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NURS 2514 > Gastrointestinal drugs > Flashcards

Gastrointestinal drugs Flashcards

1
Q

What kind of drug is ranitidine?

A

Histamine-2 receptor antagonist

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2
Q

How does Ranitidine work?

A

Blocks H2 receptors on the parietal cells of the stomach to reduce the volume of gastric juice and decreases concentration of acid

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3
Q

Nursing assessments for H2 antagonists

A

Assess for epigastric pain, and pain or signs of GI bleeding (hematemesis, frank blood, or occult blood in stool)
Assess for signs of confusion
Administer antacids an hour apart from other medications
Monitor for signs of pneumonia

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4
Q

What kind of drug is Omeprazole?

A

Proton Pump Inhibitor

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5
Q

How does Omeprazole work?

A

Causes irreversible inhibition of H+, K+ ATPase, the enzyme that generates gastric acid
A single dose inhibits acid production by 97% in 2 hrs

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6
Q

Adverse effects of Omprazole

A

MINOR
Headache
Diarrhea
N & V
SEVERE
Pneumonia
Fractures
Rebound acid hypersecretion dyspepsia
Hypomagnesemia

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7
Q

Nursing considerations for Omeprazole

A

Administer doses before meals
Monitor serum Mg with prolonged use
Monitor for signs of pneumonia
Monitor for fractures

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8
Q

How does Sucralfate work?

A

Protects against ulcers by creating a mucosal barrier against acid and pepsin
Undergoes chemical reaction in acidic environment of stomach to form a sticky gel
Adheres to ulcer for 6 hours
Eliminated in the feces
Oral administration only

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9
Q

Adverse effects of sucralfate

A

Constipation (rare)
No systemic side effects because not absorbed

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10
Q

Nursing considerations for sucralfate

A

PO only
Should not be taken within 30 min of antacids
Can alter absorption of many other meds: should be taken 2hrs apart

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11
Q

Misoprostol description

A

Replaces endogenous prostaglandin
Suppresses secretion of gastric acid
Promotes secretion of bicarb/ mucus
Increases mucosal blood flow

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12
Q

Misoprostol indication

A

Limited to prevented NSAID induced gastroduodenal ulcers
Often seen as a combo drug w/ NSAIDs

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13
Q

Misoprostol adverse effects

A

Minimal
Diarrhea

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14
Q

Nursing considerations for misoprostol

A

Contraindicated in pregnancy - will cause spontaneous abortion

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15
Q

Antacids description

A

Alkaline compounds that neutralize stomach acids
Raise pH of stomach above 5
Reduce pepsin activity
Stimulate production of prostaglandins
Not systemically absorbed

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16
Q

Indications of antacids

A

GERD, PUD, and gastritis

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17
Q

Examples of antacids

A

Magnesium hydroxide (MOM), Aluminum hydroxide, Calcium carbonate (TUMS), sodium bicarbonate

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18
Q

Adverse effects of magnesium hydroxide

A

AKA Milk of Magnesia
Diarrhea (often administered with aluminum hydroxide to counteract this effect)
Avoid in patients with undiagnosed abd. pain
Mg can accumulate in people with renal dysfunction

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19
Q

Adverse effects of aluminum hydroxide (Almajel)

A

Constipation
High affinity for phosphate (can cause hyperphosphatemia)

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20
Q

Adverse effects of Calcium carbonate (TUMS)

A

Constipation, belching, flatulence (release CO2)
Risk for acid rebound
Calcium can accumulate in kidney failure (not recommended)

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21
Q

Adverse effects of Sodium Bicarbonate

A

Belching, flatulence (releases CO2)
In renal failure can cause systemic alkalosis
High risk of sodium loading (dangerous for HTN, HF)

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22
Q

Nursing considerations for antacids

A

Monitor GI function (constipation/ diarrhea)
Monitor electrolytes
Hypermagnesia, hyperphosphatemia, hypercalcemia
Give after meals
Unpleasant to digest therefore adherence is difficult

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23
Q

Drugs for PUD

A

Amoxicillin
Metronidazole
Clarithromycin
Tetracycline

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24
Q

Example of bulk-forming laxative

A

Psyllium

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25
Q

Psyllium description

A

Similar action to finer (increased bulk to soft formed stool)
Made of polysaccharides and cellulose derived from grains and plants (non digestible)
Note absorbed systemically
Should be administered with large glass of water to avoid obstruction/ impaction

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26
Q

Indications for psyllium

A

Chronic constipation, prevent straining of stool, IBS

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27
Q

What kind of laxative is lactulose?

A

Osmotic laxative

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28
Q

Lactulose description

A

Combination of galactose and fructose
Poorly absorbed and not digested by enzymes in GI tract - n&v side effects
Turns into lactic acid in colon which can have an osmotic action
Hepatic encephalopathy - helps secretion of ammonia

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29
Q

Laxative salts - magnesium hydroxide description

A

Poorly absorbed salts and osmotic action draw water into intestinal lumen
Lose dose therapy stool in 6-12 hrs
High dose used for bowel evacuation prior to surgery or to purse poisons
At risk of dehydration
Mg salts are contraindicated in patients with kidney disease

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30
Q

Examples of osmotic laxatives

A

Lactulose
Laxative salts - Magnesium hydroxide
Polyethylene glycol

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31
Q

Polythelene glycol description

A

Non absorbable compound, retain water in intestinal lumen
Causes feces to swell and soften
GI side effects (N/ bloating/ cramps/ flatulence/ diarrhea)
Can be used as a bowel cleanse prior to colonoscopy or other procedures at high doses

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32
Q

Example of stimulant laxative

A

Bisacodyl (Dulcolax)

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33
Q

Bisacodyl (Dulcolax) description

A

Stimulate intestinal motility and increases amount of water and electrolytes within bowel
Opioid induced constipation
Common drug for laxative abuse
Available as rectal suppository or PO
Given at night to produce stool the next day

34
Q

Example of surfactant laxative

A

Docusate sodium (Colace)

35
Q

Docusate sodium (Colace) description

A

Slow onset
Work in the small intestine and colon
Softens the stool by facilitating penetration of water
Causes secretion of water and electrolytes in intestine
Adverse effects: mild cramping, diarrhea

36
Q

Nursing considerations for laxatives

A

Most laxatives are given until desired effect achieved and should be used short term
Laxatives can be abused
Water consumption is important
GI assessment
Most laxatives are not absorbed systemically

37
Q

Description for using non specific antidiarrheals: opioids

A

Most effective antidiarrheal agents
Activate opioid receptors in GI to slow intestinal motility (more time for absorption of fluid and electrolytes)
May cause toxic megacolon in patients with IBD

38
Q

Diphenoxylate (+Atropine) description

A

Brand name: Lomotil
Opioid used only for diarrhea
Atropine added to discourage abuse (unpleasant side effects)
Available PO only
Adv effects: dizziness, drowsiness, light-headedness, headache, n&v

39
Q

Loperamide description

A

Brand name Imodium
Suppresses bowel motility and bowel secretions
Used to reduce volume of discharge from ileostomies
Large doses do not produce morphine like effects

40
Q

Bismuth Subsalicylate description

A

Brand name: Pepto Bismol
Coats wall of GI tract
Binds to causative bacteria or toxin which is then eliminated in stool
Adv effects: increased bleeding time, constipation, dark stools, hearing loss, tinnitus, metallic taste, blue gums

41
Q

Indications for ondansetron

A

Nausea associated with chemotherapy, radiation, anesthesia, viral gastritis and pregnancy

42
Q

Ondansetron description

A

Trade name: Zofran
Works in CTZ
Acts on serotonin blocking receptors = less available serotonin
Often used with dexamethasone to increase effect
PO/ IV/ IM admin

43
Q

Adverse effects of ondansetron

A

Headache, constipation, diarrhea, dizziness
Urinary retention, muscle pain
QT prolongation

44
Q

Nursing considerations for ondansetron

A

Monitor EKG in patients at risk
Monitor for effectiveness

45
Q

Indications for dexamethasone

A

Nausea associated with chemotherapy

46
Q

Dexamethasone description

A

MOA unknown
Can be used with other other antiemetics (ondansetron)
Used briefly for symptom management of nausea

47
Q

What kind of drug is ondansetron?

A

Antiemetic serotonin antagonist

48
Q

What kind of drug is dexamethasone?

A

Antiemetic glucocorticoid

49
Q

What kind of drug is metoclopramide?

A

Dopamine antagonist

50
Q

Metoclopramide description

A

Trade name: Maxeran
Prokinetic drug
Blocks dopamine and serotonin receptors in CTZ, enhances upper GI tract response to acetylcholine (increase peristalsis)

51
Q

Indications for metoclopramide

A

Nausea caused by post op, cancer medications, opioids, toxins, radiation

52
Q

Adverse effects of metoclopramide

A

In high doses, diarrhea and sedation
With long term use: risk of tardive dyskinesia
Cl: patients with GI obstruction, perforation or hemorrhage

53
Q

Tardive dyskinesia defintion

A

Repetitive, involuntary movements of arms, legs, and facial muscles

54
Q

Nursing assessments for metoclopramide

A

GI assessment
Assess mental status (drowsiness)
Look for uncontrolled movement

55
Q

What kind of drug is Nabilone?

A

Cannabinoid

56
Q

Nabilone description

A

MOA likely activation of receptors around vomiting centre
Used to suppress chemo induced nausea and vomiting
Second line drug dye to psychotomimetic effects and potential for abuse

57
Q

Nursing considerations and side effects for Nabilone

A

Monitor for drowsiness
SE:
CNS: temporal disintegration, dissociation (avoid in pts with psychiatric disorders)
CVS: tachycardia & hypotension (avoid in pts with cvd)

58
Q

Indications for dimenhydrinate

A

Motion sickness, radiation, sickness, post-op, drug-induced nausea

59
Q

Description for dimenhydrinate

A

Trade name Gravel
Blocks H1 receptors in GI tract and muscarininc receptors in vestibular system (anticholinergic)

60
Q

Adverse effects of dimenhydrinate

A

Drowsiness, hypotension, dry mouth and constipation
Avoid with other CNS depressants
Should not be taken with hx of glaucoma or chronic lung disease, difficulty urinating

61
Q

Nursing considerations for dimenhydrinate

A

GI assessment
Assess alertness (safety)
Vital signs (check often with CVD)
Monitor for signs of retention (bowel and bladder)

62
Q

What kind of drug is scopolamine?

A

Muscarinic antagonist

63
Q

Scopolamine description

A

Blocks nerve impulses between vestibular apparatus in inner ear and vomiting centre
Most effective drug for preventing and treating motion sickness
PO/ SC/ transdermal dosing

64
Q

Adverse effects of scopolamine

A

Common: dry mouth, blurred vision, drowsiness
Less common: urinary retention, constipation, disorientation

65
Q

Nursing considerations for scopolamine

A

GI assessment
Monitor for signs of retention (bowel & bladder)
Assess alertness (safety)

66
Q

What kind of drug is sulfazalazine?

A

5-aminosalicylates

67
Q

Sulfasalazine description

A

Used to treat mild or moderate IBD
Maintain remission after symptoms have improved
Action on prostaglandin synthesis and suppression of migration of inflammatory cells into affected region

68
Q

Nursing considerations for sulfazalazine

A

Monitor CBC periodically - can cause hematological disorders

69
Q

Adverse effects of sulfasalazine

A

Nausea, fever, rash, arthralgia

70
Q

What kind of drug is budesonide?

A

Glucocorticoids

71
Q

Budesonide description

A

Anti-inflammatory action
Use is to induce remission, not for long term maintenance
IV/ PO

72
Q

Nursing considerations for budesonide

A

Prolonged use of glucocorticoids can cause severe adverse effects, adrenal suppression, osteoporosis, increased risk for infection, Cushing’s syndrome

73
Q

Indications for budesonide

A

Mild to moderate ulcer colitis - works within the ileum and ascending colon

74
Q

What kind of drug is cyclosporine?

A

Immunosuppressant

75
Q

Cyclosporine description

A

Long term therapy
Calcineurin inhibitor - very strong immunosuppressant
Faster acting and stronger than other immunosuppressants
Continuous IV infusion, can be administered PO in low doses to maintain remission
Increased lymphoma risk, further increased when used with other immunosuppressants

76
Q

Nursing considerations for cyclosporine

A

Potentially toxic compound can cause renal impairment, neurotoxicity
Generalized suppression of the immune system increases risk of infection

77
Q

Indications for cyclosporine

A

Severe disease that has not responded to other therapies, both UC and Crohn’s

78
Q

What kind of drug is Infliximab?

A

Immunomodulator

79
Q

Infliximab description

A

Monoclonal antibodies
Designed to neutralize TNF, a key immunoinflammatory modulator
Infections: TB and other opportunistic infections are most common
Infusion reactions: fever, chills, pruritus, urticaria, cardiopulmonary reactions (chest pain, hypertension, hypotension)
Increased risk of lymphoma
6 wk regimen followed by maintenance infusions Q8Wks

80
Q

Indications for Infliximab

A

Moderate to severe UC and Crohn’s

NURS 2514 (14 decks)

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