Exam 5 GI Flashcards
1
Q
What are indications for antiemetic glucocorticoids?
A
to treat chemotherapy-induced
nausea and vomiting(CINV)
Antiemetics are administered before
chemotherapy, which is more effective
than treating nausea. Combining three
antiemetics is more effective than using a
single antiemetic
2
Q
What are adverse effects of glucocorticoid antiemetics?
A
- Adrenal insufficiency
- Infection
- Osteoporosis
- Glucose intolerance
- peptic ulcer disease
- Sodium retention hypokalemia.
3
Q
What do we teach pts to monitor for with glucocorticoid antiemetics?
A
Monitor for and report manifestations of
infection,
hyperglycemia,
edema,
black, tarry
stools, or
low potassium (muscle cramping or
weakness
4
Q
What is the action of substance/neurokinin1 antagonists?
A
Inhibits substance P/neurokinin1 in
the brain
5
Q
What is the indication for substance P/neurokinin 1 antagonists? (antiemetic)
A
prevent postoperative
nausea, vomiting, and CINV
6
Q
What are adverse effects of substance P/neurokinin 1 antagonists?
A
- Fatigue
- Diarrhea
- Dizziness
- possible liver damage
7
Q
How do we administer substance P/neurokinin1 antagonists (antiemetic)
A
- To prevent postoperative nausea and
vomiting, administer a single dose within
three hours of anesthesia induction. - For CINV, administer one hour before
chemotherapy. The client will take one dose
daily for the next two days.
8
Q
What are contraindications for substance P/neurokinin1 antagonists?
A
breastfeeding
9
Q
What is an example of substance P/neurokinin1 antagonists?
A
Aprepitant
10
Q
What’s an example of serotonin antagonist antiemetics?
A
ondansetron
11
Q
What are indications for ondansetron? (serotonin ant. antiemetic)
A
- Prevents emesis related to
chemotherapy, radiation therapy,
and postoperative recovery. - Off-label uses include treatment of
nausea and vomiting related to
pregnancy and childhood viral
gastritis
12
Q
What are adverse effects of ondansetron? (serotonin ant. antiemetics)
A
- Headache
- Diarrhea
- dizziness
- Prolonged QT interval can lead
to serious dysrhythmia
(torsade’s de pointes).
13
Q
How do we administer ondansetron?
A
- Administer PO, IM, SL or IV
- Administer IV 1 hour before
chemotherapy or PO 1 hour before
anesthesia to prevent nausea and
vomiting
14
Q
What are contraindications for ondansetron?
A
- contraindicated in clients who
have long QT syndrome
15
Q
What is an example of a dopamine ant. antiemetic?
A
prochloroperazine
16
Q
What does prochlorperazine do?
A
- Prevents emesis related to
chemotherapy, toxins, and
postoperative recovery
17
Q
What are adverse effects of prochlorperazine?
A
- Extrapyramidal symptoms
(EPSs) - Hypotension
- Sedation
- Anticholinergic effects
- Dry mouth, urinary retention,
constipation
18
Q
How do we administer prochlorperazine?
A
- Administer PO, IM, rectal, or IV.
- To prevent postoperative nausea and
vomiting, administer a single dose within
three hours of anesthesia induction. - For CINV, administer one hour before
chemotherapy. The client will take one dose
daily for the next two days.
19
Q
What are contraindications for prochlorperazine?
A
- Promethazine is contraindicated in children
younger than 2 years old and should be
used cautiously in older children.
Respiratory depression from promethazine
can be severe
20
Q
What do we teach patients about prochlorperazine?
A
Possible adverse effects include restlessness,
anxiety, and spasms of the face and neck.
* Stop the med and inform the provider if EPSs
occur
* Rise slowly from lying to standing to stop
dizziness and falls.
* Avoid activities that require alertness, such as
driving due to sedation potential.
* Increase fluid intake.
* Increase physical activity by engaging in regular
exercise.
* Suck on hard candy or chew gum to relieve dry
mouth.
* Void every four hr. Monitor I&O and palpate the
lower abdomen area q 4 to 6 hr to check for
bladder fullness
21
Q
What is an example of an antiemetic cannabinoid?
A
dronabinol
22
Q
What are indications for dronabinol?
A
- To control CINV and to increase
appetite in clients who have AIDS
23
Q
What are adverse effects of dronabinol?
A
- Potential for dissociation, dysphoria
- Hypotension, tachycardia
24
Q
What are contraindications/precautions for dronabinol?
A
- Avoid using in clients who have
mental health disorders. - Use cautiously in clients who
have cardiovascular disorders
25
What are adverse effects of dimenhydrinate and scopolamine?
sedation
anticholingeric effects
26
What are contraindications for dimenhydrinate and scopolamine?
* Concurrent use of anticholinergic
medications (antihistamines) can
intensify anticholinergic effects of
antiemetics
27
What do we teach patients using dimenhydrinate and scopolamine?
* Can cause sedation; avoid driving or other activities that
require alertness
* reduce anticholinergic effects (sipping on fluids, use of
laxatives, voiding on a regular basis)
* increase fluid intake.
* increase physical activity in regular exercise
* suck on hard candy or chew gum to help relieve dry
mouth.
* Administer a stimulant laxative such as senna to counteract
a decrease in bowel motility, or stool softeners such as
docusate sodium to prevent constipation.
* void every 4 hr. Monitor I&O and palpate the lower
abdomen area every 4 to 6 hr to assess the bladder
28
What is the action of diphenoxylate + atropine?
Antidiarrheals activate opioid receptors in the GI
tract to decrease intestinal motility and to increase
the absorption of fluid and sodium in the intestine
29
What is the indication for diphenoxylate + atropine?
* Specific antidiarrheal agents can treat
the underlying cause of diarrhea. For
example, antibiotics can treat diarrhea
caused by a bacterial infection.
* Nonspecific antidiarrheal agents
provide symptomatic treatment of
diarrhea (decrease in frequency and
fluid content of stool).
30
What are adverse effects of diphenoxylate plus atropine?
* Alcohol and other CNS depressants can
enhance CNS depression
31
What do we teach patients taking diphenoxylate plus atropine?
* Advise clients to avoid drinking plain water
because it does not contain necessary
electrolytes lost in the stool.
* Advise clients to avoid caffeine
32
What are contraindications for diphenoxylate plus atropine?
* Diphenoxylate is contraindicated in clients who
have severe electrolyte imbalance or
dehydration.
* At recommended doses for diarrhea,
diphenoxylate does not affect the CNS system.
* It is a Controlled Substance Category V
* At high doses, clients can experience typical
opioid effects, such as euphoria or CNS
depression
33
What are adverse effects of metoclopramide?
* Tardive Dyskinesia (high dose/long term)
* Extrapyramidal symptoms
* Sedation
* diarrhe
34
What do we teach pts taking metoclopramide?
| what adverse effects will they experience?
* Inform clients of the possible adverse effects,
such as restlessness, anxiety, and spasms of the
face and neck.
* Administer an antihistamine, such as
diphenhydramine, to minimize EPS
35
What are indications for Alosetron?
* Approved only for female clients who
have severe **IBS-D** that has lasted
more than 6 months and has been
resistant to conventional
management.
36
What are adverse effects of alosetron?
* Constipation result in GI toxicity
(ischemic colitis, bowel
obstruction, impaction, or
perforation).
* Diarrhea
* Nausea
37
How is alosetron prescribed?
* Alosetron can only be prescribed by
providers enrolled in a special risk
management program. The client must
sign a Client-Physician Agreement
discussing risks, benefits, and
indications that the medication must be
stopped
38
What do we teach patients on alosetron?
* Watch for rectal bleeding, bloody diarrhea,
or abdominal pain and report to the
provider. Medication should be
discontinued.
* Manifestations should resolve within
1 to 4 weeks but will return one week
after the medication is discontinued
39
What are nursing implications for alosetron?
Because of the potentially fatal outcome of GI
toxicity, only clients who meet specific criteria
and are willing to sign a treatment agreement
can receive prescriptions for the medication
40
What is the action of lubiprostone?
* Increases fluid secretion in the
intestine to promote intestinal
motility
41
What are indications for lubiprostone?
* Irritable bowel syndrome with
constipation in females
* Chronic constipation
42
What are adverse effects of lubiprostone?
* Diarrhea
* Nausea
43
What are dietary supplements used for?
* used to treat manifestations of
IBS, ulcerative colitis, and
Clostridium difficile-associated
diarrhea and rotavirus diarrhea
in children
44
What are indications of sulfasalazine?
* Management of Crohn’s
disease
* Relief of mild to moderate acute
episodes of ulcerative colitis
45
What are adverse effects of sulfasalazine?
* Blood disorders: Include
agranulocytosis, hemolytic and
macrocytic anemia
* Nausea, fever, rash, arthralgia
46
What antibiotics are used for PUD?
amoxicillin
Clarithromycin
Metronidazole
47
What are the actions for antibiotics PUD?
eradication of H.pylori bacteria
48
What are indications for PUD antibiotics?
Therapy should include
combination of two or three
antibiotics for 14 days to
increase effectiveness and
minimize development of
medication resistance.
49
What are adverse effects of PUD antibiotics?
Nausea
* Diarrhea
50
What are patient teaching points for PUD antibiotics?
Nausea and diarrhea are
common adverse effects.
* Take the full course of prescribed
medications
51
What are the actions of H2 antagnoists?
block histamine’s action at
the H2 receptor
reducing
the production of
hydrochloric acid
52
What are indications for H2 antagonists?
* Prescribed to prevent or treat gastric and
duodenal ulcers, GERD, hypersecretory
conditions (Zollinger-Ellison syndrome),
heartburn, and acid indigestion
* Used in conjunction with antibiotics to
treat ulcers caused by H. pylori
* Management of urticaria
53
What are adverse effects of H2 antagonists?
* Cimetidine: Blocked androgen receptors
resulting in decreased libido,
gynecomastia, and impotence
* CNS effects (lethargy, hallucinations,
confusion, restlessness)
54
What are examples of H2 antagonists?
* Cimetidine
* Famotidine
ranitidine
55
What are administration guidelines for H2 antagonists?
* Treatment of peptic ulcer disease usually starts as an oral dose BID
until the ulcer is healed, followed by a maintenance dose, once qHS
famotidine can be administered IV if acute
* OTC meds can discourage clients from seeking appropriate health
care. Encourage clients to see a provider if manifestations persist
56
What are contraindications/precautions for H2 antagonists?
Pregnancy Risk Category B
* Dosages should be reduced in clients with
moderate to severe kidney impairmen
57
What do we teach patients on H2 antagonists?
* CNS effects are seen more often in older
adults who have kidney or liver dysfunction
* Smoking can decrease the effectiveness
and delay healing
* Avoid alcohol, spicy food, NSAIDS
* Increase fiber and fluid to prevent
constipation
* Adhere to the full regimen
58
What ist he number one treatment for DM type 2?
metformin
59
What are adverse effects of metformin?
60
What precautions do we take with metformin?
61
What are indications for PPIs?
* Minor adverse effects with short-term treatment include
headache, diarrhea, nausea, and vomiting.
Long term:
* Pneumonia/Osteoporosis/fractures/Rebound Acid
Hypersecretion
Hypomagnesemia/Clostridium difficille-associated diarrhea
62
What are examples of PPIs?
* Pantoprazole
* Lansoprazole
63
How do you administer pantaprazole?
* Pantoprazole can be administered to clients
intravenously. There can be irritation at the injection
site leading to thrombophlebitis. Monitor the IV site
for indications of inflammation (redness, swelling,
local pain), and change the IV site if indicated.
64
What are contraindications/precautions for PPIs?
* These medications increase the risk for
pneumonia. Use cautiously in clients at high
risk for pneumonia, including patients with
COPD.
65
What are teaching points for PPIs?
* Observe for adverse effects & report manifestations of a
respiratory infection.
* Increase vitamin D and calcium intake.
* low dose if possible and to taper slowly to discontinue
* monitor and report manifestations of hypomagnesemia
(tremors, muscle cramps, seizures
Take omeprazole one x day ac in the morning.
* Active ulcers should be treated for 4 to 6 weeks
66
What are nursing implications for PPis?
* Use the medication only for as long as needed
and taper before
* For long-term PPI therapy, obtain a baseline
magnesium level and monitor throughout therapy.
* Administer oral magnesium supplements
67
What is the action of sucrulfate?
sucralfate into a
protective barrier that adheres to an ulcer.
This protects the ulcer from further injury
from acid and pepsin
68
What are indications of sucrulfate?
* Treatment of acute duodenal ulcers
and maintenance therapy.
* Neutralize or reduce acidity of gastric
acid; can reduce pepsin activity if pH
is above 5.
* Investigational use of sucralfate
includes gastric ulcers and GERD
69
What are adverse effects of sucrulfate?
Constipation
* There are no systemic effects
because sucralfate is minimally
absorbed and most of it is eliminated
in the feces
70
How do you administer sucrulfate?
* Administer on an empty stomach, 1 h before or 2
hours after meals.
71
What are contraindications for sucrulfate?
Pregnancy Risk Category B.
72
What do we teach patients on sucrulfate?
* To prevent constipation, increase
dietary fiber and fluid intake.
* Take four times daily, 1 hr before
meals and again at bedtime.
* If needed, break or dissolve the
medication in water, but do not crush
or chew the tablet
73
What are nursing implications for sucrulfate?
* Take sucralfate 30 min before or
after antacids
74
What are actions of aluminum hydtoxide?
* Neutralize or reduce the acidity of gastric
acid; can reduce pepsin activity if the pH
is raised above 5
75
What are indications of aluminum hydroxide?
* Treatment of peptic ulcer
disease.
* Prevention of stress-induced
ulcers.
* Relief of the manifestations of
GERD.
Other Meds
* Magnesium hydroxide
* Calcium carbonate
76
What are adverse effects of aluminum hydroxide?
* Aluminum and calcium compounds:
Constipation
* Magnesium compounds: Diarrhea
* Fluid retention: those containing sodium
* Electrolyte imbalance
* Hypophosphatemia (aluminum)
* Hypercalcemia (Calcium)
* Alkalosis: increased risk with sodium
compounds
* Toxicity, hypermagnesemia
77
What are contraindications for aluminum hydroxide?
* Antacids decrease absorption of several meds,
including ranitidine and cimetidine.
* Allow at least 1 hr time between taking
antacids and these medications
* Prevent absorption of iron supplements, anxiety
medications
78
What do we teach pts on aluminum hydroxide?
* Chew tablets thoroughly and then drink at
least 8 oz of water or milk.
* Shake liquid formulations to ensure even
dispersion of the medication.
* Take all medications at least 1 hr before or
after taking an antacid
* Do not take other meds within 1 to 2 hr of
aluminum compounds without provider
approval
79
What are nursing implications of aluminum hydroxide?
Avoid antacids that w/ magnesium if impaired kidney
function
80
what are indications for misoprostol?
* Used in clients taking long-term
NSAIDs to prevent gastric ulcers.
* Unlabeled use: Used in clients who
are pregnant only to induce labor by
causing cervical ripening or induce
medical termination of pregnancy
81
What are adverse effects of misoprostol?
Diarrhea: With concurrent use of
magnesium antacids
* Dysmenorrhea, spotting
82
What are contraindications/precautions of misoprostol?
Pregnancy Risk Category X.
* Clients who could become pregnant must be
warned verbally and in writing about the
dangers of misoprostol. The client must have a
negative blood pregnancy test 2weeks before
starting therapy, be able to adhere to
contraceptive measures, and should start the
medication on the second or third day of the
menstrual cycle.
83
What do we teach patients on misoprostol?
* Notify the provider of diarrhea,
abdominal pain, dysmenorrhea,
or spotting
* Take at meals and at HS
84
What is scopolamine used for?
motion sickness
patch behind the ear
wear it for 3 days
put on 4 hrs before sickness
drying agent too
85
What are symptoms of anitcholingerics
cant see
cant pee
cant poop
cant spit
86
What do we use cannabanoids for?
increase appetite in aids pts
help with chemo n/v
