PHARM week 7 ch 24,25&26
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What is hyperlipidemia? what does it lead to?
Elevated levels of fatty substances (lipids) in blood-> athersclerosis (plaque formation) in BV's
what are the 4 types of lipoproteins? describe them.
- 1. VLDL: bad
- 2. LDL: lower the better
- 3. HDL: higher the better
- 4. chylomicrons
what do anti-cholesterol drugs usually end in?
what is the tx for hyperlipidemia?
- 1. diet low in saturated fats and red meats
- 2. exercise
- 3. lipid lowering agents (anti-cholesterol drugs)
what are the considerations when using lipid lowering agents?
- 1. monitor liver enzymes b/c the may increase (hepaotoxicity) if so, change or d/c drug.
- 2. niacin (nicotinic acid, OTC drug) helps with lowering lipids, but still need to monitor liver enzymes.
- 3. Niacin "fluching" may be decreased with a low dose of ASA.
- 4. may cause muscle breakdown/pain.
what does the parasympathetic stimulation do in terms of the GI tract?
- 1. increases GI motility
- 2. increases secretions of bile
- 3. increases secretions of saliva
- 4. increases pancreatic/gastric juices
- PRESENCE OF FOOD IN STOMACH-> RELEASES
- 5. gastrin
- 6. secretin
- 7. cholesystokinin
what is parasympathetic stimulation in terms of the GI tract?
- 1. decreases GI motility
- 2. decreases secretions
- 3. increases vasoconstriction of intestinal mucosa in BV's
what is absorbed in the small intestine?
ducts in duodenum receive bile and pancreatic enzymes to?
- 1. digest food
- 2. neutralize pH
what is the primary function of the large intestine?
- 1. absorb H2O
- 2. receive undigested material (fiber)
1. What is Gastro-esophageal reflux disease (GERD)? 2. what is it due to?
- 1. stomach acid hits esophagus
- 2. lower esophageal sphincter incompetence
what is GERD often secondary to?
What is another name for gastric/duodenal ulcers?
Peptic Ulcer disease (PUD)
What is PUD?
mucosal lining becomes eroded (80% of time it is duodenum)
what are the 3 causes of PUD?
- 1. Helicobacter pylori (release toxins which destroy gastric mucosa)
- 2. ASA/NSAID/Steroid use
- 3. idiopathic hypersecretion of stomach acid
what are the S&S of PUD?
- 1. N&V
- 2. epigastric pain (often 2-3 hrs after meals)
- 3. increase in WBC
- 4. anemia (if chronic bleeding)
- 5. hematemesis (blood in vomit)
- 6. melena (black, tarry stools)
what are the aggravating factors of PUD?
- 1. ETOH
- 2. caffeine
- 3. spicy foods
- 4. stress
what is the tx of PUD?
- 1. H + blockers
- 2. antibiotics if H. pylori
What are antacids?
alkaline (high pH:above 7) agents
do antacids enhance healing?
no, but provide temporary relief of heartburn
long term use of antacids usually results in?
"acid rebound" making problems worse
antacids may bind with other drugs esp.?
what are some side effects of antacids?
- 1. constipation
- 2. diarrhea
- 3. in high doses, may induce changes in blood ph->alkalosis
when is not a good time to give antacids?
1-2 hrs prior or after other drugs to avoid interactions
what are the considerations when administering antacids?
- 1. shake liquid products well before use
- 2. follow administration with a small amount of water/milk to facilitate passage into stomach
- 3. never give simultaneous with antibiotics
- 4. antacids should be administered following meals or a snack
DO not give people with PUD?
- 1. ASA
- 2. ibuprofen
- 3. naproxen
what are histamine receptor antagonists?
reduce acid in stomach by interfering with its release from gastric parietal cells (blocks histamine stimulation of them)
when is histamine receptor antagonists contraindicated?
- 1. pregnancy
- 2. people under 16
what are proton pump inhibitors?
inhibits H+ release from gastric parietal cells
what should you monitor people taking cimetidine (Tagamet) for?
- 1. diarrhea
- 2. dizziness
- 3. rash
- 4. CONFUSION
Any patients taking proton pump inhibitors/H2 receptor antagonist and also taking what drugs should watch the blood serum levels of these drugs?
- 1. digoxin
- 2. phenytoin
- 3. warfarin
what are the enzymes to promote digestion?
- 1. pancreatic enzymes
- 2. lactase enzymes
what are lactase enzymes?
break down the sugar lactose into absorbable units
what are pancreatic enzymes?
derived from animals so watch for reactions!
What are emetics?
agents used to induce vomiting
what are emetics used to treat?
food/drug poisonings (unless substance is corrosive/ they are unconscious)
when syrup of ipecac (emetic) is given, what do you not give?
why is syrup of ipecac not given to children under 1 year?
the risk of aspiration
before emetics can be given, what do you do?
call poison control
what are antiemetics?
agents given to prevent N&V
what are the methods of action for antiemetics?
- 1. block Ach receptors
- 2. block histamine (which when released trigger N&V)
- 3. block dopamine and/or seratonin
what are the delivery routes for antiemetics?
- 1. transdermal
- 2. parenteral
- 3. oral
(antiemetics) if vomiting occurs the nurses job is to?
(antiemetics) assess clients recieving antihistamine and anticholinergic antiemetics for?
- 1. urinary retention
- 2. narrow-angle glaucoma
- 3. constipation
- 4. HYPERTENSION
what are stimulant laxatives?
- those which increase motility of GI tract by either:
- 1. irritating the mucosa
- 2. stimulating smooth mucsle in mucosa
what is the route for stimulant laxatives?
stimulant laxatives are contraindicated in people with?
- 1. abdominal pain
- 2. nausea
- 3. vomiting
- 4. rectal fissures
is stimulant laxatives short term or long term therapy?
what are saline (water/salt mix) laxatives? what do they lead to?
agents with an ionic concentration->blood, thereby "pulling" water from intestinal wall into feces to promote defecation
saline laxatives/bulk-forming laxatives are contraindicated for people with?
- 1. abdominal pain
- 2. nausea
- 3. vomiting
- 4. other symptoms of appendicitis
is saline laxatives long term or short term tx?
what are bulk-forming laxatives?
natural or semisynthetic compounds that absorb fluid and swell in the intestine to promote defecation.
are bulk-forming laxatives short term or long term?
how long can it take for bulk-forming laxatives to work?
up to 3 days
how should bulk-forming laxatives be administered?
mixed with liquid and drink immediately. follow with another glass of liquid.
what are stool softeners?
detergent type agents which promote mixing of fecal fat with water, making stool softer.
avoid use of stool softeners for?
longer than 1 week
how may stool softners be adminstered?
- Mixed with
- 1. fruit juice
- 2. milk
- 3. formula
- to mask taste
how long can stool softners take to work?
up to 3 days
stool softner prevents what? but does nto cure it.
what are antidiarreals?
drugs which slow intestinal mobitlity
what are the 2 main types of antidiahrrheals?
- 1. opiods
- 2. anticholergics (inhibit peristalsis)
what should a patient taking antidiahrheals be monitored for?
CNS depression esp if using other CNS depressants
what should you monitor in a infant taking antidiarrheals?
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