[11] FINALS | GIT Flashcards
ANTIEMETICS
NON-PRESCRIPTION ANTIEMETICS
Antihistamine
* Dimenhydrinate (Dramamine, Dimetabs)
* Cyclizine HCl (Marezine)
* Diphenhydramine hydrochloride (Benadryl)
Bismuth Subsalicylate
* Bismuth subsalicylate (Pepto-Bismol)
Phosphorated Carbohydrate Solution
* Phosphorated carbohydrate solution (Emetrol)
ANTIEMETICS
PRESCRIPTION ANTIEMETICS
Antihistamines
* Hydroxyzine (Vistaril, Atarax, Iterax)
* Promethazine (Phenargan)
Anticholinergics
* Hyoscine (Buscopan) – antispasmodic
* Scopolamine (Transderm-Scop)
* S/E: drowsiness, blurred vision (pupillary dilation), tachycardia, constipation, dry mouth
ANTIEMETICS
PRESCRIPTION ANTIEMETICS: Dopamine Agonists
Phenothiazine Antiemetics
* Drug Interaction: alcohol, narcotics, sedatives, general anesthesia
* S/E: moderate sedation, hypotension, EPS, CNS effects, mild anticholinergic signs
* Ex.: Chlorpromazine (Thorazine) and Prochlorperazine Meleate (Compazine)
Butyrophenones
* Treat post-op N&V and emesis associated with calcium chemotherapy, toxins, and radiation therapy
* S/E: EPS, hypotension
* Ex.: Haloperidol (Haldol), Droperidol (Reglan, Plasil)
Metoclopramide (Reglan, Plasil)
* Blocks dopamine and serotonin receptors in the CTZ
* S/E: sedation and diarrhea
ANTIEMETICS
BENZODIAZEPINES
* Ex. Diazepam (Valium) and Lorazepam (Ativan) - DOC
SEROTONIN (5-HT3) RECEPTOR AGONISTS
* Used for calcium chemotherapy-induced emesis
* MOA: blocks serotonin receptors in the CTZ and specialized cells in the GIT
* S/E: headache, dizziness, diarrhea, fatigue
* Ex. Ondansetron (Zofran), Dolasetron (Anzemet)
GLUCOCORTICOIDS (Corticosteroids)
* Dexamethasone (Decadron)
* Methylprednisolone (Solu-Medrol)
ANTIEMETICS
CANNABINOIDS
* Active ingredient in Marijuana
* Dronabinol (Marinol) and Nabilone (Cesamet)
* S/E: mood changes, euphoria, drowsiness, dizziness, headaches, depersonalization, nightmares, confusion, incoordination, memory lapse, dry mouth, orthostatic hypotension or HPN, tachycardia
MISCELLANEOUS ANTIEMETICS
* Suppresses the impulses to the chemoreceptor trigger zone, tjus inhibiting the activity of the vomiting center
* Diphenidol (Vontrol) and Trimethobenzamide (Tigan)
* S/E: dry mouth, blurred vision, constipation, increased heart rate
* A/R: dizziness, anxiety, skin rash, diarrhea
ANTIEMETICS
NURSING RESPONSIBILITIES
* Observe the characteristic of vomitus
* Obtain hx of present illness
* Check VS
* Encourage to maintain oral hygiene
* Instruct not to consume alcohol
* Don’t give antiemetics to pregnant women in their 1st
* trimester
* Instruct the patient not to drive.
* Encourage the use of nonpharmacological methods.
EMETICS
NURSING RESPONSIBILITIES
* Determine the toxic substances ingested.
* Caustic substances: ammonia, chlorine bleach, toilet cleaners
* Petroleum distillates: gasoline, kerosene, paint thinners
* Check VS and report abN findings.
* Call the poison control center.
* Offer sufficient fluids should be given.
* Don’t offer Ipecac or fluid to a semi-conscious or unconscious patient.
* Keep away from children.
ANTIDIARRHEALS
OPIATES
* Action: decrease intestinal motility, decreasing peristalsis
* S/E: constipation
* Ex.: tincture of opium (Paregoric, Codeine)
OPIATE-RELATED AGENTS
* Action: decrease intestinal peristalsis and can be used as combination with opiates; decreased abdominal cramping
* Ex.: Diphenoxilate (Lomotil), Difenoxin (Motofen), Loperamide (Imodium)
* S/E: drowsiness, dizziness, constipation, dry mouth, weakness, rashes, flushing, blurred vision, mydriasis urine retention
* A/R: paralytic ileus, severe allergic reaction
ANTIDIARRHEALS
ADSORBENTS
Action: Coats the wall of the GI tract and adsorbs the bacteria or toxins that cause the diarrhea
Ex. Kaolin and Pectin (Kaopectate) and Bismuth Salts (Pepto-Bismol)
S/E: Constipation
A/R: Fecal impaction or ulceration in infants and elderly
ANTIDIARRHEALS
SOMATOSTATIN ANALOG
Inhibit the gastric acid, pepsinogen, gastrin, cholecystokinin, and serotonin secretions and intestinal fluid
It decreases smooth muscle contractility
Ex. Octreotide Acetate (Sandostatin)
MISCELLANEOUS
Used to control diarrhea
Ex. Furazolidone (Furoxone), Lactobacillus, and Parepectolin (CSS V)
ANTIDIARRHEALS
NURSING RESPONSIBILITIES
* Assess for hx of infection and other causes of diarrhea.
* Check VS.
* Assess freq and char of stools, S/S of DHN
* Check clients BS.
* Instruct patient to avoid taking sedatives, tranquilizers, and other narcotics because CNS depression may result.
* Encourage to increase OFI
* Monitor electrolytes
LAXATIVES
Action: promote evacuation of the bowel, promote softening of the stools
TYPES:
Osmotic/Saline
Stimulants
Bulk-forming
Emollients (Stool Softener)
LAXATIVES
OSMOTIC LAXATIVES
Action: pull water into the colon and incrase water in the feces to increase bulk which stimulates peristalsis
Include salts and saline products (Na, K, and Mg), lactulose, and glycerine
Lactulose
Draws water into the intestines to form a soft stool; dereases serum ammonia
Glyerine
Increases water in the feces in the large intestine
S/E: flatulence, diarrhea, abdominal cramps, nausea, and vomiting
C/I: renal insufficiency, DM
LAXATIVES
STIMULANT (CONTACT LAXATIVES)
Acts directly on the intestine, causing an irritation to the sensory nerve endings that promotes peristalsis and evacuation
S/E: nausea, abdominal cramps, weakness, and reddish-brown urine (phenolphthalein, senna, or cascara)
Prolonged use of Senna (Senokot) - damages nerve; loss of intestinal muscular tone
Ex.
Castor Oil - stimulates urine contaction; for bowel preparation
Bisacodyl (Dulcolax) - barium enema
Senna (Senokot)
Phenolphthalein (Ex-Lax, Doxidan)
LAXATIVES
BULK-FORMING LAXATIVES
Action: natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing fecal bulk and peristalsis
This group of laxative not absorbed by the body, no systemic S/E and does not cause laxative dependence
Ex. Psyllium (Metamucil) and Methylcellulose (Citrucel)
S/E: nausea, vomiting, flatus, diarrhea, abdominal cramps
LAXATIVES
EMOLLIENTS (STOOL SOFTENER)
Action: lubricate the intestinal wall and soften the stool, allowing a smooth passage of fecal contents, thus decreasing straining during defacation
S/E: nausea, vomiting, diarrhea, abdominal cramping
Ex.
Softenener - Docusate Ca (Surfak)
Docusate Na (Colace)
Lubricants: Mineral Oil
LAXATIVES
NURSING RESPONSIBILITIES
Assess for renal insufficiency
Monitor I and O
Instruct to increase OFI
Eat food rich in fiber
Avoid overuse of laxatives because F and E imbalances and dependency
Encourage exercise
Bulk-forming laxatives to be mixed with 8-10 ounces of water, stir and drink immediately
Mineral oil should be taken with juice
Take it before meals or at bedtime so vitamin absorption will not be blocked; 30 minutes after other meds
Store suppositories at < 30 deg. C
ANTIULCER DRUGS
PEPTIC ULCER DISEASE
Esophageal Ulcer - reflux of acidic gastric contents into the esophagus
Gastric Ulcer - occurs because of the breakdown of the GMB
Duodenal Ulcer - hypersecretion of acid from the stomach that passes to the duodenum
ANTIULCER DRUGS
TRANQUILIZERS
Action: to reduce vagal stimulation and decrease anxiety
Ex.: Librax - combinaiton of the anxiolytics chlordiazepoxide (Librium) and the anticholinergic Clidinium bromide (Quarzan)
ANTIULCER DRUGS
ANTICHOLINERGICS
Actions:
Decrease Ach by blocking the cholinergic receptors
Relieve pain by decreasing gastric motility and secretion
Delay gastric emptying
Ex.: Propantheline bromine (Pro-banthine)
ANTIULCER DRUGS
ANTACIDS
Actions: Neutralize HCl and reduce pepsin activity
With Systemic Effect
Sodium Bicarbonate: Bromo-Seltzer and Alka-Seltzer
Calcium Carbonate (Tums)
Non-Systemic Effect
Aluminum
Aluminum, Aluminum Hydroxide
Aluminum Carbonate (S/E: constipation, hypophosphatemia)
Magnesium
Magnesium Carbonate, Magnesium Phosphate
S/E: diarrhea, hypermagnesemia
ANTIULCER DRUGS
HISTAMINE 2 BLOCKER
Action: block the H2 receptors of the parietal cells in the stomach thus reducing gastric and concentration
ANTIULCER DRUGS
HISTAMINE 2 BLOCKER
Cimetidine (Tagamet)
1975; first H2 blocker
Increases the effects of theophylline, beta-blockers, anticoagulants, anticonvulsants
Duration: 4-5 hours
Ranitidine (Zantac)
1983
Peak concentraction: 1-3 hours
Gastic and duodenal ulcer used prophylactically, relieves symptoms of reflux esophagitis, prevent stress ulver and aspiration pneumonitis
Duration: up to 12 hours
ANTIULCER DRUGS
HISTAMINE 2 BLOCKER
Famotidine (Pepcid)
1986
Short term use for duodenal ulcer and Zollinger-Ellison syndrome
50-80% more potent thatn Cimetidine and 5-8 x tan Ranitidine
Nizatidine (Axid)
1988
Latest H2 blocker
Relieves nocturnal gastric acid secretions for 12 hours
Administer at bedtime to prevent recurrence of duodenal ulcer
ANTIULCER DRUGS
PROTON PUMP INHIBITORS
Action: supresses gastric acid secretion by inhibiting the hydrogen/K ATPase enzyme system located in the gastric parietal cells
Inhibits gastric acid secretion up to 90%
Agents that block the final step of acid production
S/E: headache, dizziness, diarrhea, abdominal pain, rash
ANTIULCER DRUGS
PROTON PUMP INHIBITORS
Omeprazole (Prilosec)
First
DOA: 72 hours
Lansoprazole (Prevacid)
1993
Ulcer relief usually occurs within 1 week
DOA: 24 hours
Rabeprazole (Aciphex)
More effective in treating duodenal ulcers rather than gastric
Most effective in GERD and hypersecretory disease (Zollinger-Ellison Syndrome)
Pantoprazole (Protonix)
Treat short-term erosive GERD
IV is effective in treating Zollinger-Ellison Syndrome
Esomeprazole (Nexium)
Newest PPI
Highest success rate in healing erosive GERD
ANTIULCER DRUGS
PEPSIN INHIBITOR
Action: covers the ulcer and protects it form acid and pepsin; adhering to the ulcer surface
It does not neutralize acid or decrease acid secretions
Ex. Sucralfate (Carafate)
S/E: constipation, dry mouth, dizziness
Given before meal
ANTIULCER DRUGS
PROSTAGLANDIN ANALOGUE ANTIULCER DRUG
Action: suppress gastric acid secretion and increase cytoprotective mucus in the GI tract
Ex. Misoprostol (Cytotec)
C/I: pregnant and women of child-bearing age
S/E: diarrhea, abdominal pain, flatulence, nausea, vomiting, constipated and menstrual spotting
ANTIULCER DRUGS
NURSING RESPONSIBILITIES: Antacid
Avoid administering antacid with other drugs, 1-2 hours after other meds
Encourage to take 2 oz of water to ensure that the drug reaches the stomach
Administer on empty stomach or 1-3 hours after meal and at bedtime
Avoid taking antacids with milk or food high in vitamin D
ANTIULCER DRUGS
NURSING RESPONSIBILITIES: H2 BLOCKER
Administer drugs before meals
Avoid smoking
Instruct the client not to drive or engage in dangerous activities
Drug-induced impotence and gynecomastia are reversible
NURSING RESPONSIBILITIES: Pepsin Inhibitor
Administer on empty stomach
Administer antacid 30 minutes before or after sucralfate
Increase OFI, dietary bulk
Exercise
No smoking
