Gastrointestinal System Flashcards by Heidi Koster

Therapeutic Use

Histamine (H2) antagonist - ranitidine

Gastric and duodenal ulcers
Heartburn, dyspepsia
Erosive esophagitis
Gastrointestinal reflux disease (GERD)
Aspiration pneumonitis
Hypersecretory disorders such as Zollinger-Ellison syndrome (gastrin)
Systemic mastocytosis (histamine)

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What is the suffix for Histamine (H2) antagonists?

-tidine

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Adverse Effects

Histamine (H2) antagonist - ranitidine

Impotence, reduced libido with cimetidine (Tagamet), not ranitidine
Confusion, aplastic anemia, agranulocytosis, and arrhythmia
Increased susceptibility to pneumonia

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Nursing Interventions

Histamine (H2) antagonist - ranitidine

For clients who develop impotence or reduced libido, recommend switching to ranitidine
For clients who develop CNS effects, recommend switching to ranitidine
Monitor older clients for confusion

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Client Education

Histamine (H2) antagonist - ranitidine

Take all medications as prescribed
Avoid smoking
Avoid foods or medications that irritate the GI tract
Tell clients to report any signs of obvious or occult gastrointestinal bleeding, such as coffee-ground emesis

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Therapeutic Use

Proton Pump Inhibitors (PPI) - omeprazole

Gastric and duodenal ulcers
Prolonged dyspepsia
Gastrointestinal reflux disease (GERD)
Erosive esophagitis
Hypersecretory disorders such as Zollinger-Ellison syndrome, systemic mastocytosis

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What is the suffix for Proton Pump Inhibitors (PPI)?

-prazole

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Adverse Effects

Proton Pump Inhibitors (PPI) - omeprazole

Bone-loss (long term use)
Headache, abdominal pain, nausea, vomiting, and diarrhea
Hypomagnesemia

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Therapeutic Use

Mucosal Protectant - sucralfate

Acute duodenal ulcers

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Expected Pharmacological Action

Mucosal Protectant - sucralfate

Sucralfate causes a chemical reaction to occur in the stomach, creating a gel that coats ulcers and creates a barrier between the stomach and gastric secretions

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Therapeutic Use

Antacids - aluminum hydroxide

Peptic ulcer disease

Gastrointestinal reflux disease (GERD)

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Expected Pharmacological Action

Antacids - aluminum hydroxide

Antacids are alkaline compounds that neutralize gastric acid

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Adverse Effects

Antacids - aluminum hydroxide

Constipation (aluminum and calcium antacids)
Diarrhea (magnesium antacids)
Hypophophatemia

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Medication Administration

Antacids - aluminum hydroxide

Administer orally up to four times a day
Make sure clients chew tablets thoroughly and follow with at least 8 oz of water
Do not give within 1 to 2 hours of administering drugs that interact with antacids

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Therapeutic Use

Prostaglandin E analog - misoprostol

Prevention of ulcers from long-term NSAID use

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Adverse Effects

Prostaglandin E analog - misoprostol

Diarrhea, abdominal pain

Dysmenorrhea, uterine cramping, spotting (women), miscarriage

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Medication Administration

Prostaglandin E analog - misoprostol

Administer orally four times a day, with meals and again at bedtime
Confirm nonpregnant state before initiating drug therapy, as this drug can cause spontaneous abortion
Make sure women of childbearing age use effective contraception during drug therapy

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Adverse Effects

Serotonin Antagonist - ondansetron

Serotonin syndrome, torsade de pointes, and Steven-Johnson syndrome
Headache
Dizziness
Diarrhea
Constipation

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Therapeutic Use

Antihistamine/anticholinergics - dimenhydrinate

Antiemesis, vertigo, motion sickness

Medication Administration

Antihistamine/anticholinergics - dimenhydrinate

Give dimenhydrinate orally, IM, or IV
Give the initial dose 30 to 60 minutes before the activity that triggers nausea
Give subsequent doses before meals and at bedtime
Make sure clients swallow chewable tablets whole

Client Education

Antihistamine/anticholinergics - dimenhydrinate

Do not take prior to driving or activities requiring mental alertness
Sit or lie down if feeling drowsy
Change positions gradually
Suck on hard candy or chew gum
Sip water
Increase fluid and fiber intake
Increase activity levels
Urinate every 4 hours and report any undesirable changes in urinary elimination

Adverse Effects

Dopamine Antagonist/Prokinetic - metoclopramide

Sedation
Restlessness
Diarrhea
Extrapyramidal symptoms, especially tardive dyskinesia (long-term, high doses, irreversible), neuroleptic malignant syndrome

Evaluation of Medication Effectiveness

Dopamine Antagonist/Prokinetic - metoclopramide

Absence of nausea and vomiting

Medication Administration

Bulk-Forming Agents - psyllium

Give orally one to three times a day with at least 8 oz of fluid
Mix powdered forms with 8 oz of fluid
Expect soft, formed stools 1 to 3 days after initiating therapy
Tell clients that taking it before meals might reduce apepetite

Client Education

Bulk-Forming Agents - psyllium

Take with at least 8 oz of water or juice
Report difficulty swallowing, chest pain, or absence of bowel movements
Report persistent diarrhea
Drink plenty of fluids
Advise clients to increase exercise and fluid intake (at least 2 to 3 L/day) and consume high-fiber foods (bra, fresh fruits/vegetables)

Therapeutic Use

Surfactant Laxatives/Stool Softeners - docusate sodium

Constipation

Prevention of fecal impaction, straining during defecation, painful elimination of hard stools

Contraindications

Surfactant Laxative/Stool Softeners - docusate sodium

Gastrointestinal obstruction, perforation, concurrent use of mineral oil, fecal impaction, nausea, vomiting, undiagnosed abdominal pain

Adverse Effects

Stimulant Laxatives - bisacodyl

Diarrhea, mild abdominal cramps
Burning sensation (suppositories)
Proctitis (prolonged use of suppositories)
Laxative abuse

Therapeutic Use

Opioids - diphenoxylate with atropine

Diarrhea

Reduction of volume of ileostomy effluent (loperamide/atropine)

Adverse Effects

Opioids - diphenoxylate with atropine

Drowsiness 
Anticholinergic effects (dry mouth)
Cardiac arrest, QT interval prolongation, torsades de pointes, ventricular arrhythmias, syncope
Constipation
Allergic reactions

Contraindications

Opioids - diphenoxylate with atropine

Children younger than 2 years
Inflammatory bowel disease
Advanced hepatic disease
Glaucoma
Severe fluid and electrolyte imbalance
Pseudomembranous enterocolitis
Diarrhea due to poisoning
Ileus
Gastrointestinal bleeding
Ulcerative colitis
Renal or liver dysfunction
History of chemical abuse
Prostatic hypertrophy

Nursing Interventions

5-HT3 Blocker - alosetron

Make sure clients meet specific criteria and sign the required treatment agreement before administration
Risk management program: Client, provider, pharmacist; Outlines potential adverse effects; outlines criteria that must be met for treatment; only for women who did not improve with traditional therapies
Give orally twice daily
Reevaluate after 4 weeks without improvement and recommend an increased dosage if the client is tolerating the drug
Stop therapy after 8 weeks if diarrhea persists

Client Education

5-HT3 Blocker - alosetron

Report constipation immediately and stop taking the drug

Report abdominal pain, bloody diarrhea, or rectal bleeding immediately and stop taking the drug

Therapeutic Use

5-HT4 Receptor Agonist - lubiprostone

Irritable bowel syndrome with constipation (IBS-C) in women age 18 or older
Chronic idiopathic constipation (CIC) in men and women

Contraindications

5-HT4 Receptor Agonist - lubiprostone

Severe diarrhea, diverticulitis, Crohn’s disease, ulcerative colitis, volvulus, gastrointestinal obstruction

Therapeutic Use

5-aminosalicylates - sulfasalazine

Mild to moderate inflammatory bowel disease

Adverse Effects

5-aminosalicylates - sulfasalazine

Headache, pneumonitis, anorexia, nausea, vomiting, diarrhea, drug-induced hepatitis, crystaluria, infertility, oligospermia, orange-yellow discoloration of urine, exfoliate dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, rash, photosensitivity, yellow discoloration of urine, agranulocytosis, aplastic anemia, blood dyscrasias, eosinophilia, hemolytic anemia, megaloblastic anemia, thrombocytopenia, peripheral neuropathy, angioedema, hypersensitivity reactions including anaphylaxis, fever

Adverse Effects

Immunosuppressants - azathioprine

Progressive multifocal leukoencephalopathy, retinopathy, pulmonary edema
Nausea, vomiting, diarrhea, anorexia, hepatotoxicity, mucositis, pancreatitis
Alopecia, rash
Anemia, neutropenia, thrombocytopenia, leukopenia, pancytopenia
Arthralgia
Malignancy (including post-transplant lymphoma, HSTCL, and skin cancer), serum sickness, chills, fever, Raynaud’s phenomenon

Contraindications

Immunosuppressants - azathioprine

Active infection or immunization with live virus vaccines, pancreatitis, anuria

Therapeutic Use

Aloe

Used to heal burns because of its anti-inflammatory and analgesic properties

Therapeutic Use

Echinacea

Stimulates the immune system

Therapeutic Use

Feverfew

Decreases the number and severity of migraine headaches

Therapeutic Use

Ginger

Used to treat morning sickness, motion sickness, and nausea from surgery

Therapeutic Use

Gingko Biloba

Claims to improve memory

Therapeutic Use

St. John’s Wort

Used for mild depression

Therapeutic Use

Block Cohosh

Treats manifestations of menopause

Therapeutic Use

Saw Palmetto

Treats symptoms of benign prostate hypertrophy

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Gastrointestinal System Flashcards

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