GI Meds

Question 1

Proton Pump Inhibitor prototype

Answer 1

Omeprazole

Question 2

Proton Pump Inhibitor action

Answer 2

block basal and stimulated acid production, and reduce gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid

Question 3

Proton Pump Inhibitor therapeutic use

Answer 3

prescribed for gastric and duodenal ulcers, erosive esophagitis, GERD, and hypersecretory conditions such as Zollinger- Ellison syndrome

Question 4

Proton Pump Inhibitor complications

Answer 4

PNEUMONIA, OSTEOPOROSIS and FRACTURES (advise clients to increase vitamin D and calcium intake), REBOUND ACID HYPERSECRETION (take low dose and taper to discontinue), HYPOMAGNESEMIA (tremors, muscle cramps, seizures)

Question 5

Proton Pump Inhibitor contraindications/ precautions

Answer 5

pregnancy risk category C, contraindicated in clients that are hypersensitive and lactating, dysphagia, liver disease, people in high risk for pneumonia including those with COPD

Question 6

Proton Pump Inhibitor nursing administration

Answer 6

Do not crush/break/chew sustained-release capsules
Take once per day prior to eating in the morning
Avoid alcohol and NSAIDS
Active ulcers should be treated for 4-6 weeks
Notify provider for signs of occult GI bleeding (e.g. coffee-ground emesis)
Assess for electrolyte imbalances: hyponatremia & hypomagnesemia
Monitor hepatic enzymes, blood studies

Question 7

Mucosal Protectant prototype

Answer 7

Sulcrafate

Question 8

Mucosal Protectant action

Answer 8

acidic environment of the stomach turns product into a protective barrier that adheres to an ulcer, which protects the ulcer from further injury and from acid and pepsin
able to stick to the ulcer for up to 6 hours

Question 9

Mucosal Protectant therapeutic use

Answer 9

acute duodenal ulcers and those requiring maintenance therapy, it is not absorbed so has no systemic effects, investigational use includes gastric ulcers and GERD

Question 10

Mucosal Protectant complications

Answer 10

CONSTIPATION

Question 11

Mucosal Protectant contraindications/ precautions

Answer 11

pregnancy risk category B, contraindicated in those who are hypersensitive to the meds, use cautiously in clients with CKD

Question 12

Mucosal Protectant nursing administration

Answer 12

Take 4 times a day on an empty stomach, 1 hour before meals, & again at bedtime
Can break/dissolve in water, but should not crush or chew tablet
Can interfere with the absorption of phenytoin, digoxin, warfarin, & ciprofloxacin; allow a 2-hr interval between these medications and sucralfate
Antacids interfere with absorption of sucralfate; take sucralfate 30 minutes before antacid
Increase dietary fiber and drink at least 1500 mL/day
Monitor blood sugar in those with DM because it can cause hypoglycemia

Question 13

Histamine 2 Receptors prototype

Answer 13

Ranitidine

Question 14

Histamine 2 Receptors action

Answer 14

Block H2 receptors, which reduces the volume of gastric acid and lowers the concentration of hydrogen ions in the stomach

Question 15

Histamine 2 Receptors therapeutic use

Answer 15

Gastric and duodenal ulcers, GERD, hypersecretory conditions (Zollinger-Ellison syndrome), aspiration pneumonitis, heartburn, and acid indigestion
Used in conjunction with antibiotics to treat ulcers caused by H. Pylori

Question 16

Histamine 2 Receptors complications

Answer 16

CONSTIPATION, DIARRHEA

Question 17

Histamine 2 Receptors contraindications/ precautions

Answer 17

Pregnancy Risk Category B.
In older adults can cause antiadrenergic effects (impotence) and CNS effects (confusion).
Decrease gastric acidity , which promotes bacterial colonization of the stomach and the respiratory tract. Use cautiously in clients who are high risk for pneumonia, including clients who have COPD

Question 18

Histamine 2 Receptors nursing administration

Answer 18

Report adverse effects to provider.
Cimetidine, ranitidine, and famotidine can be administered IV.
Advise patients to eat meals on a regular schedule, in a relaxed environment, and not to overeat.
Advise to avoid food that cause gastric secretions such as caffeinated beverages including regular and decaf coffee.
Inform that adequate rest can increase healing.
Smoking can delay healing.
Avoid aspirin and other NSAIDs unless taking a low-dose aspirin therapy for the prevention of cardiovascular disease.
Alcohol can exacerbate peptic ulcer disease. Advise clients to avoid drinking alcohol.
Availability of the medication OTC can discourage clients from seeking appropriate health care. Encourage clients to see a provider if manifestations persist.
Encourage clients to adhere to medication regimen, and provide support.
Ranitidine can be taken with or without food.
Treatment of peptic ulcer disease is usually started as an oral dose twice a day until the ulcer is healed, followed by a maintenance dose, which is usually taken once a day at bedtime.
Teach clients to notify provider for and indication of obvious or occult GI bleeding, such as coffee ground emesis.

Question 19

Antiemetics prototype

Answer 19

Ondansetron 
Prochlorperazine
Metoclopramide
Promethazine
Hydroxyzine

Question 20

Antiemetics action

Answer 20

Prevents emesis by blocking the serotonin receptors in the chemoreceptor trigger zone (CTZ), and antagonizing the serotonin receptors on the afferent vagal neurons that travel from the upper GI tract to the CTZ
result from blockade of dopamine receptors in the CTZ
muscarinic and histaminergic receptors in nerve pathways that connect the inner ear and VC are blocked

Question 21

Antiemetics therapeutic use

Answer 21

treat chemo, radiation, and post operative induced nausea and vomiting
treat motion sickness

Question 22

Antiemetics complications

Answer 22

HEADACHE, DIARRHEA, DIZZINESS, PROLONGED QT INTERVAL can lead to a serious dysrhythmia (torsades de pointes)
EXTRAPYRAMIDAL SYMPTOMS (restlesness, anxiety, spasms of face and neck- treat with anticholinergic such as diphenhydramine or benztropine) HYPOTENSION, SEDATION, ANTICHOLINERGIC EFFECTS such as dry mouth, urinary retention, and constipation (increase fluid intake, increase exercise, client should void every 4 hours  with I&O monitored)

Question 23

Antiemetics contraindications/ precautions

Answer 23

Ondansetron should not be given to clients who have a long QT syndrome.
Use dopamine antagonists cautiously, if at all, with children and older adults due to the increased risk of extrapyramidal side effects.
Dopamine antagonists, antihistamines, and anticholinergic antiemitics should be given cautiously in clients who have urinary retention or obstruction, asthma, and and narrow angle glaucoma.
Aprepitant should be used cautiously in children and in clients who have severe liver and kidney disease.
Promethazine is contraindicated in children younger than 2 years old and should be used with extreme caution in older children

Question 24

Antiemetics nursing administrations

Answer 24

Treat headache with non-opioid analgesics

Monitor stool pattern

Question 25

Laxatives prototype

Answer 25

Docusate Sodium

Question 26

Laxatives action

Answer 26

Surfactant laxatives lower surface tension of the stool to allow penetration of water

Question 27

Laxatives therapeutic use

Answer 27

Relieve constipation related to pregnancy or opioid use. Prevent painful elimination in clients who have conditions such as hemorrhoids or following procedure such as episiotomy prevent straining in clients who have conditions such as cerebral aneurysm or following MI Decrease risk of fecal impaction in immobile clients and promote defecation in older adults who have decreased peristalsis due to age -related changes in the GI tract

Question 28

Laxatives complications

Answer 28

GI IRRITATION, TOXIC MAGNESIUM LEVELS because of magnesium as potential ingredient (advise clients with impaired kidney function to avoid laxatives with magnesium) SODIUM ABSORPTION and FLUID RETENTION with laxatives that contain sodium (careful in patients that have heart disease and those with kidney disease) DEHYDRATION- osmotic diuretics can cause dehydration (monitor I&O, drink 8-10 glasses of water per day)

Question 29

Laxatives contraindications/ precautions

Answer 29

Contraindicated in clients who have fecal impaction, bowel obstruction, and acute surgical abdomen to prevent perforation. Contraindicated in clients who have nausea, cramping, and abdominal pain. Contraindicated in clients with diverticulitis and ulcerative colitis; w/ the exception of bulk-forming laxatives Use cautiously during pregnancy and lactation. Bisacodyl and docusate are Pregnancy Risk Category C

Question 30

Laxatives nursing administration

Answer 30

Obtain complete history of laxative use, and provide teaching. Teach clients that chronic laxative use can lead to fluid and electrolyte imbalances. to promote defecation and resumption of normal bowel function, instruct clients to increase high-fiber foods and to increase amounts of fluids. Recommend at least 2 - 3 L/day from beverages and food sources. Encourage clients to maintain a regular exercise regimen to improve bowel function. Instruct clients to take bulk-forming and surfactant laxatives with 8 oz. water

Question 31

Prokenetic Agents prototype

Answer 31

Metoclopramide

Question 32

Prokenetic Agents action

Answer 32

IF the CTZ is activated (e.g., by chemotherapy) the CTZ in turn activates the vomiting center to expel gastric contents. Metoclopramid controls nausea and vomiting by blocking dopamine and serotonin receptors in the CTZ. Metoclopramide augments action of acetylcholine, which causes an increase in upper GI motility, increasing peristalsis

Question 33

Prokenetic Agents therapeutic use

Answer 33

Control postoperative and chemotherapy-induced nausea and vomiting, as well as the facilitation of intubation and examination of the GI tract. The oral form is used for diabetic gastroparesis (delayed stomach emptying with gas and bloating) and management of GERD through its ability to increase motility

Question 34

Prokenetic Agents complications

Answer 34

EXTRAPYRAMIDAL SYMPTOMS: Inform clients of the possible adverse effects such as restlessness, anxiety, and spasms of the face and neck. Administer and antihistamine, such as diphenhydramine, to minimize EPSs. SEDATION Inform clients of the potential of sedation. Advise clients to avoid activities that require alertness, such as driving. DIARRHEA Monitor bowel function and indications of dehydration

Question 35

Prokenetic Agents contraindications/ precautions

Answer 35

Contraindicated in clients who have GI perforation, GI bleeding, bowel obstruction, and hemorrhage. Contraindicated in clients who have seizure disorder due to an increased risk for seizures. Use cautiously in children and older adults due to the increased risk for EPS

Question 36

Prokenetic Agents nursing administration

Answer 36

Monitor the CNS depression and EPSs. Medication can be given orally or IV. If the IV dose 10 mg or less, it may be administered IVP undiluted over 2 min. If the dose is greater than 10 mg, it should be diluted abd infused over 15 min. Dilute the medication in at least 50 mL dextrose 5% in water, sodium chloride, and lactated Ringer’s

Question 37

Aminosalicylates prototype

Answer 37

Sulfasalazine

Question 38

Aminosalicylates action

Answer 38

Decrease inflammation by inhibiting prostaglandin synthesis

Question 39

Aminosalicylates therapeutic use

Answer 39

IBS, Crohn’s dz, ulcerative colitis | IBD is controlled, rather than cured, by these medications, which often are used in combination therapy

Question 40

Aminosalicylates complications

Answer 40

BLOOD DISORDERS Include agranulocytosis, hemolytic and macrocytic anemia NAUSEA, CRAMPS, RASH, ARTHRALGIA Notify provider if adverse effects persist.

Question 41

Aminosalicylates contraindications/ precautions

Answer 41

Women who are pregnant, plan to become pregnant, or who are breastfeeding should consult provider about continued use of sulfasalazine. 5-aminosalicylates are contraindicated in clients who have sensitivity to sulfonamides, salicylates, or thiazide diuretics. Use cautiously in older adults. Use cautiously in clients who have liver or kidney disease or blood dyscrasias

Question 42

Aminosalicylates nursing administration

Answer 42

Ensure that controlled-release and enteric-coated are not crushed or chewed