GI / Insulin Flashcards
PPI or Proton Pump Inhibitor
Omeprazole/Prilosec
Prilosec/Omeprazole Use
Peptic Ulcers, GERD, Erosive Esophagitis, Chronic Hypersecretory conditions
Prilosec/Omeprazole Pharmocodynamics
Antiesecretory (inhibits acid secretion), Elevates pH
H2 Receptor Antagonists
Ranitidine or Zantac
Ranitidine/Zantac Pharmocodynamics
Antisecretory
Ranitidine/Zantac Use
GERD, Duodenal Ulcer, Gastric Ulcer, Pathologic hypersecretory conditions, Prevention of upper GI bleeding
Heartburn/acid indigestion (OTC strength only)
Ranitidine/Zantac Serious Adverse Effects
Neutropenia, Agranulocytosis, Thrombocytopenia, Autoimmune hemolytic or aplastic anemia
Prilosec/Omeprazole Nursing Interventions
Interacts with other drugs metabolized by CYP450 system. Administer for recommended time, Take before meals, DO NOT CRUSH or CHEW
Ranitidine/Zantac Nursing Interventions
Give atleast 2 hours apart from antacids, Do not substitute OTC drugs for prescription forms, Avoid Alcohol, caffeine, spicy food, products containing Ibuprofen or Aspirin and SMOKING. Smoking reverses drug action
Antacid
Aluminum hydroxide with magnesium hydroxide (Maalox/Mylanta)
Aluminum hydroxide with magnesium hydroxide (Maalox/Mylanta) Pharmacodynamics
Raises Gastric pH, minimal absorption from GI tract
Aluminum hydroxide with magnesium hydroxide (Maalox/Mylanta) USE
GERD, peptic ulcers, prevents stress ulcer bleeding
Aluminum hydroxide with magnesium hydroxide (Maalox/Mylanta) Contraindications
Chronic Renal Failure due to magnesium toxicity
Aluminum hydroxide with magnesium hydroxide (Maalox/Mylanta) COMMON ADVERSE EFFECTS/SERIOUS ADVERSE EFFECTS
Diarrhea: MG
Constipation: Aluminum
Potential electrolyte imbalance
Aluminum hydroxide with magnesium hydroxide (Maalox/Mylanta) NURSING INTERVENTIONS
Interacts with many drugs due to increased pH and urine pH. Antacid will bind to it and make it not effective.
GI Stimulants
Metoclopramide/Reglan
Metoclopramide/Reglan PHARMACODYNAMICS
Increases peristalsis and gastric emptying
Antiemetic effect
Metoclopramide/Reglan USE
GI stimulant
Diabetic gastric stasis
GERD
Antiemetic: Post surgery and Chemo
Metoclopramide/Reglan Contraindications
When stimulation may be dangerous. If there is an obsturction it could get bigger
Metoclopramide/Reglan Adverse Effects
CNS complaints. SERIOUS: Tardive Dyskinesia, Depression
Metoclopramide/Reglan INTERVENTIONS
Give 30 minutes before meals or Chemo
Monitor for depression, Parkinson-like symptoms, extrapyramidal effects, tardive dyskinesia
Antiemetic
Ondansetron/Zofran
Ondansetron/Zofran USE
Prevents N/V, 75% protein bound, metabolized by CYP450 system
Ondansetron/Zofran Adverse Effects
Headache, Constipation, Malaise
SERIOUS: Arrhythmias, Hyptotension, Extrapyramidal effects
Antiflatulents
Simethicone/Mylicon
Simethicone/Mylicon
Use: Pain from excess gass in GI tract
Not absorbed by GI tract, no systemic distribution.
Take PC and HS
“Gas bubbles UNITE” and make one big bubble to get it out easier
Antidiarrheals
Diphenoxylate HCL with atropine sulfate/Lomotil
Diphenoxylate HCL with atropine sulfate/Lomotil Pharmacodynamics
Slows intestinal motility, Fluid reabsorption
Diphenoxylate HCL with atropine sulfate/Lomotil USE
Diarrhea
Diphenoxylate HCL with atropine sulfate/Lomotil CONTRAINDICATIONS
Diarrhea associated with organisms that penetrate intestinal mucosa (Don’t want E-coli/Salmonella to stay in)
Diphenoxylate HCL with atropine sulfate/Lomotil ADVERSE EFFECTS
Drowsiness, Dizziness, Dry Mouth SERIOUS: Atropine Overdose (Red, Dry, Mad, Blind) Toxic Megacolon (perforation of bowel)
Diphenoxylate HCL with atropine sulfate/Lomotil INTERVENTIONS
Decrease Dose as diarrhea decreases
Do not exceed prescribed dose (max 10 days)
Monitor for s/s atropine overdose and toxic megacolon
increase fluids
Saline Laxative
Magnesium Hydroxide/Milk of Magnesia
Hyperosmotic Laxative
Similar to Saline. Draws water into bowel, Increase stretch of bowel and increase peristalsis
Magnesium Hydroxide/Milk of Magnesia Pharmocodynamics
Attracts and Retains water in intestinal lumen
Magnesium Hydroxide/Milk of Magnesia USE
Short term for Constipation
Magnesium Hydroxide/Milk of Magnesia Contraindications/ Side Effects
Renal Failure
Common Adverse Effect: Overactive GI activity
Serious: Fluid and electrolyte imbalance
Magnesium Hydroxide/Milk of Magnesia Interventions
Drink glass of water after administration
Not for long term use
Increase fiber, water and activity
Stimulant
Senna, Dulcolax
Similar to saline, Stimulates Peristalsis
Bulk Forming
Metamucil/Fibercon
Keeps water in stool, Increase bulk distends colon, stimulates evacuation
SAFEST Most NATURAL laxative
Stool Softener
Colace
Stool Softener
Surfactants (reduces surface tension of stool, allowing water to enter) Prevents Constipations
Stool Softener What does it do/not do?
PREVENTS constipation. Does NOT treat it. Does not stimulate peristalsis
Lubricant Laxative
Mineral Oil
Lubricant Laxative What does it do/not do?
Coats wall of intestine, allows easier passage of stool. Not a stimulant. Chronic use may decrease absorption of fat soluble vitamins
Rapid Acting Insulin
LAG (Lispro/Humalog, Aspart/Novolog, Glulisine/Apidra)
Lispro/Humalog Onset/Peak/Duration
RAPID ACTING
Onset: 15 min
Peak 30-90 min
Duration: 3-4 hr
Aspart/Novolog Onset/Peak/Duration
RAPID ACTING
Onset: 5-10 min
Peak 45-90 min
Duration: 3-5 hr
Glulisine/Apidra Onset/Peak/Duration
RAPID ACTING Onset: Less than 20 min Peak 90 min Duration: 5.25 hr CAN BE GIVEN IV
Short Acting (Clear)
CAN BE GIVEN IV on a correctional or sliding scale
REGULAR(Humulin R or Novolin R)
REGULAR(Humulin R or Novolin R
SHORT ACTING
Onset: 30-60 Min
Peak 2-3 hr
Duration: 8-12 hr
Intermediate Acting (CLOUDY)
NPH (Humulin N)
NPH (Humulin N)
INTERMEDIATE ACTING
Onset: 60-90 Min (CLOUDY)
Peak 4-12 hr
Duration: 18-24 hr
Long Acting (Clear)
Can NOT be mixed with other insulins and should not be given at the same site as other insulins
Detemir/Levemir
Glargine/Lantus
Detemir/Levemir
Long Acting (Clear)
Onset: Unknown
Peak 3-14 hr
Duration: 5-23 hr
Glargine/Lantus
Long Acting (Clear)
Onset: 1 hr
Peak unknown
Duration: 24 hr
Premixed Insulins
70/30 NPH/Regular
50/50 lispro protamine/lispro mixed
70/30 aspart protamine/aspart mixed
ALWAYS LISTS LONGER ACTING COMPONENT FIRST
70/30 NPH/Regular
Onset: 30-60 min
Peak 2-12 hr
Duration: 24 hr
50/50 lispro protamine/lispro mixed
Onset: 15 min
Peak 45 min -1 hr
Duration: 10-12 hr
70/30 aspart protamine/aspart mixed
Onset: less than 10 min
Peak 1-4 hr
Duration: Up to 24 hr
