Lewis 48 - Liver, Pancreas, and Biliary Tract Problems

Question 1

MOA/Class

hycosamine
dicyclomine

Answer 1

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

Anticholinergic

Tucker 33

Question 2

Side Effects

hycosamine
dicyclomine

Answer 2

drowsiness, dizziness, dry mouth, urinary retention, tachycardia

Tucker 33

Question 3

Nursing Considerations

hycosamine
dicyclomine

Answer 3

Additive effects with other anticholinergics.

Tucker 33

Question 4

Indications

hycosamine
dicyclomine

Answer 4

IBS-D, acute pancreatitis

Tucker 33

Question 5

MOA/Class

ondansetron

Answer 5

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

5-HT3 (Serotonin) Receptor blocker

Tucker 59

Question 6

Side Effects

ondansetron

Answer 6

May cause prolonged QT interval.

Tucker 59

Question 7

Nursing Considerations

ondansetron

Answer 7

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

Tucker 59

Question 8

Indications

ondansetron

Answer 8

Nausea/vomiting

Tucker 59

Question 9

MOA/Class

chlorpromazine, prochlorperazine, promethazine

Answer 9

Alters the responsiveness of the CTZ by altering dopamine levels

Phenothiazine

Tucker 59

Question 10

Side Effects

chlorpromazine, prochlorperazine, promethazine

Answer 10

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

Tucker 59

Question 11

Nursing Considerations

chlorpromazine, prochlorperazine, promethazine

Answer 11

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

Tucker 59

Question 12

Indication

chlorpromazine, prochlorperazine, promethazine

Answer 12

Nausea, intractable hiccups

Tucker 59

Question 13

MOA/Class

nadolol, propranolol

Answer 13

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

Question 14

Side Effects

nadolol, propranolol

Answer 14

fatigue, dizziness, bradycardia, impotence

Tucker 31

Question 15

Nursing Considerations

nadolol, propranolol

Answer 15

Monitor BP and respiratory status.

Tucker 31

Question 16

Indications

nadolol, propranolol

Answer 16

Portal hypertension; non-bleeding varices

Tucker 31

Question 17

MOA/Class

octreotide

Answer 17

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

Growth homone antagonist

Tucker 35

Question 18

Side Effects

octreotide

Answer 18

Bradycardia, palpitations, blood glucose alterations

Tucker 35

Question 19

Nursing Considerations

octreotide

Answer 19

Monitor thyroid and blood glucose levels

Tucker 35

Question 20

Indications

octreotide

Answer 20

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

Tucker 35

Question 21

MOA/Class

vasopressin

Answer 21

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

ADH analog

Tucker 35

Question 22

Side Effects

vasopressin

Answer 22

Angina, abdominal cramps

Tucker 35

Question 23

Nursing Considerations

vasopressin

Answer 23

Monitor BP and fluid volume status

Tucker 35

Question 24

Indications

vasopressin

Answer 24

GI hemorrhage, central diabetes insipidus, vasodilatory shock

Tucker 35

Question 25

# MOA/Class albumin

Answer 25

Increases plasma protein levels | Colloid ## Footnote Tucker - Appendix E

Question 26

# Side Effects albumin

Answer 26

Generally well-tolerated. ## Footnote Tucker - Appendix E

Question 27

# Nursing Considerations albumin

Answer 27

Monitor fluid volume status ## Footnote Tucker - Appendix E

Question 28

# Indications albumin

Answer 28

Low colloid oncotic pressure ## Footnote Tucker - Appendix E

Question 29

# MOA/Class spironolactone

Answer 29

Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium | Aldosterone antagonist/ K+ sparing diuretic ## Footnote Tucker 51

Question 30

# Side effects spironolactone

Answer 30

Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses ## Footnote Tucker 51

Question 31

# Nursing Considerations spironolactone

Answer 31

May be used in combination with loop diuretics to help offset potassium loss ## Footnote Tucker 51

Question 32

# Indications spironolactone

Answer 32

Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism ## Footnote Tucker 51

Question 33

# MOA/Class lactulose

Answer 33

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 ## Footnote Tucker 58

Question 34

# Side Effects lactulose

Answer 34

Loose stool, bloating, flatulence ## Footnote Tucker 58

Question 35

# Nursing Considerations lactulose

Answer 35

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. ## Footnote Tucker 58

Question 36

# Indications lactulose

Answer 36

Hepatic encephalopathy; constipation ## Footnote Tucker 58

Question 37

# MOA/Class rifaximin

Answer 37

Decreases GI flora thus reducing ammonia formation | Antibiotic ## Footnote Tucker 09

Question 38

# Side Effects rifaximin

Answer 38

Dizziness, peripheral edema, *c. diff * ## Footnote Tucker 09

Question 39

# Nursing Considerations rifaximin

Answer 39

Monitor mental status and fluid/electrolyte balance ## Footnote Tucker 09

Question 40

# Indications rifaximin

Answer 40

Hepatic encephalopathy;* E. coli*; traveler's diarrhea ## Footnote Tucker 09

Question 41

# MOA/Class cholestyramine

Answer 41

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 ## Footnote Tucker 47

Question 42

# Side Effects cholestyramine

Answer 42

Headache, fatigue, increased bleeding time, rash, constipation, flatulence, nausea ## Footnote Tucker 47

Question 43

# Nursing Considerations cholestyramine

Answer 43

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 ## Footnote Tucker 47

Question 44

# Indications cholestyramine

Answer 44

Hypercholesterolemia, pruritis due to biliary dysfunction ## Footnote Tucker 47

Question 45

# MOA/Class omeprazole, pantoprazole

Answer 45

Suppresses gastric acid secretion by blocking the proton pump of the gastric parietal cells | Proton pump inhibitor ## Footnote Tucker 57

Question 46

# Side Effects omeprazole, pantoprazole

Answer 46

Headache, dizziness, insomnia, GI upset Bone desity loss, c. diff, pneumonia (with long-term use) ## Footnote Tucker 57

Question 47

# Nursing Considerations omeprazole, pantoprazole

Answer 47

Can cause altered absorption of other drugs due to changes in gastric pH. ## Footnote Tucker 57

Question 48

# Indications omeprazole, pantoprazole

Answer 48

GERD, stress ulcer prevention May be used to control acid secretion to promote GI rest. ## Footnote Tucker 57

Question 49

# MOA/Class aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

Answer 49

Neutralizes stomach acid. ## Footnote Tucker 57

Question 50

# Side effects aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

Answer 50

Calcium and aluminum formations - constipation Magnesium formations - diarrhea Sodium bicarbonate - fluid retention, hypokalemia ## Footnote Tucker 57

Question 51

# Nursing Considerations aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

Answer 51

Can cause altered absorption of other drugs due to changes in gastric pH. ## Footnote Tucker 57

Question 52

# Indications aluminum, calcium carbonate, magnesium salts, sodium bicarbonate

Answer 52

Gastric hyperacidity ## Footnote Tucker 57

Question 53

# MOA/Class fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

Answer 53

Binds to opioid receptors producing analgesia | Opiod agonist/narcotic ## Footnote Tucker 26

Question 54

# Side Effects fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

Answer 54

Respiratory depression, orthostatic hypotension, lightheadedness, hallucinations, pupil construction, sedation, impaired mental processes, vomiting, constipation, urinary retention ## Footnote Tucker 26

Question 55

# Nursing Considerations fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

Answer 55

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. ## Footnote Tucker 26

Question 56

# Indications fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, tramadol

Answer 56

Pain management ## Footnote Tucker 26

Question 57

# MOA/Class pancrelipase

Answer 57

Pancreatic enzyme replacement | Pancreatic enzyme replacement ## Footnote Tucker 57

Question 58

# Side Effects pancrelipase

Answer 58

Abdominal pain, diarrhea, stomach cramps, hyperuricemia ## Footnote Tucker 57

Question 59

# Nursing Considerations pancrelipase

Answer 59

Administer with meals and snacks; Avoid use with pork allergy. ## Footnote Tucker 57

Question 60

# Indications pancrelipase

Answer 60

Pancreatic insufficiency (chronic pancreatitis; cystic fibrosis; etc.) ## Footnote Tucker 57

Question 61

# MOA/Class hydroxyzine, diphenhydramine

Answer 61

Block histamine from binding to H1 histamine receptors on basophils and mast cells (thus preventing the release of additional histamine and other inflammatory mediators). ## Footnote Tucker 54

Question 62

# Side Effects hydroxyzine, diphenhydramine

Answer 62

Anticholinergic effects Drowsiness especially when combined with other CNS depressants; also prolonged QT interval and urinary retention ## Footnote Tucker 54

Question 63

# Nursing Considerations hydroxyzine, diphenhydramine

Answer 63

Stop several days before allergy testing. Manage anticholinergic (drying) effects. Most beneficial when given early in histamine-induced reactions. ## Footnote Tucker 54

Question 64

# Indications hydroxyzine, diphenhydramine

Answer 64

Allergic rhinitis, adjuct for anaphylaxis, pruritis, motion sickness, *insomnia (use with caution especially in older adults). ## Footnote Tucker 54