Drugs Affecting the Gastrointestinal System and Liver Flashcards
Heartburn - too much acid; triggered by variety reasons; burning feeling in chest/throat
Gastroesophageal reflux disease (GERD) - contents refluxing from stomach back into esophagus because LES weakness
Peptic ulcer disease (PUD) - ulcers like craters in stomach/duodenum go to diff layers
Duodenal ulcer
Common disorders of upper GI
Assessment focus:
Follow administration protocol - imp give at appropriate time and follow any guidelines in terms according to things admin simultaneously; make sure work best way
Educate:
Nursing and GI secretion drugs
Baseline H&P including allergies and medications
Focus: GI and abdominal assessment related to disorder and AE - assess where at with disorder; lot AE r/t GI sys
Assessment focus: - Nursing and GI secretion drugs
Non-pharm interventions for disorder - anytime diagnosed with disorder talk about these
Proper administration
Shortest duration to reduce risk of AE
Educate: - Nursing and GI secretion drugs
GI related
Nausea
Vomiting
Diarrhea
Constipation
Abdominal discomfort
Rash
GI secretion drugs: common AE
Neutralize stomach acid by direct chemical reaction; bicarbonate - base
MoA: - Antacids: prototype: Sodium Bicarbonate
relief of upset stomach r/t hyperacidity
Indications: - Antacids: prototype: Sodium Bicarbonate
PO: rapid onset, short duration, give PRN to treat symptoms (heartburn most common - not preventative measure) *also used IV for metabolic acidosis and cardiac emerg. (more severe AE profile and urgent nursing)
Route: - Antacids: prototype: Sodium Bicarbonate
gastric acid rebound (take antacid (base) to neutralize and med do too well and stomach realizes pH too low and have additional acid released), belching, fluid retention, hypokalemia; metabolic alkalosis (headache, confusion, irritability, nausea, weakness, tetany) if overdosed - if take OTC more than directed and long duration time risk for developing this
AE: - Antacids: prototype: Sodium Bicarbonate
Give other meds 1-2 hours after oral antacid: bind to lot other drugs and less absorption drugs so not effective; chew tab and give with 8 oz water; do not take with milk; electrolyte disturbances; teach – not to take > 2 wks - prolonged period get looked at - reduce risk of developing metabolic alkalosis; OTC
Nursing: - Antacids: prototype: Sodium Bicarbonate
blocks histamine-2 receptor sites to reduce gastric acid secretion and pepsin production: when histamine-2 receptors activated results in increased acid secretion in stomach - reduce acid secretion by blocking these receptors
MoA: - Histamine type 2 (H2) receptor antagonists (H2RA): Prototype: cimetidine (Tagamet)
GI ulcers; GERD; hypersecretory conditions; heartburn and acid indigestion
Indications: - Histamine type 2 (H2) receptor antagonists (H2RA): Prototype: cimetidine (Tagamet)
headache, dizziness; severe cases: cardiac arrhythmias - typ not problematic for most people, concerned if have underlying cardiac prob/arrhythmia
AE: - Histamine type 2 (H2) receptor antagonists (H2RA): Prototype: cimetidine (Tagamet)
Teach: smoking diminishes effectiveness of med; extended duration (> 6 months) risk for vit B12 malabsorption: histamine 2 receptor and PPI can induce atrophic gastritis - not secrete intrinsic factor so have malabsorption B12 because carrier for vit into bloodstream so develop pernicious anemia - use for shortest duration possible - risk with long-term use; OTC
Nursing: - Histamine type 2 (H2) receptor antagonists (H2RA): Prototype: cimetidine (Tagamet)
Blocks secretion hydrochloric acid in the stomach; ALL gastric acid secretion is temporarily blocked; efficacy highest - gold standard
MoA: - Proton Pump Inhibitors (PPI): Prototype: omeprazole (Prilosec)
sig GERD/not responsive to drugs safer long-term, GI ulcers - decrease acid secretion and allow it to heal; prevention ulcers in acute care - stress ulcers
Indications: - Proton Pump Inhibitors (PPI): Prototype: omeprazole (Prilosec)
long term use risk - monitor (1+ year): atrophic gastritis (lack IF: malabsorption of vit. B12-pernicious anemia), increased risk for osteoporosis related fracture (decrease Ca2 absorption in pts so without adequate Ca not make good bones); associated with development C-diff
Caution: - Proton Pump Inhibitors (PPI): Prototype: omeprazole (Prilosec)
Headache, dizziness, URI; pretty well tolerated - concentrate on long-term risks
AE: - Proton Pump Inhibitors (PPI): Prototype: omeprazole (Prilosec)
administer on an empty stomach (30-60 min before a meal) - med enough time to work so acid secretion can be blocked - eat stims acid release, early enough before start eating so can happen before acid secreted by stomach when wake up and eat; Teach – shortest duration - take break from PPIs to reduce risk of long-term issues - med vacations, report s/s severe diarrhea: C. diff; monitor H/H = taking long term, developed anemia; prescription/OTC; gold standard for UGI secretions
Nursing: - Proton Pump Inhibitors (PPI): Prototype: omeprazole (Prilosec)
Binds to base of ulcers and erosions forming protective barrier over ulcer and protects from acid secretion (can make the ulcer worse to help form barrier and help ulcer heal) and from pepsin
MoA: - Gastrointestinal Protectant: Prototype: sucralfate (Carafate)
mainly GI ulcer; chronic renal failure/hyperphosphatemia
Indications: - Gastrointestinal Protectant: Prototype: sucralfate (Carafate)
constipation, dry mouth, dizziness
AE: - Gastrointestinal Protectant: Prototype: sucralfate (Carafate)
Administer med on an empty stomach, 1 hour before or 2 hours after meals and at bedtime - sig frequency; admin other meds at least 2 hours before (impairs absorption)
Nursing: - Gastrointestinal Protectant: Prototype: sucralfate (Carafate)
When reviewing the health history of a patient prescribed an antacid, the nurse knows that antacids containing magnesium need to be used cautiously in patients with which condition?
A.Hypertension
B.Renal failure
C.Peptic ulcer disease
D.Heart failure
Answer: B
Magnesium plays minor role in HTN
Rationale: Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.
Renal failure - kidneys help control electrolyte balance - if take with magnesium might get too high
A client has taken omeprazole for many years. Which test should the nurse anticipate the primary care provider to order to monitor for an adverse effect?
A.Esophagogastroduodenoscopy (EGD)
B.Serum creatinine
C.Bone density scan
D.H. Pylori test
Answer: C
Complication related to med with long-term use: risk for osteoporosis
Rationale: New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.
Laxatives treat constipation
Assessment
Monitor for AE
Monitor for therapeutic effect
Implementation
Teaching
Laxatives: nursing role and laxatives
Baseline H&P including allergies and medications
Focused assessment (GI): bowel sounds, I&O, electrolytes, BM
Contraindicated in acute bowel disorders such as ileus, obstruction, ischemia, perforation - make prob worse to stim GI tract, fix prob before laxatives
Assessment - Laxatives: nursing role and laxatives
Loose stools (diarrhea - sometimes scheduled/PRN), nausea, vomiting, abdominal pain, dehydration - too many loose stools from too much med, electrolyte imbalance - too many loose stools from too much med
Monitor for AE- Laxatives: nursing role and laxatives
Achievement of a soft bowel movement within 24 hours of administration
Monitor for therapeutic effect - Laxatives: nursing role and laxatives
HOLD if loose stools - too much
Teach: Encourage 3 L water daily - prevent hard stools, high fiber diet to stim bowels, increase activity
For multiple PRN softener/laxative orders:
Implementation - Laxatives: nursing role and laxatives
Teach not to take a laxative if experiencing nausea, vomiting, abdominal pain - sign of acute bowel disorder and need eval
Contact provider if experiencing severe abdominal pain, muscle weakness, cramps, and/or dizziness - signs of more acute bowel prob; too much laxatives and dehydration and electrolyte imbalance
Long-term use of laxatives results in decreased bowel tone and may lead to dependency and once happens hard revert off them - bowel not stim peristalsis on own; use for no more than 7 days unless directed; somethings take where less dependency or situations where have take it
Teaching - Laxatives: nursing role and laxatives
Variety laxatives and routes choose from
First use docusate - stool softener; most handle without issue; most gentle laxative
No results within 24 hrs to more powerful laxatives, then bisacodyl or polyethylene glycol (multiple drugs may be needed to achieve results)
For multiple PRN softener/laxative orders:
Promotes electrolyte and water absorption into colon, promotes incorporation of water into the stool (results in stool softening); pulls water into colon; for first line
MoA: - Lubricant / Stool Softener: Prototype: docusate (Colace)
Relief and prevention of constipation, prevent straining - softens little bit; not same amount of volume as miralax
Indications: - Lubricant / Stool Softener: Prototype: docusate (Colace)
PO or suppository
Route: - Lubricant / Stool Softener: Prototype: docusate (Colace)
well-tolerated, low risk for dehydration and electrolyte imbalance - not big response to it
AE: - Lubricant / Stool Softener: Prototype: docusate (Colace)
First-line pharmacologic therapy for prevention of constipation; OTC
Nursing: - Lubricant / Stool Softener: Prototype: docusate (Colace)
Chemical irritant that directly stimulates GI tract motility; more potent than docusate
MoA: - Bowel Chemical Stimulant: Prototype: bisacodyl (Dulcolax)
constipation, evacuate the bowel for diagnostic procedures - colonoscopy - bowel prep
Indications: - Bowel Chemical Stimulant: Prototype: bisacodyl (Dulcolax)
PO or suppository
Route: - Bowel Chemical Stimulant: Prototype: bisacodyl (Dulcolax)
see nursing role - lot risk for dehydration and electrolyte imbalance because lot loose stools esp if for prep
AE: - Bowel Chemical Stimulant: Prototype: bisacodyl (Dulcolax)
Admin PO with water (interact milk, juice, antacids - impairs absorption)
Nursing: - Bowel Chemical Stimulant: Prototype: bisacodyl (Dulcolax)
Increase water absorption into the colon and GI tract (water follows polyethylene glycol; which stays in the colon and GI tract); more potent laxative for getting water into stool
MoA: - Bulk Stimulants: Hyperosmotic laxative: Prototype: polyethylene glycol (Miralax)
constipation, evacuate bowel for diagnostic procedures (high doses)
Indications: - Bulk Stimulants: Hyperosmotic laxative: Prototype: polyethylene glycol (Miralax)
see nursing role; high risk for dehydration and electrolyte imbalance esp if taking lot of it
AE: - Bulk Stimulants: Hyperosmotic laxative: Prototype: polyethylene glycol (Miralax)
Mix with 4-8 oz of water; acute care fall risk with bowel prep - take lot of it, big dose and need go to bathroom, need consider that for BM - people nearby to help and ensure have call light
Nursing: - Bulk Stimulants: Hyperosmotic laxative: Prototype: polyethylene glycol (Miralax)
The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications or cautions for the use of oral laxatives? Select all that apply.
A.Nausea and vomiting
B.Ingestion of toxic substances
C.Undiagnosed abdominal pain
D.Fecal impaction
E.Acute surgical abdomen
F.Irritable bowel syndrome
Answer: A, C, D, E
Obstruction and other things for impaction
Use laxatives for toxic substances to flush it out
Rationale: Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for other laxative use
Slow things down
Contraindications:
Assess:
Teach:
Anti-diarrheals: nursing implications
Diarrhea caused by poisoning or by bacterial toxins, or viral infection; any infectious agent - allows stay in GI tract and prolongs duration of illness because flushing it out as stool
Acute abdominal disorders including GI obstructions - figure out prob and address
Contraindications: - Anti-diarrheals: nursing implications
GI
Baseline H&P including allergies and medications
I & O’s and elimination patterns, electrolytes, hydration, bowel sounds and abdomen
Number BM, signs dehydration/electrolyte imbalances
Therapeutic effect: decrease number of bowel movements
Monitor for Adverse effects
Assess: - Anti-diarrheals: nursing implications
Teach to take medications exactly as prescribed - do not overtake them; some really slow down GI tract quickly but can cause them not have BM for long-period of time because not want cause constipation - potent ones
Notify health care provider if symptoms persist after 2 days and/or s/s of dehydration - get evaluated, fluids to replace; check out for something causing diarrhea
Do not use for infectious diarrhea - make it worse
Keep/stay hydrated: drink lots fluids to replace diarrhea: 3 L water/day
Teach: - Anti-diarrheals: nursing implications
Slow the motility of GI tract through direct action on lining of GI tract
MoA: - Antidiarrheals: Prototype: Loperamide (Imodium)
non-infectious diarrhea
Indications: - Antidiarrheals: Prototype: Loperamide (Imodium)
constipation - go opp way by slowing down GI tract too much, abdominal distension, abdominal discomfort, nausea, dry mouth
AE: - Antidiarrheals: Prototype: Loperamide (Imodium)
admin drug after each loose stool; not to exceed recommended daily maximum dose; OTC
Nursing: - Antidiarrheals: Prototype: Loperamide (Imodium)
Nausea - complex reflex reaction to various stimuli
Antiemetics local or central effect
Goal is target chemoreceptor trigger zone that then triggers vomiting center in the medulla
Many classifications used to treat/help:
N&V
Anticholinergics
Antihistamines
Antidopaminergics
Neurokinin receptor antagonists
Prokinetics
Serotonin blockers
Tetrahydrocannabinoids
Many classifications used to treat/help: - N&V
Baseline H&P including allergies and medications
Focus: GI, I&O, neuro/LOC - sedation common with antiemetic meds
Document emesis output amount, color and frequency (times); helps us understand if intervention effective but need baseline
Signs/symptoms dehydration, electrolyte imbalance from vomiting - K sig lost through emesis
Fall risk - not know vomit until happens; sedation factor of meds
Drug-drug: CNS depressants: since both cause sedation and can make it worse
Assessment: - Nursing and antiemetic agents
Give PRN medication as appropriate (ondansetron first line tx (PRN list given) - dose range and routes; good place start with pat but ask what works best for them) - standing order protocol
Consider appropriate route, use least invasive
Verify route – wrong route can be dangerous! Risks increase with IV
Preventative therapy: admin 30-60 minutes prior to chemotherapy dose or end of surgery; prevent known circumstance of n&v give 30-60 before
Implementation: - Nursing and antiemetic agents
Timing of administration - take antiemetic one hour before opioid for it to be efficient; want effect before precipitating factor
Do not operate heavy machinery - many cause sedation
Teach: - Nursing and antiemetic agents
Therapeutic effects: absence of nausea and/or vomiting - reassess pat after intervention in approrpiate amount of time
Document response to intervention
AE: drowsiness, lot can cause dizziness (increase risk for falls), cardiovascular implications
Evaluation: - Nursing and antiemetic agents
Polypharmacy, anticholinergic effects, CNS effects - increased risk for falls: increased sedation
Lifespan older adults: - Nursing and antiemetic agents
Pay attention: What one ordered and route
Oral
Oral disintegrating tablet (ODT)
Transdermal patch (drug: scopolamine)
Suppository
Intramuscular
Intravenous
Consider patient situation
Oral preferred, but if vomiting, select alternate route (contact provider)
Suppository often used in hospice care - not always have cognitive awareness for PO drugs
Antiemetic routes: be attentive
blocks serotonin peripherally, centrally and small intestine; blocks chemoreceptor trigger zone (CTZ)
MoA: - Serotonin Blockers: Prototype: Ondansetron (Zofran)
Nausea and vomiting (post-op, chemotherapy, viral illnesses)
Indications: - Serotonin Blockers: Prototype: Ondansetron (Zofran)
cardiac arrhythmias, CNS depression
Caution: - Serotonin Blockers: Prototype: Ondansetron (Zofran)
drowsiness, dizziness, headache, diarrhea, prolonged QTc/causes dysrhythmias - cautious about administering to those with underlying cardiac arrhythmias because worsens
AE: - Serotonin Blockers: Prototype: Ondansetron (Zofran)
see general nursing
Nursing: - Serotonin Blockers: Prototype: Ondansetron (Zofran)
The nurse is teaching a client who has been prescribed an antiemetic. What should the nurse include in the teaching?
A.Occasional problems with taste may be experienced
B.It is safe to take this medication with a glass of wine
C.Avoid driving as this medication can cause drowsiness
D.Periodic monitoring of blood pressure is required
Answer: C
Rationale: Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs must not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped unless instructed to do so.
The nurse is caring for a client prescribed ondansetron and baclofen. The nurse should prioritize which assessment?
A.Bowel sounds
B.Level of consciousness
C.Intake and output
D.Range of motion
Answer: B
Baclofen - pain
Both can cause CNS depression
Rationale: The nurse’s most immediate concern with the combination of these drugs is drowsiness. Drowsiness increases the risk for falls. Although bowel sounds and I&O are a priority for ondansetron, they are not a priority with baclofen. Range of motion should be assessed with the use of baclofen, but is not essential to ondansetron.
Leads to acute liver failure: nausea, vomiting, jaundice, malaise, confusion
When OD can cause acute liver failure - life-threatening and do have an antidote
Treat/antidote: acetylcysteine
Use within 24 hours of toxicity
Acute acetaminophen overdose - Drugs for liver disorders
Liver cirrhosis, increased ammonia levels
Encephalopathy: liver responsible for metabolizing ammonia to urea, cirrhosis not make process happen and ammonia in bloodstream and once to brain becomes really toxic, have this; act strangely and weird behaviors
Treat: lactulose
Excretes ammonia in stool - body cannot process it; get out someway to reverse encephalopathy
Loose stools are expected therapeutic effect
Hepatic encephalopathy - Drugs for liver disorders
Pulls fluid out of venous system and into lumen of small intestine; Inhibits diffusion of ammonia back to blood, excreting more ammonia in stool; if not have liver disease/cirrhosis - apply as would for laxatives; if for liver disease - does MoA for ammonia
MoA: - Hyperosmotic Laxative: Prototype: Lactulose (Enulose)
hepatic encephalopathy, constipation
Indications: - Hyperosmotic Laxative: Prototype: Lactulose (Enulose)
oral or enema; hepatic encephalopathy: might be scheduled to prevent it; if acute and elevated ammonia levels given frequently; constipation: 1/day
Route: - Hyperosmotic Laxative: Prototype: Lactulose (Enulose)
n/v/d; electrolyte imbalances; potential dehydration
AE: - Hyperosmotic Laxative: Prototype: Lactulose (Enulose)
Titrate as directed (# of loose stools - to excrete enough ammonia to bring down their levels) or scheduled dose; monitor ammonia levels closely because goal is to bring them down, I & O, electrolytes, mental status, skin rectal area; use caution w/additional laxatives; Teach: bad taste; compliance if have liver disease - have lot loose stools every day not ideal - uncomfy, lot trips to bathroom, rectal irritation; not taste great so lot barriers to compliance get hepatic encephalopathy quickly and readmitted frequently; not have be loose but frequent enough pace to keep ammonia levels down
Nursing: - Hyperosmotic Laxative: Prototype: Lactulose (Enulose)
Decrease volume: Diuretic (HCTZ); Inhibit RAAS (lisinopril, losartan)
Decrease resistance: Vasodilation; Inhibit RAAS (lisinopril, losartan)
How do the drugs work to reduce BP
BP
Most imp nursing assessment prior to administering antihypertensive
Hypotension
Falls
Rebound HTN if abruptly stop taking it
Probs can result from taking an antihypertensive
Check BP: Goal is SBP around 120 mmHg and/or DBP around 80 mmHg - low enough not have complications from long-term HTN; not too much med where hypotensive
Avoid hypotension - may need multiple to achieve goal
Eval effectiveness of antihypertensive drug
