GI Flashcards
What are the major activities of the GI system?
Secretion of enzymes, acid, bicarb, and mucus; Absorption of water and almost all the essential nutrients needed by the body; Digestion of food into usable and absorbable components; Motility of food and secretions through the system.
What is nausea/vomiting?
The most common and uncomfortable complaint. Vomiting is a complex reflex to various stimuli.
When would we want to induce vomiting?
In the case of an overdose, induce within 60 minutes.
When would we not want a patient to vomit?
Patients who just had surgery, a patient with increased intracranial pressure, and a patient with partial consciousness.
How can we manage N/V?
By using emetics or antiemetics.
What are emetics?
They induce vomiting and they are no longer recommended for at home poison control.
What are antiemetics?
Decrease or prevent N/V. They are centrally or locally acting; if centrally acting, we will see side effects of drowsiness and sedation. They have varying degrees of effectiveness.
What are the groups of centrally acting antiemetics?
Antihistamines, Dopamine agonists, Anticholinergics, Serotonin antagonists, Benzodiazepines, Glucocorticoids, Cannabinoids, Miscellaneous.
What are phenothiazines?
Antiemetic.
What meds are phenothiazines?
Chlorpromazine (Thorazine), Promethazine (Phenergan), Prochlorperazine edisylate (Compazine).
What is the trade name and prototype for phenothiazines?
Promethazine (Phenergan).
What are the indications for Promethazine (Phenergan)?
Treat/prevent motion sickness, N/V.
How do phenothiazines work?
Block H1 receptor sites, and inhibit the chemoreceptor trigger zone.
What pregnancy category is Promethazine (Phenergan)?
Pregnancy category C.
What are the contraindications for Promethazine (Phenergan)?
Hypersensitivity, narrow-angle glaucoma, severe liver disease, intestinal obstruction, bone marrow depression.
When should we take caution when giving Promethazine (Phenergan)?
Cardiovascular disease, liver dysfunction, asthma, respiratory dysfunction, HTN, older adults, debilitated patients.
What are the side effects of Promethazine (Phenergan)?
Drowsiness (significant), confusion, anorexia, dry mouth and eyes, constipation, urinary retention, blurred vision, transient leukopenia, HTN, photosensitivity.
What drug interactions occur with Promethazine (Phenergan)?
Increased CNS depression and anticholinergic effects when taken with alcohol or other CNS depressants.
What are the adverse effects of Promethazine (Phenergan)?
Extrapyramidal syndrome, tardive dyskinesia, akathisia.
What lab results can occur with Promethazine (Phenergan)?
False pregnancy test.
What are nonpharmacologic antiemetics?
Weak tea, flat ginger ale or cola, gelatin, gatorade (cut in half with water), pedialyte, crackers, IV fluids for severe dehydration, cool rag on the forehead/neck, italian ice, ginger.
What is the indication for over the counter antiemetics?
Prevent motion sickness, N/V, dizziness.
What are over the counter antiemetics not effective for?
Severe vomiting related to anticancer agents, radiation, or toxins.
How do over the counter antiemetics work?
Inhibit vestibular stimulation in middle ear.
What are the side effects of over the counter antiemetics?
Drowsiness, dry mouth, constipation.
Over the counter antiemetics are no longer recommended for treatment of N/V in which patients?
Pregnant women in 1st trimester.
What are the non-prescription antiemetic medications?
Dimenhydrinate (Dramamine), Meclizine Hydrochloride (Antivert), Diphenhydramine Hydrochloride (Benadryl), Trimethobenzamide (Tigan), Bismuth subsalicylate (Pepto Bismol).
Which one of these is the most common?
Dimenhydrinate (Dramamine).
Which one of these is used for vertigo?
Meclizine Hydrochloride (Antivert).
Which one of these has a paradoxical reaction of nausea?
Diphenhydramine Hydrochloride (Benadryl).
Which one of these can be used during pregnancy if the severe vomiting is threatening the mother’s/fetus’s health?
Trimethobenzamide (Tigan).
Which one of these can increase the risk of urinary retention in patients with BPH?
Trimethobenzamide (Tigan).
Which one of these acts as an absorbent?
Bismuth subsalicylate (Pepto Bismol).
How does Bismuth subsalicylate (Pepto Bismol) work?
Acts directly on gastric mucosa to suppress V/D; coats the wall of the GI tract and absorbs bacteria and toxins that cause diarrhea.
What is Bismuth subsalicylate (Pepto Bismol) indicated for?
Heartburn, indigestion, N/V/D, upset stomach.
You shouldn’t take Pepto Bismol if you’re allergic to?
Aspirin because it contains aspirin.
How is Pepto Bismol given?
Chewable, capsule, tablet, liquid.
Which test does Pepto Bismol affect?
Can cause a false positive guaiac (stool test).
When should we avoid inducing vomiting?
If the patient has ingested caustic substances such as chlorine bleach, ammonia, lye, toilet cleaners, battery acid; to prevent aspiration if petroleum distillates are ingested.
What should we use if emesis is contraindicated?
Activated charcoal - it is an absorbent.
What medication is an emetic?
Ipecac.
How does Ipecac work?
Induced vomiting by stimulating CT2 and acts directly on the gastric mucosa.
Which version of Ipecac should the patient use?
Syrup only. The fluid extract is potent and can cause fatalities.
What should the patient remember when taking Ipecac?
Take with a glass of water.
What is the onset for Ipecac?
15-30 minutes; if not successful, use the absorbent.
What do we lose a lot of when we vomit?
Vitamin K and potassium.
What patients tend to abuse Ipecac?
Anorexic and bulimic patients - can cause cardiomyopathy, VF, and possible death.
What is diarrhea?
Frequent loose stools, > 3 a day.
What are the causes of diarrhea?
Spicy/spoiled foods, bacteria/virus, laxative abuse, bowel tumor, IBS (Crohns/UC), stress/anxiety, malabsorption syndrome (Celiac’s disease).
What can diarrhea cause?
Dehydration, electrolyte imbalance (potassium and Vitamin K - lack of can cause ventricular dysrhythmias - watch coumadin), can be serious in elderly or young children.
What are nonpharmacologic treatments for diarrhea?
Avoid milk products/rich foods, drink pedialyte/gatorade, IV solution if serious.
What is traveler’s diarrhea also known as?
Acute diarrhea/ Montezuma’s revenge.
What is traveler’s diarrhea caused by?
E. Coli in contaminated water, fruit, veggies, meat.
What is the duration of traveler’s diarrhea?
2 days.
What is the treatment for traveler’s diarrhea?
Imodium; if serious, Fluoroquinolone.
How to prevent traveler’s diarrhea?
Bottled water, avoid ice, wash fruits and veggies, cook meat thoroughly.
What are the 4 classifications of antidiarrheals?
Opiates, Somatostatin analogue, adsorbents, Miscellaneous.
What is Diphenoxylate with Atropine (Lomotil)?
Opiate prototype for antidiarrheals.
How does Diphenoxylate with Atropine (Lomotil) work?
Treats diarrhea by slowing peristalsis and inhibits gastric motility.
How is Diphenoxylate with Atropine (Lomotil) given?
PO, well absorbed.
What is the onset for Diphenoxylate with Atropine (Lomotil)?
45-60 minutes.
What is the peak for Diphenoxylate with Atropine (Lomotil)?
2 hours.
What is the half-life of Diphenoxylate with Atropine (Lomotil)?
2.5 hours.
How is Diphenoxylate with Atropine (Lomotil) excreted?
By feces and urine.
What are the side effects of Diphenoxylate with Atropine (Lomotil)?
Drowsiness, dizziness, constipation, dry mouth, weakness, flush, rash, blurred vision, urine retention.
What are the adverse effects of Diphenoxylate with Atropine (Lomotil)?
Angioneurotic edema.
What are the contraindications for Diphenoxylate with Atropine (Lomotil)?
Severe hepatic/renal disease, glaucoma, severe electrolyte imbalance, children < 2.
What are the life-threatening effects of Diphenoxylate with Atropine (Lomotil)?
Paralytic ileus, toxic megacolon, severe allergic reaction.
What drug interactions occur with Diphenoxylate with Atropine (Lomotil)?
Increased CNS depression with alcohol, narcotics, antihistamines, MAOIs; may enhance hypertensive crisis.
What labs are affected by Diphenoxylate with Atropine (Lomotil)?
LFTs and amylase are increased.
What is Octreotide (Sandostatin)?
Somatostatin analogue.
How does Octreotide (Sandostatin) work?
Inhibits gastric acids, pepsinogen, gastrin, cholecystokinin, serotonin secretions, and intestinal fluid.
What is Octreotide (Sandostatin) prescribed for?
Diarrhea resulting from metastatic cancer.
What is constipation?
Accumulation of hard fecal matter in the large intestine.
What causes constipation?
Insufficient water intake, fecal impaction, chronic laxative use, ignoring the urge to defecate, drugs (narcotics, anticholinergics, certain antacids), poor dietary habits (low fiber intake), bowel obstruction, neurological disorders (paraplegia), lack of exercise.
What are non-pharmacological treatments for constipation?
High fiber diet (slowly add in), exercise, water, routine bowel habits.
How often are normal bowel movements?
1-3 a day to 3 per week.
What are the 4 groups of laxatives/cathartics?
Osmotics, Stimulants, Bulk forming, Emollients.
How do osmotic laxatives work?
They pull in water into the colon, increasing the water in the feces making it softer and easier to get rid of.
What are osmotic laxatives used for?
Bowel preps for diagnostic/surgical procedures.
What do you need to have in order to take osmotic laxatives?
Good renal function.
In which patients are osmotic laxatives contraindicated?
HF patients.
What medication can be used in patients with renal impairment and HF?
Golytely.
How can we improve the taste of Golytely?
Refrigerate it.
What is Bisacodyl (Dulcolax)?
An over the counter stimulant laxative prototype.
What pregnancy category is Bisacodyl (Dulcolax)?
Pregnancy category C.
What are the indications for Bisacodyl (Dulcolax)?
Short term treatment of constipation and for bowel prep for diagnostic tests.
How does Bisacodyl (Dulcolax) work?
Increases peristalsis by direct effect on smooth muscle of the intestine.
How is Bisacodyl (Dulcolax) given?
PO and PR.
What is the onset for Bisacodyl (Dulcolax) PO and PR?
PO onset is 6-12 hours, PR onset is 15-60 minutes.
In which patients is Bisacodyl (Dulcolax) contraindicated?
Hypersensitivity, fecal impaction, intestinal/biliary obstruction, appendicitis, abdominal pain, N/V, rectal fissures.
What are the side effects of Bisacodyl (Dulcolax)?
N/V/D, anorexia, cramps.
What are the adverse effects of Bisacodyl (Dulcolax)?
Dependence, hypokalemia.
What are the life-threatening effects of Bisacodyl (Dulcolax)?
Tetany.
What are the drug interactions of Bisacodyl (Dulcolax)?
Decreased effect with antacids, H2 blockers, and milk.
What laxative is the most frequently used and abused?
Bisacodyl (Dulcolax).
What is castor oil?
A stimulant laxative.
Who should not use castor oil?
Early pregnancy because it can induce uterine contractions and may cause a spontaneous abortion.
What is castor oil mainly used for?
Bowel prep.
When should you not take castor oil?
At bedtime.
What is the onset for castor oil?
2-6 hours.
What can prolonged use of Senna (Senekot) result in?
Loss of intestinal muscular tone.
What is Psyllium (Metamucil)?
A bulk forming laxative.
What pregnancy category is Psyllium (Metamucil)?
Pregnancy category C.
What is the indication for Psyllium (Metamucil)?
Control constipation.
How does Psyllium (Metamucil) work?
Acts as a bulk forming laxative by drawing water into the intestine.
How is Psyllium (Metamucil) given?
PO in powder form, take 8 ounces of water before, with, and after the laxative.
What is the onset for Psyllium (Metamucil)?
12-24 hours.
What is the peak for Psyllium (Metamucil)?
1-3 days.
What are the contraindications for Psyllium (Metamucil)?
Hypersensitivity, fecal impaction, intestinal obstruction, abdominal pain.
What are the side effects of Psyllium (Metamucil)?
Anorexia, cramps, N/V/D.
What are the adverse effects of Psyllium (Metamucil)?
Esophageal/intestinal obstruction if not taken with adequate water.
What are the life-threatening effects of Psyllium (Metamucil)?
Bronchospasm and anaphylaxis.
What are nursing considerations for all laxatives?
Encourage increased water intake if not contraindicated, avoid the overuse of laxatives because it can lead to electrolyte imbalances and dependence, encourage exercise to increase peristalsis, store suppositories in less than 86 degrees, do not take within 1 hour of any other drugs including PO antacids, discontinue if rectal bleeding, N/V/D, or cramps occur.
What are some predisposing factors for peptic ulcer disease?
Mechanical disturbances, stress, drugs, H. Pylori, environmental influences, genetic influences.
What is H. Pylori?
Gram negative bacillus known to cause gastritis.
Who would be tested for the presence of H. Pylori?
Patients with recurrent ulcers not related to NSAIDs.
How is someone diagnosed with H. Pylori?
Meretek UBT (breath test).
What is the treatment for H. Pylori?
Triple therapy for 10-14 days - Flagyl, Omeprazole, Clarithromycin.
What is GERD?
Inflammation of the esophagus.
How does GERD occur?
The result of incompetent LES caused by smoking, obesity, large meals late at night, peppermint.
How is GERD treated?
With H2 blockers and PPIs.
How can we manage ulcers non-pharmacologically?
Avoid increasing gastric secretions, this includes smoking, alcohol, spicy/hot/greasy foods, NSAIDs/steroids, raise the head of the bed, don’t eat at bedtime, wear loose fitting clothes.
What are the 5 types of antiulcer drugs?
Tranquilizers, Anticholinergics, H2 blockers, PPIs, Antibiotics.
How can we manage ulcers non pharmacologically?
Avoid increasing gastric secretions, this includes smoking, alcohol, spicy/hot/greasy foods, NSAIDs/steroids, raise the head of the bed, don’t eat at bedtime, wear loose fitting clothes.
What are the 5 types of antiulcer drugs?
- Tranquilizers - decrease vagal stimulation and anxiety.
- Anticholinergics - decrease GI motility.
- Antacids - neutralize gastric acidity, lower pepsin.
- H2 blockers.
- Proton pump inhibitors.
What is the medication for tranquilizers?
Librium combined with Quarzan (anticholinergic).
What is the medication for anticholinergics?
Pro-Banthine (propantheline bromide).
What are some medications classified as antacids?
Amphojel, Calcium Carbonate (TUMS), Maalox, Mylanta, Gaviscon.
What is the medication for H2 blockers?
Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid).
What is the medication for proton pump inhibitors?
Prevacid, Prilosec, Nexium, Protonix.
What pregnancy category is Amphojel?
Pregnancy category C.
How is Amphojel given?
PO suspension, comes in a chalky solution so shake the bottle.
What is the onset time for Amphojel?
15-30 minutes.
What is the peak time for Amphojel?
30 minutes.
What are the indications for Amphojel?
Treat hyperacidity, peptic ulcer, reflux esophagitis, lower hyperphosphatemia, incidental GERD.
What are the contraindications for Amphojel?
Hypersensitivity to aluminum products, hypophosphatemia.
In whom should caution be taken when administering Amphojel?
Older adults.
What are the side effects of Amphojel?
Constipation.
What are the adverse effects of Amphojel?
Hypophosphatemia, long term use can cause GI obstruction.
When should Amphojel be taken if taking other medications that neutralize stomach acidity?
1 hour before the other meds or two hours after.
What drug interactions are associated with Amphojel?
Decreased effects with tetracycline, phenothiazine, phenytoin, digoxin, quinidine, amphetamine. May increase effect on benzodiazepines.
What are nursing considerations for antacids?
Avoid administering with other oral drugs, give antacid 1-2 hours after other meds, shake well before administering and drink water after, report pain/coughing/vomiting blood, alert HCP if taking for > 2 weeks, avoid taking with milk or foods high in vitamin D, stools may be speckled white.
What pregnancy category is Famotidine (Pepcid)?
Pregnancy category B.
What are the indications for Famotidine?
Prevent and treat peptic ulcers, GERD, stress ulcers.
How does Famotidine work?
Inhibits gastric acid secretion by inhibiting histamine at H2 receptors in the parietal cells.
How is Famotidine given?
PO.
What is the onset time for Famotidine?
15 minutes.
What is the peak time for Famotidine?
1-3 hours.
When do ulcers usually heal?
Within 4-8 weeks.
What are the contraindications for Famotidine?
Hypersensitivity, severe renal or hepatic disease.
In whom should caution be taken when administering Famotidine?
Pregnancy and lactation.
What are the side effects of Famotidine?
HA, constipation, confusion, N/D, vertigo, depression, rash, blurred vision, malaise.
What are the adverse effects of Famotidine?
Hepatotoxicity, and blood dyscrasia - both can be life threatening.
What drug interactions are associated with Famotidine?
Decreased absorption with antacids, decreased absorption of ketoconazole, toxicity with metoprolol, increased effects of oral anticoagulants.
What are nursing considerations for H2 blockers?
Administer dose before meals, reduce dose by half for older adults, instruct client to report pain/coughing/vomiting blood, avoid smoking, separate dose from antacid by 1 hr.
What pregnancy category is Esomeprazole (Nexium)?
Pregnancy category C.
How is Esomeprazole given?
PO.
What is the onset time for Esomeprazole?
2 hours.
What is the peak time for Esomeprazole?
1.5-3 hours.
What are the indications for Esomeprazole?
Treat peptic and duodenal ulcers, GERD, erosive esophagitis, H. Pylori, Zollinger-Ellison syndrome, GI prophylaxis.
How does Esomeprazole work?
Suppresses gastric acid secretion by inhibiting hydrogen and potassium ATPase in gastric parietal cells.
What are the side effects of Esomeprazole?
HA/dizziness, fatigue, thirst, increased appetite, anorexia, N/D/C, rash, thrombocytopenia (when taken long term).
What are the adverse effects of Esomeprazole?
Elevated AST and ALT.
What drug interactions are associated with Esomeprazole?
May increase theophylline levels, decrease Prevacid with sucralfate, may interfere with absorption of ampicillin, ketoconazole, digoxin, can decrease activity of Plavix.
Should we keep the patient long term on Nexium?
No, it can increase risk of osteoporosis.
When does Esomeprazole work best?
On an empty stomach.
How does Sucralfate (Carafate) work?
Nonabsorbable and combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin.
What are the indications for Sucralfate?
Prevent gastric mucosal injury from drug-induced ulcers, and to manage ulcers.
How is Sucralfate given?
PO, 4 times a day, before meals, at bedtime.
What is the onset time for Sucralfate?
30 minutes.
What are the contraindications for Sucralfate?
Hypersensitivity, caution in renal failure.
What are the side effects of Sucralfate?
Dizziness, N/C, dry mouth, rash, pruritus, back pain, and sleepiness.
What drug interactions are associated with Sucralfate?
Decreased effects with tetracycline, phenytoin, fat-soluble vitamins, digoxin, altered absorption with Cipro, antacids, norfloxacin.
What are nursing considerations for Sucralfate?
Take on an empty stomach, administer antacids 30 minutes before or after, allow 1-2 hours between sucralfate and another drug, avoid smoking and alcohol, follow a proper diet.
