GI Drugs

Question 1

Chapter 56
Gastrointestinal System Review
Acid production in the stomach is stimulated by which factors?

Answer 1

Protein in the stomach
Calcium products in the stomach
Alcohol in the stomach
low levels of acid in the stomach
H2 stimulation

Question 2

What are the 3 accessory organs of the GI system?

Answer 2

Pancreas
Liver
Gallbladder

Question 3

What is the “nervous system” of the GI tract called?

Answer 3

Enteric nervous system

Question 4

What are the 4 major activities of the GI system? ** KNOW THIS
SADM

Answer 4

Secretion: Of enzymes, acid, bicarbonate, and mucus
Absorption: Of water and almost all of the essential nutrients needed by the body
Digestion: Of food into usable and absorbable component
Motility: Movement of food and secretions through the system

Question 5

What is secreted?

Answer 5

BAE

Bicarbonate mucus
Acid
Enzymes
and Mucus facilitates the digestion and absorption of nutrients.

Question 6

What is absorbed?

Answer 6

Water and almost all of the essential nutrients needed by the body

Question 7

GI system is controlled by what?

Answer 7

Nerve plexus

Question 8

What does the nerve plexus do?

Answer 8

Maintains basic electrical rhythm.

Responds to local stimuli to increase or decrease activity

Question 9

The nurse is aware that the types of secretions that the GI tract produces are?
HINT:8

Answer 9

Saliva
Mucus
Acid and digestive enzymes (Gastrin)
Secretin
Sodium bicarbonate 
Pancreatic enzymes, other lipases, and amylases
Bile
Endocrine hormones

Question 10

Digestion is the process of?

Answer 10

Breaking food into usable, absorbable nutrients

Question 11

Absorption is

Answer 11

The active process of removing water, nutrients, and other elements from the GI tract

Question 12

What happens once water, nutrients, etc…are removed from GI tract?

Answer 12

They are delivered to the bloodstream for use in the body

Question 13

What is GI Motility?

Answer 13

GI tract depends on an inherent motility to keep things moving through the system.

Question 14

In the esophagus the basic movement is

Answer 14

Peristalsis

Question 15

How many layers does the stomach use to produce a churning action?

Answer 15

3 layers
Mucosa- forms folds called rugae
Submucosa-controls secretions and smooth muscle contractions
Muscularis externa- protects 2 other layers

Question 16

Basic movement in the esophagus

Answer 16

Peristalsis

Question 17

Small intestine use a process of

Answer 17

Segmentation

Question 18

Large intestine uses a process of

Answer 18

Mass movement

Question 19

When the renal capsule becomes irritated the gastrointestinal tract shuts down?

Answer 19

Rationale: Renointestinal Reflex: Irritation or swelling of the renal capsule causes a cessation of movement in the GI tract, again to prevent further irritation to the capsule.

Question 20

What are some underlying causes of GI disorders?

Answer 20

Dietary Excess
Stress
Hiatal Hernia
Esophageal Reflux
Adverse Drug Effects 
Peptic Ulcer Disease

Question 21

What is ondansetron (Zofran) prescribed for?

Answer 21

To help relieve nausea symptoms

Question 22

A series of local reflexes within the GI tract helps maintaine homeostasis within the system. A change of any of these reflexes may result in disruption of

Answer 22

homeostasis- constipation (underactivity) or diarrhea (overactivity)

Question 23

Swallowing is controlled by the?

Answer 23

Medulla

Question 24

Vomiting is controlled by the CTZ

Answer 24

in the medulla or by the emetic zone in immature or injured brains.

Question 25

Ch 57 Drugs affecting GI Secretions | Effect of Drugs on GI Secretions

Answer 25

Decrease GI secretory activity Block the action of GI secretions (GERD) Form protective coverings on the GI lining to prevent erosion from GI secretions (PUD) Replace missing GI enzymes that the GI tract or ancillary glands and organs can no longer produce

Question 26

Which are the 2 main secretion "culprits"

Answer 26

GERD and PUD

Question 27

KNOW THIS - GERD When we swallow food, it travels down the esophagus through the

Answer 27

esophageal sphincter. This blocks the food from coming back up. When it doesn’t, food/gastric juices can go back up the esophagus. This can cause erosions on the esophagus and also nausea Bad news if this comes back up and go up the trachea However if esophageal sphincter does not properly close then the acid goes up the esophagus causing GERD

Question 28

Peptic Ulcer Disease Define Symptoms Cause

Answer 28

Definition Ulcers are sores or abrasions on the lining Erosions in the lining of the stomach and adjacent areas of the GI tract Symptoms Gnawing, burning pain, often occurring after meals, stomach ache Cause Bacterial infection caused by Helicobacter pylori bacteria (h. Pylori and Stress!!) think stress ulcer

Question 29

5 Drugs Used to Treat GERD and PUD 1. H2 antagonist What is the prototype? and adverse effects

Answer 29

Histamine-2 (H2) Antagonists: BLOCK the release of hydrochloric acid in response to gastrin (blocks the receptor sites) prototype? cimetidine Route: Oral IM, IV rapid onset Adverse effects: dizziness, confusion, headache, somnolence, cardiac arrhythmias, cardiac arrest, diarrhea, impotence, gynecomastia, rash

Question 30

Drugs that treat GERD and PUD 2. Antacids What is the prototype?

Answer 30

group of inorganic chemicals that NEUTRALIZE stomach acid prototype? sodium bicarbonate

Question 31

5 Drugs Used to Treat GERD and PUD 3.Proton Pump Inhibitors: What is the prototype?

Answer 31

drug that blocks the H+, K+, -ATPase enzyme system on the secretory surface of the gastric parietal cells, thus interfering with the final step of acid production and lowering acid levels in the stomach (Suppress the secretion of hydrochloric acid into the lumen of the stomach) Prototype: omeprazole

Question 32

5 Drugs Used to Treat GERD and PUD 4. GI Protectants: What is the prototype?

Answer 32

Coat any injured area in the stomach to prevent further injury from acid Prototype: sucralfate Think: Pepto Bismol

Question 33

5 Drugs Used to Treat GERD and PUD 5. Prostaglandins: HINT: can also induce labor

Answer 33

Inhibit the secretion of gastrin and increase the secretion of the mucous lining of the stomach, providing a buffer gastrin digestive hormone secreted by the GI tract Prototype: misoprostol (Cytotec)

Question 34

What are the 4 Histamine 2 antagonists? HINT: H2 antagonists How do these work?

Answer 34

``` the "tidine"s, most of these are all OTC cimetidine (Tagamet HB) NO peds! famotidine (Zantac) may cause cancer? nizatidine (pepcid) _ NO peds! ranitidine (Axid) ``` Selectively block the secretion sites and takes acid secretion down. This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production

Question 35

Histamine-2 (H2) Antagonists Indications/TX HINT: ZE syndrome

Answer 35

Short-term treatment of duodenal ulcer or benign gastric ulcer (acute bleeding in critical patients) GERD, prophylaxis of stress ulcers, relief of symptoms of heartburn, acid digestion, sour stomach Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome give one of the "tidines" to treat this condition

Question 36

Histamine-2 (H2) Antagonists Think Pepcid AC Pharmacokinetics and contraindications

Answer 36

Pharmacokinetics Readily absorbed after oral administration Metabolized in the liver and excreted in urine Contraindications Known allergy

Question 37

Histamine-2 (H2) Antagonists Caution Adverse Effects

Answer 37

Caution Pregnancy or lactation Hepatic or renal dysfunction (Liver/Kidney) Adverse Effects GI effects (diarrhea/constipation) CNS effects NONE Cardiac arrhythmias and hypotension (RARE)

Question 38

Drug to drug interactions

Answer 38

``` Warfarin phenytoin beta blockers Alcohol Quinidine Lidocaine theophyllineChloroquine ``` Benzodiazepines Nifedipine Pentoxifylline Tricyclics Procainamide carbamazepine

Question 39

``` Name the antacids aluminum salts (alternaGEL) calcium salts (oystercal, Tums) Magnesium salts (milk of magnesia) Sodium bicarbonate (Bell-ans) ``` SCAM

Answer 39

``` aluminum salts (alternaGEL) calcium salts (oystercal, Tums) Magnesium salts (milk of magnesia) Sodium bicarbonate (Bell-ans) ```

Question 40

Nursing ConsiderationsHistamine-2 (H2) Antagonists

Answer 40

Assess: History and Physical Exam and known allergy Impaired renal or hepatic function Skin, pregnancy and lactation Neurological status, including orientation and affect cardiopulmonary status, including pulse, blood pressure, abdomen and liver, and appropriate lab values

Question 41

Question: | Drugs act in several ways on the secretions of the GI tract. Which action affects the GI secretions least?

Answer 41

Replaces secretions Rationale: The effects of drugs on GI secretions: decrease GI secretory activity; block the action of GI secretions; form protective coverings on the GI lining to prevent erosion from GI secretions; replace missing GI enzymes that the GI tract or ancillary glands and organs can no longer produce.

Question 42

Cimitidine is used how in a hospital setting? HINT: H2 antagonist

Answer 42

used in a hospital (ICU) in IV form, especially on intubated patients, it works rapidly, used to turn down the volume of the acid for a patient that is immobile so that they don't aspirate on their own GI acid

Question 43

Antacids(protect the stomach from its own acid)

Answer 43

CAN DAMAGE ESOPHAGEAL LINING

Question 44

Antacids | S, C, A, M

Answer 44

``` Sodium bicarbonate (Bell-ans) Calcium carbonate (Oystercal, Tums) Aluminum salts (Amphojel) Magnesium salts (Milk of Magnesia) all OTC ```

Question 45

Antacids Actions Indications

Answer 45

Actions Immediately neutralizes the stomach acid Fast (immediate) relief Indications Symptomatic relief of upset stomach associated with hyperacidity, as well as hyperactivity

Question 46

Antacids Contraindications Caution

Answer 46

``` Contraindications Allergy Caution Any condition that can be exacerbated by electrolyte imbalance GI obstruction (absent bowel sounds) ```

Question 47

Antacids Adverse Effects (sometimes have to switch patient to a PPI instead)

Answer 47

``` Adverse Effects Constipation – Aluminum and calcium Diarrhea – magnesium Upset stomach and liquid BM – magnesium Hypercalcemia - calcium Rebound acidity Alkalosis Hypophosphatemia ```

Question 48

Antacids | Drug-Drug Interactions

Answer 48

Affect the absorption of many other drugs NO! mixing with other drugs Take at least 1 hour before. Messing with efficacy of other meds

Question 49

Nursing Considerations for Antacids

Answer 49

Assess: Do not take with other meds It does not last long History and Physical Exam and known allergy Renal dysfunction, electrolyte disturbances, and current status of pregnancy or lactation Abdomen and BS, mucus membranes and appropriate lab values

Question 50

Nursing Considerations for Antacids

Answer 50

1 hour before or after other meds Assess for bowel sounds, must be present! Not for heart failure

Question 51

Antacids | Prototype: Sodium Bicarbonate

Answer 51

Oral - rapid IV immediate Adverse effects: gastric rupture, systemic alkalosis, (headache, nausea, irritability, weakness, tetany, confusion), hypokalemia, gastric acid rebound

Question 52

3. Proton Pump Inhibitors(Suppress the secretion of hydrochloric acid into the lumen of the stomach “PRAZOLE” drugs Lots of "P"

Answer 52

``` “PRAZOLE” drugs Omeprazole (Prilosec) Esomeprazole (Nexium) Pantoprazole (Protonix) PROTONIX IS THE MOST GIVEN IN HOSPITALS (CAN BE GIVEN IV) Lansoprazole (Prevacid) Dexlansoprazole (Kapidex) Rabeprazole (Aciphex) ```

Question 53

3. Proton Pump Inhibitors Indications

Answer 53

``` Indications Heartburn GERD Ulcer prophylaxis Short-term treatment of active duodenal ulcers Erosive esophagitis benign active gastric disease Long-term treatment of pathological hypersecretory conditions ``` Mainly used for heartburn, GERD, and ulcer prophylaxis in the hospital due to stress. Usually, most patients in the hospital are placed on PPI.

Question 54

Pharmacokinetics

Answer 54

Pharmacokinetics Acid labile, rapidly absorbed in the GI tract Metabolized in the liver and excreted in the urine

Question 55

Proton Pump Inhibitors Contraindications Caution

Answer 55

Contraindications Allergy Caution Pregnancy or lactation

Question 56

3. Proton Pump Inhibitors

Answer 56

RARE ADVERSE EFFECTS REVIEW AND LEARN Adverse Effects CNS effects: Dizziness, headache, asthenia, vertigo, insomnia, apathy GI Effects: Diarrhea, abdominal pain, and tongue atrophy Upper respiratory tract symptoms: Cough, stuff nose, hoarseness, and epistaxis Other: Rash, alopecia, pruritis, dry skin, back pain, and fever

Question 57

3. Proton Pump Inhibitors | Drug-Drug Interactions

Answer 57

``` Drug-Drug Interactions Benzodiazepine (anxiolytics/hypnotics) such as chlordiazepoxide, clonazepam, clorazepate, diazepam phenytoin (antiarrhythmic) warfarin Ketoconazole (antifunagals) theophylline (bronchodilator) Sucralfate (antiulcer agent) Clopidogrel - (antiplatelet agent) for ACS syndrome ``` So this does interfere with meds like blood thinners and breathing meds.

Question 58

Nursing Considerations for Proton Pump Inhibitors ASSESS (know this!)

Answer 58

``` Assess KNOW THIS Patient asks “Why am I on this?” Need regular bone density test Possible C-Diff Take 30 mins before meals (at home) ``` Protect your stomach, also tell the patient it is to prevent indigestion, bc of all the medicines and different diet we have you on, will help prevent ulcer. GIVEN PROPHYLACTICALLY - To prevent indigestion, and from getting an ulcer. Because it prevents development of all ulcers due to surgery or hospital stress. Bone density test because it increases risk for osteoporosis with long term use. It increases risk for fractures, spine, wrist, and hip. Since it suppresses normal HCL in the stomach which would normally control. Intestinal bacteria.

Question 59

PPI Prototype

Answer 59

Omeprazole Oral only! Adverse effects: headache, dizziness, rash, nausea, vomiting, abdominal pain, upper respiratory infection symptoms, cough irritability, weakness,

Question 60

4. GI Protectant(Coat any injured area in the stomach to prevent further injury from acid)

Answer 60

Given to treat and and prevent both stomach and duodenum or duodenal ulcers in the small intestine.

Question 61

4. GI Protectant Actions Indications Pharmacokinetics Contraindications Allergy Renal failure

Answer 61

``` Actions It forms a thick protective layer over the ulcer. Indications Promote ulcer healing Pharmacokinetics Rapidly absorbed, metabolized in the liver, and excreted in feces Contraindications Allergy KIDNEY failure ```

Question 62

4. GI Protectant (Pepto Bismol)

Answer 62

It forms a thick protective layer over the ulcer which provides physical barrier against the stomach acids and enzymes. It is like a band aid over an open wound.

Question 63

GI Protectant Caution Advere Effects

Answer 63

``` Caution Pregnancy or lactation Adverse Effects GI effects – Constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth Dizziness Sleepiness Vertigo Skin rash Back pain ```

Question 64

GI Protectant (Pepto Bismol) Drug-Drug Interactions

Answer 64

``` Drug-Drug Interactions Aluminum salts (AlternaGEL) tx peptic, duodenal, and gastric ulcers. ``` Phenytoin, (anti arrhythmic/anticonvulsant) fluoroquinolone, A quinolone antibiotic is a member of a large group of broad-spectrum bacteriocidals "floxaxacin"s , such as cipro or penicillamine- Penicillamine, sold under the brand name of Cuprimine among others, is a medication primarily used for the treatment of Wilson's disease. It is also used for people with kidney stones who have high urine cystine levels, rheumatoid arthritis, and various heavy metal poisonings. It is taken by mouth DO NOT TAKE WITH ANTACIDS! Caution GI Protectant- can interact with seizure medications!

Question 65

4. Nursing Considerations for Antipeptic Agent | Assess

Answer 65

Take on an empty stomach 1-2 hours before taking other meds Do not take with other meds History and Physical Exam and known allergy Pregnancy and lactation, skin, neurological status, including level of orientation, affect, and reflexes Abdomen and BS and respiratory status, including respiratory rate and rhythm

Question 66

GI Protectant prototype

Answer 66

Sucralfate Oral only AE: Sleeplessness, dizziness, vertigo, insomnia, rash, constipation, diarrhea, nausea, indigestion, dry mouth, back pain.

Question 67

5. Prostaglandin(Protect the stomach lining) misoprostol (Cytotec) Like Pepto Bismol but in an IV form

Answer 67

Inhibit the secretion of gastrin and increase the secretion of the mucous lining of the stomach, providing a buffer gastrin digestive hormone secreted by the GI tract Synthetic prostaglandin E1 analogue misoprostol (Cytotec)

Question 68

5. Prostaglandin Actions and Indications

Answer 68

Actions Inhibits gastric acid secretion and increases bicarbonate and mucous production in the stomach Indications Prevention of NSAID-induced gastric ulcers (Aleve) Treatment of duodenal ulcers

Question 69

If a patient was taking NSAID's for a long period of time, and we wanted to prevent the development of gastric ulcers, which medication would they be given?

Answer 69

misoprostol (Cytotec)

Question 70

5. Prostaglandin Pharmacokinetics Contraindications KNOW THIS! ALSO USED FOR GI. WILL BE ON EXAM

Answer 70

Pharmacokinetics Rapidly absorbed from GI tract, metabolized in the liver, and excreted in the urine Contraindications Pregnancy It can also be used to induce labor, It also works by softening the cervix and causing uterine contractions leading to the expulsion of its contents.

Question 71

5. Prostaglandin KNOW THESE BOTH GI AND PREGNANCY

Answer 71

Caution Lactation Adverse Effects GI effects – Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, and constipation GU effects – Miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders If given to pregnant women, may cause them to give birth!

Question 72

Nursing Considerations for Prostaglandin

Answer 72

Assess: History and Physical Exam and known allergy Pregnancy and lactation, skin, neurological status, including level of orientation, affect, and reflexes Abdomen and BS and respiratory status, including respiratory rate and rhythm

Question 73

Prototype Prostaglandin | Misoprostol

Answer 73

Given Oral GI effects – diarrhea, nausea, abdominal pain, flatulance, vomiting, excessive bleeding or spotting, hypermenorrhea, dysmenorrhea, miscarriage

Question 74

Digestive Enzymes Know these

Answer 74

Substances produced in the GI tract to break down foods into usable nutrients Saliva substitute Pancrelipase - prototype

Question 75

Pancrelipase - prototype (Creon, Pancrease) 4k-8K units PO with each meal and snacks Peds varies

Answer 75

Is a replacement therapy in patients with deficient exocrine pancreatic secretions. Adverse Effects: Nausea, abdominal cramps, diarrhea, hyperuricosuria.

Question 76

``` Saliva substitute (MouthKote, Salivart) ```

Answer 76

Spray or apply to oral mucosa.– Contains electrolytes and carboxymethylcellulose to act as a thickening agent in dry mouth conditions are replacement enzymes that help the digestion and absorption of fats, proteins, and carbohydrates

Question 77

Digestive Enzymes KNOW THIS WITH THESE TYPE OF PATIENT STRICT I’S AND O’S (CHF patient's)

Answer 77

Contraindications Saliva – Allergy Pancreatic enzymes - Allergy Caution Saliva – CHF, hypertension, or renal failure Pancreatic enzyme – Pregnancy and lactation

Question 78

Digestive Enzymes Adverse Effect

Answer 78

TOO MUCH SALIVA MIGHT AFFECT ELECTROLYTES increased levels of magnesium, sodium, or potassium , nausea, abdominal cramps, and diarrhea

Question 79

Nursing Considerations for Digestive Enzymes

Answer 79

Assess: History and Physical Exam and known allergy Heart failure or hypertension, pregnancy and lactation Abdomen and BS, mucus membranes and appropriate lab values

Question 80

True or False: There is a drug-to-drug interaction between the antipeptides and penicillin?

Answer 80

False | Rationale: D-to-D interactions include aluminum salts, phenytoin, fluoroquinolone, or penicillamine.

Question 81

``` What H2 antagonist has been associated with antiandronegic effects? A. Famotidine B. Cimetidine C. Nizatidine D. Ranitidine ```

Answer 81

``` B. Cimetidine Rationale: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrongenic effects, including gynecomastia and galactorrhea. ```

Question 82

Use of Agents Affecting Gastrointestinal Secretions Across the Lifespan

Answer 82

Children – dose should be weight/age dependent. Monitor for electrolyte imbalance. Adults – warn to not overuse, questionable during lactation and pregnancy (use with caution) Older adults – monitor for interactions with other drugs, PPI best choice for GERD for fewer SE

Question 83

What is the best choice to give older adults for GERD, with the least side effects?

Answer 83

PPI | Proton Pump Inhibitor

Question 84

Chapter 58: Drugs Affecting Gastrointestinal Motility Laxatives KNOW THIS

Answer 84

``` Metoclopramide Lactulose Magnesium citrate Magnesium sulfate Docusate Mineral oil ```

Question 85

Types of Laxatives

Answer 85

1. Chemical Stimulants Chemically irritate the lining of the GI tract 2. Bulk Stimulants Cause the fecal matter to increase in bulk 3. Lubricants Help the intestinal contents move more smoothly BULK STIMULANTS- MED GIVES IT WATER SO THAT IT CAN POOP IT OUT There are three types of laxatives. First is the chemical stimulants, they act as irritants and stimulants to the intestines. must for post op to lessen straining

Question 86

How do these laxatives work?

Answer 86

They irritate the GI tract and when it's stimulated it causes movement causing it to go, to churn, to flow.

Question 87

Chemical Stimulants

Answer 87

Actions Begin working at the beginning of the small intestine and increase motility throughout the rest of the GI tract by irritating the nerve plexusThe work by releasing water and electrolytes in the bowel which cars increase peristalsis movement thus relieving constipation.

Question 88

Chem stimulants (laxatives) Pharmacokinetics Most of these agents are only minimally absorbed and exert their therapeutic effects directly in the GI tract

Answer 88

The work by releasing water and electrolytes in the bowel which cars increase peristalsis movement thus relieving constipation.

Question 89

1. Chemical Stimulants | Contraindications and Caution

Answer 89

``` Contraindications Allergy Acute abdominal disorders Caution Heart block, CAD, debilitation Pregnancy and lactationKNOW THE ACUTE AND DISORDERS – ANY ISSUES WITH STOMACH WILL REFUSE TO USING LAXATIVE UNTIL RESOLVED ```

Question 90

1. Chemical Stimulants Adverse Effects and Drug to drug interactions

Answer 90

Adverse Effects GI: diarrhea, abdominal cramping, nausea CNS: dizziness, headache, weakness Sweating, palpitations, flushing, fainting Cathartic dependence Castor oil: blocks absorption of fats and fat-soluble vitamins Drug-Drug Interactions Other prescribed medications CATHARTIC DEPENDENCE ESP ELDERLY- THEY WANT TO POOP EVERY DAY (LOTS DEPENDENT ON LAXATIVES) SO NOW BODY GETS USED TO POOPING ONLY WITH LAXATIVE

Question 91

Nursing Considerations for Laxatives

Answer 91

Assess: History and Physical Exam and known allergy Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting Pregnancy or lactation, neurological status, level of activity and appropriate lab values Maybe there is blockage and surgical intervention is needed instead of a laxative. No castor oil for pregnant ladies. It also causes stimulation of uterine contraction or premature labor. USE FINGER TO HELP PATIENT GET DISIMPACTED

Question 92

Chemical Stimulants

Answer 92

Senna (Senokot): Reliable drug, similar to cascara (OTC) Bisacodyl (Dulcolax): Very popular OTC laxative Cascara (Generic): Reliable agent that leads to intestinal evacuation Castor Oil (Neoloid): Old standby for thorough evacuation of the intestine

Question 93

KNOW THESE Senna + docusate helps with Bisacodyl – supp or enteric coated Castor oil – broken down into rinoleic acid, very irritating to The body’s reaction is to get rid of this irritant and it does this by

Answer 93

KNOW THESE Senna + docusate helps with constipation due to opioids Bisacodyl – supp or enteric coated Castor oil – broken down into rinoleic acid, very irritating to the GI tract. The body’s reaction is to get rid of this irritant and it does this by increasing peristalsis. (Other use helps hair grow)

Question 94

Chemical Stimulant Laxative

Answer 94

Adverse Effects: diarrhea, abdominal cramps, perianal irritation, dizziness, cathartic dependence

Question 95

2. Bulk Stimulants Actions/Indications Pharmacokinetics

Answer 95

Actions/Indications Increase motility by increasing size of fecal material, which will increase fluid in the GI tract, cause more stretch on GI tract, stimulate local stretch receptors, and activate local GI activity Pharmacokinetics Oral Not generally absorbed systemically Made up of hydrophyllic colloids, means they have affinity for water. From digestible parts of fruits or vegetables. Forms gel in the large intestine. Causing decreased less absorption of water within the intestine. Used in immobile patients

Question 96

2. Bulk Stimulants

Answer 96

``` Contraindications Allergy Acute abdominal disorders Caution Heart block, CAD, debilitation Pregnancy and lactation ``` Watch out for CHF patients

Question 97

2. Bulk Stimulants

Answer 97

``` Adverse Effects GI: diarrhea, abdominal cramping, nausea CNS: dizziness, headache, weakness Sweating, palpitations, flushing, fainting Drug-Drug Interactions Other prescribed medications ```

Question 98

2. Bulk Stimulants

Answer 98

Methylcellulose (Citrucel) Polycarbophil (FiberCon) Psyllium (Metamucil)

Question 99

3. Lubricants

Answer 99

Actions/Indications Draw more water into GI tract and stimulate increased GI motility Pharmacokinetics Rates vary based on oral, suppository, or IV form Consist of mag citrate or mag hydroxide, they are not absorbable meaning not absorbed the blood, only remains in the intestine. Water goes in the intestines due to water gradient. Mostly oral or suppository

Question 100

3. Osmotic Laxatives

Answer 100

``` Lactulose (Constilac) Polyethylene glycol electrolyte solution (GoLYTELY) Magnesium sulfate (Epsom salts) Magnesium citrate (Citrate of Magnesia) Magnesium hydroxide (Milk of Magnesia) Polyethylene glycol (MiraLAX) Sodium picosulfate with magnesium oxide (Prepopik) KNOW THESE – GoLYTELY is like CleanPiq ``` lactulose (Constilac) – used for alcoholic patient’s if ammonia levels get over 100 they can get neuro problems Lactulose for ammonia in liver disease. Body cannot get rid of excess ammonia, then causes neurological changes. CIWA Protocol in hospital- sliding scale for DT symptoms, get score, medication Know ATIVAN

Question 101

Lactulose (Constilac) -

Answer 101

Lactulose (Constilac) - BRING AMMONIA LEVELS DOWN Given every 6 hours Pt. will be pooping

Question 102

Osmotic Laxatives #3

Answer 102

Contraindications Lactulose: appendicitis, acute surgical abdomen, fecal impaction, intestinal obstruction Caution Lactulose: Diabetes Magnesium: Renal insufficiency Polyethylene glycol: seizuresDiabetes because it is sweet. No IV for lactulose Can be given rectally If patient is not responsive can place an NG tube to give this medication

Question 103

Osmotic Laxatives #4

Answer 103

Adverse Effects GI: diarrhea, abdominal cramping, abdominal bloating, nausea; dehydration: dry mouth, dizziness, light-headedness CNS: dizziness, headache, weakness Sweating, palpitations, flushing, fainting Rectal irritation Drug-Drug Interactions Other prescriptions Magnesium: neuromuscular junction blockers CNS for ammonia

Question 104

Prototype for Osmotic Laxatives

Answer 104

Magnesium Citrate

Question 105

Lubricants #1

Answer 105

Docusate (Colace) Has a detergent action on the surface of the intestinal bolus, making a softer stool Glycerin (Sani-Supp) Hyperosmolar laxative used to gently evacuate the rectum without systemic effects higher in the GI tract Mineral Oil (Agoral) Forms a slippery coat on the contents of the intestinal tract Commonly given in hospital is docusate (Colace) Mild laxative to keep you regular (more like a maintenance drug)

Question 106

Lubricants #2

Answer 106

``` Pharmacokinetics Not absorbed systemically Excreted in feces Contraindications Allergy Acute abdominal disorders Caution Heart block, CAD, debilitation Pregnancy and lactation ```

Question 107

Lubricants #3

Answer 107

Adverse Effects GI: diarrhea, abdominal cramping, nausea; leakage and staining with mineral oil CNS: dizziness, headache, weakness Sweating, palpitations, flushing, fainting Drug-Drug Interactions Frequent use of mineral oil can interfere with absorption of the fat-soluble vitamins A, D, E, and K

Question 108

Prototype Lubricant

Answer 108

Mineral Oil

Question 109

Use of Laxative and Antidiarrheal Agents Across the Lifespan

Answer 109

KNOW THIS Children, laxative should not be used in children routinely. Proper diet should be encouraged. If a laxative is indicated then a glycerin suppository is the best choice for infant in the young children. Adults – adults should be educated not to get dependent on laxatives. They should change their diet instead. Take fiber, eat more leafy green. Older adults they are more likely to develop adverse effects associated with this drugs. These include confusion dizziness and electrolyte imbalance. They must be monitored closely by their PCP.

Question 110

Gastrointestinal Stimulants

Answer 110

Dexpanthenol (Ilopan) Increases acetylcholine levels and stimulates the parasympathetic system Metoclopramide (Reglan) Blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine Leads to increased GI activity and rapid movement of food through the upper GI tract KNOW THESE. Especially Reglan and how often to give. PO or IV Stimulate brain to send signals to GI tract Best friend of dieticians of hospitals

Question 111

Gastrointestinal Stimulants #1

Answer 111

``` Actions Stimulate parasympathetic activity within the GI tract Increase GI secretions and motility Indications Rapid movement of GI contents is desirable Pharmacokinetics Rapidly absorbed Metabolized in the liver Excreted in the urine ```

Question 112

Gastrointestinal Stimulants #2

Answer 112

``` Contraindications Allergy GI obstruction Caution Pregnancy Lactation ```

Question 113

Gastrointestinal Stimulants #3 Adverse Effects Know this!

Answer 113

``` Adverse Effects Nausea, vomiting, diarrhea, intestinal spasms, cramping, decreased blood pressure and heart rate, weakness, and fatigue Drug-Drug Interactions Digoxin Cyclosporine Alcohol ```

Question 114

Prototype Gastrointestinal Stimulants

Answer 114

``` Metoclopramide Oral IM IV Actions: stimulates movement of the upper GI tract without stimulating gastric, pancreatic or biliary secretions appears to sensitize tissues to the effects of acetylcholine. ```

Question 115

``` Which of the following is a very popular OTC laxative? A. Cascara B. Magnesium citrate C. Bisacodyl D. Polycarbophil ```

Answer 115

C. Bisacodyl Rationale: Bisacodyl (Dulcolax): Very popular OTC laxative.

Question 116

Types of Antidiarrheal Drugs

Answer 116

Bismuth Subsalicylate (Pepto-Bismol): Coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and diarrhea Crofelemer (Fulyzaq): Symptomatic relief of noninfectious diarrhea in adults on HIV/AIDS antiretroviral medication Loperamide (Imodium): Has a direct effect on the muscle layers of the GI tract; slows peristalsis and allows increased time for absorption of fluid and electrolytes Opium Derivatives (Paregoric): Stimulates spasm within the GI tract, stops peristalsis and diarrhea Imodium – commonly used in hospital slows down churning of the food to the anu

Question 117

Chapter 59: Antiemetic Agents | Nausea and Vomiting

Answer 117

Most common and most uncomfortable complaints. Vomiting is a complex reflex reaction to various stimuli. In some cases, it may be desired to induce vomiting. In many clinical conditions, the reflex reaction of vomiting is not beneficial.#1 N/V is for post op patients due to anesthesia ICP for ex. Don’t give patient a pill for nausea give through IV We don’t want to necessarily induce vomiting due to aspiration

Question 118

Managing Nausea and Vomiting

Answer 118

``` Emetics Cause vomiting No longer recommended for at-home poison control Antiemetics Decrease or prevent nausea and vomiting Centrally acting or locally acting Varying degrees of effectiveness ``` Aspiration is very dangerous because it goes to the lungs

Question 119

Groups of Centrally Acting Antiemetics 5 groups

Answer 119

``` Phenothiazines Nonphenothiazines Serotonin (5-HT3) Receptor Blockers Substance P/Neurokinin 1 Receptor Antagonists Miscellaneous Group ```

Question 120

Phenothiazines

Answer 120

Antianxiety drug that blocks the responsiveness of the CTZ to stimuli, leading to a decrease in nausea and vomiting Prochlorperazine (generic) Chlorpromazine (generic) Perphenazine (generic)Chemoreceptor trigger zone Some psych meds can be used to control nausea. Dosing will be different for nausea. These work!

Question 121

Phenothiazines Actions Indications Contraindications

Answer 121

``` Actions Depresses various areas of the central nervous system (CNS) Indications Treatment of nausea and vomiting Contraindications Coma, severe CNS depression, brain damage or injury Severe hypotension or hypertension Severe liver dysfunction ```

Question 122

Phenothiazines

Answer 122

``` Caution Renal dysfunction Moderate liver impairment Active peptic ulcer Pregnancy and lactation ```

Question 123

Phenothiazines

Answer 123

Adverse Effects Drowsiness, dizziness, weakness, tremor, headache Hypotension, hypertension, cardiac arrhythmias Dry mouth, nasal congestion, anorexia, pallor, sweating, urinary retention Menstrual disorders, galactorrhea, and gynecomastia Photosensitivity Drug-Drug Interactions Other CNS depressants, including alcohol

Question 124

Prototype Phenothiazines | Prochlorperazine

Answer 124

Control severe N/V Adverse effects: drowsiness, dystonia, photophobia, blurred vision, urine discolored pink to red brown.

Question 125

Nonphenothiazines #1 Prevention of Prototype is ONDANSETRON DO NOT DILUTE

Answer 125

Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, prevention of postoperative nausea and vomiting Metoclopramide (Reglan) Ondansetron (Zofran) NOT Reglan! For post op vomiting patient Cancer patients! AE: Headache, dizziness, drowsiness, myalgia, urinary retention,

Question 126

Nonphenothiazines #2 For post op vomiting patient Prototype is ONDANSETRON

Answer 126

``` Actions Acts to reduce the responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting Indications Prevention of nausea and vomiting Adverse Effects Drowsiness Fatigue Restlessness Extrapyramidal symptoms ```

Question 127

Seratonin 5 HTC Receptor Blockers

Answer 127

It is not just for depression and sleep. It can also for N/V. They block the serotonin receptors in the Gi tract thus preventing N/V usually caused by cancer treatments.

Question 128

Substance P/Neurokinin 1 Receptor Antagonists | These are newer meds!

Answer 128

Newest class of drugs for treating nausea and vomiting Aprepitant (Emend) Rolapitant (Varubi)

Question 129

Substance P/Neurokinin 1 Receptor Antagonists #1 Actions: tells the brain to stop being nauseated!

Answer 129

Actions Act directly in the CNS to block receptors associated with nausea and vomiting Indications In combination with other agents to prevent nausea and vomiting Pharmacokinetics Given orally, metabolized in the liver, and excreted in urine and feces

Question 130

Substance P/Neurokinin 1 Receptor Antagonists #1 Contraindication

Answer 130

``` Contraindication Allergy Caution Pregnancy and lactation Adverse Effects Anorexia, fatigue, constipation, diarrhea, liver enzyme elevation, dehydration Drug-Drug Interactions Pimozide, warfarin, hormonal contraceptives CAN INTERFERE WITH BIRTH CONTROL ```

Question 131

Substance P/Neurokinin 1 Receptor Antagonists #1 Prototype: Aprepitant

Answer 131

In combination with other agents for the prevention of acute and delayed nausea and vomiting associated with severely emetogenic cancer chemotherapy. AE: anorexia, fatigue, constipation, diarrhea, liver enzyme elevations, dehydration

Question 132

Miscellaneous Agents

Answer 132

Dronabinol (Marinol) and nabilone (Cesamet) Contain the active ingredient of cannabis Hydroxyzine (Vistaril) May suppress cortical areas of the CNS Trimethobenzamide (Tigan) Not associated with as much sedation and CNS suppression as other agents MARINOL IS PILL FORM OF MARIJUANA (USED TO BE GIVEN ONLY TO CANCER PATIENTS) A LAST CHOICE FOR N/V OTHER MEDS NOT USED AS MUCH BC CAUSES SOME CNS SUPPRESSION. GIVEN TO PATIENT’S WHO ARE ALLERGIC TO OTHER OPTIONS.

Question 133

Question #1Please answer the following statement as true or false. Emetic medications are used to induce vomiting and should be kept in the home in case of an accidental poisoning.

Answer 133

False Rationale: Emetics cause vomiting and are no longer recommended for at-home poison control.

Question 134

``` Question #2 What is an anticholinergic antiemetic recommended for vestibular (inner ear) problems? A. Granisetron B. Meclizine C. Palonosetron D. Perphenazine ```

Answer 134

B. Meclizine Rationale: These drugs—buclizine, cyclizine and meclizine are anticholinergics that act as antihistamines and block the transmission of impulses to the CTZ. They are recommended for the nausea and vomiting associated with motion sickness or vestibular (inner ear) problems.

Question 135

Antidiarrheal Drugs #1

Answer 135

Actions Slow the motility of the GI tract through direct action on the lining of the GI tract Indications Relief of symptoms of acute or chronic diarrhea Reduction of volume of discharge from ileostomies Prevention and treatment of traveler’s diarrhea Pharmacokinetics Vary depending on agent

Question 136

Antidiarrheal Drugs #2

Answer 136

``` Contraindications Allergy Caution Pregnancy Lactation History of GI obstruction History of acute abdominal conditions Diarrhea due to poisonings ```

Question 137

Antidiarrheal Drugs #3

Answer 137

``` Adverse Effects Constipation Abdominal distension Abdominal discomfort Nausea Dry mouth Toxic megacolon - life threatening GI condition Fatigue Weakness Dizzines ```

Question 138

Antidiarrheal Drugs #4 | Drug-Drug Interactions

Answer 138

Depends on the drug

Question 139

Nursing Considerations for Antidiarrheal Drugs

Answer 139

Assess: History and Physical Exam and known allergy Acute abdominal conditions, GI activity, hepatic impairment, BS and abdomen Elimination patterns, neurological status

Question 140

Prototype Antidiarrheal Drugs

Answer 140

Loperamide

Question 141

Question #2 T or F? Pepto Bismol can be involved in salicylate toxiticy?

Answer 141

True Rationale: Bismuth Subsalicylate (Pepto-Bismol) coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and diarrhea.

Question 142

Question #3 Why should laxatives be taken only on a short-term basis? A. To prevent a fluid volume deficit B. To prevent cathartic dependence C. To obtain relief of abdominal distention D. To obtain relief of intestinal cramping

Answer 142

B. To prevent cathartic dependence Rationale: Administer laxative only as a temporary measure to prevent development of cathartic dependence.