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Pharmacology for Advanced Practice Nurses > GI deck 4 > Flashcards

GI deck 4 Flashcards

1
Q

Prokinetics MOA

A

Stimulate motility of the GI tract without stimulating gastric, biliary, or pancreatic secretions

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2
Q

Prokinetic drug

A

Metoclopramide

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3
Q

Metoclopramide phamacodynamics

A

Metoclopramide stimulates motility in the upper GI tract.

Metoclopramide also has some actions similar to the phenothiazines and dopamine antagonists.

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4
Q

Metoclopramide has a

A

Black Box warning due to risk of developing tardive dyskinesia.

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5
Q

Prokinetics are contraindicated in

A

gastrointestinal (GI) hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation.

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6
Q

prokinetics use cautiously in

A

patients with a history of depression.

Depression may occur, including suicidal ideation.

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7
Q

porkineitcs are used more on a

A

short term basis

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8
Q

Prokinetics ADR

A 
Tardive dyskinesia
Depression, dizziness
Diarrhea 
Hypoglycemia in patients with diabetes
Rare: galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia
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9
Q

Prokinetics Additive ___

A

CNS depression occurs when used with other CNS depressants.

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10
Q

Prokineticcs increased risk of

A

EPS occurs with other drugs that have the potential for EPS.

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11
Q

Prokineitcs drugs with

A

anticholinergic effects reverse the action of metoclopramide.

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12
Q

Prokinetics clinical use and dosing

A

GERD
Adults: 10 mg 30 minutes before meals
Diabetic gastroparesis
10 mg 30 minutes before meals and at bedtime for 2 to 8 weeks
In patients with continuous complete remission below 40 mL/minute, their therapy initiated at approximately half the recommended dosage

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13
Q

Prokinetics monitoring

A

Renal function
New-onset movement disorder
Depression or suicidal ideation

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14
Q

Prokineitcs patient education

A

Administration
Take 30 minutes before meals.
Do not double doses.

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15
Q

Prokinetics ADR

A

Drowsiness
Additive CNS depression when taken with CNS depressants (alcohol)
Reporting any involuntary movements

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16
Q

Prokinetics lifestyle managment

A

GERD related lifestlyle changes

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17
Q

PPI (proton pump inhibitors) are

A

Drowsiness
Additive CNS depression when taken with CNS depressants (alcohol)
Reporting any involuntary movements

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18
Q

PPI are used for

A

erosive gastritis, GERD, and Zollinger-Ellison syndrome and as part of a treatment of active PUD, especially duodenal ulcers caused by Helicobacter pylori

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19
Q

PPI MOI

A

Reduce H+ secretion by inhibition of the H+/K+/adenosine triphosphatase (ATPase) enzyme system at the secretory surface of the parietal cell

Decrease in acid secretion lasts for up to 72 hours after each dose

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20
Q

PPI precautions and contraindications

A

Extensively metabolized in the liver; use cautiously in patients with hepatic dysfunction and in older adults

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21
Q

PPI pregnancy

A

category B or C
Congenital anomalies have been reported.
Use with caution.

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22
Q

PPI Children

A

Esomeprazole, omeprazole, and lansoprazole approved for short-term use in children as young as 1 year of age

Pantoprazole not approved in children 5 years of age and younger and rabeprazole not approved in children age less than 12 years

23
Q

PPI ADR

A

Risk for significant nutrient deficiencies: iron, vitamin B12, and calcium

24
Q

Long term PPI use increases

A

Long-term PPI use increases risk for osteoporosis and increased hip fractures
Long-term PPI therapy increases risk of Clostridium difficile, Salmonella, and Camphylobacter infections

25
Q

PPI there is an increased

A

risk of pneumonia

26
Q

PPI use questionable

A

gastric cancer risk

27
Q

PPI causes

A

kidney injury chronic kideny disease

28
Q

PPI Big picture

A

do not want them on it longer than 8 weeks. If longer than 8 weeks they should see a GI specialist

29
Q

PPI decreases effectiveness of

A

of atazanavir, indinavir, and nelfinavir

30
Q

PPI interfere with

A

absorption of drugs and depend on an acidic gastric pH to be effective

31
Q

PPI incresed monitoring of

A

international normalized ratio (INR) if taken with warfarin

32
Q

PPI with clopidogrel (plavix) has a

A

Black Box warning regarding interactions with omeprazole

33
Q

PPI clinical use and dosing for duodenal and gastric ulcers

A

PPIs are combined with antibiotics to treat H. pylori.

34
Q

PPI clinical use dosing for GERD

A

Used for 8 weeks, then patient weaned off

May need to double dose for 4 weeks and then decrease dose for another 4 weeks

35
Q

PPI may mask the symptoms of

A

gastric cancers

36
Q

PPI weaning

A

Decrease from twice/day to once/day, then every other day, with an H2RA used for symptoms, then patient weaned off.

37
Q

Six classes of laxatives

A 
Stimulants
Osmotics
Bulk-producing laxatives
Lubricants
Surfactants
Hypoerosolar laxatives
Chloride chanel activators
Opioid receptor antagonists
38
Q

Laxatives Stimulants MOI

A

direct action on intestinal mucosa by stimulating the myenteric plexus

39
Q

Laxatives Osmotics MOI

A

draw water into the intestinal lumen

Bulk-producing laxatives: natural and semisynthetic polysaccharides and cellulose that mix with water in the intestine

40
Q

Laxatives Lubricants MOI

A

soften stool and lubricates intestine

41
Q

Laxatives surfactants MOI

A

reduce the surface tension of the oil–water interface on the stool and facilitate admixture of fat and water into the stool

42
Q

Laxatives hyperosmolar MOI

A

draws water into intestine

43
Q

Laxatives chloride channel activators MOI

A

activate CIC-2 chloride channels in the GI tract to produce chloride-rich secretions that soften the stool

44
Q

Laxatives opioid receport antagonits MOI

A

mu receptor antagonists

45
Q

Laxatives all are contrindicated in the

A

the presence of nausea, vomiting, or undiagnosed abdominal pain or if bowel obstruction is suspected or diagnosed

46
Q

Magnesium hydroxide contraindicated

A

renal dysfunction

47
Q

methylneltrexone may cause

A

opioid withdrawl

48
Q

laxatives ADR

A

Excessive bowel activity, cramping, flatulence, and bloating

49
Q

Laxative rapid short term use

A

Stimulants are the drugs of choice.
Osmotic laxatives also work well (magnesium hydroxide, PEG 3350).
Surfactants: docusate

50
Q

Laxative slower response

A

Bulk-forming laxatives

51
Q

Laxative for pregnancy

A

Bulk-forming laxatives are safest.

PEG (Miralax) or docusate may be used.

52
Q

Laxative rapid actving administration

A

Rapid-acting laxatives are best taken in the morning; slower-acting ones are best taken at bedtime.

53
Q

Laxative what is KEY

A

Prevention is the key.
Laxatives are temporary fixes.
Misconceptions about bowel function should be corrected.

Pharmacology for Advanced Practice Nurses (50 decks)

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