MOD 5 Flashcards
what is the GI tract’s primary function?
to provide the human body with fluids and nutrients
what are the two sets of tubular glands of stomach mucosa consists?
Gastric glands
Pyloric glands
what dose the Gastric gland do?
secrete HCL acid, pepsinogen, intrinsic factor, and mucus
what dose the Pyloric glands do?
secrete mucus, pepsinogen, and hormone gastrin.
Hepatocytes (liver cells) continually produce bile, composed of bile salts, bilirubin, cholesterol, lecithin, and electrolytes.
what is the function of bile?
- emulsify fats
2. help absorb cholesterol, fatty acids, monoglycerides and other lipids from intestinal tract.
where are fat soluble vitamins absorbed?
intestine
what are the fat soluble vitamins?
vitamins A, D, E, and K
what is the major functions of the pancreas?
- Insulin production by the beta islet cells. (endocrine)
2. Production of pancreatic juice containing enzymes that aide in digestion. (exocrine)
Absorbent Agents belong to class of drugs known as what?
protective agents of the GI mucosa.
why must absorbent agents be administered soon after poison ingestion?
because can only bind drugs or toxins that have not been absorbed from the GI tract.
Absorbent agents intended as adjunct tx to poison management and should be combined with what?
with dialysis, antidote adm, or gastric lavage.
Activated charcoal
odorless, tasteless black powder.
May dilute with H2O to put down naso or orogastric tube. Protect airway!!!!
what are Adverse Drug Reaction to absorbent agents?
Black stools and constipation. Give Lax to prevent constipation.
what should you expect to do if food is present in the stomach?
give larger doses
how long after poisoning should charcoal be administered for maximum effect?
within 30 min
how often can charcoal be administered for drugs undergo entero hepatic recycling?
q 2 hours for drugs
when is charcoal contraindicated?
when a corrosive agent or a petroleum distillate has been ingested.
what do Antiflatulent Agents do?
Provide defoaming action in GI tract with H2O – repellent properties. Disperses gas pockets in the GI tract.
what are Antiflatulent Agents used to tx?
excess flatus; functional gastric bloating; post-op flatus,Diverticulitis, spastic or irritable colon, air swallowing and peptic ulcer.
simethicone (Mylicon)
Antiflatulent Agents: Oral suspension, chewable tablets, capsules
how should simethicone (Mylicon) be administered?
- adm pc &at hs
- chew tablets thoroughly before swallowing and take -with a full glass of water.
what do Digestive Agents do?
Aid digestion in clients who lack these substances that naturally digest food
what do Bile acids do?
stimulate bile production in the liver
what do Bile salts do?
emulsify fats, dispersing into small globules; help in absorption of fatty acids, fat-soluble vitamins, cholesterol and other lipids.
what does HCL acid do?
begins protein digestion in the stomach
what dose Trypsin aid?
digestion of proteins
what does Amylase aid?
digestion of CHO lipase and aids in digestion of fats
Bile Salts
used infreq
Acidulin
- tx conditions where there is not enough HCL acid,
hypochlorhydria or achlorhydria. - Adm tid ac.
- Not as effective as dilute HCL acid
HCL acid (dilute)
sip solution through straw to prevent
tooth enamel damage.
pancreatin
po. with meals or snacks. Aids in digestion of all foods
pancrelipase (Pancrease)
tx pancreatitis, cystic fibrosis,
steatorrhea (fatty stools).
what are the adverse reactions to Digestive Agents?
- Bile salts – abd cramping, diarrhea
- HCL acid – acid base abnormalities
- Pancreatic enzymes – nausea, diarrhea
why do you not adm pancreatic enzymes with antacids?
negates the effects, give with meals three times a day
Diarrhea
increased freq or weight and liquidity of stools produced by rapid peristalsis.
Constipation
decreased movement of fecal matter through large Intestine.
what can diarrhea cause?
abd discomfort, malaise and lethargy from dehydration
what is a risk of constipation?
may be harmful in clients who should not strain (valsalva maneuver), such as those with recent MI.
what is the difference between Cathartics and laxatives ?
Cathartic implies fluid evacuation. Laxative implies elimination of a soft, formed stool.
Opium preparations
Antidiarrheal Agents:used to treat acute, nonspecific diarrhea.The morphine decreases GI motility and peristaltic movements.They are absorbed well but may produce some of the systemic effects of morphine in large doses.
what cant opium preparations be used for?
diarrhea caused by toxic chemicals or pathogens
opium tincture
Schedule II drug
Opium tincture may be added to enteral feeding preparations to prevent the diarrhea that they typically cause.
paregoric
– Schedule III
commonly used with Kaolin, pectin and bismuth
salts, because of absorbent and protective effects
what do Diphenoxylate & loperamide do?
decreases GI motility by
Depressing the circular and longitudinal muscle action
in large and small intestines
diphenoxylate (Lomotil)
Schedule V drug.
Contains atropine (anticholingeric agent) to
discourage abuse.
what Sx of atropine toxicity?
dry
mouth, urine retention, tachycardia, hyperthermia
Kaolin and Pectin
Locally acting, not absorbed, bind with bacteria,toxins and other irritants on the intestinal mucosa.Used for acute or chronic diarrhea. Kaolin coats the walls of the GI tract and decreases the pH. Pectin may be added to enteral feedings, most commonly used, prolonged use can cause constipation
Cholestyramine (Questran)
tx diarrhea due to excess bile acids in the colon.
what are signs of hypo peristalsis?
- anorexia and nausea in early stage
- abd distention
- auscultation of rushes or high pitched sounds over the abdomen
- eventually a “silent abdomen” – absent bowel sounds
- percussion of air or fluid over abdomen, resonant sound,not dull
- absence of flatus
- absence of bowel movements
- vomiting with resulting fluid & elec imbalance
when should you observe for signs of atropine toxicity?
with lomotil adm
what should you monitor a client receiving opium antidiarrheal medication for?
CNS depression
what do hyperosmolar (osmotics) do?
Draw water into the intestine, leading to distention and eventual peristalsis. Usually liquid or semi liquid stools result.
glycerin
Laxatives Hyperosmolar (osmotics)
– suppositories helpful in establishing
bowel retraining. Acts in 15-30 min. Pulls water
into the feces and stimulates reflex evacuation.
lactulose (Cephulac, Chronulac)
Laxatives Hyperosmolar (osmotics)
– tx chronic constipation and reduce ammonia levels
(production and absorption) from the intestines in
liver disease.
Bowel evacuation occurs in 1-2 days.
Magnesium salts (Milk of Magnesia)
Laxatives Hyperosmolar (osmotics) – saline compound for prompt & complete evacuation.Works in 1-3 hours.
what are adverse reactions to Hyperosmolar (osmotics) Laxatives?
- N/V
- abd pain
- fluid and electrolyte imbalance
- hypovolemic shock
when using Hyperosmolar (osmotics) Laxatives what should you monitor for?
Monitor for FVD & elec imbalance
what should you teach a patient using laxatives?
-Teach proper use of laxatives and caution about lax dependence
when a patient is using laxative when should they call the HCP?
if has client has diarrhea withhold the agent and notify
HCP.
what do Dietary Fiber and Related Bulk Forming Laxatives do?
These laxatives increase fecal bulk and H2O content, promoting peristalsis and elimination. Used to treat simple cases of constipation, irritable bowel syndrome, diverticulosis, need to avoid valsalva maneuver (recent MI, cerebral aneurysms). May be ordered to treat chronic diarrhea to add bulk to the stool.
psyllium hydrophilic (Metamucil)
turns in to jelly and must be given with large amounts of water ( can cause esophageal obstruction)
Emollient Laxatives
Known as stool softeners. Prevent constipation in patients that should avoid straining, recent surgery, higher ICP, or hernias.
what do Stimulant Laxatives do?
Irritate the intestinal mucosa or stimulate nerve endings of the intestinal smooth muscle, also alter fluid and electrolyte
absorption.
what are Stimulant Laxatives used for?
Preferred drugs for emptying the bowel before general surgery,Used to tx constipation caused by prolonged bed rest, neurologic dysfunction of the colon, and constipating drugs such as narcotics.
why are Stimulant Laxatives not given to pregnant women?
These agents may stimulate contractions and are never to be used in lactating women.
what are some Stimulant Laxatives?
-bisacodyl (Dulcolax)- po or sup not to chew theey are enteric coated.
-Castor Oil
-Senna (Senokot)
-GoLytely
-CASCARA Sangrada
(Don’t take with antacids)
how do Lubricant Laxatives work?
Mineral oil lubricates the feces and the intestinal mucosa by preventing H2O reabsorption from the lumen of the bowel.
what are Lubricant Laxatives used to TX?
Used to treat constipation and maintain soft stools when Valsalva’s maneuver contraindicated. Used to treat fecal impaction.
Mineral Oil
May impair absorption of many oral meds, including
fat soluble vitamins, oral contraceptives, and
anticoagulants.
what are early signs of fat-soluble vitamin deficiency?
- Vit A – Night blindness
- Vit D – profuse sweating, restlessness, irritability
- Vit E – muscle weakness, intermittent claudication
- Vit K – abnormal bleeding tendency
How do Emetics work?
are substances that produce vomiting. Emetics are not used to treat poisoning by strong acids or alkalis, petroleum distillates such as kerosene, or substances causing convulsions.
How do Indirect, or systemic, emetics, such as apomorphine work?
induce vomiting by acting indirectly through the blood on the brain center that controls vomiting.
what do Antiemetics do?
- Block the histamine (H1) receptors;
- inhibit vestibular stimulation of the ear (primary cause of motion sickness);
- exert anticholinergic or CNS depressant effects.
dimenhydrinate (Dramamine)
Antiemetics: po most commonly used drug for motion sickness because of low incidence of adverse effects.
diphenhydramine hydrochloride (Benadryl)
Antiemetics: use limited by its sedation
meclizine (Antivert)
Antiemetics: dry mouth may occur
what are Phenothiazine Antiemetics used to tx?
Used primarily to treat psychotic disorders. Used to control post-op N/V, N/V from viral illness, cancer chemotherapy and radiation.
promethazine (Phenergan)
Phenothiazine Antiemetics: must dilute and it will cause sedation
scopolamine (Transderm – Scop)
anticholinergic, patch lasts for 3 days, used for motion sickness, may cause confusion in the elderly
metoclopramide (Reglan)
tx GERD, is a GI prokinetic for the upper GI tract, accelerates gastric emptying time.
ondanestron (Zofran)
Serotonin (5-HT3) receptor antagonists: Indicated in cancer, chemotherapy; po before start of therapy or IV.
dronabinol (Marinol)
Cannabinoids: prevent N/V associated with chemotherapy, appetite stimulant in clients with AIDS
what are the adverse effects metoclopramide (Reglan)?
Parkinson like symptoms, cogwheel rigidity, diarrhea (DC if diarrhea occurs)
when giving Phenergan what should you monitor for?
assess IV site infiltration or redness. (position statement by Texas BON about Phenergan IVP)
what do you need to caution a client about using scopolamine patches?
avoid touching the drug side of the patch and to wash hands after application, as transferring drug from hand to eye can cause pupil dilatation.
when using Antiemetics you want to check the client for?
- Monitor for urinary retention (frequency and sense of fullness) esp in BPH.
- Observe for sedation, hypotension and extrapyramidal effects (acute dystonia and dyskinesia) esp with phenothiazines
how much should Phenergan be diluted?
for every 1cc must dilute with 10cc
what is a peptic ulcer?
A peptic ulcer is an open lesion of the epithelial, mucosal membranes of the
lower esophagus, stomach, or duodenum
what are Factors that contribute to the
development of peptic ulcer disease?
smoking, consumption of coffee
and alcohol, bacteria, (helicobacter pylori) use of ASA, NSAID’s or corticosteroids, and stress.(Ulcerogenic meds)
what Factors that contribute to hypersecretion of acid and pepsin?
cholinergic stimulation via vagus nerve and acid secretion from food stimulation.
what can Peptic Ulcer agents do?
- decrease vagal activity (tranquilizers)
- decrease acetylcholine (anticholinergics)
- neutralize gastric acid (antacids)
- block the H2 receptor (H2 blockers)
- block the proton pump (PPI’s)
- inhibit pepsin (mucosal protective drug)
- prostaglandin analogue (cytotec)
what do Antacids do?
- reduces the total acid load in the GI tract.
- They do not coat the lining of ulcers or GI tract.
- They do not neutralize all the stomach acid and usually do not increase the pH above 4.0 or 5.0.
- May neutralize from normal 1.3 to 2.3 or 3.3.
when should Antacids be taken?
Take 1 – 3 hours after a meal and at bedtime
what are Antacids Used to tx?
pain and promote healing in PUD, relieve
esophageal reflux, acid indigestion, heart burn, dyspepsia, prevent stress ulcers and GI bleeding in acute pt’s
what can Antacids be used with?
May be used with H2 antagonists. Most commonly combined with simethicone.
Aluminum antacids
antacids:
- control hyperphosphatemia in renal failure.
- Aluminum binds with phosphate, preventing phosphate absorption.
calcium carbonate (ALKA-Mints, Calcilac, Tums)
antacids:helps to raise serum Ca, suspension or chewable tablet. Used in hyperphosphatemia in clients with renal failure.
aluminum hydroxide (Amphogel)
antacids:used to treat hyperphosphatemia (CRF)
Antacids can interfere with the absorption of concomitantly adm oral drugs by binding with them or changing GI transit time. So when would you want to administer?
Give antacids 1 -2 hours after the other po meds
Esp digoxin, iron, INH, tetracyclines, quinolones
Calcium antacids can cause what?
milk-alkali syndrome (Burnetts syndrome) renal stones,
what are S/S of for milk-alkali syndrome?
headache,confusion, nausea, vomiting, anorexia, abdominal pain, and hypercalcemia.
Histamine2-Receptor Antagonists
Most commonly prescribed anti-ulcer drug in the US, are now OTC
How do Histamine2-Receptor Antagonists work?
They block the stimulant action of histamine on the acid-secreting parietal cells of the stomach. Acid secretion by the gastrin, acetylcholine and histamine to their respective receptors on the
parietal cells. By blocking any one of these, acid
secretion is reduced. ( they do not shut off the secretion of acid completely)
Histamine2-Receptor Antagonists are frequently ordered when?
prophylactically for clients in intensive care to prevent stress ulcers
what are the Histamine2-Receptor Antagonists?
cimetidine (Tagamet) – least potent, po or IV
famotidine (Pepcid) po or IV
nizatidine (Axid) po
ranitidine (Zantac) po or IV
how long do you have to wait after administering and antacid to give a Histamine2-Receptor Antagonists?
Do not administer antacids & H2 antagonists within 1 hr of each other antacids decreases the absorption.
cimetidine (Tagamet)
Tagamet decreases the clearance and prolongs
half-lives of drugs that are metabolized by the liver. Increases the effects (esp warfarin, valium beta blockers, Ca channel blockers)
what are the Adverse effects of Histamine2-Receptor Antagonists?
constipation, diarrhea; confusion, and severe bradycardia with rapid IV administration.
What do PPI’s TX?
tx GI reflux disease and pathological hypersecretory disorders. Suppresses gastric acid secretion by blocking the proton pump.
What are the different PPI’s?
omeprazole (Prilosec) lansoprazole (Prevacid) prototype rabeprazole (Aciphex) pantoprazole (Protonix) esomeprazole (Nexium)
misoprostol (Cytotec)
prevent NSAID - induced gastric ulcers. A synthetic prostaglandin E1 analogue with antisecretory and mucosal protective properties. NSAID’s inhibit
prostaglandin synthesis, which diminishes mucosal
secretion.Usually po, unlabeled use in labor as a vaginal supp to ripen (soften) the cervix.
sulcrafate (Carafate)
Pepsin Inhibitor: short term tx ( up to 8 weeks) of duodenal ulcers. In an acid environment becomes paste like, highly VISCOUS and adhesive. Forming a barrier at the ulcer site, allows the ulcer to heal. Timing of adm is important, drug is more effective in the lower pH of an empty stomach. 1 hour ac and hs. Po tablets or liquid.
when giving a Histamine2-Receptor Antagonists IV how should they be given?
Dilute Tagamet in at least 50 ml, Pepcid in at least 10 ml,and Zantac in at least 20 ml of compatible IV solutionbefore IV administration, using saline, 5% or 10% dextrose, lactated Ringers, or 5%sodium bicarbonate
when giving a Histamine2-Receptor Antagonists IV what should you monitor for?
signs of cardiovascular toxicity, such
as severe bradycardia,
When treating ulcers caused by h pylori bacteria, what triple combination drug therapy is ordered?
metronidazole (Flagyl) or amoxicillin, omeprazole (Prilosec) and clarithromycin (Biaxin).
what are the Two common types of IBD?
Ulcerative Colitis
Crohn’s Disease
aminosalicylates
decreases inflammation
sulfasalazine (Azulfidine)
aminosalicylates:
- with food
- Maintain fluid intake
- Teach sun precautions due to photosensitivity:
- avoid sun exposure between 10 AM and 3 PM
- use sunscreen with at least 15 SPF
- wear sunglasses, long sleeves, pants and hat when outside
mesalamine (Asacol)
aminosalicylates:
- delayed release tablets, Rowasa – rectal suppository and suspension
- swallow tablets whole, don’t chew, crush or break them.
- ac and hs with a full glass of water
immunomodulators
suppress the immune system and are reserved for more advanced cases of IBS
methotrexate
immunomodulators:
- Well balanced diet and at least 1500 ml/ daily fluids
- Avoid trauma, seek medical treatment for wounds that don’t heal
- Report signs of infection
- Consult Dr before using OTC/ herbal meds or receiving immunizations
- Good oral hygiene, visit dentist regularly to minimize gingival inflammation
corticosteroids
used topically as rectal formulations and systemically to reduce inflammation during flare-ups
prednisone
Biologic Response Modifiers
directed against tumor necrosis factor (TNF) which causes inflammation
infliximab (Remicade)
Biologic Response Modifiers:
- used for advanced cases of Crohn’s and serious inflammatory conditions such as RA
- risk for serious or life threatening infections (TB, fungal and other opportunistic infections)
what are the signs of infection?
night sweats, fever, fatigue, weight loss, headache, cough, sore throat, presence of sputum
orlistat (Xenical)
-lipase inhibitor, manage obesity, weight loss management
-Decreases fat absorption
Side effects:
-Hepatotoxicity, fecal urgency, increased flatus, oily stools
- Take tid with meals or up to 1 hour after a meal
- Take supplements for fat soluble vitamins
- Follow decreased calorie diet
- Psyllium with each dose or at bedtime to decrease GI effects
Enteral Nutrition
For clients with functional GI tracts. Delivered by bolus, gravity drip or continuous drip methods.
Parenteral Nutrition
For clients who can’t tolerate oral feeding or enteral nutrition. TPN can provide CHO, proteins, lipids, electrolytes, vitamins and trace elements IV. Concentrations of dextrose 5% to 10% may be adm via a peripheral vein, but hypertonic solutions greater than 12.5% must be adm via a central line. TPN initiated slowly 40-50 ml/hr to avoid severe hyperglycemia. When discontinuing central TPN, taper the rate down gradually over 24 hrs to avoid hypoglycemia.
