Gastrointestinal System Flashcards
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)
What is the suffix for Histamine (H2) antagonists?
-tidine
Adverse Effects
Histamine (H2) antagonist - ranitidine
Impotence, reduced libido with cimetidine (Tagamet), not ranitidine
Confusion, aplastic anemia, agranulocytosis, and arrhythmia
Increased susceptibility to pneumonia
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
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
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
What is the suffix for Proton Pump Inhibitors (PPI)?
-prazole
Adverse Effects
Proton Pump Inhibitors (PPI) - omeprazole
Bone-loss (long term use)
Headache, abdominal pain, nausea, vomiting, and diarrhea
Hypomagnesemia
Therapeutic Use
Mucosal Protectant - sucralfate
Acute duodenal ulcers
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
Therapeutic Use
Antacids - aluminum hydroxide
Peptic ulcer disease
Gastrointestinal reflux disease (GERD)
Expected Pharmacological Action
Antacids - aluminum hydroxide
Antacids are alkaline compounds that neutralize gastric acid
Adverse Effects
Antacids - aluminum hydroxide
Constipation (aluminum and calcium antacids)
Diarrhea (magnesium antacids)
Hypophophatemia
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
Therapeutic Use
Prostaglandin E analog - misoprostol
Prevention of ulcers from long-term NSAID use
Adverse Effects
Prostaglandin E analog - misoprostol
Diarrhea, abdominal pain
Dysmenorrhea, uterine cramping, spotting (women), miscarriage
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
Adverse Effects
Serotonin Antagonist - ondansetron
Serotonin syndrome, torsade de pointes, and Steven-Johnson syndrome Headache Dizziness Diarrhea Constipation
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
