Last exam presentation GI and musculoskeletal Flashcards
Stomach acids
DIGESTIVE ENZYMES (HYDROCHLORIC ACID, PEPSINOGEN)
PH: 1-4 – MOST ACIDIC FLUID IN THE BODY
Six Functions of the GI System
INGESTION
MECHANICAL PROCESSING
DIGESTION
SECRETION
ABSORPTION
EXCRETION
Stomach protection against acidity
Thick mucous
Bicarbonate
FURTHER NEUTRALIZED UPON REACHING THE DUODENUM, BY BICARBONATE FROM PANCREATIC &
BILIARY (LIVER AND GALLBLADDER) SECRETIONS
Gastroesophageal reflux disease
GERD
Caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus
S/S of GERD
HEARTBURN
REGURGITATION (FOOD COMES BACK INTO YOUR MOUTH FROM THE ESOPHAGUS)
THE FEELING OF FOOD CAUGHT IN YOUR THROAT
COUGHING
CHEST PAIN
PROBLEM SWALLOWING
VOMITING
SORE THROAT AND HOARSENESS
Teaching GERD
MAINTAIN HEALTHY WEIGHT
AVOID LAYING DOWN AFTER MEALS / EATING LATE AT NIGHT
ELEVATE HEAD OF BED BY 6 INCHES
AVOID IRRITATING FOODS, SUCH AS FAT, CHOCOLATE, CAFFEINE, SPEARMINT/PEPPERMINT
EXERCISE
QUIT SMOKING
LIMIT ALCOHOL
AVOID NSAIDS
Peptic ulcer disease PUD
PUD is caused by the breakdown of GI mucosa by pepsin, in combination with the caustic effects of hydrochloric acid
PUD IS THE MOST HARMFUL DISEASE RELATED TO HYPERACIDITY BECAUSE IT CAN RESULT IN BLEEDING ULCERS, A LIFE-THREATENING CONDITION
common causes PUD
FAMILY HISTORY,
SMOKING,
CAFFEINE,
NSAIDS,
STRESS,
HELIOBACTER PYLORI
stress related mucosal damage
COMMON CONDITION THAT CAN OCCUR IN HOSPITALIZED PATIENTS LEADING TO PUD.
THUS, MANY POST- OPERATIVE OR CRITICALLY ILL PATIENTS RECEIVE MEDICATION TO PREVENT THE FORMATION OF A STRESS ULCER, WHICH IS ALSO CALLED PROPHYLAXIS.
Gastric ulcer
OCCURS IN THE STOMACH
LESS COMMON
WOMEN OVER 60 Y/O
NSAID, STRESS RELATED
GENERALLY AGGRAVATED BY FOOD/EATING
LOSS OF APPETITE, WEIGHT LOSS AND VOMITING ARE COMMON
REMISSIONS ARE INFREQUENT OR ABSENT
MAY CAUSE HEMATOCHEZIA OR MELENA
Duodenal Ulcer
OCCURS IN THE DUODENUM
MORE COMMON
MALES 30-50 Y/O
H-PYLORI ASSOCIATED, STRESS
GENERALLY AGGRAVATED BY HUNGER AND DISAPPEARS WITH INGESTION OF FOOD
GNAWING OR BURNING UPPER ABDOMINAL PAIN OCCURRING 1-3 HOURS AFTER A MEAL
MAY CAUSE HEMATOCHEZIA OR MELENA
Heliobacter pylori infection
Heliobacter pylori bacteria infects the stomach, attacking the lining that protects the stomach.
H pylori treatment
must be
proton pump
antibiotics
if used
pepto
Must be tested because uninfected patients treated with this therapy will have worse outcomes
*Combination therapy
1. Proton pump inhibitors or H2 receptor antagonist
- Antibiotics such as: Amoxicillin (), Clarithromycin (), Metronidazole (), Tetracycline (,)
IF A PPI IS USED ***Need to use two antibiotics to ensure eradication (7-14 day regimen)
Pepto-Bismol – this is sometimes used to inhibit bacterial growthand prevent the H. pylori from adhering to gastric mucos
H pylori
produces
makes
active
PRODUCES UREASE – NEUTRALIZES STOMACH ACID FOR SURVIVAL
MAKES CHEMICALS CALLED ADHESINS ALLOWING IT TO STICK TIGHTLY TO GI MUCOSA
CAN REMAIN ACTIVE FOR LIFE IF NOT TREATED PROPERLY
Antacids
Used to neutralize stomach acid, elevate pH, and reduce the symptoms of heartburn. Elevated pH also inactivates pepsin, a digestive enzym
anti ulcer mediations
ANTACIDS
H2-RECEPTOR ANTAGONISTS
PROTON PUMP INHIBITORS (PPI)
MUCOSAL PROTECTANTS
ANTI-FLATULENT
Antacids
relives
otc
may contain
forms
Relieves heartburn, acid indigestion and upset stomach
many otc medications avaiable- calc carbonate
almunim hydroxide, magnesium hydroxide
may contain simethicone-anti flatualnt
comes in variety of forms- tablet, chewable,capsule or liquid
Anatacid
taken
do not
contradicted
med-
Taken 3-4 tomes dauly
do not administer 1-2 hours of other meds
contracidicated w/ preexisting kidney disease
med-calcium carbonate
H-2 receptor agnoists
famotdine
moa
Block histamine’s action at the H2 receptor of the parietal cell, thus reducing the production of hydrochloric acid
famotidine
treats
otc
taken
liver/kindey
contact
treats gerd,pud,erosive esophagitis, hypersecratory conditions
OTC is for heartburn and sour stomach
taken 15-60 mins before eating or drinking stuff that causes heartburn
liver/kideny disease may require dose adjustment
contact provider imedatly w/ increased pain, bleeding or coughing/vomiting blood
Proton pump inhibitor
pantoprazole
moa
Binds to the hydrogen-potassium ATPase enzyme system of the parietal cell, also referred to as
the “proton pump” because it pumps hydrogen ions into the stomach. PPIs inhibit the secretion of
hydrochloric acid, and the antisecretory effect lasts longer than 24 hou
Pantoprazole
treats
given w/
delayed
use of
long term
treats damage from gerd/ other conditions where stomach produces too much acid
given w/antiboitocs
delayed release can be taken w/ w.out food
use of alcohol, saids, or food that cause gi irritation should be discouraged
long term therapy may cause hypomagnesema
mucosal protectants
sucralfate
mao
Locally covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salt
sucralfate
forms
minimally
administer
may cause
caution
forms barrier coat over ulcer-protect ulcer from stomach acid
minimally absorbed by gi tract
administer on empty stomach-2 hours after or 1 before meals
may cause constipaton
caution/ patients w/ chronic renal failre or dialysis d/y impaired absorption of almunim
anti-flatulant
simethcone
mao
Works by altering the elasticity of the mucous-coated gas bubbles, which cause them to break
into smaller bubbles, thus reducing pain and facilitating expulsion
simethicone
treats
incoprorate
added
taken
shake
treats symptoms of gas/pressure/fullness/bloating
incorpatre other measures, like position changes, ambulation, no straws, no beans
often added to antacids
taken 4x a day
shake liquid formula before administering
diarrhea
Passage of 3 or more loose or liquid stools per day
causes of diarrhea
bacteria
viruses
parasites
meds like antibiotics,cancer,antacids w/ magnesium
food intolerances and sesntivtes
diseases that affect colon,such as chrons disease, irritable bowel syndrome
absorbents
bismuth subsictylate
moa
Work by coating the walls of the GI tract and binding the causative bacteria or toxin for elimination from the GI tract through the stool.
bismuth subsalicylte
take
safe
may cause
contains
discontinue
take as directed
safe over 12 years
may cause black/ darkened tongue and dark stool
contains aspirin
discntue if tinnitus occurs
anticholinergics
hyoscyamine
moa-works on
inhibit
decreses
Works on the smooth muscle of the GI tract to
inhibit propulsive motility and
decreases gastric acid secretion (decreases stomach/intestinal motion and GI secreti
hyoscyamine
s/e
dizziness
drowsiness
dry mouth
opioid like medication
loperamide
moa
Works by decreasing the flow of fluids and electrolytes into the bowel and by slowing down the
movement of the bowel to decrease the number of bowel movements.
loperamide
take
avoid
may cause
contrindicated
may cause
take as directed
avoid alcohol and depressants
may cause drowsiness
contraindicated under 2 years
may cause abnormal heart rhythm
probiotics
lactobavillus
moa
Helps replenish normal bacterial flora in the gastrointestinal tract.
lactobacillus
used
often
s/e
safe
used for prevention of diahhrea
often used concurrently w/ antibiotics to prevent side affects
s/e- mild gas and bloating
safe in children
constipation
less then 3 bowel movements in a week, stools are hard dry and lumpy, may be difficult to pass,
contipation causes
lack of fiber
lack of ambulation
various diseases
recovery from surgery
s/e of meds
Fiber supplements
psyllium hydrophilic mucilloid
moa
Adds bulk to the stool to facilitate passage through the rectum.
psyllium hydrophilic mucilloid
OTC
mix
administer
may cause
takes
lowers
OTC fiber supplement
mix w/ 8 ounces of water/ fluids-could cause choking
administer 2 hours before or 2 hours after meds that affect absorption
may cause bloating/cramping
may take several days-12-72 hrs
lowers cholesterol
stool softeners
decussate
moa
Facilitates movement of water and fats into stool to make it soft and improve regularity of bowel
movements
docusate
otc
produces
may cause
OTC
produces bowel movement in 12-72 hrs
may cause cramping
osmotic agents
polyethylene glycol
moa
Cause water to be retained with the stool, increasing the number of bowel movements and
softening the stool so it is easier to pass (pulls water into the stool).
polyethylene glycol
measure
dissolve
produces bm
may cause
measure 17 grams of powder in bottle top
dissolve in 4-8 oz of water
produces bm in 1-3 days
may cause loose watery stools
lubricants
fleet
moa
coats stool to help seal in water
fleets
produces
may cause
produces bm in 2-15 minutes
may cause cramps, diarrhea, bloating,uspet stomach, or diarrhea
stimulants
bisocodyle
moa
Causes the intestines to contract, inducing the stool to move through the colon.
bisacodyl
dosage
bm
may cause
oral dosage or rectal suppositories are available
bm in 15 min - 1 hr
may cause stomach cramps, dizziness, rectal burning
antiemetics
nausea-unpleasant sensation of urge to vomit
emesis-vomit
notify pcp if longer then 24 hrs, blood in vomit, pain,
causes of nausea/vomiting
pregnancy
infections
motion sickness
food posiionig
side affects
chemo
GERd and ulcers
anticholinergics
scopolamine
moa
Anticholinergics block ACh receptors to prevent nausea-inducing stimuli to the Chemoreceptor Trigger Zone (CTZ) and the Vomiting Center (VC).
They also dry GI secretions and reduce smooth muscle spasms
scopolamine
only wear
impair
can cause
only wear one transdermal patch at a time– apply behind ear
may impair mental/physical abilities required for hazardous tasks-driving/operatinf
can cause temporary dilation of pupils,blurrewd vision
antihistamines
meclizine
moa
Block H1 receptors in the vestibular center and may also block acetylcholine (ACh).
meclizine
contraidicated
dosage
do not exceed
drowsiness
contracinticated w/ glacoma or in prostate gland englarment
dosage should start one hour before travel begins
do not exceed recmoneded dosage
drowsiness may occur
dopamine antagonist
prochloerpazine
moa
Blocks dopamine in the Chemoreceptor Trigger Zone (CTZ). It also calms the central nervous system and may also block acetylcholin
procholeparzine
take
avoid
may expirence
urine
take as prescribed
avoid alcohol and other depressents
may expiernce photosensitivity and extreme temps need to be avoided
urine may be pinkish or redish brown
pro kinetics
metoclopramide
Blocks dopamine and may also sensitize tissues to acetylcholine. It is used to promote peristalsis to empty the gastrointestinal tract and thus reduce nausea
metoclopramide
inform immediately
inform immeditly if depression or abnormal muscle movements like
lip smacking
frowning
sticking out tongue
blinking and moving eyes
shaking of arms and legs
serotonin antagonists
ondansetron
moa
Blocks serotonin receptors in the GI tract, the chemoreceptor trigger zone (CTZ), and the vomiting center (VC
ondanasteron
warning
causes
inform
WARNIMG- serotinin syndrome can occur if adnimsterd concurrently w/ serotonin antagonists
can cause headaches, drowsiness, contpaiton, fever, diarrhea
inform healthcare provider w/ change of hr, lightheaded, s/s of hypresneitivity
herbal and vitamin supplements
ginger –traditional tradiotnal Indian and Chinese antiemetic
peppermint
pyridoxine- recommended for nausea and vomiting in pregnancy
acute pain
onset
causes
function
Sudden onset
Does not last longer than six months
Goes away when underlying cause is resolved
Causes:
Surgery
Broken bones
Dental work
Burns or cuts
Labor and childbirth
A person can return to normal function once acute pain is gone
chronic pain
onset
lasts
causes
signals
Gradual onset
Lasts longer than six months
Continues after injury/illness is resolved
Causes:
Headache
Arthritis
Cancer
Nerve pain
Back pain
Fibromyalgia pain
Pain signals remain active in the nervous system for weeks, months, or years.
acetaminophen -non opioid analgesics
moa
Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily in the CNS.
acetaminophen
used
s/e
teaching(taken,shouldnot,avoid,stop)
antidote
Used to treat mild pain (analgesic) and fever (antipyretic)
Adverse/Side Effects: skin reddening, blisters, rash, and hepatotoxicity.
Patient Teaching & Education:
taken as directed and the dosing schedule should be adhered to appropriately.
should not take the medication for greater than 10 days
.
avoid taking alcohol
Stop mediation and report if rash-seven Johnson syndrome
antidote-azcetlycetsine
non steroidal ant-inflammatories-nsaids
aspirin,ibuprofin,kerolorac, celecoxib
moa
Inhibit the biosynthesis of prostaglandin by different forms of the COX enzyme. COX 1 and COX 2 inhibitors decrease inflammation
aspirin, ibupfrom, ketolorac, celexoib
selective
treats
decreased
has effects
selective to only cox-2 enzyme
treats pain, also block the stomachs protection, so may cause stomach irritation
decreased production of stomach lining and gastric irritation
has analgesic, antipyretic and antiinflamtory, antiplatelt effect,
aspirin
moa
Produces analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins. It also decreases platelet aggregation.
aspirin
used
s/e
warning
caution w/
BBW
do not
used for treatment of mild pain and fever
s/e-gi upset, gi bleed, tinnitus-ear
warning-causes stomach bleeding,
caution w/ nsaids,ulcers,blood thinners, age >60,alchohol use, higher dosage
Black box warning-done give to children to treat flu because of Reyes syndrome
do not crush
reyes syndrome
primarily occurs in children in conjunction with a viral illness; it can cause symptoms such as
persistent vomiting,
confusion or
loss of consciousness and
requires immediate medical attention
ibuprofen
moa
Inhibits prostaglandin synthesis.
ibuprofen
use
s/e
teaching
avoid
don’t take
use–mild to moderate pain/fever, inflammatory disorders like arthritis or osteoarthritis.
s/e- headache, gi bleed, constipation, dyspepsia, nausea, vomiting, SJS, renal failure
teaching/education- consume w/ water-remain upright for 30 mins
avoid use of alcohol
don’t take longer then 10 days
ketorolac
moa
Inhibits prostaglandin synthesis.
ketorolac
used
short term
s/e
avoid
contraindicated
used to treat breakthrough pain during treatment of pain w/ opiods
indication of use- short term management of pain- up tp 5 days
s/e-drowsniness, headache, gi bleed, abnormal taste, dyspepsia, nausea, SJS, edema, renal failure
teaching/ education - avoid aclhocol
contraindicated w/ PUD, Gi bleeds,perfoartion.
celecoxib
moa
Inhibits the enzyme COX-2 that is required for the synthesis of prostaglandins.
celecoxib
used
s/e
teaching
bbw
Used to treat the pain associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
s/e-hypertension, peripheral edema, increased liver enzymes, abdominal pain, dyspepsia, gastroesophageal reflux disease, vomiting, and diarrhea.
pt teaching/education-take as directed-lowest effective dose
report s/s of gi toxicity
BBW- increased risk of cardiovascular events, gastrointestinal bleeding, ulceration, and perforation
morphine-opiod analgesic moa
Binds to opioid receptors in the CNS and alters the perception of and response to painful stimuli while producing generalized CNS depression.
morphine
used
S/e
teaching
black box warning
resp
used to treat moderate/severe/acute/chronic pain and pulmonary edema
s/e-respitory depression, hypotension , lightheadedness, dizziness, sedation, constipation, n/v, sweating
teaching-pt should know risks of opioid use
BBW-when combined with cns depressants, slowed/difficulty breathing and death can occur. risk for abuse/depednece
respiratory depression is huge risk for elderly pts
naloxone- antagonist
moa
Reverses analgesia and the CNS and respiratory depression caused by opioid agonists. It competes with opioid receptor sites in the brain and, thereby, prevents binding with receptors or displaces opioids already occupying receptor sites.
nalaxone
used
s/e
opioid depression
used as reversal for opioid depression
s/e-tremors, drowsiness, sweating, decreased respirations, hypertension, nausea, and vomiting.
opioid depression and opioid dependence-
opioid depression
abrupt reversal of opioid depression may result in n/v, sweating, inc hr/bp tremulousness, seizures, ventricular tachycardia and fibrillation, pulmonary edema, and cardiac arrest, which may result in death.
opioid dependence
aches, fever, sweating, runny nose, sneezing, piloerection, yawning, weakness, shivering or trembling, nervousness, restlessness or irritability, diarrhea, nausea or vomiting, abdominal cramps, increased blood pressure, and tachycardia.
baclofen
adjuvant analgesic
moa
Inhibits reflexes at the spinal level
baclofen
used
s/e
teaching
Used to treat muscle symptoms,(spasm, pain, and stiffness, caused by multiple sclerosis), spinal cord injuries/ disorders
s/e-Drowsiness, dizziness, or lightheadedness, confusion, nausea, constipation, and muscle weakness
teaching -drowsiness will decrease
take as directed
do not abruptly discontinue
cyclobenzaprine
adjuvant analgesic
moa
Reduces tonic somatic muscle activity at the level of the brainstem. It is structurally similar to tricyclic antidepressants.
cyclobenzaprine
used
s/e
teaching
used to treat acute muscle spasms
s/e-: dizziness, drowsiness, dry mouth, urinary retention, serotonin syndrome with antidepressant use, or increased sedation with other CNS depressants
teaching/ education- take as directed
drowsiness or dizziness
slow positional changes
tizadine
adjuvant analgesic
moa
Acts as an agonist at central alpha-adrenergic receptor sites. It reduces spasticity by increasing presynaptic inhibition of motor neurons.
tizanidine
used
s/e
teaching
Used to treat increased muscle tone, spasms, and spasticity.
s/e-somnolence, dry mouth, hypotension, bradycardia, dizziness, fatigue, weakness or asthenia, hallucinations, liver function test abnormality, and hepatotoxicity.
teaching- slow positional changes
allopurinol
antigout
moa
Blocks the production of uric acid by inhibiting the action of xanthine oxidase.
allopurinol
used
s/e
teaching
increase
causes
Used for the prevention/treatment of gouty arthritis, nephropathy and secondary hyperuricemia
s/e -: hypotension, flushing, hypertension, drowsiness, nausea/ vomiting, diarrhea, hepatitis, renal failure, drug rashw/ eosinophilia and systemic symptoms (DRESS)
teaching-alkaline diet- no dairy, eggs,meats,grains,processed food
increase fluid intake-kidney stones
causes dizziness/drownsiness
Anesthetics
local
concouis
general
Local anesthetic is when a medication is injected into the skin at the site of the procedure to achieve numbness for procedures like suturing.
Conscious Sedation is a combination of medications that allow the patient to be relaxed and free of pain during a medical procedure.
—-This allows the patient to remain awake and aware, without feeling discomfort.
—-The patient may or may not be able to speak or respond in this state.
General Anesthesia is a medication-induced reversible unconsciousness with loss of protective reflexes.
—Arousal, even to painful stimuli, cannot occur.
—–General anesthesia requires the establishment and maintenance of airway control
