskinesia
CI: GI obstruction, perforation, hemorrhage
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
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer?
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?
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?
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
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
Laxatives arre contraindicated in pts with
abd pain, nausea, cramps
symptoms of appendecitis
fecal impaction or obstructions of bowel d/t risk of perforation
4 classifications of laxatives based on MOA
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
Metamucil; methylcellulose (bulk-forming agent) should be taken
with full glass of H2) to prevent esophageal obstruction
Colace is a ? MOA?
lowers surface tension; inhibit fluid absorption
example of stimulant laxatives?
bisacodyl: group II
senna: group II
castor oil: group I
stimulant laxatives are indicated only for
opioid induced constipation
constipation d/t slow intestinal transit
castor oil is indicated for rapid and thorough evacuation of bowels (prep for procedures)
Osmotic laxative (mg salts) are CI in
pts with kidney disease
sodium phos is a? CI?
HF, HTN, edema
what are the fat-soluble vits?
A D E K
what is the first indication of vit A deficiency?
Vit A deficiency can lead to
xeropthalmia and keratomalacia
Vit A toxicity is referred to as? it can lead to?
Vit A (retinol) therapeutic use?
vit a deficiency
What is the UL of vit A?
classic effects of vit d deficiency
Vit E helps
protect against peroxidation of lipids
High-dose vit E increases risk of
doses above 200 IU/day should be avoided
Vit K is required
for synthesis of clotting factors and prothrombin
Vit K deficiency can cause
bleeding tendencies and spontaneous hemorrhage
In order to prevent neonatal hemorrhage,
Vit K (.5-1 mg) is given after delivery
Ther uses for Vit K
bleeding caused by Vit K deficiency
control of hemorrhage causes by warfarin
Vit C deficiency leads to
scurvy: faulty bone and tooth devt; loosening of teethc; gingivitis; poor wound healing; heamorrhage
the UL for vit C is
niacin deficiency is called
pellagra "rough skin"
riboflavin (B2) deficiency results in
thiamine (b1) deficiency has two forms
wet beriberi (primary symptom is leg edema
dry beriberi (neuro and motor deficits)
Pyridoxine (B6) deficiency results from
inborn errors of metabolism
Pyridoxine UL is
Which vit B interferes with levodopa?
folic acid deficiency results in
neural tube defects
recommendation to ensure sufficient folate
all women capable of being pregnant should take 400-800 mcg of folic acid each day
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