GI/GU Exam 3 Flashcards
1
Q
3 goals of treatment for PUD
A
Alleviate the symptoms
Promote healing
Prevent complications (Hemorrhage/perforation)
2
Q
We can cure H. pylori ulcers. True or false
A
True
3
Q
What is the guideline recommendation for H. pylori antibiotic treatment
A
2 antibiotics combo’d with a proton pump inhibitor or H2 receptor blocker
4
Q
Cimetidine brand name
A
Tagamet
5
Q
Use of Cimetidine (Tagamet) (3)
A
Treats gastric Ulcers
Duodenal ulcers
GERD
6
Q
MOA of of Cimetidine
A
Blocks H2 Receptors on parietal cells to decrease acid production
7
Q
Cimetidine Distribution be aware
A
Can cross BBB
8
Q
Side affects of Cimetidine? Serious
A
Generally well tolerate- serious can be pneumonia because it increases PH in GI tract (alkaline)- over proliferation of bacteria also in lungs.
9
Q
“Tidine”
A
All H2 blockers
10
Q
MAR drugs for Tidines
A
Antacids- affects absorption of drug
11
Q
PMH (2) for Cimetidine
A
Renal or hepatic dysfunction
12
Q
Monitor patient and educate patient on what for Cimetidine (3)
A
- Gastric bleed S/S
- Respiratory Infection (Pneumonia risk)
- PUD factors (alcohol, smoking, aspirin/NSAID use
13
Q
Omeprazole
A
Prilosec- Proton pump inhibitor
14
Q
Use of Omeprazole
A
Gastric and duodenal ulcers, GERD
15
Q
MOA of Omeprazole
A
irreversible inhibition of H+K- ATPase (proton pump)- the enzyme that generates gastric acid- final stage
16
Q
All proton pump inhibitors end with _____
A
prazole
17
Q
Proton pump inhibitors any common adverse effects?
A
Generally well tolerated
18
Q
Serious side affects of Omeprazole
A
- Fractures- decreased CA absorption (Take Vitamin D and Calcium supplement)
- Rebound Acid Hyper secretion when stop taking the med
- Hypomagnesemia (General electrolyte concerns)
- Pneumonia- Just like H2RA
19
Q
3 MAR concerns for Omeprazole
A
Diuretics- Electrolyte concerns
Clopidogrel- Drug reaction- causes platelets not to be as sticky
Certain HIV Drugs- HARD NO
20
Q
Omeprazole administration PO (1)
A
Take the lowest dose for the shortest period of time possible
21
Q
Patient education for Omeprazole (4)
A
- S/S of gastric bleeding
- S/S of hypomagnesemia
- Limit the factors contributing to PUD (smoke, drink, nsaid, etc)
- S/S of respiratory infection (pneumonia)
**Same patient monitoring and education as H2 receptor agonists, plus the electrolyte disturbance)
22
Q
Sucralfate Use and MOA
(My fate is to crate)
A
Duodenal ulcer, sticks to ulcer crates and coats it- protecting it from acid
23
Q
Sucralfate Adverse reaction and drug interaction
A
No serious adverse, can affect absorption of other drugs, separate by 2 hours
24
Q
Misoprostol (cytotec) use and MOA
A
Ulcers due to NSAID use and it is the analog of prostaglandin E1
25
Misoprostol Adverse effects (Hard No 1)
Pregnancy- Category X, stimulate uterine contractions
| Common- Diarrhea and abdominal cramping
26
Aluminum hydroxide antacid use, effect on bowel?
treat hyperphosphatemia and causes constipation not diarrhea
27
Magnesium hydroxide adverse effects and effect on bowel
Can cause mag toxicity (CNS depression) in patients with renal impairment- no constipation but causes diarrhea
28
Sodium bicarbonate use and effect on bowel
Not routinely used for ulcers- used to treat acidosis and to alkalinize urine- systemic effect on PH , releases CO2
NO constipation or Diarrhea effect
29
Differences between Laxative effect and catharsis
Laxative- production of soft, formed stool over a day or more- prevent constipation or treat acute or chronic constipation
Catharsis- Evacuation of bowel- poison, parasites, diagnostic study requires empty gut (fast and furious)
30
Group 1 Laxative Therapeutic Effect
Rapid action (2-6 hours), prep for surgery, educate patient on safety (bedside commode and call bell within reach)
31
Group 2 Therapeutic Effect
Intermediate (6-12 hours), semifluid stool
32
Group 3 Laxatives Therapeutic Effect
Most frequently abused by public (act 1-3 days) soft formed stool, treat constipation or straining
33
Contraindications for Laxative Use
- Any appendicitis symptoms, enteritis, diverticulitis, UC
- obstruction or impaction,
- habitual use
- use with caution in pregnancy and lactation
34
Psyllium brand name, group, what type of agent
Metamucil (II), bulk forming
35
Psyllium (metamucil) use
Preferred temp treatment of constipation, can also slow diarrhea in colostomy and ileostomy patients
36
Psyllium (Metamucil) MOA
pull water into stoole (form a gel that swells), provide bulk, pushes on GI to promote peristalsis
37
Psyllium (metamucil) hard no and patient education
Esophageal obstruction and tell px to drink plenty of fluids to prevent obstruction
38
Docusate sodium brand name, Class, type of agent
Colace (III), surfactant
39
Docusate sodium (Colace) Use
Prevent constipation, common in hospital for immobile patients
40
Colace MOA
Pull water and fat into stool, prevent reabsorption of water by intestines
41
Colace adverse?
Minimal
42
Castor oil group
I
43
Bisacodyl Use
Opioid constipation and slow intestinal transit time constipation
44
MOA of bisacodyl
Stimulate intestinal motility and increase water and electrolytes that stay in the GI tract
45
Route of bisacodyl (treat from attic and basement)
Oral and rectal
46
Bisacodyl Group type of agent
II, stimulant
47
Osmotic laxatives (I and II)
```
Magnesium salts (mag citrate) (1) or
Polyethylene glycol ( Peg - Miralax) (II)
```
48
Use of Miralax
Chronic constipation
49
Use of Magnesium salts or Mag Citrate
Bowel prep, evacuation of parasites or poison
50
Adverse effects of osmotic laxatives
dehydration and hypermagnesemia in renal impaired
51
Lactulose Use
osmotic laxative, used for individuals who have high ammonia levels- liver failure
52
Mineral oil use
Laxative used for lubrication for fecal impaction
53
Mineral oil adverse effect
Lipid pneumonia, deposit of mineral oil in the liver, anal leakage
54
Glycerin Suppository use
Osmotic agent laxative, softens impacted feces and can stimulate rectal contraction- effects 30 minutes after insertion
55
Ondansetron Brand name and class
Zofran
| Serotonin antagonist
56
Use of Ondansetron (CPR)
Chemo, postoperative, radiation
57
MOA of Ondansetron
Block serotonin receptors on vagal afferents and in chemoreceptor trigger zone
58
Serious side effect of Ondansetron
Prolonged QT Interval
59
Prochlorperazine (AZINE) class of anti-emetic
Dopamine antagonist
60
Prochlorperazine use (CPG)
chemo, post op, general
61
MOA of Prochlorperazine
Block dopamine receptors in CTZ
62
Adverse effects of Prochlorperazine
Anti-cholinergic effects. hypotension, sedation, tardive dyskinesia
63
Cannabinoids Drug name
Dronabinol (Marinol)
64
Use for Marinol
Chemo
65
Marinol moa
Activate cannabinoid receptors associated with vomiting center, trigger appetite
66
Scopolamine (Transderm scop) Drug class
Anticholinergic
67
Scopolamine use
motion sickness
68
MOA of scopolamine
Block muscarinic receptors in the pathway from the inner ear to vomiting center
69
Dimenhydrinate drug class
Antihistamine
70
Use of dimenhydrinate
Motion sickness
71
MOA of dimenhydrinate
Block H1 receptors and muscarinic receptors in the pathway from the inner ear to the vomiting center
72
Two types of anti-diarrheals
Specific and non-specific
73
Diphenoxylate with Atropine brand name
Lomotil
74
Loperamide brand name
Imodium
75
Lomotil and Imodium used for
Non-specific antidiarrheal agent
76
Why is atropine added to opioid antidiarrheal agent
Will minimize abuse, blocks cholinergic receptors (parasympathetic system)
77
MOA of opioid antidiarrheal agents
activate opioid receptors in the GI tract (Mu receptors)
Lehman terms- they slow motility and allow more time for absorption
78
Inflammatory Bowel Diseases 2 types
Crohns Disease or Ulcerative colitis
79
Irritable Bowel Syndrome types
Most common disorder of the GI tract, crampy abdominal pain
IBS-C (Constipation)
IBS-D (Diarrhea)
IBS-M (Mixed)
80
Nonspecific drugs for Irritable bowel syndrome
Antispasmodics
Bulk-forming agents
Antidiarrheals
Tricyclic Antidepressants
81
Alosteron Moa and use
Selective blockade of 5-HT3 receptors- specific anti-diarrheal for irritable bowel syndrome
82
Alosetron Adverse Effect
Overshoot mark
| Constipation (Ischemic colitis)
83
Metoclopramide Brand name
Reglan
84
Metoclopramide Use
Diabetic gastroparesis (Diabetetic peristalsis due to poor perfusion to GI tract) or GERD
85
MOA of Metoclopramide
Emesis- Blocks dopamine and serotonin in the CTZ
| GI- enhances actions of Acetylcholine, promoting peristalsis
86
Adverse effects of Metoclopramide long term and high dose
Long term: irreversible tardive dyskinesia
| High-dose therapy: Sedation and diarrhea are common
87
What percentage of vitamins do we actually take in orally vs urinate out
10% taken in and 90% is urinated out
88
Difference between fat soluble and water soluble vitamins
Fat soluble stored in fat- take week to months to eliminate
| Water soluble- quickly secreted, deficiencies are noted quickly
89
List fat soluble vitamins (Any adverse to any?)
Vitamins A, D, K, E
| Only vitamin A reaches toxic level, highly teratogenic in excess
90
Water Soluble Vitamins List
B1, B2, B3, B6, B9, B12, Vitamin C
91
Vitamin deficiencies are often the result of 4 common factors
- Fad diets
- Alcohol/drug abuse
- Poverty
- Prolonged parenteral feedings
92
Vitamin B1 also called? Used for what
Thiamine, often added to IV bags (banana bags)
| Malnutrition and chronic alcoholics
93
Vitamin B3 (Niacin) Used for
High doses used to reduce cholesterol- risks often outweigh benefits
94
Vitamin B9 Folic Acid Use
Deficiency is rare. Often given to
- Malnourished
- Chronic Alcoholics
- Megaloblastic anemias
- Pregnancy to prevent neural tube injury
95
Vitamin B12 Use
Gastric bypass surgery patients and pernicious anemia
Gastric Bypass patients don't have sufficient parietal cells to secrete intrinsic factor which allows B12 to be absorbed in small intestine
96
Vitamin C use
wound healing, iron absorption, acidifies urine
97
Vitamin D
Calcium absorption
98
Vitamin K use and who is deficient of this, reversal agent for..
Clotting and bone health.
| reversal agent for warfarin (coumadin)
99
Patient Education on Minerals
- Only take when prescribed via provider
- All minerals taken in excess are toxic
- micro minerals- iron and zinc
100
Assessments prior to Potassium replacement therapy
Serum K and cardiac rhythm status
101
PMH/MAR for Potassium replacement therapy
```
ACE inhibitors
Potassium sparing diuretics (spironalactone)
Hypoaldosteronism
Renal dysfunction
Slowed GI transit times (PO)
```
102
Administration of Potassium
PO: sprinkles, tablet (do not crush), liquid (heavily flavored)
Take with water or meals to avoid GI upset
IV: Never IV push
PIV- 10mEq/hour
Central line- 20-40 mEq/hour
Burning at site- dilate with normal fluids and slow admin
103
Eval and intervention of potassium replacement therapy
Reassess the client 5-10 minutes after beginning infusion- assess for discomfort and and IV patency
104
Hyperkalemia patient treatment
Diuretic (lasix)- pee it out
IV push- Insulin and dextrose 50%, goes from blood to cell- Potassium/insulin groupie
Kayexalate (oral or rectal)- Dont absorb, dumps sodium to pick up potassium and then excrete through stool
105
Magnesium controls what
the availability of acetylcholine in the neuromuscular junction
106
MAR awareness for Magnesium sulfate (IV) or Mg Oxide (PO)
Drugs that cause CNS depression
107
PMH/MAR for Magnesium
MAR: CNS Depression drugs
Renal dysfunction
slowed GI transit time (PO),
HARD NO: Serious cardiac disease
108
Reversal agent for mag toxicity
Calcium gluconate
109
Call bell light for mag administration why
Laxative effects of PO Magnesium
110
Admin routes of Magnesium
PO, Slow IV infusion
| Never IV PUSH
111
Iron Supplement used for
Anemia only for iron deficiency, so evaluate type of anemia
112
Take Iron with what vitamin
Vitamin C to aid absorption
113
Avoid taking iron with these drugs that can affect absorption
```
1- antacids,
2- antibiotics (some)
3- proton pump inhibitors
4- parkinsons drugs
5 - calcium supps
```
114
Patient education for Iron supplement
- avoid taking with calcium containing foods (milk and eggs) also caffeine beverages
- If liquid, dilute liquid and take with a straw as it can stain teeth
- take between meals
- Dark green or black stools- harmless side effect
115
Ferrous Dextran is what
IV Iron supplement
116
Enteral nutrition use
Patient who has working GI system, unable to take PO
117
Contraindications for Enteral Nutrition
Major GI issues (peritonitis, any obstruction, intractable diarrhea)
118
Enteral Nutrition (Tube feeding patients) need what
Free water order
| Contains carbs, proteins, lipids, vitamins/minerals
119
Complications of Enteral Nutrition
Aspiration (pneumonia), N/V, diarrhea, metabolic complications: refeeding syndrome (huge electrolyte shifts)- Band of Brothers, clogged feeding tube
120
Stop tube feed minimum of ____ minutes before and after med administration
15 minutes
121
For drug administration into tube feed, check what? do what to drug? flushing?
- check compatibility, crush the drug, administer
- 30ml flush at the beginning
- 5ml flush between each drug to asses reaction.
- 30 ml flush at end of administering all drugs
122
What to do with elixir drugs in tube feeding patient
Its hypertonic, so always dilute prevent GI upset
123
Parenteral Nutrition Use two types
IV nutrition
Patient cannot tolerate enteral feedings.
TPN: Central line access
PPN: Peripheral access
124
Mechanical, Metabolic, Infectious Complications with Parenteral Nutrition
Mechanical: Issues related to central line placement
Metabolic: Fluid overload, refeeding syndrome, electrolyte imbalance (CHECK ORDER AND VERIFY NUTRIENTS)
Infectious: High glucose content, susceptible to infections from bacterial proliferation
125
Bethanechol Brand name
Urecholine
126
Bethanechol Use and MOA
Promotes Peeing- Promotes parasympathetic nervous system- rest and digest
- Relaxes the trigone and sphincter
- contracts the detrusor
127
How long to feel effects of Bethanechol (Urecholine)
30-60 minutes
128
Assess what prior to giving Bethanechol
BP and HR, current urine output
129
Hard nos of Bethanechol
Hyperthyroidism, hypotensive or bradycardic patients, small bowel or urinary tract obstructions
This drug promotes rest/digest
130
Take Bethanechol with or without food
One hour before or after food or can cause N/V
131
Reversal agent for Muscarinic poisoning
Atropine- for parasympathetic nervous system
132
Cholinergic Muscarinic Antagonist Drug
Oxybutynin (Ditropan XL)
133
Oxybutynin Use and MOA
urinary incontinence, blocks paraysmpathetic or muscarinic receptors of the urinary tract
- contracts the trigone and sphincter
- relaxes the detrusor
134
Hard nos for Oxybutynin
Glaucoma, severely decreased gastric motility
135
Adverse effect of Oxybutynin
Anti-cholinergic effects
| Beers Criteria, constipation, blurred vision, photophobia (no constriction, dry mouth)
136
Patient education on oxybutynin
Chew gum for dry mouth, wear sunglasses (pupils are dilated, blocking the parasympathetic), avoid hazardous activities for problems with vision, avoid heat because it might be hard to sweat.
137
PMH for Oxybutynin and MAR
Hyperthyroid, myasthenia gravis, Parkinsons
| - Anticholinergic drugs (SSRIS, tricyclics)
138
Distribution of Oxybutynin
Can cross BBB
139
Sildenafil Brand name
Viagra
140
Sildenafil use
Erectile dysfunction and pulmonary arterial hypertension
141
Sildenafil MOA
Prevents cGMP from converting to GMP
142
Oral peak with Sildenafil
Peak effects in 60 minutes on empty stomach, high fat meal-2 hours
143
Adverse effects of Sildenafil
Hypotension, priapism
| Rare effects- Sudden hearing loss, and Vision eye issues
144
Hard no of Sildenafil med
Nitrates
145
Dont take this with any boner meds
Grapefruit juice
146
Two types of BPH Mechanical Vs Dynamic
Overgrowth of epithelial cells- mechanical obstruction blocking the urethra
Overgrowth of smooth muscle cells- dynamic obstructing, constricting
147
Finasteride (proscar) treats what
Enlarged prostate due to epithelial growth, low dose for male pattern baldness
148
MOA of Finasteride (Proscar)
Prevents formation of active form of testosterone in the prostate, promotes regression of epithelial tissue
149
Adverse effects of Proscar
Category X for pregnancy- glove the nurses giving this
| - Gyno and reduced ejaculate volume in some
150
If taking Proscar and PSA (Prosthetic Serum antigen levels) don't decrease what are you thinking
Evaluate patient for prostate cancer
151
Tamsulosin brand name
Flomax
152
Tamsulosin Use
Used for mild prostatic enlargement, does not reduce prostate size, allow muscle to relax and urine to pass through
153
Flomax MOA
Blockade of A1 receptors relaxes smooth muscle in bladder neck and prostate, must be taken lifelong
154
Flomax Adverse effects
Common headache and dizziness, abnormal ejaculation (failure, reduced volume)
155
Flomax taking with heart drugs?
Other A1 receptor blockers can cause hypotension and drop BP
156
What is focus of care for individuals with inflammatory bowel disease?
antibiotics, anti-inflammatory, and immunosuppressants
157
Preferred drug combo for ulcers due to H pylori
Clarithromycin+amoxicillin and a PPI
158
Prokinetic Agent: Metoclopramide (Reglan)
| Oral use vs. IV use
Oral: diabetic gastroparesis or GERD
IV: N/V, difficult NG placement, diagnostic procedures of GI tract
159
Physostigmine use
a medication most commonly used to manage and treat antimuscarinic toxicity and glaucoma
160
Would want to be aware if you were giving patient viagra with PMH of
Hypo or hypertension, heart failure, unstable angina, recent MI or CVA
161
Specific anti-diarrheal drugs are used for ____
used to treat diarrhea due to infectious process
