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GI Flashcards

1
Q

Types of Acid-Controllling Drugs

A

Antacids
Histamine-2 (H2) antagonists
PPIs (Proton Pump Inhibitors)

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2
Q

Acid-Related Diseases

A

Acid-realted diseases are caused by an imbalance of the three cells (parietal cells, Chief cells, Mucous cells) of the gastric gland and their secretions
Most common disease is hyperacidity
Lay terms for overproduction of HCl by the parietal cells include: Indigestion, sour stomach, heartburn, acid stomach

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3
Q

GERD

A

Gastroesophageal reflux disease:
Known as heartburn
Symptoms: burning, bloating, belching, regurgitation
Reflux of gastric secretions such as pepsin and hydrochloric acid into the esophagus

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4
Q

PUD

A

Peptic Ulcer Disease:
Several stomach disorders - commonly gastric and duodenal ulcers
Symptoms: burning, gnawing, aching

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5
Q

H. Pylori

A

Helicobacter pylori:
Bacterium found in GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers (can be detected by serum antibody tests)
Antibiotics are used to eradicate H. pylori

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6
Q

Antacids: Mechanism of Action

A

Neutralize stomach acid
Promote gastric mucosal defence mechanisms. Secretion of: Mucus (protective barrier against HCl); Bicarbonate (helps buffer acidic properties of HCl); Prostaglandins (prevent activation of proton pump)
Antacids do neutralize the acid once it’s in the stomach but do not prevent the overproduction of acid

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7
Q

Antacids: Drug Effects

A

Reduce pain associated with acid-realted disorders
Raising gastric pH only 0.3 points neutralizes 50% of the gastric acid
Raising gastric pH one point neutralizes 90% of the gastric acid
Reducing acidity reduces pain

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8
Q

Antacids: Aluminum Salts

A

Have constipating effects
Are often used with magnesium to counteract constipation
Are often recommended for patients with renal disease (more easily excreted)
Include: Aluminum hydroxide salt (Almagel [with Mg hydroxide]); Combination products (aluminum and magnesium): Maalox, Mylanta

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9
Q

Antacids: Magnesium Salts

A 
Commonly cause diarrhea; usually used with other drugs to counteract this effect
Are dangerous when used in patients with renal failure - the failing kidney cannot excrete extra magnesium, resulting in accumulation
Examples: 
- Carbonate salt: Magmix
- Hydroxide salt: milk of magnesia
- Oxide salt: Magnesium oxide
- Trisillicate salt: Gasulsol Tablets
- Combination product: Calmax, Maalox
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10
Q

Antacids: Calcium Salts

A

Come in many forms, but carbonate is most common
May cause constipation, kidney stones
Are not recommended for patients with renal disease - may accumulate to toxic levels
May cause increased gastric acid secretion (rebound hyperacidity)
Are often advertised as an extra source of dietary calcium (Tums)

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11
Q

Antacids” Calcium Salts

A

Used to prevent or treat calcium deficiency (calcium acetate, calcium liquid, and calcium carbonate)
Used in patients with kidney failure to bind dietary phosphate and reduce the amount of phosphorus absorbed from food (aluminum hydroxide, calcium acetate, calcium carbonate, calcium liquid, and sevalamer [Renagel])

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12
Q

Antacids: Sodium Bicarbonate

A 
Highly soluble
Buffers the acidic properties of HCl
Has a quick onset but short duration
May cause metabolic alkalosis
May cause problems in patients with heart failure, hypertension, or renal insufficiency because of high sodium content
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13
Q

Antacids and Antiflatulents

A

Antiflatulents are used to relieve he painful symptoms associated with gas
Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products

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14
Q

Antacids and Antiflatulents

A

OTC Antiflatulents
Simethicone (Oval Drops, Pediacol, Phazyme)
Alters elasticity of mucus-coated bubbles, causing them to break
Is used often to reduce the discomforts of gastric or intestinal gas, but there is limited data to support its effectiveness
Results in decreased gas pain and increased expulsion via mouth or rectum

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15
Q

Antacids: Contraindications

A

Known drug allergy
Severe kidney failure or electrolyte disturbance (because of the potential toxic accumulation of electrolytes in the antacids themselves)
GI obstruction (PT presents with and. pain; no antacids)

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16
Q

Antacids: Adverse Effects

A

Adverse effects are minimal and depen on the compound used
Aluminum and calcium : Constipation
Magnesium: Diarrhea
Calcium Carbonate: Produces gas and belching; combining it with simethicone reduces discomfort

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17
Q

Antacids: Drug Interactions

A

Adsorption of other drugs to antacids: Reduces the ability of the other drug to be absorbed into the body
Chelation (chemical binding, or inactivation, of another drug): Produces absorption of basic drugs; Decreased absorption of acidic drugs
Increased urinary pH: Increased excretion of acidic drugs; Decreased excretion of basic drugs

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18
Q

Antacids: Nursing Implications

A

Assess for allergies and pre-existing conditions that may restrict the use of antacids, such as: Fluid imbalances, pregnancy, renal disease, GI obstruction, heart failure (Patients with heart failure or hypertension should not use antacids with a high sodium content)

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19
Q

Antacids: Nursing Implications

A

Use with caution with other medications due to the many drug interactions
Most medications should be given 1-2 hours after giving an antacid
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset

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20
Q

Antacids: Nursing Implications

A

Be sure that chewable tablets are chewed thoroughly and that liquid forms are shaken well before giving
Administer with at least 240 ml of water to enhance absorption (except in the case of rapid-dissolve forms)
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as cancer or bleeding ulcers
If symptoms remain ongoing, patient should seek medical evaluation

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21
Q

Antacids: Nursing Implications

A

Monitor for adverse effects: N/V, abdominal pain, diarrhea; With calcium-containing products constipation, acid rebound
Monitor for therapeutic response: Notify health care provider if symptoms are not relieved

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22
Q

Histamine-2 (H2) Antagonists

A

Reduce acid secretion
Are available OTC in lower dosage forms
Are the most popular drugs for treatment of acid-related disorders: Cimetidine, Famotidine (Pepcid), Nizatidine (Axid), Ranitidine (Zantac)

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23
Q

H2 Antagoonists: Mechanism of Action and Drug Effects

A

Block histamine at the H2 receptors of acid-producing parietal cells
Reduce production of hydrogen ions, resulting in decreased production of HCl
Suppresses acid secretion in the stomach

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24
Q

H2 Antagonists: Indications

A

GERD
PUD
Erosive esophagitis
Adjunct therapy in control of upper GI bleeding
Pathological gastric hypersecratory conditions

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25
Common Stomach Disorders
GERD: Known as heartburn Symptoms: burning, bloating, belching, regurgitation. Reflux of gastric secretions such as pepsin and hydrochloric acid into the esophagus PUD: Several stomach disorders - commonly gastric and duodenal ulcers Symptoms: burning, gnawing, aching
26
H2 Antagonists: Adverse Effects
Overall, there are very few adverse effects Cimetidine may induce impotence and gynecomastia Other possible effects include: Headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing
27
H2 Antagonists: Drug Interactions
Cimetidine binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption Smoking has been shown to decrease the effectiveness of H2 blockers
28
H2 Antagonist: Nursing Implications
Assess for allergies and impaired renal or liver function Use with caution in patients who are confused or disoriented and in older adults Give 1 hour before or after antacids
29
Proton Pump
The parietal cells release positive hydrogen ions (protons) during HCl production This process is called the "proton pump" H2 blockers and antihistamines do not stop the action of this pump
30
PPIs: Mechanism of Action
PPIs irreversible bind to the hydrogen-potassium-ATPase enzyme This bond prevents the movement of hydrogen ions from the parietal cell into the stomach Result: achlorhydria - ALL gastric acid secretion is temporarily blocked: In order to return to normal acid secretion, the parietal cell must synthesize new hydrogen-potasssium-APTase
31
PPI: Drug Effect
Total inhibition of gastric acid secretion - Ianosprazole (Prevacid) - Omeprazole magnesium (Losec, Nexium) - Rabeprazole - Rabeprazole Sodium (Pariet) - Pantoprazole (Pantoloc): Only one that can be given IV - Esomeprazole (Mexium)
32
PPI: Indivcations
GERD maintenance therapy Erosive esophagitis Short-term treatment of active duodenal and benign gastric ulcers Zollinger-Ellison syndrome Treatment of H. pylori-induced ulcers: Given usually with an antibiotic
33
PPI: Adverse Effects
Safe for short-term therapy Some approved for long-term therapy (maintenance of healing) Adverse effects uncommon
34
PPI: Nursing Implications
Assess for allergies and history of liver disease Pantoprazole is the only proton pump inhibitor available for parenteral administration and can be used in patients who are unable to take oral medications PPIs may increase serum levels of diazepam (anti anxiety) or phenytoin (anti epileptic) and cause increased chance for bleeding with warfarin PPIs often work best when taken 30 to 50 minutes before meals
35
Other Drugs
Sucralfate (sulcrate) Misoprostol Simethicone (Oval drops, Pediacol, Phazyme)
36
Sucralfate (Sulcrate)
Is a cytoprotective drug (combines ulcers by ^ mucosal secretion) Is used for stress ulcers, PUD Is attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse) Absorbs little from the gut May cause constipation, nausea, and dry mouth May impair absorption of other drugs - give other drugs at least 2 hours before giving sucralfate Should not be administered with other medications Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels
37
Misoprostol
Misoprostol is a synthetic prostaglandin analgue Prostaglandins have cytoprotective functions: Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate, promote local cell regeneration, help to maintain mucosal blood flow Misoprostol is used for the prevention of NSAID - induced gastric ulcers Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea
38
Antidiarrheals: Meachanism of Action
Adsorbents: Coat the walls of the GI tract, bind to the causative bacteria or toxin, which is then eliminated through the stool Include bismuth subsalicylate (Bismuth, Maalos Multi Action, Pepto-Bismol, activated charcoal, attapulgite (Kaopectate), others)
39
Antidiarrheals: Mechanism of Action
Antimotility drugs: anticholinergics: Decrease intestinal muscle tone and peristalsis of GI tract, slow the movement of decal matter through the GI tract, Include belladonna alkaloids, atropine, hyposcyamine, hyoscine
40
Antidiarrheals: Mechanis, of Action
Antimotility drugs: opiates: Decrease bowel motility and relieve rectal spasms, decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed, reduce pain by relieving rectal spasms Include paregoric, opium tincture, codeine, loperamide (Imodium), diphenoxylate
41
Antidiarrheals: Mechanism of Action
Intestinal flora modifiers: Are also known as probiotics or bacterial replacement drugs Are bacterial cultures of Lactobacillus organisms, which work by: supplying missing bacteria to the GI tract, suppressing the growth of diarrhea-causing bacteria Include L. acidophilus
42
Antidiarrheals: Combination Products
Diphenoxylate with atropine (Lomotil) Diphenoxylate is combined with sub therapeutic amounts of atropine, this discourages recreational opiate drug use. Large doses will result in extreme anticholinergic effects (dry mouth, abdominal pain, tachycardia, blurred vision)
43
Antidiarrheals: Adverse Effects (Adsorbents)
- Increased bleeding time - Constipation, dark stools - COnfusion, twitching - Hearing loss, tnnitus, metallic taste, blue gums
44
Antidiarrheals: Adverse Effects (Anticholinergics)
Urinary renention, hesitancy, impotence Headache, dizziness, confusion, anxiety, drowsiness Dry skin, rash, flushing Blurred vision, photophobia, increased intraocular pressure Hypotension, hypertension, bradycardia, tachycardia
45
Antidiarrheals: Adverse Effects (Opiates)
``` Drowsiness, sedation, dizziness, lethargy N/V, anorexia, constipation Respiratory depression Bradycardia, palpitations, hypotension Urinary retention Flushing, rash, urticaria ```
46
Antidiarrheals: Interactions
Adsorbents decrease the absorption of many drugs, including digoxin, clindamycin, quinidine, hypoglycemic drugs, others Adsorbents cause increased bleeding time and bruising when given with anticoagulants Antacids can decrease effects of anticholinergic antidiarrheal drugs Many other interactions exist
47
Antidiarrheals: Nursing Implications
Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies Do NOT give bismuth subsalicylate (Pepto-Bismol) to children or teenagers with chicken pox because of the risk of Reye's syndrome Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes Assess fluid volume status, intake and output, and mucous membranes before, during, and after initiation of treatment Teach patients to notify their physician immediately if symptoms persist Monitor fo therapeutic effects
48
Laxatives: Mechanism of Action
``` Bulk-forming Emolient Hyperosmotic Saline Stimulant ```
49
Laxatives: Mechanism of Action (Bulk-forming)
Are high in fibre Absorb water to increase bulk Distend bowel to initiate reflex bowel activity Include: psyllium (Metamucil), methylcellulose (Entrocel solution), polycarbophil
50
Laxatives: Mechanism of Action (Emollient)
Are also referred to as stool softeners and lubricants Promote more water and fat in the tools Lubricate the decal material and intestinal walls Include: Stool softeners (docusate salts: Colace), lubricants (mineral oil: Fleet enema mineral oil)
51
Laxatives: Mechanism of Action (Hyperosmotic)
Increase fecal water content Result in bowel distention, increased peristalsis, and evacuation Include: polyethylene glycol (PEG) (Klean-Prep, Peglyte), sorbitol, glycerin, lactulose (also used to reduce elevated serum ammonia levels)
52
Laxatives: Mechanism of Action (Saline)
Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines Result in bowel distention, increased peristalsis, and evacuation Include: magnesium sulfate (Epsom salts), magnesium hydroxide (milk of magnesia), magnesium citrate (Citro-Mag, Citrodan), sodium phosphate
53
Laxatives: Mechanism of Action (Stimulant)
Increase peristalsis via intestinal nerve stimulation | Include: castor oil, senna (senokot preparations), cascara sagrada, bisacodyl
54
Laxatives: Contraindications
Drug allergy To be used with caution in the presence of the following: acute surgical abdomen, appendicitis symptoms (abd. pain, N/V), intestinal obstruction, undiagnosed abdominal pain
55
Laxatives: Adverse Effects
``` Bulk-Forming: - Impaction - Fluid overload - Electrolyte imbalances - Esophageal blockage Emollient: - Skin rashes - Decreased absorption of vitamins - Electrolyte imbalances - Rectal irritation Hyperosmotic: - Abdominal bloating -Electrolyte imbalances Saline: - Magnesium toxicity (with renal insufficiency) - Cramping - Electrolyte imbalances - Increased thirst - Diarrhea Stimulant: - Nutrient malabsorption - Skin rashes - Rectal/ Gastric irritation - Electrolyte imbalances ```
56
Antiemetic and Antinausea Drugs (VC and CTZ)
Vomiting Centre (VC) Chemoreceptor trigger zone (CTZ) - Both are located in the brain - Once stimulated, they cause the vomiting reflex
57
Antiemetic Drugs: Mechanism of Action
Many different mechanisms of action | Most work by blocking one of the vomiting pathways, thus blocking the stimulus that induces vomiting
58
Antiemetic Drugs: Indications
``` Specific indications vary per class of anti emetics General use for each type: prevention and reduction of N/V ```
59
Mechanism of Action and Other indications (Anticholinergic drugs: ACh blockers)
Bind to and block acetylcholine (ACh) receptors in the inner ear labyrinth Block transmission of nauseating stimuli to CTZ Also block transmission of nauseating stimuli from the reticular formation to the VC Include scopolamine (also used for motion sickness)
60
Mechanism of Action and Other Indications ( Antihistamine drugs (H1 receptor blockers))
Inhibit ACh by binding to H1 receptors Prevent cholinergic stimulation in vestibular and reticular areas, thus preventing N/V Include dimenhydrinate (Gravol), diphenhydramine (Benadryl), meclizine (Bonamine), promethazine (Histanil) Are also used for motion sickness, nonproductive cough, allergy symptoms, sedation
61
Mechanism of Action and Other Indications (Neuroleptic drugs)
Block dopamine receptors on the CTZ Include chlorpromazine, promethazine (Histanil), perphenazine, several others Are also used for psychotic disorders, intractable hiccups
62
Mechanism of Action and Other Indications (Prokinetic drugs)
Block dopamine in he CTZ Desensitize CTZ to impulses it receives from the GI tract Also stimulate peristalsis in the GI tract, enhancing emptying of stomach contents Include metoclopramide (Apo-Metoclop) Are also used for GERD, delayed gastric emptying
63
Mechanism of Action and Other Indications (Serotonin blockers)
Block serotonin receptors in the GI tract, CTZ, and VC Include dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran) Are used for N/V in patients receiving chemotherapy and for postoperative N/V
64
Mechanism of Action and Other Indications (Tetrahydrocannabinoids)
Are a major psychoactive substance in marijuana Have inhibitory effects on reticular formation, thalamus, cerebral cortex Alter mood and body's perception of its surroundings Include dronabinol (Marinol), nabilone (Cesarmex) Are used for N/V associated with chemotherapy and anorexia associated with weight loss in patients with AIDS
65
Adverse Effects
Vary according to drug used | Stem from their nonselective blockade of various receptors
66
Nursing Implications
Assess complete N/V Hx including precipitating factors Assess current medications Assess for contraindications and potential drug interactions Many of these drugs cause severe drowsiness; warn patients about driving or performing any hazardous tasks Taking anti emetics with alcohol may cause severe CNS depression
67
Nursing Implications
When used in patients receiving chemotherapy, anti emetics are usually given 1-3 hours before a chemotherapy drug Monitor for therapeutic effects Monitor for adverse effects
68
Nutrition Suplements
Dietary products used to provide nutritional support Malnutrition: The body's nutritional needs are not met by nutrient intake Enteral Nutrition: Provision of food or nutrients through the GI tract Parental Nutrition: Nutrients are delivered directly into the circulation by means of an IV solution
69
Enteral Nutrition
Oral consumption is the most common and least invasive route Feeding tubes through various routes can be used for enteral nutrition Feeding tubes are used for those with: Abnormal eophageal or stomach peristalsis, altered anatomy secondary to surgery, depressed consciousness, impaired digestive capacity
70
Enteral Formulation Groups
Provide the basic building blocks for anabolism Supply complete dietary needs through the GI tract by oral route or by feeding tube: elemental, polymeric, modular, altered amino acid, impaired glucose tolerance
71
Enteral Formulation Group: Elemental
Elemental formulations include Vivonex Plus, Peptamen, Vital HN Minimum digestion is needed; residual is minimal These formulations are used for malabsorption, partial bowel obstruction, IBD, other conditions Hyperosmolarity of formulas may cause GI problems
72
Enteral Formulation Group: Polymeric
Include Complete, Ensure, Ensure-Plus, Isocal, Osmolite, Sustagen, others Are preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer GI problems
73
Enteral Formulation Group: Modular
There are three types: - Carbohydrate: Moducal, Polycose - Fat: MCT Oil, Microlipid - Protein: Casec, ProMed Each of these is a single nutrient formula They can be added to other formulas if needed
74
Enteral Formulation Group: Altered Amino Acid
Include Criticare High, Nitrogen, Magnacal Renal, Traumacal, Ultracal High Nitrogen, Vital High Nitrogen Contain varying amounts of specific amino acids Are used for patients with diseases associated with altered metabolism capabilities
75
Enteral Formulation Group: Impaired Glucose Tolerance
Glucerna - Contains proteins, carbs, fat, sodium, potassium - Is used in patients with impaired glucose tolerance (diabetic patients)
76
Enteral Nutrition: Interactions
Various nutrients can interact with drugs to produce significant food-drug interactions Enteral nutrition can delay absorption of some medications Enteral nutrition may inactivate some medications (tetracycline and nutrient formulations that contain calcium)
77
Parenteral Nutrition
Totally digested nutrients are given IV, directly into the circulatory system - The entire GI system is bypassed, eliminating the need for absorption, metabolism, or bowel elimination
78
Parenteral Nutrition
``` Amino Acids - Nonessential amino acids - Essential amino acids - Semiessential amino acids Trace elements - Chromium - Iodine - Copper - Manganese ```
79
Parenteral Nutrition
Parenteral nutrition is also known as total parenteral nutrition (TPN) or hyperalimentation Formulations will vary according to individual patient nutritional needs - Amino acids - Carbs - Lipids - Trace Elements
80
Parenteral Nutrition
Peripheral administration - Temporary, short-term use (less than 2 wks) - Dextrose concentration generally less than 10% Central administration - Long-term use (over 2 weeks) - Dextrose concentration may be 10-50%
81
Peripheral TPN
Used to provide nutrients to patients who need more nutrients than present oral intake can provide - Procedures that restrict oral feedings - Anorexia caused by chemotherapy or radiation treatments - GI illnesses that prevent oral food intake - After surgery - When nutrition deficits are minimal, but oral nutrition will not be started for more than 5 days
82
Peripheral TPN: Adverse Effects
Phlebitis is the most devastating adverse effect - Can lead to loss of a limb Another potential adverse effect is fluid overload
83
Central TPN
Delivered through a large central vein - Subclavian - Internal jugular Used for long term (more than 2 wks) Disadvantages are the risks associated with central line insertion, use, and maintenance - Higher risk for infection, catheter-induced trauma, metabolic alterations
84
Central TPN
Delivers total dietary nutrients to patients who require nutritional supplementation - Patients with large nutritional requirements (metabolic stress or hyper metabolism) - Patients who need nutritional support for more than 2 weeks - Patients who are unable to tolerate large fluid loads
85
Central TPN: Adverse Effects
Most common are those surrounding the use of the central line for the delivery of TPN - Infection - Catheter-induced trauma There is a greater chance of hyperglycaemia due to the larger and more concentrated volumes of supplements given with this method than with the peripheral TPN method
86
Nursing Implications
Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements Consult with a registered dietician Assess baseline laboratory studies, such as total protein, albumin, urea, RBC count, WBC count, cholesterol Collect anthropometric data Assess for allergies to components of enteral nutritional supplements (such as whey, egg whites) Assess for lactose intolerance
87
Nursing Implications
If administering enteral nutrition by tube feedings, follow facility policy for ensuring proper tube placement and for checking residual before giving a feeding Follow procedures for flushing tubing to prevent clogging the feeding tube with formula Monitor how the patient is tolerating enteral feedings carefully Most enteral feedings are started slowly and the rate is increased gradually Monitor for signs of lactose intolerance - Cramping, diarrhea, abdominal bloating, flatulence
88
Nursing Implications
Follow facility policies and procedures for care and maintenance of TPN IV lines, including tubing and dressing changes Monitor patient's temperature; report any increase immediately Monitor blood glucose levels with a glucometer Monitor for hyperlgycemia - Headache, dehydration, weakness Monitor for hypoglycemia - Cold, clammy skin, dizziness, tachycardia, tingling of the extremities
89
Nursing Implications
While a patient is on TPN, the pancreas is providing increased amounts of insulin to cover the increased glucose levels If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels If TPN must be discontinued abruptly, then infuse 5-10% glucose to prevent hypoglycemia Monitor for fluid overload while on TPN - Weak pulse, hypertension, tachycardia, confusion, decreased urine output, pitting edema Monitor daily weights and intake and output volumes
90
Nursing Implications
Monitor for therapeutic responses to nutritional supplementation - Improved well-being, energy, strength, and performance of activities of daily living - Increased weight - Lab studies that reflect a more positive nutritional status

Pharm II (5 decks)

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