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NRSG 213 > Lecture 9 > Flashcards

Lecture 9 Flashcards

1
Q

Overall purpose of the GI system

A

Digest and absorb nutrients from the foods and fluids we ingest

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2
Q

Gastric glands

A

Glands in the stomach that are made up of many different cells

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3
Q

Parietal cells:

A
  • Secrete HCL
  • Includes the proton pump
  • Proton pump in the parietal cells pump hydrogen ions for creation of HCL (requires energy)
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4
Q

Chief cells

A
  • Secrete pepsinogen which becomes pepsin

- …for the digestion of proteins

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5
Q

Mucoid cells

A
  • Secrete mucous to protect the lining of stomach from acid
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6
Q

The parietal cell is stimulated by three substances

A
  • Acetylcholine, histamine, gastrin
  • When any one of these substances is released (and receptors are stimulated) it leads to HCL production
  • Medications that inhibit HCL secretion work to inhibit these substances or block receptors
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7
Q

Control of the GI system: parasympathetic NS

A
  • Exerts an excitatory influence to increase digestive secretions and GI muscular activity
  • “rest and digest”
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8
Q

Control of the GI system: Sympathetic NS

A
  • Exerts an inhibitory influence to depress digestive secretions and GI muscular activity
  • “FFF”
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9
Q

Antacids - Action

A
  • Only work on acid already in stomach, not on acid yet to be made
  • Repeated doses may be necessary
  • May also stimulate mucous production (which is GOOD - mucous protects)
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10
Q

Antacids - Effect

A
  • Increase the pH of the stomach
  • Normal pH of stomach = 1 - 2
  • Antacids can change the pH to 3 - 4
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11
Q

Antacids - used for ….

A
  1. peptic ulcers
  2. heartburn
  3. gastritis
  4. gastric hyperactivity - decreases pain associated with it
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12
Q

Types of antacids: Aluminum containing

S/E, cautions, Meds

A
  • S/E: Constipation
  • Caution with Renal failure
  • Med: Aluminum hydroxide (Amphogel)
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13
Q

Types of antacids: Magnesium containing

S/E, cautions, Meds

A
  • S/E: Diarrhea
  • Contraindicated with renal failure
  • MED: Milk of magnesia (Magnesium hydroxide)
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14
Q

Types of antacids: Calcium containing

S/E, med, also produces…

A
  • S/E: Kidney stones, constipation, and acid rebound
  • MED: Tums
  • Also produces gas - often combined with Simethicone (antiflatulent)
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15
Q

Types of antacids: Sodium bicarbonate

S/E, Med, mixed

A
  • S/E: metabolic alkalosis
  • MED: baking soda
  • Aluminum and magnesium often mixed (Maalox, Mylanta, etc) - s/e of constipation and diarrhea often balance out. OTC.
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16
Q

Types of antacids: Usual dose

A

30 - 60 mL with water every 1 -3 hrs after meals and at HS. Liquid is best, if using tablets, suck until gone. Goal is to coat the stomach.

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17
Q

Antacid instructions/warning

A
  1. Don’t take with other meds - decreases effectiveness of other meds
  2. Prematurely dissolves enteric coated meds
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18
Q

H2 antagonists - actions & details

A
  • Inhibits production of HCL
  • About 90% effective
  • Blocks the histamine 2 receptors on parietal cells
  • Makes these cells less responsive to histamine, gastrin, acetylcholine
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19
Q

H2 antagonists - uses & S/E & MED

A
  1. Peptic ulcer disease
  2. Hyperacidity
  3. Gastric reflux - Heartburn
    - S/E: Very few, very safe, but smoking decreases the action of these medications (available OTC in lower dose)
    - MED: Cimetidine (Tagamet). PO, QID, or IV.
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20
Q

Other H2 inhibitors & strength compared to Tagamet

A
  • Pepcid (famotidine). Very strong, 20 - 50 times the strength of Tagamet.
  • Axid (Nizatidine). 4 - 8 times the strength of Tagamet.
  • Zantac (Ranitidine). 4 - 8 times the strength of Tagamet.
  • All of these can be given BID.
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21
Q

Proton pump inhibitors - Actions & details

A
  • Newest class of medications for acid disorders
  • Inhibits final step in the acid secretion process of the parietal cell
  • Binds permanently with H+/K+ ATPase
  • stops the supply of energy to the proton pump in parietal cell
  • No pumping of H+ = No HCL
  • Blocks over 90% of acid production until the parietal cell manufactures new H+/K+ ATPase.
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22
Q

Proton pump inhibitors - Uses

A
  • Not usually for long-term use
  • First line treatment for:
  • Erosive esophagitis,
  • symptomatic GERD,
  • active duodenal ulcers and active benign gastric ulcers, - gastric hypersecretory conditions
  • NSAID-induced ulcers and stress ulcer prophylaxis
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23
Q

Proton pump inhibitors - S/E & MED

A
  • S/E: similar to H2 antagonists - fairly rare
  • MED: Omeprazole (Prilosec). PO only - recently OTC with a lower dosage.
  • MED: Pantoprazole (Protonix). Given IV, PO, NG (but frequently clogs NG tube - large delayed release granules can’t really be crushed)
24
Q

Acute diarrhea

A
  • Sudden onset in healthy person
  • Lasts 3 days - 2 weeks
  • Causes: Bacterial, Viral, Food poison
25
Q

Chronic diarrhea

A
  • Person has other symptoms such as: Fever, N/V, Wt. loss, loss of appetite, weakness
  • Lasts 3 - 4 weeks
  • Causes: Bowel disease, Tumors, hyperthyroidism
26
Q

Diarrhea is a symptom not a disease - find the cause!

A

Need to know the reason for the diarrhea before treatment

27
Q

Antidiarrheal agents - Adsorbents

A
  • Coats walls of GI system
  • Binds with bacteria & toxins to eliminate them
  • Some have an ASA like substance in them (Bismuth subsalicylate, which can cause dark stool & blue lips)
  • MEDS:
    1. Kaopectate
    2. pepto-bismol
    3. Activated charcoal `
28
Q

Antidiarrheal agents - Anticholinergics

A
  • Decreases peristalsis to slow the movement of the GI system
  • Serious S/E - prescription only. S/E: HA, N/V, Dry mouth, sweating
    MEDS:
    1. Donnatal
    2. Atropine
29
Q

Antidiarrheal agents - intestinal flora modifiers

A
  • Supplies bacteria to the intestine that will restore the normal flora
  • Good for diarrhea associated with antibiotics
  • MED: Lactobacillus acidophilus (Bacid)
30
Q

Antidiarrheal agents - Opiates

A
  • Decreases bowel motility
  • Eliminates pain
  • MEDS:
    1. Codeine
    2. Diphenoxylate / Atropine (Lomotil)
    3. Loperamide (Imodium)
31
Q

Antidiarrheal agents - lil detail

A

Many medications are combinations of all the antidiarrheals mentioned

32
Q

Laxatives - Use & detail

A
  • For treatment of constipation (infrequent or difficult passage of stool)
  • Constipation is also a symptom not a disease - find the cause!
  • Usual time from ingestion to defection is 24 - 36 hours
33
Q

Common causes of constipation:

A
  1. Metabolic/endocrine disorders (Diabetes, pregnancy, hypothyroidism)
  2. Neurogenic (spinal cord injury)
  3. Adverse medication reactions (Analgesics, aluminum antacids)
  4. Lifestyle –>
    a) poor bowel habits - avoid the urge? no schedule?
    b) Diet
    c) Activity
    d) Psychological - own bathroom? Privacy? etc…
34
Q

Laxatives work by:

A
  1. Changing fecal consistency
  2. Increasing movement of GI
  3. Removing stool from rectum

There is common misuse of these medications - natural action is better

35
Q

Types of Laxatives - Bulk forming (Actions)

A
  • These add fiber to the intestine
  • This fiber pulls water and increases bulk of the stool
  • GI reflex moves the stool out because it is so big
36
Q

Types of Laxatives - Bulk forming (NRSG implications & MEDs)

A
  • Often in powder to mix with water
  • takes 12 hrs - 3 days to work
  • S/E: can dehydrate you
  • Best for once in a while use for acute constipation
  • MEDS:
    1. Metamucil
    2. Citrucel
    3. Fiberall
37
Q

Types of Laxatives - Emollients, Type #1 = stool softeners

A
  • Works by lowering the tension of fluids so water and fat are pulled into the stool
  • Takes 1 - 3 days to work
  • Very mild
38
Q

Types of Laxatives - Emollients, Type #2 = Lubricants

A
  • Coats the fecal matter and keeps water from dehydrating stool
  • Also makes it slippery
  • Takes about 6 - 8 hours to work
  • Better for once in a while use
39
Q

Types of Laxatives - Emollients (MEDS)

A
  1. Mineral oil
  2. Docusate sodium (Colace)
  3. Docusate Calcium (Surfak)
40
Q

Types of Laxatives - Hyper-osmotic Laxatives

A
  • Increases fecal water content
  • Causes distention and increased peristalsis
  • Works only on the large intestine
  • Works very quickly—in hours
  • Used for surgical bowel procedures
41
Q

Types of Laxatives - Hyper-osmotic Laxatives (MEDS)

A
  1. Polyethylene glycol (Golytely)

2. Lactulose

42
Q

Types of Laxatives - Saline type laxatives

A
  • Inhibits the bowel from taking in water and electrolytes
  • Keeps the stool loose and watery
  • Increases distention and peristalsis
  • Often given in enema
  • Enema form takes only 2 - 5 min to work
  • Better for chronic constipation
43
Q

Saline type laxatives - MEDS

A
  1. Milk of magnesia
  2. Fleet enema
  3. Epsom salts
44
Q

Types of Laxatives - stimulant laxatives

A
  • stimulates the nerves of the intestines to increase peristalsis
  • Takes 6 - 12 hours to work
  • Can be quite harsh
  • Better for once in a while use
    MEDS:
    1. Dulcolax
    2. Senokot
45
Q

Considerations of laxative use

A
  1. Take laxatives with plenty of water
  2. Long-term use can lead to dependance
  3. Don’t use with N/V, or abdominal pain
  4. No recommended for children
46
Q

Antiemetics (anti-nausea) agents:

A

Work in two centers in the brain:

  1. Vomiting center (VC)
  2. Chemoreceptors trigger zone (CTZ) - in brain stem
47
Q

Antiemetics - Anticholinergics

A
  • Action: Binds to and blocks acetylcholine so nauseous stimuli is not sent to brain
  • S/E: Drowsiness, Dry secretions, Prevents smooth muscle spasms
  • MED: Scopolamine (esp good for motion sickness. Patch behind ear)
48
Q

Antiemetics - Antidopaminergics

A
  • Action: Blocks dopamine receptors in the chemoreceptor trigger zone. Calms the CNS and decreases anxiety and tension.
  • S/E: Orth. hypotension, blurred vision, dry mouth, constipation
  • MED: Compazine (Rectal, IM, PO)
49
Q

Antiemetics - Prokinetics

A
  • Action: Blocks dopamine in the CTZ. Stimulates acetylcholine receptors in the GI tract.
  • S/E: Hypotension, sedation, fatigue, dry mouth, diarrhea
  • MED: Metoclopramide (Reglan) …IV
50
Q

Antiemetics - serotonin blockers

A
  • Action: Blocks serotonin receptors in the GI tract, CTZ, & VC
  • Primarily used for chemo-induced N/V
  • Also used for some post-op N/V and hyperemesis gravidarium
  • Few S/E: Doesn’t interact negatively with other medications
  • MED: Ondansetron (Zofran) PO & IV. Give before chemo or surgery to prevent N/V
51
Q

Antiemetics - Tetrahydrocannabinoids

A
  • Action: Has an inhibitory effect on the reticular formation, thalamus, and cerebral cortex
  • S/E: Drowsiness, dizziness, anxiety, confusion, visual disturbances, dry mouth, increased appetite
  • MED: Dronabinol (Marinol) PO
52
Q

Antiemetics - Ginger (Herbal)

A
  • Common uses: sore throat, migraine, HA, N/V, morning sickness, motion sickness
  • Adverse effects: Skin reactions, anorexia, N/V
  • Med interactions: increased bleeding risks with anticoagulants (warfarin) or antiplatlet medication
53
Q

Enteral feedings

A
  • Feedings through the GI tract
  • other: nasogastric, nasoduodenal, nasojejunal, gastrostomy, jejunostomy
  • Many commercial formulas made to meet or supplement nutrition.
54
Q

Parenteral feeding

A
  • Feeding directly into Circulatory system by IV
  • Also known as total parenteral nutrition or TPN
  • Contains vitamins, minerals, amino acids, glucose, etc. Often made by the pharmacy to specifically meet the needs of the patient.
  • PIV or central vein
55
Q

Parenteral feeding via PIV

A
  • under 2 weeks of administering
  • Supplemental nutrition only
  • 500 - 700 calories/day
  • S/E: Phlebitis, fluid overload
56
Q

Parenteral feeding via central line

A
  • Long-term administering
  • Total nutrition needs met
  • 2000 - 4000 calories/day
  • S/E: Infection of insertion site at subclavian or jugular vein, hyperglycemia
57
Q

Reasons for Parenteral feeding use:

A
  1. Cancer - radiation/chemotherapy
  2. GI illness that prevents oral feeding
  3. Extreme surgery
  4. Renal failure (reduces toxins)
  5. Need for more nutrition than can eat (Burn patient)

NRSG 213 (9 decks)

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