G.I. in class Flashcards
your neighbor is worried about getting seasick and throwing up. what are two options
Scopolamine patch & Dramamine
1) they should take it before they get on the boat
2)
what is one drug we can give for chemotherapy induced nausea and vomiting
drug, MOA, ADR, pt edu
ondansetron,
this is a serotonin receptor antagonist
blocks the receptor in the CTZ as well as the intestinal wall and stomach
ADRs: prolonged QT interval, headache, dizziness, diarrhea , drowsiness
pt education: don’t take it before driving, rest,
what is the drug classification that is the most effective med to stop someone from vomiting
serotonin receptor antagonist (like ondansetron)
indications for a serotonin receptor antagonist
post op nausea/vomiting, prophylaxis, radiation and chemotherapy induced nausea and vomiting
what are two types of dopamine antagonists used as Antiemetics
Phenothiazines (such as Promethazine), and Butyrophenos (such as Halorepidol)
what are the ADRs of Droperidol (inapsine) and Haloperidol (haldol)
black box: respiratory depression
ADRs: prolongs QT, anticholinergic side effects, hypotension, sedation, extrapyramidal symptoms, blocks dopamine leading to parkinson-like symptoms
what are the ADRs of Phenothiazines
anganulocytosis, Neuroleptic malignant syndrome, extrapuramidal reactions, anticholinergic (constipation blurred eyes), sedation respiratory depression , NMS
is metoclopramide useful for the patient with nausea>
yes, but we dont often use it for nausea, we tend to use it more for its prokinetic effects
pt is admitted for nausea and vomiting, physician orders Metoclopramide, the nurse will question this order for which of the following reasons:
A) pt is being treated for chemo
B) the patient is diagnosed with a GI perforation
C) pt has history of substance abuse
D) pt states that he has not had a bowell movement in two days
B) the patient is diagnosed with a GI perforation (or obstruction)
the 18 month old child with GI illness and nausea. prescribed orders Promethazine IV
why is this an issue
call the prescriber and request another medication to treat the nausea
respiratory depression
promethazine (phenergan) is administered IV to a pt with nausea and vomiting. which is the most concerning?
A) blood pressure drops to 118/70
B) pt states that he feels really tired
C)pt denies nausea 30 min after admin
D) IV med has infiltrated the tissues
Infiltration
promethazine (phenergan) is administered IV to a pt with nausea and vomiting. which is the most concerning?
A) blood pressure drops to 118/70
B) pt states that he feels really tired
C)pt denies nausea 30 min after admin
D) IV med has infiltrated the tissues
promethazine (phenergan) is administered IV to a pt with nausea and vomiting. which is the most concerning?
A) blood pressure drops to 118/70
B) pt states that he feels really tired
C)pt denies nausea 30 min after admin
D) IV med has infiltrated the tissues
promethazine (phenergan) is administered IV to a pt with nausea and vomiting. which is the most concerning?
A) blood pressure drops to 118/70
B) pt states that he feels really tired
C)pt denies nausea 30 min after admin
D) IV med has infiltrated the tissues
the med has infiltrated leading to tissue necrosis
what are examples of cannabinoids?
Dronabinol (marinol) and Nabilone (Cesamet)
pt is admitted for HIV/AIDS and has lost a lot of weight, also is nausea and vomiting, anorexia
what would be a good med?
Dronabinol
which of the following treat nausea and vomiting?
1) ondansetron
2) diphenoxylate with atropine (lomotine)
3. promethazine
d. metoclopramide
e. metronidiazole
f. aprepitant
g. dronabinol
h. ciprofloxacin
1) ondansetron
3. promethazine
d. metoclopramide
f. aprepitant
g. dronabinol
unrelenting nausea, pt already has ondansetron. what med can be added to the plan
aprepitant b/c it has a delayed reaction
which is not an anti-diarrheal agent?
a) bismuth subsalicylate
b. diphenoxylate with atropine (lomotine)
c. loperamide (immodium)
d. bisacodyl (dulcolax)
bisacodyl (dulcolax)
provider recommends Bismuth SUbsalicylate to the pt with mild case of diarhea. what are teaching points?
-may cause black stools
-contains a derivative of aspirin
- if taken excessively, pt may experience ringing in the ears
pt with diarrhea is prescribed Diphenoxylte with Atropine
TF:
1. its an opioid substance
2. schedule 5 drug on controlled substance list
3. commonly used to treat GI disorders including diarrhea, nausea, GERB
4. a commonly abused drug, pts often take high doses for euphoria
it is an opioid and it is a schedule 5 drug on controlled substance
Ecoli travelers diarrhea can be treated with Ciprofloxacin T/F
true
C-diff can be an adverse reaction for broad spectrum antibiotic. Metroniozone can be used
true
nursing teaching regarding Methylcellulose (Citrucel) for constipation
take with 8 oz of water
it adds bulk
bulk forming laxaties such as Methycellulose are sometimes used to treat patients with diarrhea T/F?
true
which is the best medication to prevent a patient from straining to have a bowel movement?
how does it work?
docusate sodium breaks up the surface tension on the stool to turn it into a jell like form
what is an example of a stimulate laxative?
Senna (ex-lax)
it works by irritating sensory nerve endings in the instestinal mucosa to stimulate parystalsis
nursing considerations for someone using the osmotic laxative magnesium hydroxide?
-pt should drink adequate water
-kidney function needs to be assessed
pt is admitted with liver disease and has an elevated
ammonia level. which laxative would be prescribed for this purpose?
Lactulose
agents used in the treatment of GERD:
-antisecretory agents like H2 receptor antagonists and proton pump inhibitors
-antisecretory agents that enhance muscosaldefenses like prostaglandin analogs
-mucosal protectants
-antacids
-antibiotics to treat H. Pylori
which antisecretory agents decrease the most acid?
proton pump inhibitors decrease 90% in acid release
(histamine 2 receptor antagonist only decrease 65% acid release)
what is Cimetidine (Tagamet)
it was the first gen H2 blocker, available OTC
-liver enzyme inhibitor
-crosses blood brain barrier
-lots of drug interactions
examples of 2nd gen H2 blockers and why they are better than 1st gen
Famotidine and Nizatidine
-they do not inhibit liver enzymes
what is the timing for when you should take a proton pump inhibitor? what are some example
-30 min to 1hr prior to eating , usually before breakki
-Omeprazole, Lansoprazole, esomeprazole, Pantoprazole
what are some long term adverse effects of proton pump inhibitors?
-osteoporosis (b/c it decreases your absorption of calcium)
-pneumonia
-rebound acid hypersecretion
-hypomagnesemia
-gastric cancer
__
which med is likely to be used for an NSAID related ulcer?
misoprostol
when are Mucosal Protectant drugs indicated? what is the name -
Sucralfate (Carafate)
for use in peptic ulcer disease. they are NOT helpful in the treatment of GERD
it forms a gel-like substance that covers the ulcer and protects it from acid and pepsin
how do antacids work?
-they decrease acidity by neutralization
how do antacids work?
-they decrease acidity by neutralization
ADRS of antacids
aluminum products can lead to constipation
magnesium products are contraindicated in pts with ppoorrenal function
calcium products systemic absorption is minimal, but rarely may lead to hypercalcemia and metabolic alkalosis
sodium products can exacerbate hypertension and heart failure
lots of the drugs affect the gastric PH so may affect reabsorption of other drugs
what is the treatment of choice for H.Pylori?
2-3 antibiotics and an anti secretory like a PPI or H2 blocker
Histamine 2 blockers such as Famotidine and PPIs are recommended in the pt with GERD or PUD b/c they have which following therapeutic effect?
A) cover and protect gastric ulcer
B) neutralize the gastric acid
C) decrease the gastric acid secretion.
C) decrease the gastric acid secretion.
