Exam I Flashcards
The overproduction of stomach acid is called…
Gastric hyperacidity
These are basic compounds composed of different combinations of acid neutralizing ionic salts…
Antacids
This is the enzyme in the stomach that breaks down proteins
Pepsin
What are the four main conditions caused by hyperacidity?
Acid reflux,
Ulcer disease,
Esophageal damage,
Esophageal cancer
_____ _____ aids digestion and also serves as a barrier to infection
Hydrochloric acid (HCl)
_____ is a base that is a natural mechanism to prevent hyperacidity
Bicarbonate
_____ is an enzyme precursor to pepsin, and enzyme that digests dietary proteins
Pepsinogen
_____ have a variety of anti-inflammatory and protective functions
Prostaglandins
What are the three primary types of glands in the stomach?
Cardiac,
Pyloric,
Gastric
What is the maintained pH level of the stomach?
1 to 4
Which substances stimulate HCl secretion?
Food,
Caffeine,
Chocolate,
Alcohol
Excess consumption of large, fatty meals or alcohol, and emotional distress can lead to hyper production and disorders such as peptic ulcer disease
_____ _____ _____ is a general term for gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin.
Peptic ulcer disease
_____ is the activated form of pepsinogen
Pepsin
The sight, smell, and taste of food and its presence in the stomach are the primary stimulus for the release of _____ from the parietal cells.
HCl
Ulceration is driven by the protein breakdown action of _____ together with the causative effects of _____. This causes acid-peptic disorders (peptic ulcer disease)
Pepsin,
HCl
What is the first line treatment for H. Pylori?
10-14 days of PPI and antibiotics
What causes GI lesions?
Decreased blood flow,
Mucosal ischemia,
Hypo perfusion,
Reperfusion injury
_____, _____, and _____ predispose patients to GI bleed.
NG tubes,
Suctioning,
Ventilators
Which drug class is a histamine receptor blocker?
Proton Pump Inhibitor (PPI)
_____ are basic compounds used to neutralize stomach acid
Antacids
What is he mechanism of action for antacids?
Neutralizes stomach acid,
Promotes gastric mucosal defense
Aluminum salts, magnesium salts, calcium salts, and sodium bicarbonate salts are all forms of ______
Antacids
_____ and _____ salts can cause constipation
Aluminum,
Calcium
_____ salts can cause diarrhea
Magnesium
_____ salts can cause kidney stones
Calcium
_____ salts can cause metabolic alkalosis
Sodium bicarbonate
_____ salts are recommended for real disease
Aluminum
_____ and _____ salts are dangerous for patients with renal disease
Magnesium,
Calcium
Antacids can effect _____ _____ and cause interactions with drugs such as tetracycline, thyroid hormones, corticosteroids, digoxin, and some antibiotics.
GI absorption
Tums antacids are a _____ salt
Calcium
Milk of Magnesia is a _____ salt
Magnesium
Basajel is a _____ salt
Aluminum
_____ _____ reduce acid secretions, increasing pH) by blocking H2 receptors of the acid producing parietal cells.
H2 antagonists
What are the indications for antacids?
Peptic ulcer,
Gastritis,
Gastric hyperacidity,
Heartburn
What are the indications for H2 antagonists?
GERD,
Peptic ulcer disease,
GI bleed,
Erosive esophagitis
What are the side effects of H2 antagonists?
Confusion and disorientation in the elderly
Ranitidine (Zantac) and Famotidine (Pepcid) can cause thrombocytopenia
Cimetidine (Tagamet) may induce impotence and Gynacomastia
The H2 anatagonist ______ may cause impotence and Gynacomastia
Cimetidine (Tagamet)
The H2 antagonist _____ may raise the blood concentration of certain drugs, making it dangerous for the elderly.
Cimetidine (Tagamet)
______ reduces the effectiveness of H2 antagonists
Smoking
When should H2 antagonists be taken in relation to antacids?
1-2 hours before antacids
During assessment, what is important to note when the patient uses H2 antagonists?
- Renal and liver function (BUN, creatinine, bilirubin, ALP, AST, ALT)
- Level of consciousness
During assessment, what is important to note when the patient uses Antacids?
Electrolyte disturbance (sodium bicarbonate causes imbalance)
What is the patient teaching when giving antacids?
- Thoroughly chew all chewable tablets,
- Thoroughly shake all liquids,
- Drink 8oz of water to aid in absorption,
- Do not take within 1-2 hours of other medications (altered absorption),
- Call dr. w/prolonged diarrhea/constipation, increased abdominal pain, nausea, vomiting, blood in vomit or stool
- if taking enteric-coated medications, antacids may prematurely dissolve coating and cause stomach upset
What are the indications for proton pump inhibitors (PPIs)?
GERD,
Peptic Ulcer Disease,
NSAID induced ulcers,
Treatment of H-Pylori
What is the mechanism of action for proton pump inhibitors (PPIs)?
Builds to H+/P+ ATP enzyme,
Blocks H+ from parietal cells into stomach
What are the side effects of proton pump inhibitors (PPIs)?
Magnesium depletion,
Osteoporosis
What are the drug interactions for proton pump inhibitors (PPIs)?
- Increased serum levels of diazepam and phenytoin
- Chance of increased bleeding in patients taking a PPI and warfarin
- Absorption interference can occur with ketoconazole, ampicillin, iron salts, and digoxin
- risk of death if given to those with cardiac issues
What are the nursing considerations for those taking proton pump inhibitors (PPIs)?
- Take on an empty stomach, 30-60 minutes before eating
- Assess swallowing capacity due to size of some oral capsules
- Assess for history of osteoporosis (speeds bone mineral loss)
- Discuss all medications being taken for drug interaction
- Assess for abdominal distention and rigidity, may indicate medical emergency
- Predisposition to C-diff
- Potential for pneumonia
- Depletes magnesium
- Granules from capsules can be given via NG tube, must be 16 gauge
What patient teaching is required with proton pump inhibitors (PPIs)?
Take with food
What are two popular H2 antagonists and what form do they come in?
Cimetidine (Tagamet), PO, has potential for drug interactions;
Famotidine (Pepcid), PO and IV, no drug interactions
What is the primary drug used as a mucosal protectant in the treatment of active stress ulcerations and long-term therapy for peptic ulcer disease (PUD)?
Sucralfate (Carafate)
Side effects are uncommon but include nausea, constipation, and dry mouth
What is the mechanism of action for anti-cholinergics?
Blocks acetylcholine receptors in the vestibular nuclei and reticular formation
What is the mechanism of action for antihistamines?
Block H1 receptors, preventing acetylcholine from binding to receptors in the vestibular nuclei
What is the mechanism of action for anti-dopaminergics?
Blocks dopamine in the CTZ and may also block acetylcholine
What is the mechanism of action for prokinetics?
Blocks dopamine in the CTZ or stimulates acetylcholine receptors in the G.I. tract
What is the mechanism of action for serotonin blockers?
Blocks serotonin receptors in the G.I. tract, CTZ, and VC
What are the indications for anti-cholinergics?
Motion sickness,
secretion reduction before surgery,
nausea and vomiting
What are the indications for antihistamines?
Motion sickness, nonproductive cough, sedation, rhinitis, allergy symptoms, nausea and vomiting
What are the indications for anti-dopaminergics?
Psychotic disorders (mania, schizophrenia, anxiety), intractable hiccups, nausea and vomiting
What are the indications for prokinetics?
Delayed gastric emptying,
Gastroesophageal reflux,
nausea and vomiting
What are the indications for serotonin blockers?
Nausea and vomiting associated with chemotherapy, postoperative nausea and vomiting
What antiemetic category is meclizine (antivert) in and what are the indications?
Antihistamine,
Motion sickness, nonproductive cough, sedation, rhinitis, allergy symptoms, nausea and vomiting
What antiemetic category is metaclopramide (reglan) in and what are the indications?
Prokinetics,
Delayed gastric emptying, gastroesophageal reflux, nausea and vomiting
Prokinetic contribute to regular motility
What antiemetic category is ondasetron (zofran) in and what are the indications?
Serotonin blockers,
Nausea and vomiting associated with chemotherapy, postoperative nausea and vomiting
What antiemetic category is prochlorperazine (compazine) in and what are the indications?
Antidopaminergics, Psychotic disorders (mania, schizophrenia, anxiety), intractable hiccups, nausea and vomiting
What are the adverse affects of antihistamines such as meclizine (Antivert)?
Dizziness, drowsiness, confusion, blurred vision, dilated peoples, dry mouth, urinary retention
What are the adverse affects of antidopaminergics such as prochlorperazine (compazine)?
Orthostatic hypotension, tachycardia, EPS, tardive dyskinesia, headache, blurred vision, dry eyes, urinary retention, dry mouth, nausea and vomiting, anorexia, constipation
What are the adverse effects of prokinetic such as metaclopramide ?
Hypotension, supraventricular tachycardia, sedation, fatigue, restlessness, headache, dystonia, dry mouth, nausea and vomiting, diarrhea
What are the adverse effects of serotonin blockers such as ondasetron?
Headache, diarrhea, rash, bronchospasm, prolonged QT interval
A patient is receiving a continuous tube feeding via of PEG tube. Which antiemetic drug would most likely be prescribed for this patient?
Prokinetics,
Metaclopramide (Reglan)
Which group of anti-emetics does the nurse identify as most likely to cause a prolonged QT interval, which can lead to sudden cardiac death?
Serotonin blockers
What are the nursing implications for anti-emetics and antinausea drugs?
- Assess complete nausea and vomiting history including precipitating factors
- Assess current medications
- Assess for contradictions and potential drug interactions
- Taking anti-emetics with alcohol may cause severe CNS depression
- Anti-emetics may cause severe drowsiness
- Advise patient to change position slowly to avoid hypotensive effects
- Anti-emetics for chemotherapy are given 30 to 60 minutes before treatment
Which anti-emetics are used for chemotherapy induced nausea and vomiting?
- Prokinetics, Metoclopramide (Reglan); taken by mouth with onset of action at 20 to 60 minutes and duration of action 3 to 4 hours
- Serotonin blockers, Ondansetron (Zofran); taken by mouth or given by IV with onset of action 15 to 30 minutes and duration of action 6 to 12 hours
Which anti-emetic are used for motion sickness prophylaxis?
Antihistamines, meclizine (Antivert)
Taken by mouth with onset of action at one hour and duration of action 8 to 24 hours
Which herbal therapy is used to treat nausea and vomiting, morning sickness, and motion sickness?
Ginger
_____ _____ is the administration of nutrients by around other than the alimentary canal, such as intravenously
Parenteral nutrition
_____ _____ _____ is the intravenous administration of the total nutrient requirements of the patient with gastrointestinal dysfunction, accomplished via peripheral or central venous catheter
Total parenteral nutrition (TPN)
_____ nutrition is the provision of food or nutrients through the gastrointestinal tract, either naturally for by feeding tube
Enteral
What are the adverse effects of TPN/PPN?
Phlebitis,
Fluid overload
What are the nursing considerations for TPN/PPN?
- Assess for nausea and vomiting,
- Assess labs (protein, albumin,BUN, RBC, WBC, B12, hemoglobin, hematocrit, cholesterol, electrolytes, lymphocytes, serum transferrin, iron, creatinine, lipids, urinalysis)
pH must be ____ or lower to provide NG tube feeding
5.5
_____ attach to enzymes or coenzymes and help them activate anabolic (tissue building) processes
Vitamins
What vitamin does the nurse expect to be ordered for a patient diagnosed with Warnicke’s encephalopathy?
Vitamin B1 (thiamine)
What are the nursing implications for parenteral nutrition administration?
- Monitor labs: kidney, lipids, magnesium, phosphorus, calcium, vitamin D
- Evaluate for disturbed body image
- Monitor blood sugars every six hours
- Administration runs 12 to 24 hours
- Dual nurse check off
- Requires central line
- May only be infused with lipids
- Infuse through port closest to midline
What are the indications for TPN administration?
- to rest intestinal and bowel structures inflamed or irritated due to disease processes
- to provide nutrition needed for healing and health sustaining function
Which lab values are monitored during TPN administration ?
H&H, WBC, RBC, total protein, Albumin, CBC, BUN, B12
Which vitamin is most often indicated for the prevention and treatment of vision alterations?
Vitamin A
Vegetarians are most at risk for which vitamin deficiency?
B12
What vitamin does the nurse identify as useful in the treatment of hyperlipidemia?
B3 (Niacin)
The _____ lobe of the pituitary gland is responsible for growth hormone (GH), TSH, prolactin, FSH &LH
Anterior
The _____ lobe of the pituitary gland is responsible for the Antidiuretic hormones kidneys (ADH) and oxytocin (uterus)
Posterior
_____ is the drug that alleviates symptoms of carcinoid tumors. They help control the secretion of vasoactive intestinal polypeptide (VIP), which can cause profuse diarrhea, flushing, and hypotension. It is also use to treat esophageal varices.
Octreotide (Sandostatin)
Can be given IV, IM, or SubQ
When administering octreotide (Sandostatin) to a patient, it is most important for the nurse to assess which parameter?
Blood sugar
May impair gallbladder function and should be used with caution for patients with renal impairments
May cause prolonged QT interval, which is enhanced if taken with Ciprofloxin (Cipro), causing sudden cardiac death
Which two drugs are used in the treatment of diabetes insipidus because of their vasoconstrictor properties. They also treat various types of bleeding, in particular gastrointestinal hemorrhage.
Vasopressin (Pitressin),
Desmopressin (Minirin, Stimate)
Which Antidiuretic Hormone treats hemophilia A and type I Von Willebrand’s disease (familial clotting disorder)?
Vasopressin (Pitressin),
Desmopressin (Minirin, Stimate)
Which antidiuretic hormone can be used on patients with pulseless cardiac arrest?
Vasopressin (Pitressin)
Rarely used, must wait 20 minutes before administration of another dose
Which somatostatin may impair gallbladder function and should be used with caution for patients with renal impairments and may cause prolonged QT interval, which is enhanced if taken with Ciprofloxin (Cipro), causing sudden cardiac death
Octreotide (Sandostatin)
Monitor creatinine
Which anterior pituitary hormone is used to promote growth in children?
Somatropin (Humatrope)
- Also used for patients with HIV infection with wasting
- Adverse effects include headache, injection site reactions, muscle pain, hypoglycemia, hyperglycemia.
Do not shake product, swirl
What are the nursing assessments prior to administration of Ocreotide (Sandostatin)?
Baseline glucose levels,
Respiratory status
What are the nursing assessments prior to administration of Desmopressin (Stimate)?
Check vital signs,
Assess for seizures, asthma, cardiovascular disease
If these conditions are present, careful monitoring of vital signs, heart sounds, and breath sounds are required after administration
What are the nursing assessments prior to administration of Somatropin (Humatrope)?
Baseline thyroid level, Glucose, Calcium, Height/weight, Renal and liver function (ALT, AST)
Potential side effects are hyperglycemia, hypothyroidism, and hypercalciuria
Which 5-Alpha-Reductase inhibitor is used to treat benign prostatic hyperplasia (BPN) and may also be used for the treatment of male pattern baldness?
Finasteride (Proscar)
S/S of BPH include difficulty urinating, urinary retention, ‘dribbling’
What are the side effects of Finasteride (Priscar)?
Loss of libido, Loss of erection, Ejaculatory dysfunction, Decreased concentration of PSA, Changes and kidney function
Pregnant women should handle with extreme caution
Which erectile dysfunction drug is also used for treatment of pulmonary hypertension?
Sildenafil (Viagra)
Sildenafil (Viagra) should not be taken with _____ as it can potentiate their hypotensive effects
Nitrates
What are the adverse effects of sildenafil (Viagra)?
Headache (due to vasodilation), Flushing, Heartburn (dyspepsia), Chest pain, Hypotension, Priapism, Unexplained visual loss (likely due to vasodilation)
Which nursing assessments should be done before acid controlling drugs are given?
- Baseline lab tests to check for hepatic and renal function (ALT, ALP, AST, BUN, creatinine),
- Use of prescription, over-the-counter and herbal medicines
Which acid controlling drugs have the extension -dine?
H2 Receptor Antagonists
- Cimetidine (Tagamet)
- Famotidine (Pepcid)
- Rantidine (Zantac)
Which acid controlling drugs have the extension -zole?
Proton Pump Inhibitors (PPIs)
- Pantroprazole (Protonix)
- Omeprazole (Prilosec)
- Lansoprazole (Prevacid)
Which anti-histamine drugs (H1 receptor blockers) have the extension -zine?
Meclizine (Antivert)
