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NU 308 Pharmacology > Exam 5 GI > Flashcards

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

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2
Q

What are adverse effects of glucocorticoid antiemetics?

A
  • Adrenal insufficiency
  • Infection
  • Osteoporosis
  • Glucose intolerance
  • peptic ulcer disease
  • Sodium retention hypokalemia.
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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

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4
Q

What is the action of substance/neurokinin1 antagonists?

A

Inhibits substance P/neurokinin1 in
the brain

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5
Q

What is the indication for substance P/neurokinin 1 antagonists? (antiemetic)

A

prevent postoperative
nausea, vomiting, and CINV

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6
Q

What are adverse effects of substance P/neurokinin 1 antagonists?

A
  • Fatigue
  • Diarrhea
  • Dizziness
  • possible liver damage
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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.
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8
Q

What are contraindications for substance P/neurokinin1 antagonists?

A

breastfeeding

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9
Q

What is an example of substance P/neurokinin1 antagonists?

A

Aprepitant

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10
Q

What’s an example of serotonin antagonist antiemetics?

A

ondansetron

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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
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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).
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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
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14
Q

What are contraindications for ondansetron?

A
  • contraindicated in clients who
    have long QT syndrome
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15
Q

What is an example of a dopamine ant. antiemetic?

A

prochloroperazine

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16
Q

What does prochlorperazine do?

A
  • Prevents emesis related to
    chemotherapy, toxins, and
    postoperative recovery
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17
Q

What are adverse effects of prochlorperazine?

A
  • Extrapyramidal symptoms
    (EPSs)
  • Hypotension
  • Sedation
  • Anticholinergic effects
  • Dry mouth, urinary retention,
    constipation
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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.
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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
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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

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21
Q

What is an example of an antiemetic cannabinoid?

A

dronabinol

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22
Q

What are indications for dronabinol?

A
  • To control CINV and to increase
    appetite in clients who have AIDS
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23
Q

What are adverse effects of dronabinol?

A
  • Potential for dissociation, dysphoria
  • Hypotension, tachycardia
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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
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25
Q

What are adverse effects of dimenhydrinate and scopolamine?

A

sedation
anticholingeric effects

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26
Q

What are contraindications for dimenhydrinate and scopolamine?

A
  • Concurrent use of anticholinergic
    medications (antihistamines) can
    intensify anticholinergic effects of
    antiemetics
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27
Q

What do we teach patients using dimenhydrinate and scopolamine?

A
  • 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
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28
Q

What is the action of diphenoxylate + atropine?

A

Antidiarrheals activate opioid receptors in the GI
tract to decrease intestinal motility and to increase
the absorption of fluid and sodium in the intestine

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29
Q

What is the indication for diphenoxylate + atropine?

A
  • 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).
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30
Q

What are adverse effects of diphenoxylate plus atropine?

A
  • Alcohol and other CNS depressants can
    enhance CNS depression
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31
Q

What do we teach patients taking diphenoxylate plus atropine?

A
  • Advise clients to avoid drinking plain water
    because it does not contain necessary
    electrolytes lost in the stool.
  • Advise clients to avoid caffeine
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32
Q

What are contraindications for diphenoxylate plus atropine?

A
  • 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
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33
Q

What are adverse effects of metoclopramide?

A
  • Tardive Dyskinesia (high dose/long term)
  • Extrapyramidal symptoms
  • Sedation
  • diarrhe
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34
Q

What do we teach pts taking metoclopramide?

what adverse effects will they experience?

A
  • 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
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35
Q

What are indications for Alosetron?

A
  • 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
Q

What are adverse effects of alosetron?

A
  • Constipation result in GI toxicity
    (ischemic colitis, bowel
    obstruction, impaction, or
    perforation).
  • Diarrhea
  • Nausea
37
Q

How is alosetron prescribed?

A
  • 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
Q

What do we teach patients on alosetron?

A
  • 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
Q

What are nursing implications for alosetron?

A

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
Q

What is the action of lubiprostone?

A
  • Increases fluid secretion in the
    intestine to promote intestinal
    motility
41
Q

What are indications for lubiprostone?

A
  • Irritable bowel syndrome with
    constipation in females
  • Chronic constipation
42
Q

What are adverse effects of lubiprostone?

A
  • Diarrhea
  • Nausea
43
Q

What are dietary supplements used for?

A
  • used to treat manifestations of
    IBS, ulcerative colitis, and
    Clostridium difficile-associated
    diarrhea and rotavirus diarrhea
    in children
44
Q

What are indications of sulfasalazine?

A
  • Management of Crohn’s
    disease
  • Relief of mild to moderate acute
    episodes of ulcerative colitis
45
Q

What are adverse effects of sulfasalazine?

A
  • Blood disorders: Include
    agranulocytosis, hemolytic and
    macrocytic anemia
  • Nausea, fever, rash, arthralgia
46
Q

What antibiotics are used for PUD?

A

amoxicillin
Clarithromycin
Metronidazole

47
Q

What are the actions for antibiotics PUD?

A

eradication of H.pylori bacteria

48
Q

What are indications for PUD antibiotics?

A

Therapy should include
combination of two or three
antibiotics for 14 days to
increase effectiveness and
minimize development of
medication resistance.

49
Q

What are adverse effects of PUD antibiotics?

A

Nausea
* Diarrhea

50
Q

What are patient teaching points for PUD antibiotics?

A

Nausea and diarrhea are
common adverse effects.
* Take the full course of prescribed
medications

51
Q

What are the actions of H2 antagnoists?

A

block histamine’s action at
the H2 receptor
reducing
the production of
hydrochloric acid

52
Q

What are indications for H2 antagonists?

A
  • 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
Q

What are adverse effects of H2 antagonists?

A
  • Cimetidine: Blocked androgen receptors
    resulting in decreased libido,
    gynecomastia, and impotence
  • CNS effects (lethargy, hallucinations,
    confusion, restlessness)
54
Q

What are examples of H2 antagonists?

A
  • Cimetidine
  • Famotidine
    ranitidine
55
Q

What are administration guidelines for H2 antagonists?

A
  • 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
Q

What are contraindications/precautions for H2 antagonists?

A

Pregnancy Risk Category B

  • Dosages should be reduced in clients with
    moderate to severe kidney impairmen
57
Q

What do we teach patients on H2 antagonists?

A
  • 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
Q

What ist he number one treatment for DM type 2?

A

metformin

59
Q

What are adverse effects of metformin?

A
60
Q

What precautions do we take with metformin?

A
61
Q

What are indications for PPIs?

A
  • 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
Q

What are examples of PPIs?

A
  • Pantoprazole
  • Lansoprazole
63
Q

How do you administer pantaprazole?

A
  • 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
Q

What are contraindications/precautions for PPIs?

A
  • These medications increase the risk for
    pneumonia. Use cautiously in clients at high
    risk for pneumonia, including patients with
    COPD.
65
Q

What are teaching points for PPIs?

A
  • 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
Q

What are nursing implications for PPis?

A
  • 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
Q

What is the action of sucrulfate?

A

sucralfate into a
protective barrier that adheres to an ulcer.
This protects the ulcer from further injury
from acid and pepsin

68
Q

What are indications of sucrulfate?

A
  • 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
Q

What are adverse effects of sucrulfate?

A

Constipation
* There are no systemic effects
because sucralfate is minimally
absorbed and most of it is eliminated
in the feces

70
Q

How do you administer sucrulfate?

A
  • Administer on an empty stomach, 1 h before or 2
    hours after meals.
71
Q

What are contraindications for sucrulfate?

A

Pregnancy Risk Category B.

72
Q

What do we teach patients on sucrulfate?

A
  • 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
Q

What are nursing implications for sucrulfate?

A
  • Take sucralfate 30 min before or
    after antacids
74
Q

What are actions of aluminum hydtoxide?

A
  • Neutralize or reduce the acidity of gastric
    acid; can reduce pepsin activity if the pH
    is raised above 5
75
Q

What are indications of aluminum hydroxide?

A
  • Treatment of peptic ulcer
    disease.
  • Prevention of stress-induced
    ulcers.
  • Relief of the manifestations of
    GERD.
    Other Meds
  • Magnesium hydroxide
  • Calcium carbonate
76
Q

What are adverse effects of aluminum hydroxide?

A
  • 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
Q

What are contraindications for aluminum hydroxide?

A
  • 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
Q

What do we teach pts on aluminum hydroxide?

A
  • 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
Q

What are nursing implications of aluminum hydroxide?

A

Avoid antacids that w/ magnesium if impaired kidney
function

80
Q

what are indications for misoprostol?

A
  • 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
Q

What are adverse effects of misoprostol?

A

Diarrhea: With concurrent use of
magnesium antacids
* Dysmenorrhea, spotting

82
Q

What are contraindications/precautions of misoprostol?

A

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
Q

What do we teach patients on misoprostol?

A
  • Notify the provider of diarrhea,
    abdominal pain, dysmenorrhea,
    or spotting
  • Take at meals and at HS
84
Q

What is scopolamine used for?

A

motion sickness
patch behind the ear
wear it for 3 days
put on 4 hrs before sickness
drying agent too

85
Q

What are symptoms of anitcholingerics

A

cant see
cant pee
cant poop
cant spit

86
Q

What do we use cannabanoids for?

A

increase appetite in aids pts
help with chemo n/v

NU 308 Pharmacology (23 decks)

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