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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
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H pylori promotes
gastric cancer
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Zollinger-ellison syndrome is
- a rare disorder
- caused by a tumor that secretes gastrin
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Goal of therapy in PUD is to (4)
- alleviate symptoms
- promote healing
- prevent complications
- prevent recurrence
- *drugs do not alter disease process (except abx)
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5 major groups of antiulcer
- abx
- antisecretory
- mucosal protectant
- antisecretory w/ enhancement
- antacids
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Tx for NSAID-induced ulcers? (2)
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Drugs that reduce acidity should be admin in doses enough to
raise pH at 5 and above
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Tests for H pylori (5)
- invasive: endoscopy and bx
- noninvasive: breath, stool, blood
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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)
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Bismuth SE
harmless black coloration of tongue and stool
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Metronidazole can cause
disulfiram-like reaction when used with ETOH
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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
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H2RA promote; examples
- ulcer healing by suppressing gastric acid secretion
- ranitidine
- cimetidine
- famotidine
- nizatidine
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Cimetidine absorption; therapeutic effects
- decreased by food
- 4-6 weeks of therapy
- may be given prophylactically
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Cimetidine is drug of choice for tx
- preventing aspiration pneumonitis
- given 60-90 mins before anesthesia
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AE of Cimetidine (5)
- gynecomastia
- reduced libido
- impotence
- CNS effects
- pneumonia
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Cimetidine can increase levels of
- warfarin
- phenytoin
- theophylline
- lidocaine
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Compared to cimetidine, ranitidine (3)
- more potent
- has fewer SE
- has fewer drug interactions
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Most effective drug for suppressing gastric acid secretion
PPIs (omeprazole, pantoprazole, -prazole)
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Omeprazole (Prilosec) MOA
irreversible inhibition of H K ATPase (enzyme that generates gastric acid)
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Omeprazole tx should be
limited to 4-8 weeks
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Omeprazole is used for (5)
- duodenal ulcers
- gastric ulcers
- erosive esophagitis
- GERD
- long term zollinger-ellison syndrome
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ulcer prophylaxis should only be done (4)
- in ICU pts
- multiple trauma
- spinal cord injury
- prolonged mech ventilation
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AE of omeprazole (4)
- pneumonia
- fxs
- rebound acid hypersecretion
- hypomagnesemia (tremors, muscle cramps, SZ, dysrhythmias)
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PPIs have been associated with
dose-related C diff
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Omeprazole decreases the effects of
- Plavix
- for pts with risk factors for GI bleeding, combining the drugs is OK
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Esomeprazole is used for
prophylaxis of NSAID-induced ulcers
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Sucralfate inidication; AE
- duodenal ulcers
- create protective barrier against acid and pepsin
- constipation
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Misoprostol is; therapeutic use; MOA; pregnancy category
- an analog of prostaglandin E
- prevention of gastric ulcers cause by NSAIDs
- replaces endogenous prostaglandins
- Cat X
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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
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ondansetron MOA; SE (3)
- blocks 5HT (serotonin) receptors
- headache, diarrhea, dizziness
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Most effective antiemetic caused by cisplatin and other antiCA drugs
serotonin antagonists (zofran)
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Serious AE of ondansetron?
- QT prolongation
- caution: electrolyte abnormalities, heart failure, bradydysrhythmias
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Dose of zofran for post op n/v
16 mg PO 1 hr before anesthesia
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Dolasetron AE
fatal dysrhythmias when given in high doses
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Palonosetron compared to other serotonin antagonists
- has longer half life
- effected against both acute and delayed emesis
- IV only
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Which 2 glucocorticoids are used to suppress CINV?
- solu-medrol
- dexamethasone
- IV, short term, intermittent
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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)
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Fosapretitant (Emend) is? indication?
- prodrug convert to aprepitant in the body
- indicated only for CINV
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Which benzo is used in combination with other antiemetics? benefits? (4)
- lorazepam
- sedation
- suppression of anticipatory emesis
- production of anterograde amnesia
- control EPS
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Dopamine antagonist (phenothiazine) MOA; SE? (4)
- block dopamine2 receptors
- EPS
- anticholinergic effects
- hypotension
- sedation
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Promethazine can cause
- respiratory depression
- tissue injury
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Promethazine is CI in
children < 2 yrs
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Which route is preferred for promethazine?
- IM
- IV route: 25mg/mL rate of 25mg/min
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Butyrophenones drugs used for anti NV? MOA? SE?
- haloperidol; droperidol
- block dopamine2 receptors
- EPS, sedation, hypotension, QT prolongation
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Which 2 cannbinoids are used to prevent CINV?
- dronabinol (Marinol)
- nabilone (Cesamet)
- considered 2nd line d/t potential for abuse
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Dronabinol is also used to
increase appetite in pts with AIDS
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Cannabinoids SE
- temportal disintegration
- dissociation
- depersonalization
- dysphoria
- CI for pts w/ psych issues
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Dronabinol is classified as
Schedule III d/t its slow onset and no interest in streets
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Regimens for CINV
- High risk: aprepitant + dexamethasone + ondansetron
- Moderate: dexamethasone + palonosetron
- Low: Dexamethasone
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First-line therapy for NV in pregnancy
- doxylamine + vit B6 (pyridoxine)
- trade name: Dicletin, Diclegis
- start with 2 tabs at bedtime
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Most effective drug for motion sickness; SE? (3)
- scopolamine
- dry mouth, blurred vision, drowsiness
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Most effective antidiarrheal agents (5)
- opioids
- dcrease intestinal motility
- allow more time for absorption of fluid and electrolytes
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Opioids used for diarrhea
- diphenoxylate (+atropine)
- difenoxin (+ atropine)
- loperamide
- paregoric
- opium tincture
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Infectious diarrhea is
usually self-limiting and requires no treatment
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tx for infectious diarrhea
- cipro or norfloxacin
- children and pregnant women: azithromycin
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Prohyplaxis vaccine for diarrhea
Dukoral
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nonspecific drugs for IBS include
- antispasmodics
- bulf-forming agents
- antidiarrheals
- TCAs
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IBS-specific drugs include
- alosetron (IBS-D)
- lubiprostone (IBS-C)
- tegaserod (IBS-C)
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Alosetron is indicated
- ONLY for women with IBS-D lasting 6 mos
- selectively blocks 5HT receptors
- improvement should be seen in 4 weeks
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Alosetron should be discontinued when
constipation occurs and ischemic colitis
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Tegaserod is CI
in women with known CV disease
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2 IBD are
Crohn's and ulcerative colitis
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5 drugs for IBDs are
- 5-aminosalicylates
- glucocorticoids
- immunosuppressants
- immunomodulators
- antibiotics
- these drugs are NOT curative
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Sulfasalazine is indicated for; AE?
- IBD (mild to mod) and RA
- hematologic disorders (CBC needed)
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Indications for Mesalamine, olsalazine, balasalazide
- mesalamine: mild to mod IBD
- olsalazine: maintenance therapy of ulcerative colitis
- balsalazide: mild to mod active ulcerative colitis
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immunosuppressants used for IBD and crohn's
- azathioprine & mercaptopurine
- cyclosporine
- methotrexate
- used for LONG term therapy
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Immunomodulators used for IBD and crohn's
- infliximab (remicade) TNF inhib
- certolizumab
- adalimumab (humira) TNF inhib
- natalizumab (tysabri) interfere with alpha4 integrin
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Infliximabd (remicade) AE
- infection (TB, opportunistic)
- infusion reactions
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Abx (Flagyl and Cipro) are only effective against
- Crohn's
- it is not helpful in ulcerative colitis
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Reglan has 2 actions
- suppress emesis
- increase upper GI motility
- AE: sedation, diarrhea, tardive dyskinesia
- CI: GI obstruction, perforation, hemorrhage
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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
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A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer?
omeprazole
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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?
plavix
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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?
disorientation
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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
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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
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Laxatives arre contraindicated in pts with
- abd pain, nausea, cramps
- symptoms of appendecitis
- fecal impaction or obstructions of bowel d/t risk of perforation
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4 classifications of laxatives based on MOA
- bulk-forming
- surfactant
- stimulant
- osmotic
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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
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Metamucil; methylcellulose (bulk-forming agent) should be taken
with full glass of H2) to prevent esophageal obstruction
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Colace is a ? MOA?
- surfactant laxative
- lowers surface tension; inhibit fluid absorption
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example of stimulant laxatives?
- bisacodyl: group II
- senna: group II
- castor oil: group I
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stimulant laxatives are indicated only for
- opioid induced constipation
- constipation d/t slow intestinal transit
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castor oil is indicated for rapid and thorough evacuation of bowels (prep for procedures)
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Osmotic laxative (mg salts) are CI in
pts with kidney disease
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sodium phos is a? CI?
- osmotic laxative
- HF, HTN, edema
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what are the fat-soluble vits?
A D E K
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what is the first indication of vit A deficiency?
night blindness
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Vit A deficiency can lead to
xeropthalmia and keratomalacia
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Vit A toxicity is referred to as? it can lead to?
- hypervitaminosis A
- birth defects
- liver injury
- bone-related disorders
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Vit A (retinol) therapeutic use?
vit a deficiency
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What is the UL of vit A?
3000 mcg/day
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classic effects of vit d deficiency
- rickets (children)
- osteomalacia (adults)
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Vit E helps
protect against peroxidation of lipids
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High-dose vit E increases risk of
- hemorrhagic stroke
- doses above 200 IU/day should be avoided
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Vit K is required
for synthesis of clotting factors and prothrombin
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Vit K deficiency can cause
bleeding tendencies and spontaneous hemorrhage
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In order to prevent neonatal hemorrhage,
Vit K (.5-1 mg) is given after delivery
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Ther uses for Vit K
- thrombinemia
- bleeding caused by Vit K deficiency
- control of hemorrhage causes by warfarin
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Vit C deficiency leads to
scurvy: faulty bone and tooth devt; loosening of teethc; gingivitis; poor wound healing; heamorrhage
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the UL for vit C is
2 gm/day
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niacin deficiency is called
pellagra "rough skin"
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riboflavin (B2) deficiency results in
- sore throat
- angular stomatitis
- cheilosis
- glossitis
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thiamine (b1) deficiency has two forms
- wet beriberi (primary symptom is leg edema
- dry beriberi (neuro and motor deficits)
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Pyridoxine (B6) deficiency results from
- poor diet
- isoniazid therapy
- inborn errors of metabolism
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Pyridoxine UL is
100 mg/day
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Which vit B interferes with levodopa?
B6 (pyridoxine)
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folic acid deficiency results in
- neural tube defects
- anencephaly
- spina bifida
-
recommendation to ensure sufficient folate
all women capable of being pregnant should take 400-800 mcg of folic acid each day
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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
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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
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Which 2 sympathomimetic amines are uses for wt loss?
- diethylpropion
- phentermine
- only used short term (3 mos or less)
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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
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Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism?
hold the vitamin
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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
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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
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A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy?
leukemia
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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?
constipation
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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
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In a patient with a thiamine deficiency, which finding would indicate the development of Wernicke-Korsakoff syndrome?
nystagmus, diplopia, ataxia
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Which statement about lorcaserin [Belviq] is correct
It is classified as a Schedule IV controlled substance. Correct
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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
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The nurse teaches the patient to monitor for which adverse effect when taking phentermine?
tachycardia, anginal pain, and hypertension
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