Last exam presentation GI and musculoskeletal

Question 1

Stomach acids

Answer 1

DIGESTIVE ENZYMES (HYDROCHLORIC ACID, PEPSINOGEN)

PH: 1-4 – MOST ACIDIC FLUID IN THE BODY

Question 2

Six Functions of the GI System

Answer 2

INGESTION

MECHANICAL PROCESSING

DIGESTION

SECRETION

ABSORPTION

EXCRETION

Question 3

Stomach protection against acidity

Answer 3

Thick mucous

Bicarbonate

FURTHER NEUTRALIZED UPON REACHING THE DUODENUM, BY BICARBONATE FROM PANCREATIC &
BILIARY (LIVER AND GALLBLADDER) SECRETIONS

Question 4

Gastroesophageal reflux disease
GERD

Answer 4

Caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus

Question 5

S/S of GERD

Answer 5

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

Question 6

Teaching GERD

Answer 6

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

Question 7

Peptic ulcer disease PUD

Answer 7

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

Question 8

common causes PUD

Answer 8

FAMILY HISTORY,
SMOKING,
CAFFEINE,
NSAIDS,
STRESS,
HELIOBACTER PYLORI

Question 9

stress related mucosal damage

Answer 9

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.

Question 10

Gastric ulcer

Answer 10

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

Question 11

Duodenal Ulcer

Answer 11

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

Question 12

Heliobacter pylori infection

Answer 12

Heliobacter pylori bacteria infects the stomach, attacking the lining that protects the stomach.

Question 13

H pylori treatment

must be
proton pump
antibiotics
if used
pepto

Answer 13

Must be tested because uninfected patients treated with this therapy will have worse outcomes

*Combination therapy
1. Proton pump inhibitors or H2 receptor antagonist

2. 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

Question 14

H pylori

produces
makes
active

Answer 14

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

Question 15

Antacids

Answer 15

Used to neutralize stomach acid, elevate pH, and reduce the symptoms of heartburn. Elevated pH also inactivates pepsin, a digestive enzym

Question 16

anti ulcer mediations

Answer 16

ANTACIDS

H2-RECEPTOR ANTAGONISTS

PROTON PUMP INHIBITORS (PPI)

MUCOSAL PROTECTANTS

ANTI-FLATULENT

Question 17

Antacids

relives
otc
may contain
forms

Answer 17

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

Question 18

Anatacid

taken
do not
contradicted
med-

Answer 18

Taken 3-4 tomes dauly

do not administer 1-2 hours of other meds

contracidicated w/ preexisting kidney disease

med-calcium carbonate

Question 19

H-2 receptor agnoists

famotdine
moa

Answer 19

Block histamine’s action at the H2 receptor of the parietal cell, thus reducing the production of hydrochloric acid

Question 20

famotidine

treats
otc
taken
liver/kindey
contact

Answer 20

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

Question 21

Proton pump inhibitor

pantoprazole
moa

Answer 21

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

Question 22

Pantoprazole
treats
given w/
delayed
use of
long term

Answer 22

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

Question 23

mucosal protectants

sucralfate
mao

Answer 23

Locally covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salt

Question 24

sucralfate

forms
minimally
administer
may cause
caution

Answer 24

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

Question 25

anti-flatulant simethcone mao

Answer 25

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

Question 26

simethicone treats incoprorate added taken shake

Answer 26

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

Question 27

diarrhea

Answer 27

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

Question 28

absorbents bismuth subsictylate moa

Answer 28

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.

Question 29

bismuth subsalicylte take safe may cause contains discontinue

Answer 29

take as directed safe over 12 years may cause black/ darkened tongue and dark stool contains aspirin discntue if tinnitus occurs

Question 30

anticholinergics hyoscyamine moa-works on inhibit decreses

Answer 30

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

Question 31

hyoscyamine s/e

Answer 31

dizziness drowsiness dry mouth

Question 32

opioid like medication loperamide moa

Answer 32

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.

Question 33

loperamide take avoid may cause contrindicated may cause

Answer 33

take as directed avoid alcohol and depressants may cause drowsiness contraindicated under 2 years may cause abnormal heart rhythm

Question 34

probiotics lactobavillus moa

Answer 34

Helps replenish normal bacterial flora in the gastrointestinal tract.

Question 35

lactobacillus used often s/e safe

Answer 35

used for prevention of diahhrea often used concurrently w/ antibiotics to prevent side affects s/e- mild gas and bloating safe in children

Question 36

constipation

Answer 36

less then 3 bowel movements in a week, stools are hard dry and lumpy, may be difficult to pass,

Question 37

contipation causes

Answer 37

lack of fiber lack of ambulation various diseases recovery from surgery s/e of meds

Question 38

Fiber supplements psyllium hydrophilic mucilloid moa

Answer 38

Adds bulk to the stool to facilitate passage through the rectum.

Question 39

psyllium hydrophilic mucilloid OTC mix administer may cause takes lowers

Answer 39

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

Question 40

stool softeners decussate moa

Answer 40

Facilitates movement of water and fats into stool to make it soft and improve regularity of bowel movements

Question 41

docusate otc produces may cause

Answer 41

OTC produces bowel movement in 12-72 hrs may cause cramping

Question 42

osmotic agents polyethylene glycol moa

Answer 42

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).

Question 43

polyethylene glycol measure dissolve produces bm may cause

Answer 43

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

Question 44

lubricants fleet moa

Answer 44

coats stool to help seal in water

Question 45

fleets produces may cause

Answer 45

produces bm in 2-15 minutes may cause cramps, diarrhea, bloating,uspet stomach, or diarrhea

Question 46

stimulants bisocodyle moa

Answer 46

Causes the intestines to contract, inducing the stool to move through the colon.

Question 47

bisacodyl dosage bm may cause

Answer 47

oral dosage or rectal suppositories are available bm in 15 min - 1 hr may cause stomach cramps, dizziness, rectal burning

Question 48

antiemetics

Answer 48

nausea-unpleasant sensation of urge to vomit emesis-vomit notify pcp if longer then 24 hrs, blood in vomit, pain,

Question 49

causes of nausea/vomiting

Answer 49

pregnancy infections motion sickness food posiionig side affects chemo GERd and ulcers

Question 50

anticholinergics scopolamine moa

Answer 50

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

Question 51

scopolamine only wear impair can cause

Answer 51

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

Question 52

antihistamines meclizine moa

Answer 52

Block H1 receptors in the vestibular center and may also block acetylcholine (ACh).

Question 53

meclizine contraidicated dosage do not exceed drowsiness

Answer 53

contracinticated w/ glacoma or in prostate gland englarment dosage should start one hour before travel begins do not exceed recmoneded dosage drowsiness may occur

Question 54

dopamine antagonist prochloerpazine moa

Answer 54

Blocks dopamine in the Chemoreceptor Trigger Zone (CTZ). It also calms the central nervous system and may also block acetylcholin

Question 55

procholeparzine take avoid may expirence urine

Answer 55

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

Question 56

pro kinetics metoclopramide

Answer 56

Blocks dopamine and may also sensitize tissues to acetylcholine. It is used to promote peristalsis to empty the gastrointestinal tract and thus reduce nausea

Question 57

metoclopramide inform immediately

Answer 57

inform immeditly if depression or abnormal muscle movements like lip smacking frowning sticking out tongue blinking and moving eyes shaking of arms and legs

Question 58

serotonin antagonists ondansetron moa

Answer 58

Blocks serotonin receptors in the GI tract, the chemoreceptor trigger zone (CTZ), and the vomiting center (VC

Question 59

ondanasteron warning causes inform

Answer 59

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

Question 60

herbal and vitamin supplements

Answer 60

ginger --traditional tradiotnal Indian and Chinese antiemetic peppermint pyridoxine- recommended for nausea and vomiting in pregnancy

Question 61

acute pain onset causes function

Answer 61

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

Question 62

chronic pain onset lasts causes signals

Answer 62

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.

Question 63

acetaminophen -non opioid analgesics moa

Answer 63

Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily in the CNS.

Question 64

acetaminophen used s/e teaching(taken,shouldnot,avoid,stop) antidote

Answer 64

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

Question 65

non steroidal ant-inflammatories-nsaids aspirin,ibuprofin,kerolorac, celecoxib moa

Answer 65

Inhibit the biosynthesis of prostaglandin by different forms of the COX enzyme. COX 1 and COX 2 inhibitors decrease inflammation

Question 66

aspirin, ibupfrom, ketolorac, celexoib selective treats decreased has effects

Answer 66

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,

Question 67

aspirin moa

Answer 67

Produces analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins. It also decreases platelet aggregation.

Question 68

aspirin used s/e warning caution w/ BBW do not

Answer 68

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

Question 69

reyes syndrome

Answer 69

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

Question 70

ibuprofen moa

Answer 70

Inhibits prostaglandin synthesis.

Question 71

ibuprofen use s/e teaching avoid don't take

Answer 71

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

Question 72

ketorolac moa

Answer 72

Inhibits prostaglandin synthesis.

Question 73

ketorolac used short term s/e avoid contraindicated

Answer 73

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.

Question 74

celecoxib moa

Answer 74

Inhibits the enzyme COX-2 that is required for the synthesis of prostaglandins.

Question 75

celecoxib used s/e teaching bbw

Answer 75

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

Question 76

morphine-opiod analgesic moa

Answer 76

Binds to opioid receptors in the CNS and alters the perception of and response to painful stimuli while producing generalized CNS depression.

Question 77

morphine used S/e teaching black box warning resp

Answer 77

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

Question 78

naloxone- antagonist moa

Answer 78

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.

Question 79

nalaxone used s/e opioid depression

Answer 79

used as reversal for opioid depression s/e-tremors, drowsiness, sweating, decreased respirations, hypertension, nausea, and vomiting. opioid depression and opioid dependence-

Question 80

opioid depression

Answer 80

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.

Question 81

opioid dependence

Answer 81

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.

Question 82

baclofen adjuvant analgesic moa

Answer 82

Inhibits reflexes at the spinal level

Question 83

baclofen used s/e teaching

Answer 83

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

Question 84

cyclobenzaprine adjuvant analgesic moa

Answer 84

Reduces tonic somatic muscle activity at the level of the brainstem. It is structurally similar to tricyclic antidepressants.

Question 85

cyclobenzaprine used s/e teaching

Answer 85

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

Question 86

tizadine adjuvant analgesic moa

Answer 86

Acts as an agonist at central alpha-adrenergic receptor sites. It reduces spasticity by increasing presynaptic inhibition of motor neurons.

Question 87

tizanidine used s/e teaching

Answer 87

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

Question 88

allopurinol antigout moa

Answer 88

Blocks the production of uric acid by inhibiting the action of xanthine oxidase.

Question 89

allopurinol used s/e teaching increase causes

Answer 89

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

Question 90

Anesthetics local concouis general

Answer 90

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