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d-nursing pharmacology > Last exam presentation GI and musculoskeletal > Flashcards

Last exam presentation GI and musculoskeletal Flashcards

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1
Q

Stomach acids

A

DIGESTIVE ENZYMES (HYDROCHLORIC ACID, PEPSINOGEN)

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

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2
Q

Six Functions of the GI System

A

INGESTION

MECHANICAL PROCESSING

DIGESTION

SECRETION

ABSORPTION

EXCRETION

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3
Q

Stomach protection against acidity

A

Thick mucous

Bicarbonate

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

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4
Q

Gastroesophageal reflux disease
GERD

A

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

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5
Q

S/S of GERD

A

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

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6
Q

Teaching GERD

A

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

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7
Q

Peptic ulcer disease PUD

A

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

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8
Q

common causes PUD

A

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

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9
Q

stress related mucosal damage

A

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.

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10
Q

Gastric ulcer

A

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

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11
Q

Duodenal Ulcer

A

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

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12
Q

Heliobacter pylori infection

A

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

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13
Q

H pylori treatment

must be
proton pump
antibiotics
if used
pepto

A

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

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

  1. 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

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14
Q

H pylori

produces
makes
active

A

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

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15
Q

Antacids

A

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

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16
Q

anti ulcer mediations

A

ANTACIDS

H2-RECEPTOR ANTAGONISTS

PROTON PUMP INHIBITORS (PPI)

MUCOSAL PROTECTANTS

ANTI-FLATULENT

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17
Q

Antacids

relives
otc
may contain
forms

A

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

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18
Q

Anatacid

taken
do not
contradicted
med-

A

Taken 3-4 tomes dauly

do not administer 1-2 hours of other meds

contracidicated w/ preexisting kidney disease

med-calcium carbonate

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19
Q

H-2 receptor agnoists

famotdine
moa

A

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

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20
Q

famotidine

treats
otc
taken
liver/kindey
contact

A

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

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21
Q

Proton pump inhibitor

pantoprazole
moa

A

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

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22
Q

Pantoprazole
treats
given w/
delayed
use of
long term

A

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

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23
Q

mucosal protectants

sucralfate
mao

A

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

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24
Q

sucralfate

forms
minimally
administer
may cause
caution

A

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

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25
Q

anti-flatulant

simethcone
mao

A

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

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26
Q

simethicone

treats
incoprorate
added
taken
shake

A

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

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27
Q

diarrhea

A

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

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28
Q

absorbents

bismuth subsictylate
moa

A

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.

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29
Q

bismuth subsalicylte

take
safe
may cause
contains
discontinue

A

take as directed

safe over 12 years

may cause black/ darkened tongue and dark stool

contains aspirin

discntue if tinnitus occurs

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30
Q

anticholinergics

hyoscyamine
moa-works on
inhibit
decreses

A

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

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31
Q

hyoscyamine

s/e

A

dizziness

drowsiness
dry mouth

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32
Q

opioid like medication

loperamide
moa

A

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.

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33
Q

loperamide
take
avoid
may cause
contrindicated
may cause

A

take as directed

avoid alcohol and depressants

may cause drowsiness

contraindicated under 2 years

may cause abnormal heart rhythm

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34
Q

probiotics

lactobavillus

moa

A

Helps replenish normal bacterial flora in the gastrointestinal tract.

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35
Q

lactobacillus
used
often
s/e
safe

A

used for prevention of diahhrea

often used concurrently w/ antibiotics to prevent side affects

s/e- mild gas and bloating

safe in children

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36
Q

constipation

A

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

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37
Q

contipation causes

A

lack of fiber

lack of ambulation

various diseases

recovery from surgery

s/e of meds

38
Q

Fiber supplements

psyllium hydrophilic mucilloid

moa

A

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

39
Q

psyllium hydrophilic mucilloid

OTC
mix
administer
may cause
takes
lowers

A

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

40
Q

stool softeners

decussate

moa

A

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

41
Q

docusate
otc
produces
may cause

A

OTC

produces bowel movement in 12-72 hrs

may cause cramping

42
Q

osmotic agents
polyethylene glycol
moa

A

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).

43
Q

polyethylene glycol
measure
dissolve
produces bm
may cause

A

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

44
Q

lubricants

fleet

moa

A

coats stool to help seal in water

45
Q

fleets
produces
may cause

A

produces bm in 2-15 minutes

may cause cramps, diarrhea, bloating,uspet stomach, or diarrhea

46
Q

stimulants

bisocodyle

moa

A

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

47
Q

bisacodyl

dosage
bm
may cause

A

oral dosage or rectal suppositories are available

bm in 15 min - 1 hr

may cause stomach cramps, dizziness, rectal burning

48
Q

antiemetics

A

nausea-unpleasant sensation of urge to vomit
emesis-vomit

notify pcp if longer then 24 hrs, blood in vomit, pain,

49
Q

causes of nausea/vomiting

A

pregnancy

infections

motion sickness

food posiionig

side affects

chemo

GERd and ulcers

50
Q

anticholinergics

scopolamine

moa

A

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

51
Q

scopolamine
only wear
impair
can cause

A

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

52
Q

antihistamines

meclizine
moa

A

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

53
Q

meclizine

contraidicated
dosage
do not exceed
drowsiness

A

contracinticated w/ glacoma or in prostate gland englarment

dosage should start one hour before travel begins

do not exceed recmoneded dosage

drowsiness may occur

54
Q

dopamine antagonist

prochloerpazine
moa

A

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

55
Q

procholeparzine
take
avoid
may expirence
urine

A

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

56
Q

pro kinetics

metoclopramide

A

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

57
Q

metoclopramide
inform immediately

A

inform immeditly if depression or abnormal muscle movements like

lip smacking

frowning

sticking out tongue

blinking and moving eyes

shaking of arms and legs

58
Q

serotonin antagonists

ondansetron

moa

A

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

59
Q

ondanasteron
warning
causes
inform

A

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

60
Q

herbal and vitamin supplements

A

ginger –traditional tradiotnal Indian and Chinese antiemetic

peppermint

pyridoxine- recommended for nausea and vomiting in pregnancy

61
Q

acute pain
onset
causes
function

A

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

62
Q

chronic pain
onset
lasts
causes
signals

A

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.

63
Q

acetaminophen -non opioid analgesics

moa

A

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

64
Q

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

A

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

65
Q

non steroidal ant-inflammatories-nsaids

aspirin,ibuprofin,kerolorac, celecoxib
moa

A

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

66
Q

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

A

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,

67
Q

aspirin
moa

A

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

68
Q

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

A

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

69
Q

reyes syndrome

A

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

70
Q

ibuprofen
moa

A

Inhibits prostaglandin synthesis.

71
Q

ibuprofen
use
s/e
teaching
avoid
don’t take

A

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

72
Q

ketorolac
moa

A

Inhibits prostaglandin synthesis.

73
Q

ketorolac
used
short term
s/e
avoid
contraindicated

A

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.

74
Q

celecoxib
moa

A

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

75
Q

celecoxib
used
s/e
teaching
bbw

A

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

76
Q

morphine-opiod analgesic moa

A

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

77
Q

morphine

used

S/e

teaching

black box warning

resp

A

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

78
Q

naloxone- antagonist
moa

A

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.

79
Q

nalaxone

used
s/e
opioid depression

A

used as reversal for opioid depression

s/e-tremors, drowsiness, sweating, decreased respirations, hypertension, nausea, and vomiting.

opioid depression and opioid dependence-

80
Q

opioid depression

A

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.

81
Q

opioid dependence

A

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.

82
Q

baclofen

adjuvant analgesic
moa

A

Inhibits reflexes at the spinal level

83
Q

baclofen
used
s/e
teaching

A

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

84
Q

cyclobenzaprine
adjuvant analgesic
moa

A

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

85
Q

cyclobenzaprine
used
s/e
teaching

A

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

86
Q

tizadine
adjuvant analgesic
moa

A

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

87
Q

tizanidine
used
s/e
teaching

A

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

88
Q

allopurinol
antigout
moa

A

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

89
Q

allopurinol
used
s/e
teaching
increase
causes

A

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

90
Q

Anesthetics
local
concouis
general

A

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

d-nursing pharmacology (14 decks)

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