G.I. in class

Question 1

your neighbor is worried about getting seasick and throwing up. what are two options

Answer 1

Scopolamine patch & Dramamine
1) they should take it before they get on the boat
2)

Question 2

what is one drug we can give for chemotherapy induced nausea and vomiting
drug, MOA, ADR, pt edu

Answer 2

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,

Question 3

what is the drug classification that is the most effective med to stop someone from vomiting

Answer 3

serotonin receptor antagonist (like ondansetron)

Question 4

indications for a serotonin receptor antagonist

Answer 4

post op nausea/vomiting, prophylaxis, radiation and chemotherapy induced nausea and vomiting

Question 5

what are two types of dopamine antagonists used as Antiemetics

Answer 5

Phenothiazines (such as Promethazine), and Butyrophenos (such as Halorepidol)

Question 6

what are the ADRs of Droperidol (inapsine) and Haloperidol (haldol)

Answer 6

black box: respiratory depression
ADRs: prolongs QT, anticholinergic side effects, hypotension, sedation, extrapyramidal symptoms, blocks dopamine leading to parkinson-like symptoms

Question 7

what are the ADRs of Phenothiazines

Answer 7

anganulocytosis, Neuroleptic malignant syndrome, extrapuramidal reactions, anticholinergic (constipation blurred eyes), sedation respiratory depression , NMS

Question 8

is metoclopramide useful for the patient with nausea>

Answer 8

yes, but we dont often use it for nausea, we tend to use it more for its prokinetic effects

Question 9

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

Answer 9

B) the patient is diagnosed with a GI perforation (or obstruction)

Question 10

the 18 month old child with GI illness and nausea. prescribed orders Promethazine IV
why is this an issue

Answer 10

call the prescriber and request another medication to treat the nausea

respiratory depression

Question 11

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

Answer 11

Infiltration

Question 12

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

Question 12

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

Question 12

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

Answer 12

the med has infiltrated leading to tissue necrosis

Question 13

what are examples of cannabinoids?

Answer 13

Dronabinol (marinol) and Nabilone (Cesamet)

Question 14

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?

Answer 14

Dronabinol

Question 15

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

Answer 15

1) ondansetron
3. promethazine
d. metoclopramide
f. aprepitant
g. dronabinol

Question 16

unrelenting nausea, pt already has ondansetron. what med can be added to the plan

Answer 16

aprepitant b/c it has a delayed reaction

Question 17

which is not an anti-diarrheal agent?
a) bismuth subsalicylate
b. diphenoxylate with atropine (lomotine)
c. loperamide (immodium)
d. bisacodyl (dulcolax)

Answer 17

bisacodyl (dulcolax)

Question 18

provider recommends Bismuth SUbsalicylate to the pt with mild case of diarhea. what are teaching points?

Answer 18

-may cause black stools
-contains a derivative of aspirin
- if taken excessively, pt may experience ringing in the ears

Question 19

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

Answer 19

it is an opioid and it is a schedule 5 drug on controlled substance

Question 20

Ecoli travelers diarrhea can be treated with Ciprofloxacin T/F

Answer 20

true

Question 21

C-diff can be an adverse reaction for broad spectrum antibiotic. Metroniozone can be used

Answer 21

true

Question 22

nursing teaching regarding Methylcellulose (Citrucel) for constipation

Answer 22

take with 8 oz of water
it adds bulk

Question 23

bulk forming laxaties such as Methycellulose are sometimes used to treat patients with diarrhea T/F?

Answer 23

true

Question 24

which is the best medication to prevent a patient from straining to have a bowel movement?
how does it work?

Answer 24

docusate sodium breaks up the surface tension on the stool to turn it into a jell like form

Question 25

what is an example of a stimulate laxative?

Answer 25

Senna (ex-lax)
it works by irritating sensory nerve endings in the instestinal mucosa to stimulate parystalsis

Question 26

nursing considerations for someone using the osmotic laxative magnesium hydroxide?

Answer 26

-pt should drink adequate water
-kidney function needs to be assessed

Question 27

pt is admitted with liver disease and has an elevated
ammonia level. which laxative would be prescribed for this purpose?

Answer 27

Lactulose

Question 28

agents used in the treatment of GERD:

Answer 28

-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

Question 29

which antisecretory agents decrease the most acid?

Answer 29

proton pump inhibitors decrease 90% in acid release
(histamine 2 receptor antagonist only decrease 65% acid release)

Question 30

what is Cimetidine (Tagamet)

Answer 30

it was the first gen H2 blocker, available OTC
-liver enzyme inhibitor
-crosses blood brain barrier
-lots of drug interactions

Question 31

examples of 2nd gen H2 blockers and why they are better than 1st gen

Answer 31

Famotidine and Nizatidine
-they do not inhibit liver enzymes

Question 32

what is the timing for when you should take a proton pump inhibitor? what are some example

Answer 32

-30 min to 1hr prior to eating , usually before breakki
-Omeprazole, Lansoprazole, esomeprazole, Pantoprazole

Question 33

what are some long term adverse effects of proton pump inhibitors?

Answer 33

-osteoporosis (b/c it decreases your absorption of calcium)
-pneumonia
-rebound acid hypersecretion
-hypomagnesemia
-gastric cancer
__

Question 34

which med is likely to be used for an NSAID related ulcer?

Answer 34

misoprostol

Question 35

when are Mucosal Protectant drugs indicated? what is the name -

Answer 35

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

Question 36

how do antacids work?

Answer 36

-they decrease acidity by neutralization

Question 37

how do antacids work?

Answer 37

-they decrease acidity by neutralization

Question 38

ADRS of antacids

Answer 38

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

Question 39

what is the treatment of choice for H.Pylori?

Answer 39

2-3 antibiotics and an anti secretory like a PPI or H2 blocker

Question 40

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.

Answer 40

C) decrease the gastric acid secretion.