GI System Flashcards
Antacids Adverse Effects
Aluminum, calcium- constipation
Calcium- kidney stones
Magnesium- Diarrhea, magnesium toxicity if kidneys impaired
Sodium- Fluid retention, alkalosis
Histamine-2 Receptor Blockers (H2RBs) Action
Block H2 receptor of parietal cells —> reduce hydrogen ion secretion —> increase PH in stomach
H2RBs Therapeutic use
Treatment of acid-related disorders
Adjunct therapy to control upper GI bleed
Management of urticaria (rash)
Available forms: PO, IV. Nizatidine PO only
H2RBs Adverse Effects
Cimetidine: confusion, disorientation in the elderly, impotence, gynecomastia.
Famotidine: Thrombocytopenia
Ranitidine: Thrombocytopenia
Nizatidine: Cough or hoarseness, chest pain
Proton Pump Inhibitors (PPIs) Examples
Omeprazole
Lansoprazole
Pantoprazole
PPIs Adverse Effects
Pneumonia
Osteoporosis (long term effect)
Hypomagnesemia
Wrist, spine, hip fracture
C. Diff-associated diarrhea
PPIs therapeutic use (temporary use)
Ulcers
Esophagitis
GERD
NSAID induced ulcers
Prevention of stress ulcer (can be b/c of someone w/ an NG tube)
Available forms: PO and IV
Nursing Implications on H2RBs
Take H2RBs 1-2 hours before antacids (antacids decrease its absorption)
Not given alone (works as an additional medication for GI bleed)
Caution in clients with COPD, pneumonia, and kidney impairment.
Cimetidine: increases anticoagulant effects of warfarin and theophylline levels
Smoking decreases effectivemess of H2RBs
PPIs nursing implications
Food can decrease absorption of PPIs (take medication an hour before or after)
Make sure Don’t bite medications
Do not open PPI capsule and sprinkle contents over food: capsule contents may be opened and mixed with apple juice but not in food.
Take omeprazole once a day before breakfast
Take before meals if prescribed more than once a day
Nursing implications
Shake liquid formulations of antacids
Administer medications at least 1 hour before or after an antacid
Alternate use of aluminum or calcium and magnesium antacids to normalize bowel pattern
Consume high-fiber foods and drink adequate fluids if taking magnesium hydroxide
Avoid antacids with sodium if positive for HTN or heart failure
Avoid antacids with magnesium if positive for renal dysfunction
Chew tablets throughly and drink at least 8 oz of water or milk
Maintain adequate intake of calcium and vitamin D
Notify provider of GI bleed symptoms of if symptoms of hyper acidity are not relieved .
Sucralfate - cytoprotective Adverse Effects
May cause dry mouth, nausea, constipation
May impair absorption of other drugs
Sucralfate implications
Increase fiber and fluid intake
Give 30 min before or after antacids and maintain 2-hr interval when giving other drugs
Take 1-hour before meals and at bedtime
Misoprostol- prostaglandin analogue symptoms
Therapeutic doses may cause abdominal cramps and diarrhea
Simethicone therapeutic effect
Anti-flatulent
Reduces the discomfort when passing gas
Antidiarrheals
Adsorbents- Bismuth salicylate, activated charcoal
Anticholinergic- Belladonna
Opiates- OTC loperamide, Diphenoxylate/atropine
Probiotics-Lactobacillus acidophilus
Adsorbents Adverse Effects
Increased bleeding times
Confusion
Tinnitus, metallic taste
Anticholinergics Adverse effects
H/A, dizziness, blurred vision
Urinary retention
Dry skin, flushing
Opiates
Dizziness, drowsiness
Urinary retention, constipation
Probiotics
Flatulence, bloating
Laxatives examples
Bulk-forming
Emollient
Hyperosmotic
Saline
Stimulant
Bulk-forming action and examples
Absorb water to increase bulk
- psyllium
-methylcellulose
Emollient actions and examples
Lubricate and soften stool
-lubricant: mineral oil
-stool softener: docusate sodium
Hyperosmotic actions and examples
Increase fecal water content
- polyethylene glycol (PEG)
- Sorbitol
- Lactulose
Saline actions and examples
Increase osmotic pressure causing more water to enter the intestines
- magnesium hydroxide
- magnesium citrate
Stimulant actions and examples
Increase peristalsis via intestinal nerve stimulation
- senna
- Bisacodyl
Laxative adverse effects
Dehydration, electrolyte imbalance
GI irritation
Diarrhea, rectal burning sensation
Nursing implications
Obtain history of symptoms, bowel elimination patterns, and laxative use
Assess fluid and electrolyte status before initiating therapy
Client teaching
— increase fiber intake ( bran, fresh fruits, veggies, and fluid intake 2-3L/day)
— Use laxatives occasionally if needed
— Do not use laxatives if experiencing N/V and abdominal pain
— Take laxatives with 6-8 oz of water
Take bisacodyl at bedtime for results in 6-12 hrs
; suppositories are effective within one hour
Antiemetics therapeutic use
Prevent of relieve Nausea and vomiting
Action: block neurological stimulus that induces vomiting
Antiemetics examples
Antidopaminergic: Prochlorperazine (PO, PR, IM, IV)
Serotonin blocker: Ondansetron (PO, IM, IV)
Prokinetic: Metoclopramide (PO, IM, IV)
Cannabinoid: Dronabinol (PO)
Antidopaminergic- Prochlorperazine Adverse Effects
Extrapyramidal symptoms (EPS)
Tardive dyskinesia
Sedation
Hypotension
Anticholinergic effects
Serotonin blocker - Ondansetron Adverse Effects
Headache, dizziness
Dysrhythmia
Diarrhea
Prokinetic- Metoclopramide Adverse Effects
EPS
Tardive dyskinesia
Sedation
Diarrhea
Cannabinoid- Dronabinol Adverse Effects
Hypotension
Tachycardia
Dysphoria
Antiemetics Contraindications
Caution in clients with asthma, narrow angle glaucoma, and urinary retention or GI obstruction
Caution in children and older adults
Antiemetic Interactions
Antiemetics and opioids or alcohol —> increased CNS depression
Antiemetics and antihypertensives —> increased hypotensive effects
Nursing implications for antiemetics
Assess precipitating factors for N/V, medical history, and current medications
Give antiemetics 30-60 min before chemotherapy
Assess for Anticholinergic effects and EPS
Client teaching for antiemetics
Avoid driving and performin hazardous tasks due to sedations
Do not combine alcohol and antiemetics due to CNS depression
Change positions slowly due to orthostatic hypotension
Stop the medication and notify the provider if positive for EPS.
Increase fluid intake, engage in physical activity, and suck on hard candy or chew gum to help relieve Anticholinergic effects
What is gonna be on our test
Question on fimetidine
When shouldn’t you give certain medications.. remember contraindications
Do not give Laxatives, antidiarrheals, antacids (can stimulate the GI tract as well), and antiemetics with someone with GI obstructions
Evaluate the effectiveness of a medication: need to know if the medication is working
A lot of questions on antacids
Different GI medications address different GI issues
Know specific contraindications for each specific antacid
Lactulose will give you diarrhea : remember that if you are inducing diarrhea you are concerned about electrolyte imbalance. (Electrolytes include Sodium, magnesium, potassium.)
Laxatives don’t usually work right away. Baseline they take 1-3 days exception would be per rectum or saline
Almost all laxatives are PO example saline is PO but bisocodyl are PR and PO there are saline that can also be used as PR as well
A lot of questions on constipation use and diarrhea use
Know mechanism of action for each antiemetics…. Example Metoclopramide helps empty stomach contents faster
Bisocodyl and senna : if someone stops taking them the body is gonna withdraw (it stimulates GI effects) so body will depend on it gonna be worried about dependency
Remember dehydration for laxatives
