Lewis 48 - Liver, Pancreas, and Biliary Tract Problems Flashcards
MOA/Class
hycosamine
dicyclomine
Decreases stomach and intestinal motility and the secretion of stomach fluids, including acid.
Anticholinergic
Tucker 33
Side Effects
hycosamine
dicyclomine
drowsiness, dizziness, dry mouth, urinary retention, tachycardia
Tucker 33
Nursing Considerations
hycosamine
dicyclomine
Additive effects with other anticholinergics.
Tucker 33
Indications
hycosamine
dicyclomine
IBS-D, acute pancreatitis
Tucker 33
MOA/Class
ondansetron
Blocks the effects of serotonin on the vagus nerve and CTZ.
5-HT3 (Serotonin) Receptor blocker
Tucker 59
Side Effects
ondansetron
May cause prolonged QT interval.
Tucker 59
Nursing Considerations
ondansetron
Available IV and ODT. Concurrent use with other seritonergic medications can increase the risk of serotonin syndrome.
Tucker 59
Indications
ondansetron
Nausea/vomiting
Tucker 59
MOA/Class
chlorpromazine, prochlorperazine, promethazine
Alters the responsiveness of the CTZ by altering dopamine levels
Phenothiazine
Tucker 59
Side Effects
chlorpromazine, prochlorperazine, promethazine
Drowsiness, dizziness, pink-red/brown urine, photosensitivity
Tucker 59
Nursing Considerations
chlorpromazine, prochlorperazine, promethazine
Long-term use can cause significant side effects such as extrapyramidal symptoms (EPS), tardive dyskinesia (TD), and neuroleptic malignant syndrome (NMS)
Tucker 59
Indication
chlorpromazine, prochlorperazine, promethazine
Nausea, intractable hiccups
Tucker 59
MOA/Class
nadolol, propranolol
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
Side Effects
nadolol, propranolol
fatigue, dizziness, bradycardia, impotence
Tucker 31
Nursing Considerations
nadolol, propranolol
Monitor BP and respiratory status.
Tucker 31
Indications
nadolol, propranolol
Portal hypertension; non-bleeding varices
Tucker 31
MOA/Class
octreotide
Promotes platelet aggregation and decreases splanchnic blood flow. Suppresses secretion of gastric peptides.
Growth homone antagonist
Tucker 35
Side Effects
octreotide
Bradycardia, palpitations, blood glucose alterations
Tucker 35
Nursing Considerations
octreotide
Monitor thyroid and blood glucose levels
Tucker 35
Indications
octreotide
GI bleeds, GI endocrine tumors including vasoactive peptide tumors (VIPomas)
Tucker 35
MOA/Class
vasopressin
Alters permeability of the renal collecting ducts; Stimulates musculature of the GI tract
ADH analog
Tucker 35
Side Effects
vasopressin
Angina, abdominal cramps
Tucker 35
Nursing Considerations
vasopressin
Monitor BP and fluid volume status
Tucker 35
Indications
vasopressin
GI hemorrhage, central diabetes insipidus, vasodilatory shock
Tucker 35
MOA/Class
albumin
Increases plasma protein levels
Colloid
Tucker - Appendix E
Side Effects
albumin
Generally well-tolerated.
Tucker - Appendix E
Nursing Considerations
albumin
Monitor fluid volume status
Tucker - Appendix E
Indications
albumin
Low colloid oncotic pressure
Tucker - Appendix E
MOA/Class
spironolactone
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
Side effects
spironolactone
Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses
Tucker 51
Nursing Considerations
spironolactone
May be used in combination with loop diuretics to help offset potassium loss
Tucker 51
Indications
spironolactone
Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism
Tucker 51
MOA/Class
lactulose
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
Side Effects
lactulose
Loose stool, bloating, flatulence
Tucker 58
Nursing Considerations
lactulose
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
Indications
lactulose
Hepatic encephalopathy; constipation
Tucker 58
MOA/Class
rifaximin
Decreases GI flora thus reducing ammonia formation
Antibiotic
Tucker 09
Side Effects
rifaximin
Dizziness, peripheral edema, *c. diff *
Tucker 09
Nursing Considerations
rifaximin
Monitor mental status and fluid/electrolyte balance
Tucker 09
Indications
rifaximin
Hepatic encephalopathy;* E. coli*; traveler’s diarrhea
Tucker 09
MOA/Class
cholestyramine
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
Side Effects
cholestyramine
Headache, fatigue, increased bleeding time, rash, constipation, flatulence, nausea
Tucker 47
Nursing Considerations
cholestyramine
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
Indications
cholestyramine
Hypercholesterolemia, pruritis due to biliary dysfunction
Tucker 47
MOA/Class
omeprazole, pantoprazole
Suppresses gastric acid secretion by blocking the proton pump of the gastric parietal cells
Proton pump inhibitor
Tucker 57
Side Effects
omeprazole, pantoprazole
Headache, dizziness, insomnia, GI upset
Bone desity loss, c. diff, pneumonia (with long-term use)
Tucker 57
Nursing Considerations
omeprazole, pantoprazole
Can cause altered absorption of other drugs due to changes in gastric pH.
Tucker 57
Indications
omeprazole, pantoprazole
GERD, stress ulcer prevention
May be used to control acid secretion to promote GI rest.
Tucker 57
MOA/Class
aluminum, calcium carbonate, magnesium salts, sodium bicarbonate
Neutralizes stomach acid.
Tucker 57
Side effects
aluminum, calcium carbonate, magnesium salts, sodium bicarbonate
Calcium and aluminum formations - constipation
Magnesium formations - diarrhea
Sodium bicarbonate - fluid retention, hypokalemia
Tucker 57
Nursing Considerations
aluminum, calcium carbonate, magnesium salts, sodium bicarbonate
Can cause altered absorption of other drugs due to changes in gastric pH.
Tucker 57
Indications
aluminum, calcium carbonate, magnesium salts, sodium bicarbonate
Gastric hyperacidity
Tucker 57
MOA/Class
fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol
Binds to opioid receptors producing analgesia
Opiod agonist/narcotic
Tucker 26
Side Effects
fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol
Respiratory depression, orthostatic hypotension, lightheadedness, hallucinations, pupil construction, sedation, impaired mental processes, vomiting, constipation, urinary retention
Tucker 26
Nursing Considerations
fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol
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
Indications
fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol
Pain management
Tucker 26
MOA/Class
pancrelipase
Pancreatic enzyme replacement
Pancreatic enzyme replacement
Tucker 57
Side Effects
pancrelipase
Abdominal pain, diarrhea, stomach cramps, hyperuricemia
Tucker 57
Nursing Considerations
pancrelipase
Administer with meals and snacks; Avoid use with pork allergy.
Tucker 57
Indications
pancrelipase
Pancreatic insufficiency (chronic pancreatitis; cystic fibrosis; etc.)
Tucker 57
MOA/Class
hydroxyzine, diphenhydramine
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
Side Effects
hydroxyzine, diphenhydramine
Anticholinergic effects
Drowsiness especially when combined with other CNS depressants; also prolonged QT interval and urinary retention
Tucker 54
Nursing Considerations
hydroxyzine, diphenhydramine
Stop several days before allergy testing. Manage anticholinergic (drying) effects. Most beneficial when given early in histamine-induced reactions.
Tucker 54
Indications
hydroxyzine, diphenhydramine
Allergic rhinitis, adjuct for anaphylaxis, pruritis, motion sickness, *insomnia (use with caution especially in older adults).
Tucker 54
