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Pharm > GI > Flashcards

GI Flashcards

1
Q

GI Function

A 
Digestion food particles 
Absorption of the digested content 
- nutrition 
- electrolyte 
- minerals and fluids
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2
Q

What are the secreted gastric juice

A
  • chief cells, which secrete the pro enzyme pepsinogen ( pepsin)
  • parietal cells, which secrete HCL
  • Gastrin-producing cells, which secrete gastric a hormone that regulates enzyme release during digestion
  • mucus producing cell that release mucus to protect the stomach lining which extends from the mouth to the duodenum.

*** mucosa extends from the mouth to the anus

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3
Q

Where do must drugs absorb in ? And which drugs absorb in the stomach?

A
  • in the duodenum

- lipid soluble drugs and alcohol

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4
Q

Gastrointestinal disorders

A
  • vomiting ( f/e and nutrition prob)
  • diarrhea ( f/e, absorption)
  • constipation ( decreased peristalsis )
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5
Q

Primary problem with GI and concern

A

Primary: fluid and electrolyte and nutrition
Concern: how the food get through the GI tract ( peristalsis )

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6
Q

Drugs to treat GI disorders

A
  • Antiemetics ( stops you from vomiting)
  • Emetics ( causes you to vomit)
  • Anti-diarrhea ( stops diarrhea)
  • laxative ( treats pt with constipation)
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7
Q

Why does vomiting occur ?

A

Motion sickness, viral and bacterial infection, food tolerance, surgery, pregnancy, pain, shock, effects of selected drugs, radiation, disturbances of the middle ear that affect equilibrium or hit in the back of the head

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8
Q

Cerebral centers affecting vomiting

A

-Vomiting center
* found inside the medulla
* Causes vomiting to stimulate
* odor, smell, taste and gastric mucosal irritation are transmitted directly to the vomiting center. Causing pt to vomit
* Acetylcholine is a vomiting stimulant
BLOCK ACETYLCHOLINE IS VOMITING IS CAUSED BY SENSORY IMPULSES

  • Chemoreceptor trigger center
    • found near the medulla
      *Drugs and toxins
    • Dopamine stimulates CTZ, which in turns stimulate the vomiting center and causes vomiting
      BLOCK DOPAMINE IF VOMITING IS CAUSED BY A DRUG OR TOXIN
      Vestibular center
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9
Q

NON- PHARMACOLOGIC measures

A
  • weak tea
  • flat soda
  • gelatin
  • Gatorade
  • pedialyte ( for children )
  • crackers
  • toast

**Ginger and red raspberry tea

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10
Q

Non prescription anti-emetics
-Antihistamines - hydr. - cilzine hydrochloride
- Bismuth subsalicylate ( pepto - bismol) * Acts directly on the gastric mucosa to supress vomiting
◦ Dimenhydrinate (Dramamine)
◦ Cyclizine hydrochloride (Marezine)
◦ Meclizine hydrochloride (Antivert)
◦ Diphenhydramine (Benadryl)

Use/action, S/E, contra, Implication, P/E

A

Usage: for motion sickness
Cyclizine, Meclizine prevent nausea vomiting and dizziness caused by motion sickness; inhibit vestibular stimulation in the inner ear
Diphenhydramine ( Benadryl) to prevent or alleviate allergic reactions by inhibiting H1 receptor
- side effects ( similar to anticholingerics)
* drowsiness, dry mouth, constipation, NO PEE, NO POO, dizziness, hypotension, tachycardia, blurry vision, palpitation
- Contraindication: Pregnant women in first trimester, hepatic disorder, Glaucoma, hypersensitive=it’s, intolerance to alcohol or tetrazzini
Implication: determine history & factor of vomiting, assess vital signs, bowel sounds, dehydration, I&O, urinalysis before and during therapy
P/E: TAKE 30 MINS BEFORE. No driving ( drowsiness), perform good oral care, avoid alcohol

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11
Q 
Prescriptive antihistamines 
antihistamine 
anticholingerics 
dopamine antagonists
benodiazepines 
serotonin antagonists 
Glucocorticoids 
Canabinoids (for patients with cancer)
Miscellaneous
A 
For cancer Patients:
antihistamine 
anticholingerics 
dopamine antagonists
---------------------------------
-benodiazepines (lams & pams)
-serotonin antagonists (PNS similar )
-Glucocorticoids 
-Canabinoids (for patients with cancer) (act directly on cerebral cortext)
-Miscellaneous (act on CTZ)
----------------------------
associated with vomiting
antihistamine & anticholingerics ( act directly on V.C & lowers stimulation of the CTZ)
serotonin antagonists
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12
Q

Chlorpromazine (Thorazine) -dopamine antagonists & Promethazine HCl (Phenergan) & Hydroxyzine - antihistamine
-end in ZINE

Use/action, S/E, contra, Implication, P/E

  • renal PT
    NO EPS FOR PROMETHAZINE
other meds: 
 -Butyrophenones
 (- peridol)
- Benzodiazepines 
(-lams and pams)
A

-Action: blocks dopamine receptors, (acts primarily on the vomiting center, lowers stimulation of CTZ and vestibular pathway)
-Use: treat PostOp nausea and vomiting resulting from surgery, anesthetics, chemotherapy, and radiation sickness
-SE: drowsiness, dry mouth,blurred vision,tachycardia, anticholinergic symptoms ( dry everything, NO PEE NO POO) moderate sedation, hypotension, EPS, CNS effects (weakness, restlessness)
Conra:GLAUCOMA, hypersensitivity, comatose , prostatic hypertrophy, bladder neck obstruction, severe hypotension, CNS depression, CV, Seziure disorder
Implication: keep patient recumbent for at least 30 minutes following administration to minimize hypotensive effects if given IV, Assess for risk for falls, monitor BP, monitor CBC & liver function & ocular exams periodically( decrease in CBC, increase in liver functions)
P/E: do not skip doses, report symptoms of tardive dyskinesia, change positions slowly, avoid driving or activities requiring alertness before knowing response to medication, use sunscreen and protective clothes when exposed to the sun (may cause temporary pigment change), practice good oral hygiene, do not take within 2 hrs of antacid or antidiarrheal, may turn urine pink to reddish brown color

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13
Q

Serotonin antagonits
ends in -SETRON
-ONDANSETRON (ZOFRAN)
-(granisetron, dolasetron, palonosetron)

Use/action, S/E, contra, Implication, P/E

  • DOES NOT BLOCK DOPAMINE & DO NOT HAVE EPS S/E
A

-Action: Block serotonin receptors in CTZ, Block afferent vagal nerve terminals in upper GI tract -Use: Nausea and vomiting from cancer chemotherapy– induced emesis or emetogenic anticancer drug, pre/postoperative nausea and vomiting
S/E: headaches, diarrhea, dizziness, and fatigue

  • Implication: assess for nausea and vomiting as well as abdominal distention, monitor for signs and symptoms of serotonin syndrome. 30 MINS BEFORE CHEMO
  • Patient Education: take as directed, immediately report symptoms irregular heartbeat, serotonin syndrome, or involuntary movement of eyes face or limbs
  • Contraindications: hypersensitivity, pt with phenylketonuria, congenital QT syndrome, concurrent use of apomorphine
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14
Q

Glucocorticoids ends in -SONE -SOLONE
Dexamethasone & methylprednisolone

ARE NOT ON STUDY GUIDE

A

use: effective in suppressing emesis associated with cancer chemotherapy

Given IV
Check glucose level

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15
Q

Cannabinoids : dronabinol (Marinol)

*can be used for appetite increase for patients with aids

A
  • Action: inhibition of the vomiting control mechanism in the medulla oblongata
  • Use: Nausea and vomiting from chemotherapy
  • SE: mood changes, euphoria, drowsiness, dizziness, headaches, depersonalization, nightmares, confusion, incoordination, memory lapse, dry mouth, orthostatic hypotension or hypertension, and tachycardia
  • Implication: capsules should be refrigerated, drug may be administered prophylactically 1-3 hours prior to chemo and repeated every 2-4 hrs after chemo
  • Patient Education: do not double dose, call for assistance when ambulating (may cause dizziness), change positions slowly to minimize ortho hypotension, do not drink alcohol while taking this drug,
  • Contraindications: PT WITH PSYCHIATRIC DISORDER
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16
Q 
Miscellaneous 
diphenidol (vontrol), trimethobenzamide ( Tigan)

NOT ON S.G

  • do not act on anti histamine, anti cholinergic, or phenothiazine
A

use- postop nausea and vomiting, chemotherapy, radiation therapy
Action: suppress impluse to CTZ, block dopamine
S/E: drowsiness, anticholingeric s/s, hypotension, diarrhea, and EPS

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17
Q

Miscellaneous
metoclopramide (Reglan)

  • on S.G
  • Block DOPAMINE Center

** ‘ya man reglan be making the GI system move along so the tract will be alright”

A

Action: Suppress impulses to CTZ, Stimulate GI tract
Use: Used in the treatment of postoperative n/v , cancer, chemotherapy, and radiation therapy

  • SE: sedation ( drowsiness, restleness, fatigue, lethargy) and diarrhea EPS IN KIDS
  • Implication: assess for nausea vomiting and abdominal distention, monitor for tardive dyskinesia, monitor for neuroleptic syndrome(hyperthermia, muscle rigidity, altered consciousness, irregular pulse or BP, tachycardia, and diaphoresis), monitor for signs of depression
  • Patient Education: may cause drowsiness, do not drink alcohol while taking this drug,
  • Contraindications: GI obstruction, hemorrhage, and perforation,— history of tardive dyskinesia, Parkinson’s, may alter hepatic function , may cause elevated serum prolactin and aldosterone
18
Q

NURSING PROCESS ANTIEMETICS

A

Determiine fequency, amount and onset of vomiting
FIND OUT WHY THEY VOMIT NONPHARMALOGIC FIRST

** DONT GIVE TO PT WITH GLAUCOMA
Keep a baseline vitalsigns urinalysis, F/E balance, monitior bowel sounds and provide oral care.

  • *Avoid alcohol
    • Avoid in first trimester of pregnancy
19
Q

Emetics

Use of Ipecac vs Activated Charcoal:

A

-Ipecac is used to induce vomiting whereas Activated Charcoal is used as an absorbent promotes absorption of the poison/ toxic/ overdose substance.

20
Q

Emetics

–Ipecac

A

-Use: Induces vomiting after toxic substance
-SE: sedation, diarrhea, aspiration, arrhythmias and MYOCARDITIS
-Nursing implications:
• If vomiting does not occur within 15–30 min, dose may be repeated. If vomiting does not occur after the second dose, give activated charcoal. Also, gastric lavage may be needed if vomiting does not occur.
• PO: Have the patient sit up with their head forward prior to administration. Ipecac syrup may not work on an empty stomach. Administer syrup followed immediately by adequate amounts of water (1 glass [240 mL] for adults, ½–1 glass [120–240 mL] for infants and children).

-Contraindications:
• Unconscious or convulsing patients
• Patients who may not have a gag reflex
• Ingestion of caustic substances ( ammonia, chlorine bleach, lye, toilet cleaners, or battery acid)
• Petroleum distillates are ingested (gasoline, kerosene, paint thinners, and lighter fluid).
• MILK OR CARBONATED
BEVERAGE

—Patient education:
• Use ipecac syrup, not ipecac fluid extract.
• Take with a glass of water, not with milk or carbonated beverage
• Vomiting occurs in 15 to 30 minutes

21
Q

Emetics

Activated Charcoal

A

– Action: binds drugs and chemicals in the GI tract
—Use: promotes absorption of the poison/ toxic/ overdose substance.
—SE: Black stools, constipation, diarrhea and vomiting
— Nursing implications:
• Activated charcoal is most effective if administered within 30 min of ingestion of drug or poison.
• Mix dose in 6–8 oz water
• Do not administer with milk products
• Do not administer other oral drugs for 2 hours before or after administering activated charcoal
• Monitor BP, pulse, respiratory and neurologic status, and urine output as indicated by toxicity of agent(s)

—Contraindications: Milk, ice cream, or sherbet will decrease the ability of charcoal to absorb other agents.

—- Patient education:
• Inform the patient that their stools will turn black.
• Poisoning: When counseling, discuss methods of prevention, need to confer with poison control center, physician, or emergency department before administering, and need to bring ingested substance to the emergency department for identification.

22
Q

Diarrhea
Causes

**priority fluid and electrolyte imbalance

A
  • Spolied foods or excessive spicy food
  • Bacteria ( E.coil, Salmonella)
  • Viruses
  • toxins
  • Drug reaction
  • fecal impaction, laxative abuse
  • Malabsorption disorder
  • bowel tumor
  • IBD
  • stress/ anxiety
23
Q

Diarrhea
-Nonphrmacologic measures

  • Purpose
  • Precautions
A
  • clear liquids
  • oral solutions ( Gatorade, pedialyte, rehdralyte)
    -IV electrolyre solution
    ( isotonic, hypotonic)

Purpose
-Decrease hypermotility (increased peristalsis)
Precautions
- Do not use for more than 2 days or if fever present

24
Q

Traveler’ s diarrhea/ Acute diarrhea

  • prevention
  • Treatment

caused by e.coil

A

Prevention
-Drinking bottled water, washing fruit, eating cooked vegetables, meat should be well done

Treatment

  • Fluoroquinolone antibiotics (if severe)
  • Loperamide (slow peristalsis but can also slow excretion of organisms from GI tract)
25
Q

Antidiarrheals

  • purpose
  • caution
  • types
A

purpose: decrease hypermotility
caution: should NOT BE USED FOR MORE THAN @ DAYS OR IF FEVER IS PRESENT

Types:

  • opiates and opiates related agents
  • somatostatin analogue
  • Misellaneous
26
Q

opiates and opiates related agents

  • – Diphenoxylate with Atropine (Lomotil)
    • has anticholingeric properties b/c its has atropine

others not on S.G:
( difenoxin(Motofen), Loperamide (Imodium)

** 2hrs

A

-Action
• Inhibits excess GI motility, abdominal cramping, and hypersecretion
-Use: Decrease GI Motility

-SE :Dizziness, drowsiness, dry mouth, flushing, headache, CONSTIPATION & fatigue. MAY CAUSE RESPIRATORY DEPRESSION
MAY CAUSE DEPENDENCE

-implications:
Assess: 
-stool consistency & frequency
-bowel sounds (prior & throughout)
-Fluid & electrolyte balance, skin turgor for dehydration
-RESPIRATORY

P/E: Avoid alcohol/ CNS depressants

-Contraindications
• Liver disease
• Severe glaucoma

27
Q

Antidiarrhea

Adsorbents

A

act by coating the wall of the GI tract and absorbing bacteria or toxins that causes diarreah

28
Q

Adsorbents
-Colestipol and cholestyramine (Questran)

***not on S.G
Others:
-Kaolin and pectin
-Bismuth subsalicylate ( pepto bismol) (absorbs bacteris/ toxins)

A

Action: coat the wall of the GI tract and absorb bacteria or toxins that cause diarrhea.
Use: Treats diarrhea due to excess bile acids in the colon. Also used for diarrhea, dyspepsia, pyrosis and cholesterol.

Side Effects: dizziness, headache, weakness, anxiety, confusion, tinnitus, tongue discoloration, hearing loss, and stool discoloration

Nursing implications: Assess cause of diarrhea, record baseline V/S, monitor frequency of bowel movement, assess bowel sounds, monitor for dehydration, recognize that drug may need to be discontinued if diarrhea continues for more than 48 hrs.

Contraindications: glaucoma, liver disease, narcotic dependence, children, ulcerative colitis, pregnant, fever

29
Q

Anti-diarrheal Nursing process

A

Priority: obtaining an history find out why patient has diarrhea
assess vital signs, bowel sounds (Hyperactivity means they will have diarrhea)
S/S of Dehydration
Contraindicated: Pt with liver diseas, narcotic dependence, ulceratice colitits and GLAUCOMA, pregnancy

** DONT GIVE IT TO PT WITH FEVER

30
Q

Constipation

A

the accumulation of hard fecal material in the large intestine

**Common complaint and a major problem for older adults. Always treat pt. with non-pharmacologic FIRST.

31
Q

Constipation causes

A
  • Bowel obstruction; fecal impaction;
  • chronic laxative use
  • ignoring urge to defecate;
  • Neurological disorders
  • side effect of drugs (such as anticholinergics, pain meds/opioids/narcotics and certain antacids)
  • lack of exercise; insufficient consumption of fiber and/or water
32
Q

Constipation Nonpharmacologic treatment

A
  • Diet (high fiber)
  • Water
  • Exercise
  • Routine bowel habits = Should be 1-3/day or 3/week (you must determine what normal bowel habits are for each pt. before you administer a laxative)
33
Q

KNOWN Laxative

A

Laxatives should be avoided if there is any question that the patient may have Intestinal obstruction; severe abdominal pain; or if symptoms of appendicitis, ulcerative colitis or diverticulitis are present. Also pregnant women.

34
Q

Classes of laxatives

A
  • Laxatives – soft stool (less aggressive)
  • Cathartics – soft to watery stool w/ cramping
  • Purgatives – watery stool w/ cramping (very harsh)
35
Q

Types of Laxatives

A
  • Osmotic (Saline)
  • Stimulant (Irritants)
  • Bulk-forming
  • Emollient
36
Q

Laxative: Osmotic (Saline)

  • Lactulose (Chronulac)
  • given to ppl with high ammonia levels & liver disorder
  • Golytely

KAYEXALATE can be given to ppl with renal faliure gets rid of potassium

A
  • Action: Hyperosmolar salt pulls water into the colon and increases water in feces to increase bulk, which stimulates peristalsis and defecation.
  • Use: bowel preparation for diagnostic/surgical procedures, constipation and hepatic encephalopathy
  • Side Effects: F/E imbalance, hypotension, weakness ALSO belching, flatulence, N/V, diarrhea, abdominal pain, metabolic acidosis, hypokalemia, hypernatremia
  • implications: Assess cause of constipation, ask about frequency of stools, record baseline V/S, check renal function, monitor I’s&O’s, monitor F/E imbalance, monitor bowel sounds

** MAKE SURE PT HAS GOOD RENAL FUNCTION

37
Q

Laxative: Stimulant (Irritants)

  • Bisacodyl (Dulcolax) purgative (most frequent used/abused)
  • Senna (Senokot)
A
  • Action: Increase peristalsis by irritating sensory nerve endings in intestinal mucosa
  • Use: empty the bowel before diagnostic tests
  • Side Effects: abdominal cramps, weakness, reddish brown urine, diarrhea and nausea.
  • implications: Assess cause of constipation, ask about frequency of stools, record baseline V/S, check renal function, monitor I’s&O’s, monitor F/E imbalance (especially K+ and Cal), monitor bowel sounds
  • Patient educations: Drink plenty of water, avoid overuse of laxative, exercise, high fiber diet, read labels, take drugs as prescribed. Results: Orally 6-12 hr. rectally 15-30 min.
  • Contraindications: Hypersensitivity, fecal impaction, intestinal/biliary obstruction, GI bleeding, appendicitis, abdominal pain, nausea, vomiting
38
Q

Laxative: Bulk-forming
-Psyllium (Metamucil) (can be used by patients with diverticulitis, IBS and ileostomy and colostomy)

**not on S.G
others:
Methylcellulose ( citrucel), Polycarbophil ( fibercon)

A
  • Action: natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing fecal bulk and peristalsis.
  • Use: relief/prevention of constipation
  • Side Effects: Not systemically absorbed so there is no systemic effect besides abdominal cramps. If used excessively flatus, N/V, or diarrhea.
  • Nursing implications: Assess cause of constipation, ask about frequency of stools, record baseline V/S, check renal function, monitor I’s&O’s, monitor F/E imbalance, monitor bowel sounds
  • Patient educations: Teach pt. mix in glass of water/juice, stir, drink immediately followed by a half to a full glass of water. Insufficient water intake can cause the drug to solidify leading to intestinal obstruction.
  • Results 8-12hrs. Do not swallow agent in dry form. Do not inhale powder. Drink plenty water, avoid overuse of laxative, exercise, a high fiber diet, read labels, take drug as prescribed.

-Contraindications: dysphagia

39
Q

Laxative: Emollient

  • docusate sodium (Colace)
    • an oil does not stimulate a BM

stool softeners, oils the GI tract so BM can slip out)

A
  • Action: Lowers surface tension, promotes water accumulation in the intestine, emulsifies and lubricates feces for easier passage. (does not stimulate a bowel movement it lubricates)
  • Use: Used to prevent constipation, reduce straining post-surgery or myocardial infarction

-Side Effect: May cause throat irritation, N/V, diarrhea and abdominal cramps.

Nursing implications: Assess cause of constipation, ask about frequency of stools, record baseline V/S, check renal function, monitor I’s&O’s, monitor F/E imbalance, monitor bowel sounds

  • Patient education: Drink plenty water, avoid overuse of laxative, exercise, high fiber diet, read labels, take drug as prescribed
40
Q

Laxatives Nursing process

A

Assess the cause of constipation
Always asssess renal & liver function
Baseline vital sign
Teach pt tp mix agent with plenty of water 8-10oz . DONT DRINK IN POWDER FORM OR INHALE IT
read labels, take drugs as prescribed b/c it can cause F/E imbalance
HIGH FIBER, EXERCISE AND WATER
contraindication:
- undiagnosed abdomial pain (FEVER)
-inflammatory disorders of GI tract (appendicitis, diverticulitis, U.C)
- spastic colon
-bowel obstruction
-pregnancy

41
Q

sucralfate (carafate)

A

action
-Aluminum salt of sulfated sucrose reacts with gastric acid to form a thick paste, which selectively adheres to the ulcer surface.
Use
-Protection of ulcers, with subsequent healing.

S/E: dizziness, drowsiness,pruritus, rashes,hyperglycemia,constipation, diarrhea, dry mouth, gastric discomfort, indigestion, nausea,HYPERSENSITIVITY REACTIONS

implication:

  • Assess patient routinely for abdominal pain and frank or occult blood in the stool.
  • Administer on an empty stomach, 1 hr before meals and at bedtime. Tablet may be broken or dissolved in water before ingestion. Shake suspension well before administration.
  • Oral suspension is only for oral use; do not administer IV. Shake well before use. Store at room temperature, do not freeze.
  • If antacids are also required for pain, administer 30 min before or after sucralfate dose.

contra: enal failure (accumulation of aluminum can occur);
Diabetes (↑ risk of hyperglycemia with suspension);
Impaired swallowing (↑ risk of tablet aspiration).

P/E:

  • Advise patient to continue with course of therapy for 4–8 wk, even if feeling better, to ensure ulcer healing. If a dose is missed, take as soon as remembered unless almost time for next dose; do not double doses.
  • Advise patient that increase in fluid intake, dietary bulk, and exercise may prevent drug-induced constipation.
  • Emphasize the importance of routine examinations to monitor progress.

Pharm (6 decks)

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