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MSII Medication Review > Lewis 48 - Liver, Pancreas, and Biliary Tract Problems > Flashcards

Lewis 48 - Liver, Pancreas, and Biliary Tract Problems Flashcards

1
Q

MOA/Class

hycosamine
dicyclomine

A

Decreases stomach and intestinal motility and the secretion of stomach fluids, including acid.

Anticholinergic

Tucker 33

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2
Q

Side Effects

hycosamine
dicyclomine

A

drowsiness, dizziness, dry mouth, urinary retention, tachycardia

Tucker 33

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3
Q

Nursing Considerations

hycosamine
dicyclomine

A

Additive effects with other anticholinergics.

Tucker 33

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4
Q

Indications

hycosamine
dicyclomine

A

IBS-D, acute pancreatitis

Tucker 33

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5
Q

MOA/Class

ondansetron

A

Blocks the effects of serotonin on the vagus nerve and CTZ.

5-HT3 (Serotonin) Receptor blocker

Tucker 59

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6
Q

Side Effects

ondansetron

A

May cause prolonged QT interval.

Tucker 59

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7
Q

Nursing Considerations

ondansetron

A

Available IV and ODT. Concurrent use with other seritonergic medications can increase the risk of serotonin syndrome.

Tucker 59

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8
Q

Indications

ondansetron

A

Nausea/vomiting

Tucker 59

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9
Q

MOA/Class

chlorpromazine, prochlorperazine, promethazine

A

Alters the responsiveness of the CTZ by altering dopamine levels

Phenothiazine

Tucker 59

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10
Q

Side Effects

chlorpromazine, prochlorperazine, promethazine

A

Drowsiness, dizziness, pink-red/brown urine, photosensitivity

Tucker 59

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11
Q

Nursing Considerations

chlorpromazine, prochlorperazine, promethazine

A

Long-term use can cause significant side effects such as extrapyramidal symptoms (EPS), tardive dyskinesia (TD), and neuroleptic malignant syndrome (NMS)

Tucker 59

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12
Q

Indication

chlorpromazine, prochlorperazine, promethazine

A

Nausea, intractable hiccups

Tucker 59

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13
Q

MOA/Class

nadolol, propranolol

A

Blocks beta receptors in the heart decreasing HR, contractility, and excitability. Also blocks beta receptors in the juxtaglomerular cells this decreasing activation of the RAAS.

Non-selective beta adrenergic blocker

Tucker 31

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14
Q

Side Effects

nadolol, propranolol

A

fatigue, dizziness, bradycardia, impotence

Tucker 31

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15
Q

Nursing Considerations

nadolol, propranolol

A

Monitor BP and respiratory status.

Tucker 31

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16
Q

Indications

nadolol, propranolol

A

Portal hypertension; non-bleeding varices

Tucker 31

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17
Q

MOA/Class

octreotide

A

Promotes platelet aggregation and decreases splanchnic blood flow. Suppresses secretion of gastric peptides.

Growth homone antagonist

Tucker 35

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18
Q

Side Effects

octreotide

A

Bradycardia, palpitations, blood glucose alterations

Tucker 35

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19
Q

Nursing Considerations

octreotide

A

Monitor thyroid and blood glucose levels

Tucker 35

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20
Q

Indications

octreotide

A

GI bleeds, GI endocrine tumors including vasoactive peptide tumors (VIPomas)

Tucker 35

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21
Q

MOA/Class

vasopressin

A

Alters permeability of the renal collecting ducts; Stimulates musculature of the GI tract

ADH analog

Tucker 35

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22
Q

Side Effects

vasopressin

A

Angina, abdominal cramps

Tucker 35

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23
Q

Nursing Considerations

vasopressin

A

Monitor BP and fluid volume status

Tucker 35

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24
Q

Indications

vasopressin

A

GI hemorrhage, central diabetes insipidus, vasodilatory shock

Tucker 35

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25
Q

MOA/Class

albumin

A

Increases plasma protein levels

Colloid

Tucker - Appendix E

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26
Q

Side Effects

albumin

A

Generally well-tolerated.

Tucker - Appendix E

27
Q

Nursing Considerations

albumin

A

Monitor fluid volume status

Tucker - Appendix E

28
Q

Indications

albumin

A

Low colloid oncotic pressure

Tucker - Appendix E

29
Q

MOA/Class

spironolactone

A

Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium

Aldosterone antagonist/ K+ sparing diuretic

Tucker 51

30
Q

Side effects

spironolactone

A

Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses

Tucker 51

31
Q

Nursing Considerations

spironolactone

A

May be used in combination with loop diuretics to help offset potassium loss

Tucker 51

32
Q

Indications

spironolactone

A

Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism

Tucker 51

33
Q

MOA/Class

lactulose

A

Increases water content and softens stool. Lowers the pH of the colon which inhibits the diffusion of ammonia from the colon into the blood.

Osmotic laxative

Tucker 58

34
Q

Side Effects

lactulose

A

Loose stool, bloating, flatulence

Tucker 58

35
Q

Nursing Considerations

lactulose

A

Monitor patient safety when used for ammonia levels as patient may be confused and medication will loose stool.
Dose often titrated to 2-3 loose stools daily.

Tucker 58

36
Q

Indications

lactulose

A

Hepatic encephalopathy; constipation

Tucker 58

37
Q

MOA/Class

rifaximin

A

Decreases GI flora thus reducing ammonia formation

Antibiotic

Tucker 09

38
Q

Side Effects

rifaximin

A

Dizziness, peripheral edema, *c. diff *

Tucker 09

39
Q

Nursing Considerations

rifaximin

A

Monitor mental status and fluid/electrolyte balance

Tucker 09

40
Q

Indications

rifaximin

A

Hepatic encephalopathy;* E. coli*; traveler’s diarrhea

Tucker 09

41
Q

MOA/Class

cholestyramine

A

Binds with bile acids (which are high in cholesterol) to be excreted in stool.
*Bile salts are conjugated bile acids which can deposit under the skin when developed in excess causing itching. Decreasing bile acids will decrease formation of bile salts, thus decreasing itching with biliary dysfunction.

Bile acid sequestrant

Tucker 47

42
Q

Side Effects

cholestyramine

A

Headache, fatigue, increased bleeding time, rash, constipation, flatulence, nausea

Tucker 47

43
Q

Nursing Considerations

cholestyramine

A

Other PO drugs MUST be taken 1 hour before or 4 hours after a bile acid sequesterant for proper absorption.
May need to supplement fat soluble vitamins

Tucker 47

44
Q

Indications

cholestyramine

A

Hypercholesterolemia, pruritis due to biliary dysfunction

Tucker 47

45
Q

MOA/Class

omeprazole, pantoprazole

A

Suppresses gastric acid secretion by blocking the proton pump of the gastric parietal cells

Proton pump inhibitor

Tucker 57

46
Q

Side Effects

omeprazole, pantoprazole

A

Headache, dizziness, insomnia, GI upset
Bone desity loss, c. diff, pneumonia (with long-term use)

Tucker 57

47
Q

Nursing Considerations

omeprazole, pantoprazole

A

Can cause altered absorption of other drugs due to changes in gastric pH.

Tucker 57

48
Q

Indications

omeprazole, pantoprazole

A

GERD, stress ulcer prevention
May be used to control acid secretion to promote GI rest.

Tucker 57

49
Q

MOA/Class

aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

A

Neutralizes stomach acid.

Tucker 57

50
Q

Side effects

aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

A

Calcium and aluminum formations - constipation
Magnesium formations - diarrhea
Sodium bicarbonate - fluid retention, hypokalemia

Tucker 57

51
Q

Nursing Considerations

aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

A

Can cause altered absorption of other drugs due to changes in gastric pH.

Tucker 57

52
Q

Indications

aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

A

Gastric hyperacidity

Tucker 57

53
Q

MOA/Class

fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

A

Binds to opioid receptors producing analgesia

Opiod agonist/narcotic

Tucker 26

54
Q

Side Effects

fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

A

Respiratory depression, orthostatic hypotension, lightheadedness, hallucinations, pupil construction, sedation, impaired mental processes, vomiting, constipation, urinary retention

Tucker 26

55
Q

Nursing Considerations

fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

A

Encourage fluid/fiber/mobility to decrease constipation
Some formulations may be combined with acetaminophen for a synergistic effect
Monitor pain, respiratory rate, and BP before giving
Risk for dependence and tolerance
Naloxone and naltrexone for reversal/respiratory depression.

Tucker 26

56
Q

Indications

fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

A

Pain management

Tucker 26

57
Q

MOA/Class

pancrelipase

A

Pancreatic enzyme replacement

Pancreatic enzyme replacement

Tucker 57

58
Q

Side Effects

pancrelipase

A

Abdominal pain, diarrhea, stomach cramps, hyperuricemia

Tucker 57

59
Q

Nursing Considerations

pancrelipase

A

Administer with meals and snacks; Avoid use with pork allergy.

Tucker 57

60
Q

Indications

pancrelipase

A

Pancreatic insufficiency (chronic pancreatitis; cystic fibrosis; etc.)

Tucker 57

61
Q

MOA/Class

hydroxyzine, diphenhydramine

A

Block histamine from binding to H1 histamine receptors on basophils and mast cells (thus preventing the release of additional histamine and other inflammatory mediators).

Tucker 54

62
Q

Side Effects

hydroxyzine, diphenhydramine

A

Anticholinergic effects
Drowsiness especially when combined with other CNS depressants; also prolonged QT interval and urinary retention

Tucker 54

63
Q

Nursing Considerations

hydroxyzine, diphenhydramine

A

Stop several days before allergy testing. Manage anticholinergic (drying) effects. Most beneficial when given early in histamine-induced reactions.

Tucker 54

64
Q

Indications

hydroxyzine, diphenhydramine

A

Allergic rhinitis, adjuct for anaphylaxis, pruritis, motion sickness, *insomnia (use with caution especially in older adults).

Tucker 54

MSII Medication Review (13 decks)

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