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343 Pharm Exam 4 > Chapter 45: Gastrointestinal Tract Disorders > Flashcards

Chapter 45: Gastrointestinal Tract Disorders Flashcards

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1
Q

What does nausea mean?

A

Unpleasant feeling that often precedes vomiting

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2
Q

What does emesis ( vomiting ) mean?

A

Forcible emptying of gastric and occasionally intestinal contents

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3
Q

What does antiemetic drugs mean?

A

Used to relive nausea and vomiting

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4
Q

How can we manage vomit and nausea with Nonpharmacologic treatment?

A

Small sips frequently

Weak tea
Flat soda
Gelatin
Gatorade
Crackers
Dry toast

Pedialyte ( use in children )

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5
Q

What are some prescription antiemetics we will talk about? (6)

A

Antihistamines
Anticholinergic
Dopamine antagonists
Serotonin antagonists
Cannabinoids
Miscellaneous

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6
Q

She said she wanted to bring our attention to the dopamine antagonist
What is their side effect?

A

Extrapydramidal symptoms ( EPS ) - pseudo parkinosnism !!

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7
Q

What is that EPS side effects?(7)

A

Stopped posture
Mask like facies ( no expression )
Rigidity
Tremors at rest
Shuffling gait
Pill rolling motions
Bradykinesia ( slow movement )

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8
Q

Now we are going to talk about anticholinergic drugs

A
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9
Q

What is an example of an anticholinergic drug that we will talk about?
For nausea
Think of the S

A

Scopolamine

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10
Q

Scopolamine
How does it work?
Best to put it on what?

A

Patch behind your ear
Best to put it on before your sick

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11
Q

Anticholinergic drugs
Scopolamine

Side effects ? (3)

What is this contraindicated for ?

A

Dizziness
Drowsiness
Tachycardia

Glaucoma cause their inter ocular pressure becomes higher

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12
Q

Now onto antihistamines

A
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13
Q

antihistamines drugs we need to know ? (3)
Think of drama cause of the HistaMine

A

Dramamine (OTC)
Meclizine (OTC)
Hydroxozine ( prescription )

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14
Q

antihistamines drugs side effects? (3)

Contraindicated in who?

A

Dizziness
Drowsiness
Confusion
( anticholinergic side effects )

Glaucoma

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15
Q

Now !
Antidopaminergics ( dopamine agonists )
Also know as phenothiazines

A
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16
Q

Antidopaminergics ( dopamine agonists )
Also know as phenothiazines

What drugs do we need to know for this group? (2)

A

Chlorpromazine - Comparzine
Promethazine - phenergan

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17
Q

Antidopaminergics ( dopamine agonists )
Also know as phenothiazines

Side effects? (7)

S,P,H,E,D,D,U

A

Sedation
Photosensitive
Hypotension
EPS
Dry mouth
Dry eyes
Urinary retention

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18
Q

Antidopaminergics ( dopamine agonists )
Also know as phenothiazines

Usually can be given what? (2)

A

IV PO

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19
Q

Since Dopamine agonist have hypotension, what do we tell patients?

A

Getting up slowly

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20
Q

Onto serotonin blockers

A
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21
Q

serotonin blockers
What medication!?

A

Ondansetron ( Zofran )

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22
Q

serotonin blockers side effects? (7)
H,D,H,P,C,E,F

A

Headache
Dizziness
Hypotension
Palpitations
Constipation
Edema
Fatigue

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23
Q

Onto
Tetrahydrocannaboinoids

A
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24
Q

Tetrahydrocannaboinoids
Medication?

A

Dronabinol

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25
Q

Tetrahydrocannaboinoids
Side effects? (5)
M.E.D.D.O

A

Mood changes
Euphoria
Dizziness
Drowsiness
Orthostatic hypotension

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26
Q

Now to miscellaneous drugs

A
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27
Q

miscellaneous drug we need to know?

A

Metroclopramide ( Reglan )

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28
Q

miscellaneous side effects? (8)
A.D.D.D.F.R.H.E

A

Anticholinergic side effects
Drowsiness
Dizziness
Dysgeusia
Fatigue
Restlessness
Headache
EPS

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29
Q

miscellaneous does what? Like function?

A

Improves peristalsis of the GI tract
Speed up the process in moving food from stomach into the intestine

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30
Q

Another medication we may use for nausea and vomiting is ?

A

Corticosteroids

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31
Q

Corticosteroids medications drug? (2)

A

Dexmethasone & methylpredinisolone

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32
Q

Why may we give corticosteroids to help with nausea and vomit?

A

Usually given IV
chemo therapy that may cause nausea and vomiting and inflammation is why we give it

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33
Q

When we are giving antiemetics medication
What are our biggest concerns?

A

Fluid electrolytes
Daily weight
What the vomit looks like
Dehydration !!
Provide mouth care, brush their teeth & rinse the teeth

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34
Q

Special considerations
Why do we need to watch out with promethazine ( phenergan ) when giving it IV?

And how do we avoid this?

A

It’s very tissue damage

Dilute at least 10ML of fluid and given in a running IV pot farthest from the patient given in a large vein ( not hand or wrist )

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35
Q

If promethazine ( phenergan ) is given in an artery instead of a vein what can happen?

A

Losing a limb

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36
Q

A lot of the nausea medication that we may use on a normal patient may not be safe for someone who is pregnant so who is in charge for looking at good nausea medication for them?

A

Their OB

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37
Q

Since most and all nausea medications can cause drowsiness
So we tell them to avoid what?

A

Hazardous tasks

38
Q

We also tell patients to avoid alcohol usage with antienemtics why?

A

Cause it causes a lot of CNS depression and even more fatigue

39
Q

Since a lot of antiemetics cause hypotension we tell patients what?

A

Getting up slowly and changing position slowly

40
Q

If our patient is getting chemo, we usually give emetics medication how much and when?

A

30-60mins before their chemo

41
Q

Usually with metoclopramide they will have EPS so what will we do?

Does eps go away when we stop the medication

What if we are on for a long time?

A

Usually monitor for EPS

Yes

Usually we can residual symptoms

42
Q

For the scopolamine patch, we put it behind the ear but how often do we change it?

And when is it better to use ?

A

Every 3 days

Before the symptoms
( so like let’s say cruise ship? Use it before getting on a cruise ship )

43
Q

What are emetics??

A

Medication that induce vomiting

44
Q

Before we give an emetic, we usually want to talk to poison control in order to get a proper order and understanding on why we are making the patient vomit.

What if vomit is indicated
So let’s say they drink bleach but we gave them emetics? What do we give? (2)

A

Activated charcoal or gastric lavage

45
Q

Now onto diarrhea!!

A
46
Q

Notes
What are some causes of diarrhea?
Spoiled or spicy foods
Fecal impaction
Bacteria
Viruses
Toxin
Drug reactions
Laxative abuse
Malabsorption syndrome
Stress
Anxiety
Bowel tumor
Inflammatory bowel disease

A
47
Q

What is our Nonpharmacologic measures for diarrhea?

A

Clear liquids
Oral solutions ( Gatorade, pedialyte )
Bland diet
IV solutions

48
Q

What is travelers diarrhea?

A

Usually E.coli causes but it’s when you travel and get it

49
Q

How do we prevent travelers diarrhea?

A

Drink bottle water
Wash fruit
Eat cooked vegs
Eat meats cooked until well done

50
Q

What is bismuth subsalicylate ( peptobysmal ) can help with what?

A

This travelers diarrhea

51
Q

What is the purpose of antidirrheals?

A

Decrease hyper motility
( metabolic acid base imbalances, dehydration, fluid balance )

52
Q

What are the 3 types of anti diarrheal?

A

Opiates - opiate related agents
( stick to the bowel wall and absorb anything toxic )
Adsorbents
Miscellaneous

53
Q

What is the action or purpose of an opiate or opiate related agents to help with diarrhea?

A

Decrease GI motility which slows transit time through bowel allowing more water to be absorbed

So like they cause constipation really

54
Q

What are the 5 side effects of opiates?
C,P.A C,R

A

CNS depression
Physical dependence
Atropine contraindicated in glaucoma
Constipation
Respiratory depression

55
Q

We do not want to give opiates to who?

A

Severe hepatic impairment
( diphenoxylate, difenoxin, loperamide )

56
Q

Diphenoxylate and didenoxin
Usually are mixed with atropine with opiate

Loperamide is very weak opiate !

A
57
Q

What does adsorbents do for antidiarrheals?

A

Quite literally will absorb the bacteria or toxins causing diarrhea

58
Q

What are a big side effect of adsorbents? (2)

A

Tongue and stool discoloration
Black!!

59
Q

What is a classic adsorbent medication?

A

Peptilbismal

60
Q

What are miscellenous side effects? (2)

A

Gas
Dry mouth

61
Q

What type of electrolyte are we really worried about in diarrhea?

A

Potassium!!

Take potassium supplements

62
Q

Diarrhea should resolve or improves within what time?

A

48 hours

63
Q

Why should we not drink milk?

A

It can aggreavate diarrhea

64
Q

Not ontop constipation!!!

A
65
Q

What are some causes of constipation
- insufficient water intake!!!!
- poor dietary habits!!!!!
- fecal impaction
- bowel obstruction
- chronic laxative
- neurologic disorders
- ignoring urge to defected ( kids )!!
- lack of exercise
- various drugs

A
66
Q

What type of medication should we think of first when it comes to constipation?

A

Opiates !!

67
Q

What are some Nonpharmacologic treatment for constipation?

A

Diet ( high fiber )
Water
Exercise
Routine bowel habits
(30mins after they eat, bed pan )

68
Q

Why do we give laxatives?

A

Promote soft stool
Or evacuation of stool

69
Q

What are the 5 laxatives ?

A

Bulk forming
Emollient
Osmotic
Saline
Stimulant

70
Q

What is bulk forming laxative medication? (2)

A

Psyllium ( Metamucil )
Methyl cellulose ( citrucel)

71
Q

Bulk forming mechanism of action is what?

A

High fiber
They absorb water to increase bulk Distend bowel to stimulate bowel movement

72
Q

What the most important thing to know about bulk forming medication? (2)

A

If you’re going to give metamucil, which typically is a powder form, to not mix it or open it unless you are ready to drink it

If it sits for longer than 5mins it turns into this jelly like substances

And after you drink it, to drink 8 ounces of liquid ; to make sure it goes all the way the stomach

73
Q

Emollient is another class
What are the medications? (2)

A

Stool softeners : docustar sodium ( colace )

Lubricant : mineral oil

74
Q

What is the mechanism of action of emollient drug class?

A

Allows more water to be absorbed into the stool & lubricate fecal material and intestinal wall

75
Q

What are the medications we need to know for osmotic drug class? (3)

A

Glycerin
Lactose
Polyethylene glycol (PEG, Miralax)

76
Q

What is the mechanism of action of osmotic drug class? (2)

A

Increase fecal water content causing distention and increase peristalsis

Lactose decrease serum ammonia levels

77
Q

What are our saline drug clas medications ? (3)

A

Fleet enema
Milk of magnesia
Magnesium citrate

78
Q

What is the mechanism of action of saline?

A

Increase osmotic pressure and draw water into stool results in watery stool in 3-6 hours

79
Q

What are stimulant drug medications ?

A

Bisacodyl-dulcolax
Senokot

80
Q

What is the mechanism of action of stimulant?

A

Increase intestinal peristalsis

81
Q

What are bulk forming side effects ? (4)

A

Impaction
Esophageal blockage
Gas
Fluid imbalance

82
Q

What is emollient side effects? (2)

A

Mineral oil - decrease absorption of vitamins, aspiration causing lipid pneumonia

Fecal urgency / incontience

83
Q

What are 2 side effects of osmotic drug classes?

A

Abdominal bleeding
Rectal irritation

84
Q

What are side effects of saline ? (4)

A

Magnesium toxicity
Cramping
Diarrhea
Increase thirst

85
Q

What is side effects of stimulants? (5)

A

Poor absorption of nutrients
Discolored urine
Rectal irritation
Rash
GI irritation

86
Q

Another medication that is described in the book is chloride channel activators!!

How does it work?

Used ?
- idiopathic constipation in adults

Side effects are
- nausea
- diarrhea
- gas
- abdominal cramps
- edema

A

Activate chloride channels in the lining of the small intestine, leading to an increase in intestinal fluid secretion and motility

87
Q

What are some contraindication of laxatives?
- instruction
- undiagnosed abdominal pain
- no appendicitis
- diverticulitis
- ulcerative colitis

Spastic colon
Bowel obstruction
Pregnancy

A
88
Q

Biscacodyl interacts with what?

A

Milk
Antacids
Juices

89
Q

Practice question 1
Ondansetero has been ordered for a patient undergoing cancer chemotherapy to control the severe nausea and vomiting. What side effects should the nurse observe for?

Headache, dizziness, and fatigue
Anorexia and hair loss
Abdominal cramping and irritability
Psychosis and middle ear disturbances

A

Headache, dizziness, and fatigue

90
Q

Practice question 2
Bisacodyl has been ordered for a patient who is constipated. Which of the following does the nurse realize about bisacodyl?

Increase peristalsis to produce a bowel movement

Is incompatible with alcohol consumption

Should be avoided during pregnancy as it is teratogenic

May lead to paralytic ileus

A

Increase peristalsis to produce a bowel movement

91
Q

Practice question 3

A patient is ordered the stimulant laxative bisacodyl. Before administering the drug, it is most important for the nurse to assess the patient for what?

Hypertension
Anemia
Allergic to penicillin
Appendicitis

A

Appendicitis

92
Q

Practice question 4

Lactulose is ordered for a patient with liver disease. What would indicate the medication is exerting a positive therapeutic effect on the patient?

Decrease ascites
Decrease ammonia level
Decreased jaundice
Decrease blood pressure

A

Decrease ammonia level

343 Pharm Exam 4 (6 decks)

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