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Pharmacology Exam #2 > GI Secretions > Flashcards

GI Secretions Flashcards

1
Q

What are the 4 main actions of drugs on GI secretions?

A

1) Decrease GI secretory activity
2) Block the action of GI secretions
3) Form protective coverings on the GI lining to prevent erosion from GI secretions
4) Replace missing GI enzymes that the GI tract or ancillary glands/organs can no longer produce

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2
Q

What is Peptic Ulcer Disease?

A

Erosions in the lining of the stomach and adjacent areas of the GI tract

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3
Q

What are the symptoms of Peptic Ulcer Disease?

A

Gnawing, burning pain, often occuring after meals, especially when laying down

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4
Q

What are the causes of Peptic Ulcer Disease?

A
  • Most common: NSAID use (prostaglandins protect mucosa, NSAIDs decrease them)
  • Bacterial infection caused by Helicobacter pylori
  • Stress
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5
Q

Lifespan considerations for
GI Secretion Drugs
In Children

A

USE:
* Antacids
* H2 Antagonists
* Proton Pump Inhibitors

Concerns: Electrolyte disturbances, interference with nutrition

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6
Q

Lifespan considerations for
GI Secretion Drugs
In Adults

A

Concerns:
* Overuse
* GI discomfort continuing and not following up for underlying condition
* Electrolyte disturbance
* Interference with other drugs

Prolonged Use Concerns:
* C. diff., bone loss, electrolyte imbalances and more

Pregnancy considerations:
* Safety not established
* May enter breastmilk
* Misoprostol: causes miscarriage (abortifacient)

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7
Q

Lifespan considerations for
GI Secretion Drugs
In Older Adults

A

Concerns:
* Renal and hepatic impairment
* Use of multiple OTC drugs or combo OTC/Rx can cause toxicity/overdose

Older adults are frequently prescribed/use these drugs

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8
Q

Histamine-2 (H2) Antagonists
Mechanism of Action

A

Selectively BLOCK Histamine-2 receptor sites
Leads to:
* Reduced gastric acid secretion and pepsin production
* Blocked release of hydrochloric acid

⬇️ gastric acid, pepsin, and hydrochloric acid

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9
Q

Histamine-2 (H2) Antagonists
Drug Names

A

“-tidine”
* Cimetidine
* Famotidine (Pepcid)
* Nizatidine

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10
Q

Histamine-2 (H2) Antagonists
Indications

A
  • Treatment of ulcers
  • Prevention of ulcers related to STRESS and NSAID use
  • Treatment of GERD
  • Treatment of pathological hypersecretory conditions such as Zollinger-Ellison syndrome
  • Relief of symptoms of heartburn, acid indigestion, and sour stomach (OTC preparations)
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11
Q

Histamine-2 (H2) Antagonists
Contraindications

A

Absolute:
* Allergy

Caution:
* Hepatic or renal dysfunction

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12
Q

Histamine-2 (H2) Antagonists
Adverse Effects

A
  • 💩 GI effects
  • 🧠 CNS effects
  • 💓 Cardiac arrhythmias and HYPOtension (because of H2 receptors on the heart)
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13
Q

Histamine-2 (H2) Antagonists
Drug Interactions

A

TOO MANY TO LIST
Leads to slower metabolism of other drug –> toxicity of other drug

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14
Q

Histamine-2 (H2) Antagonists
Assessment

A

History:
* Allergy, pregnancy, lactation
* Impaired renal or hepatic function

Physical:
* Neurological status, including orientation and affect (because of CNS effects)
* Cardiopulmonary status including pulse and blood pressure
* Abdominal assessment

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15
Q

Histamine-2 (H2) Antagonists
Nursing Conclusions

A
  • Impaired Comfort r/t CNS/GI effects
  • Altered sensory perception r/t CNS effects
  • Injury Risk r/t CNS effects
  • Altered tissue perfusion r/t hypotension risk
  • Knowledge deficit
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16
Q

Histamine-2 (H2) Antagonists
Implementation/Patient Teaching

A
  • Administer oral drug with or before meals or at bedtime
  • Monitor pt. closely if admin. by IV
  • Monitor carefully for drug interactions
  • Readily available bathroom
  • Analgesics for any adverse effects
  • Educate pt. on CNS effects
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17
Q

Antacids
Mechanism of Action

A

Neutralize stomach acid by direct chemical reaction

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18
Q

Antacids
Indications

A

Hyperacidity

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19
Q

Antacids
Drug Names

A

Carbonates:
* Sodium Bicarbonate (Alkaseltzer)
* Calcium Bicarbonate (Tums)

Salts:
* Magnesium salts (MIlk of Magnesia)
* Aluminum salts (Gaviscon)

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20
Q

Antacids
Contraindications

A

Absolute:
* Allergy

Caution:
* Any condition that can be exacerbated by electrolyte imbalance
* GI obstruction

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21
Q

Antacids
Adverse Effects

A

R/T effects on acid/base and electrolyte imbalances
* Rebound acidity
* Alkalosis
* Constipation OR diarrhea

Calcium Carbonate adverse effects:
* Hypercalcemia
* Hypophosphatemia

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22
Q

Antacids
Drug Interactions

A
  • Affects the absorption of MANY other drugs because it alters the chemical composition of the stomach
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23
Q

Antacids
Assessment

A

History:
* Allergy, pregnancy, lactation
* Renal dysfunction

Physical:
* Abdominal assessment

Labs:
* Renal function tests
* Electrolytes

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24
Q

Antacids
Nursing Conclusions

A
  • Altered GI motility (r/t GI effects)
  • Electrolyte Imbalance Risks
  • Knowledge Deficit
25
Q

Antacids
Implementation/Patient Teaching

A
  • Take antacid 1 hr. before or 2 hrs. after other meds
  • Chew tablets thoroughly, follow with water
  • Monitor serum electrolytes periodically
  • Watch for electrolyte or acid-base imbalances
  • Monitor for diarrhea or constipation, institute a bowel plan if needed
  • Monitor nutritional status (r/t diarrhea or constipation)
  • Risk of acid rebound if too much is taken for too long
26
Q

Proton Pump Inhibitors
Mechansim of Action

A
  • Acts at specific secretory surface receptors (proton pumps) to prevent the final step of acid production

⬇️ stomach acid

27
Q

Proton Pump Inhibitors
Indications

A
  • Treatment AND prevention of ulcers
  • Treatment of GERD
  • Treatment of pathological hypersecretory conditions such as Zollinger-Ellison syndrome
28
Q

Proton Pump Inhibitors
Drug Names

A

“-prazole”
* Omeprazole (Prilosec)
* Rabeprazole
* Esomeprazole
* Pantoprazole
* Lansoprazole (Prevacid)

29
Q

Proton Pump Inhibitors
Contraindications

A

Absolute:
* Allergy

30
Q

Proton Pump Inhibitors
Adverse Effects

A
  • 🧠 CNS effects: dizziness, headaches
  • 💩 GI effects: diarrhea, abdominal pain, nausea
31
Q

Proton Pump Inhibitors
Drug Interactions

A

Risk of toxicity for these drugs
* Benzodiazepines & phenytoin

Effects toxicity/therapeutic levels for these:
* Antiretroviral medications
* Anticoagulants

32
Q

Proton Pump Inhibitors
Assessment

A

History:
* Allergy, pregnancy, lactation

Physical:
* Neurological status (CNS effects)
* Abdominal Assessment

33
Q

Proton Pump Inhibitors
Nursing Conclusions

A
  • Altered GI Motility (r/t GI effects)
  • Imbalanced nutrition risk (r/t altered absorption)
  • Altered sensory perception (r/t CNS effects)
  • Injury Risk (r/t CNS effects)
  • Knowledge Deficit
34
Q

Proton Pump Inhibitors
Implementation/Patient Teaching

A
  • DO NOT open, chew, or crush capsules
  • Monitor for diarrhea; bowel program if needed
  • Monitor nutritional status
  • Small frequent meals for GI effects
  • Avoid driving until CNS effects are known
  • Assistance with ambulation if needed
  • Follow up if no improvement in 8 weeks
35
Q

GI Protectant
Mechanism of Action

A
  • Forms an ulcer-adherent complex at the ulcer sites
  • Protects the sites against acid, pepsin, and bile salts
36
Q

GI Protectant
Indication

A

Promotes ulcer healing

37
Q

GI Protectant
Drug Name

A

Sucralfate

38
Q

GI Protectant
Contraindications

A

Absolute:
* Allergy

Relative:
* Renal failure - can lead to Aluminum toxicity

39
Q

GI Protectant
Adverse Effects

A

Most common:
Constipation

40
Q

GI Protectant
Drug Interactions

A
  • Aluminum Salts (leads to aluminum toxicity)
  • Oral medications taken at the same time (lowers levels of other drugs)
41
Q

GI Protectant
Assessment

A

History:
* Allergy, pregnancy, lactation
* Renal Failure

Physical:
* Abdominal Assessment

42
Q

GI Protectant
Nursing Conclusions

A
  • Altered GI motility (r/t medication effects)
  • Imbalanced nutrition risk (r/t altered absorbtion)
  • Knowledge Deficit
43
Q

GI Protectant
Implementation/Patient Teaching

A
  • Administer on EMPTY stomach
  • Monitor for GI pain
  • Administer antacids or antibiotics between doses (not within 30 minutes of sucralfate dose)
  • Implement bowel program as needed
  • Increase fluid and fiber for constipation
  • Periodic follow up visits
44
Q

Prostaglandin
Mechanism of Action

A

Protects the stomach by:
* inhibiting gastric acid secretion
* increasing bicarbonate (a base) and mucous production in the stomach

⬇️ gastric acid

⬆️ bicarbonate
⬆️ mucous production

45
Q

Prostaglandin
Indications

A
  • Prevention of NSAID-induced gastric ulcers
  • Pts. at high risk for an ulcer: older patients, dibilitated pts, history of ulcers
46
Q

Prostaglandin
Drug Name

A

Misoprostol

47
Q

Prostaglandin
Contraindications

A

Absolute:
* Allergy

Relative:
* Pregnancy (Category X)

48
Q

Prostaglandin
Adverse Effects

A
  • 💩 GI effects: nausea, diarrhea, abdominal pain
  • GU effects: miscarriages, excessive bleeding, menstrual irregularities
49
Q

Prostaglandin
Assessment

A

History:
* Allergies, pregnancy, lactation

Physical:
* Abdominal assessment

50
Q

Prostaglandin
Nursing Conclusions

A
  • Altered GI motility (r/t medication effects)
  • Impaired Comfort (r/t GI/GU effects)
  • Imbalanced nutrition risk (r/t GI effects)
  • Knowledge Deficit
51
Q

Prostaglandin
Implementation/Patient Teaching

A
  • Pregnancy blood test within 2 weeks before
  • Begin therapy on 2nd or 3rd day of menstrual period
  • Provide the pt with info regarding pregnancy risks: miscarriage and excessive bleeding
  • Explain risk of menstrual disorders, pain, excessive bleeding
  • Use barrier contraceptives, if needed
  • Monitor nutritional status
  • Easy access to bathroom
  • Small frequent meals (for GI effects)
52
Q

Digestive Enzymes
Mechanism of Action

A

Saliva Substitutes
* Contain electrolytes and carboxymethylcellulose to act as a thickening agent

Pancreatic enzymes
* Replacement enzymes that help the digestion and absorption of fats, proteins, and carbohydrates

53
Q

Digestive Enzymes
Indications

A

Saliva Substitutes
* Dry mouth (r/t stroke, chemo, radiation)

Pancreatic enzymes
* Cystic Fibrosis
* Pancreatic insufficiency
* Malabsorption syndrome

54
Q

Digestive Enzymes
Drug Names

A

Saliva Substitute

Pancreatic Enzymes:
Pancrelipase

55
Q

Digestive Enzymes
Contraindications

A

Absolute:
* Saliva: Allergy
* Pancreatic enzymes: allergy to pork (enzymes are made from pancreas of pigs)

Cautions:
* Saliva: CHF, HYPERtension, renal failure

56
Q

Digestive Enzymes
Adverse Effects

A

Saliva Substitutes:
* Electrolyte imbalances: ⬆️ magnesium, ⬆️ sodium, ⬆️ potassium

Pancreatic enzymes:
* 💩 GI irritation: nausea, abdominal cramps, diarrhea

57
Q

Digestive Enzymes
Assessment

A

History:
* Allergies
* CHF, hypertension, renal failure

Physical:
* Abdominal assessment
* Elimination pattern
* Mucosal membranes
* Cardiovascular system (r/t electrolyte changes)

58
Q

Digestive Enzymes
Nursing Conclusions

A
  • Impaired comfort (r/t GI effects)
  • Imbalanced nutrition: less than body requirements (r/t GI effects)
  • Knowledge deficit
59
Q

Digestive Enzymes
Implementation/Patient Teaching

A
  • Swish saliva substitute around the mouth; DO NOT swallow
  • Adminster pancreatic enzymes with meals and snacks
  • Pancreatic enzymes should NOT be crushed or chewed; capsule can be opened into applesauce
  • Monitor swallowing
  • Monitor nutritional status
  • Monitor electrolyte labs (for saliva substitutes)

Pharmacology Exam #2 (14 decks)

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