Module 4 Flashcards

1
Q

What are prostaglandins?

A

group of lipids with hormone-like actions that your body makes primarily at the site of tissue damage or infection

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2
Q

What do the COX-1 and COX-2 produce?

A

Prostaglandins

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3
Q

COX-1 is __________, meaning it runs no matter what the cellular needs are.

A

Constitutive

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4
Q

COX-2 is ________, which means it needs a _______.

A

Inducible, inflammatory stimuli

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5
Q

COX-1 is responsible for:

A

Platelet regulation, kidney function, and regulating stomach acid/mucous production

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6
Q

COX-2 is responsible for:

A

Inflammation responses: swelling, pain, heat

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7
Q

COX-1 has a constant _____ level of prostaglandin production

A

Low

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8
Q

COX-2 has a constant _____ level of prostaglandin production

A

High

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9
Q

Aspirin inhibits COX _______

A

1 and 2

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10
Q

What is another name for aspirin?

A

Acetylsalicylic acid

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11
Q

ASA is another name for?

A

Aspirin

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12
Q

Function of aspirin?

A

Suppresses inflammation, pain, and fever; causes irreversible inactivation of COX 1 and 2

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13
Q

What condition can aspirin cause in children with viral illnesses?

A

Reye’s syndrome

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14
Q

What kind of medication is aspirin?

A

Antiplatelet (prevents clots, platelet aggregation)

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15
Q

Side and adverse effects of aspirin?

A

GI distress, bleeding, renal impairment, salicylism , Reye’s syndrome , and can be nephrotoxic in high doses

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16
Q

What kind of pt is aspirin contraindicated for?

A

Risk for or actively bleeding, children with viral illnesses, renal impairment/failure

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17
Q

Drug interactions for aspirin?

A

Warfarin(and other anticoagulants) and alcohol (increased risk for bleeding as well)

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18
Q

What forms does aspirin come in?

A

Chewable, plain, enteric coated, time released, and rectal

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19
Q

Dosage for aspirin is ______ and ____ dependent

A

Age and condition

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20
Q

Nursing interventions for aspirin:

A

Decrease risks for bleeding (precautions), monitor for s/s bleeding, give with food, dont crush or allow pt to chew enteric coated, be aware of children and if have viral illness

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21
Q

What is salicylism?

A

Aspirin toxicity

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22
Q

What is the antidote for Salicylism?

A

Activated charcoal to inhibit absorption, hemodialysis if needed, gastric lavage( if needed)

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23
Q

S/S for salicylism

A

Tinnitus, vertigo, HA, fever, ALOC, sweating

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24
Q

Ibuprofen inhibits_______

A

COX-1 and COX-2

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25
Q

How do aspirin and ibuprofen differ?

A

Ibuprofen does not have anti-inflammatory properties like aspirin does and it is not cardio protection. Ibuprofen has a black box warning for risk of a cardiovascular event and GI bleeding

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26
Q

Side/adverse effects of ibuprofen?

A

N/V, GI injury (ulcers, bleeding), can be nephrotocxic and/or hepatotoxic, prolonged bleeding (but not as much as aspirin); BLACK BOX warning: cardiovascular event, GI bleeding

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27
Q

Ibuprofen nursing interventions

A

Teach to take with food and to increase fluids, avoid alcohol and “G” herbs(ginger, ginseng, ginkgo, garlic), report s/s bleeding, teach and report s/s of MI and stroke, do not crush, cut, chew ER/enteric coated tabs, teach that Ketorolac can cause kidney damage if used for about 5 days

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28
Q

What interventions should be used for older adults and NSAIDs?

A

Monitor renal function beforehand, encourage adequate fluid intake, and use lower dose to decrease the risks of complications

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29
Q

Corticosteroids

A

“-one”; anti-inflammatory and used for pain; used to suppress immune system (i.e. transplant pts)
Long half-life, taper off over several days
May cause: edema, hyperglycemia, increased appetite, weight gain, neutropenia

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30
Q

Etanercept, infliximab, adalimumab are all examples of a __________

A

DMARDs (disease-modifying anti-rheumatic drugs )

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31
Q

Prednisone, prednisolone, and dexamethasone are all _______

A

Corticosteroids

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32
Q

When are disease modifying anti-rheumatic drugs used?

A

When NSAIDs are unsuccessful in treating rheumatoid arthritis pain, prevents progression by suppressing prostaglandin activity and slowing degeneration of joints; delayed effect (3-6 weeks)

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33
Q

How long do DMARDs take to become therapeutic?

A

May take several months

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34
Q

A/E for disease modifying anti-rheumatic drugs

A

Injection site pain, risk for infection, blood dyscrasias, skin reactions(stevens-Johnson), HF

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35
Q

Nursing interventions for DMARDs

A

Monitor injection site, watch for s/s infection and skin reactions as well as HF, obtain CBC and look for blood dyscrasias

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36
Q

Drug interactions for DMARDs

A

Live virus vaccines (avoid)

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37
Q

Methotrexate

A

DMARD, immunomodulator used to slow or delay the worsening of rheumatoid arthritis , can take 3-6 weeks to see full effects

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38
Q

A/e of methotrexate

A

Infection, hepatotoxicity, bone marrow suppression, ulcerative stomatitis, fetal death

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39
Q

Nursing interventions for methotrexate

A

Monitor for s/s infection, labs and hepatotoxicity, give folic acid, monitor stomatitis, give with food, and educate about a need for contraceptives (fetal harm); educate to avoid crowds, trauma, sick ppl.

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40
Q

Pregnancy category for methotrexate

A

Category X: contraindicated

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41
Q

Contraindications for methotrexate

A

Liver failure, alcohol use, pregnancy, blood dyscrasias

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42
Q

What should a nurse do before administering DMARDs?

A

Check for infection

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43
Q

Pt teaching for DMARDs

A

Phototoxic- sunscreen s/s stevens-Johnson, s/s HF, s/s infection

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44
Q

gout

A

Extremely painful inflammatory condition that affects joints, tendons, and other tissues; increased Uric acid levels, tophi

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45
Q

Tophi

A

chunks of uric acid developed around and within joints- advanced gout

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46
Q

Gout pt should avoid foods high in ________

A

Purine (red meats, alcohol, fish, scallops

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47
Q

Gout pts should increase fluid intake to prevent

A

Kidney stones (nephrolithiasis)

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48
Q

How is acute gout treated?

A

Colchicine, NSAIDs, intra-Articular glucocorticoids

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49
Q

What kind of gout attack is colchicine given for?

A

Acute

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50
Q

What is allopurinol?

A

Urate-lowering agent; works by inhibiting the production of uric acid, used prophylactically; tx for hyperuricemia for chronic gout- avoid alcohol and increase fluids; causes a metallic taste (normal s/e)

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51
Q

A/e for allopurinol

A

Hypersensitivity, kidney injury,hepatitis, GI distress, increase in gout attacks for first months of treatment, CNS effect

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52
Q

Anti-gout medications

A

Pregnancy category C
Colchicine decreases inflammation, used for acute attack
Decreases inflammation
A/e= GI distress, bone marrow suppression , rhabdomyolysis
Contraindications in those with severe renal, cardiac, hepatic , or GI dysfunction

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53
Q

What is probenecid?

A

An anti-gout medication that inhibits uric acid reabsorption, used prophylactically (prevent gout)
A/e= kidney calculi, GI effects, hypersensitivity

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54
Q

Anti-gout medication drug/food interactions

A

Grapefruit juice (increases med effect), avoid salicylates with probenecid

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55
Q

Nursing interventions for anti-gout medications

A

Teach them to take it with food, avoid grapefruit juice and alcohol; monitor uric acid, CBC LFT and RFT, monitor for bleeding and infection, teach them to avoid foods high in purine, increase fluids, and allopurinol causes a metallic taste ( not concerning)

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56
Q

What type of drug is acetaminophen?

A

Non-opioid analgesic

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57
Q

How does acetaminophen work?

A

Analgesic and antipyretic actions, but no anti-inflammatory or anti thrombotic actions, does not cause GI upset,but liver damage can be fatal; used to treat fever and minor pain, drug of choice for older adults (initial mild-operate musculoskeletal pains) and children

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58
Q

What’s is the antidote for acetaminophen?

A

Acetylcysteine (oral, IV)

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59
Q

Pharmacokinetics of acetaminophen

A

Metabolized by liver and excreted by kidneys

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60
Q

Drug interactions for acetaminophen

A

Alcohol (damages liver as well) and warfarin (increases INR) monitor the pt

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61
Q

What is the max daily dose for acetaminophen in someone with a healthy liver?

A

4 g per day

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62
Q

In someone who drinks ______ or more drinks in a day, the max dose of acetaminophen is _______ per day

A

3; 2g

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63
Q

What two factors increases the risk for acute toxicity of acetaminophen?

A

Fasting and alcohol

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64
Q

S/s of acetaminophen toxicity

A

N/V/D, swearing, abd pain, coma, death, liver damage (within 48 hours)

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65
Q

What is the treatment for an acetaminophen overdose?

A

Administer oral or IV acetylcysteine (within 8 hours of ingestion) or gastric lavage (within 4 hours of ingestion, if needed)

66
Q

What are the chronic non-cancer pain steps to pain management?

A

Step 1: non-opioid analgesic
-adjuvant analgesic
Step 2: weak- opioid analgesic
Non opioid analgesic
Adjuvant analgesic
Step 3: minimal invasive intervention
Non- opioid analgesics
Adjuvant analgesic
Step 4: strong opioid analgesic
Non-opioid alagesic
Adjuvant analgesic

67
Q

Opioid analgesics

A

Act on specific receptors in the CNS to reduce perception of pain (mu, kappa, delta receptors , mostly mu) but do NOT eliminate pain

68
Q

Contraindications for opioid analgesics

A

Head injuries

69
Q

Routes for opioid analgesics

A

oral, IM, IV, rectal, epidural, transdermal

70
Q

What are the agonists for opioid analgesics?

A

Morphine, fentanyl, codeine, heroin, hydrocodone, hydro morphine, meperidine(less potent than morphine no resp dep), methadone, oxycodone, oxymorphone

71
Q

Weak agonists/ reuptake inhibitors for opioid analgesics

A

Tramadol

72
Q

Mixed-agonists-antagonists opioid analgesics

A

Buprenorphine, butorphanol

73
Q

Opioid side effects

A

“MORPHINE”
Myosis (pin-point pupils)
Out of it (sedation)
Respiratory depression
Physical dependence
Hypotension(orthostatic)
Infrequency(constipation/urinary retention)
Nausea
Emesis (vomiting)

74
Q

What do opioids increase the effects of?

A

Alcohol, sedatives, muscle relaxers, and any other CNS depressants

75
Q

What are opioids used for?

A

Pain relief, diarrhea, cough suppression, replacement therapy for OUD, reversing opioid overdose…

76
Q

Opioid Side effects besides “MORPHINE”…..

A

DESIGNER
Dry mouth
Euphoria
Sedation
Itch
Gastro(constipation)
Nausea/vomiting
Eyes (pupillary constriction)
Respiratory depression

77
Q

Opioids are a schedule ____ drug, which means….

A

2; high risk for abuse, but are safe and accepted for use

78
Q

Opioids should be used cautiously in……

A

Children, older adults, renal and liver impairment

79
Q

S/E of opioids?

A

Dysphoria(restlessness), sedation, hallucinations, nausea, constipation, dizziness, orthostatic hypotension, pupillary constriction, depression, anxiety, and itching sensation, bowel perf, hemorrhoids, rectal tearing

80
Q

What is the opioid prototype?

A

Morphine sulfate

81
Q

Codeine is used for…..

A

Cough suppressant and pain, less potent than morphine

82
Q

Opioid patients are high risks for….

A

Falls!(orthostatic hypotension, confusion, dizziness, etc.) bed alarm

83
Q

Overdose of opioids

A

Respiratory depression , cardiac arrest, neurotoxicity, impaired pulmonary function

84
Q

Nursing interventions for opioids

A

Respiratory status and LOC monitor and pulmonary function, take VS, urine output and constipation(retention), cautiously in pregnancy, labor and delivery, and lactation , monitor for tolerance or dependence, frequent assessments, breakthrough pain (tx w/ non opioid), fixed schedule, opioid overdose triad (coma, pinpoint pupils, respiratory depression)

85
Q

What is the opioid overdose triad

A

Coma, pinpoint pupils, respiratory depression

86
Q

Pt teaching for opioids

A

S/s hypotension- change positions slowly, constipation- increase fiber, fluids, and exercise
Monitor tolerance (cross-tolerance can occur between morphine and other opioids)

87
Q

Fentanyl

A

100 times the potency of morphine, three routes: parenteral, transdermal, and transmucosal

88
Q

what is parenteral fentanyl used for?

A

Surgical anesthesia

89
Q

How is transdermal fentanyl used?

A

Patch

90
Q

How is transmucosal fentanyl used?

A

Lozenge on a stick, buccal film, buccal tablets, sublingual tablets,sublingual spray; can be used for surgical analgesia, chronic pain control,and control of breakthrough pain (all routes- schedule 2)

91
Q

What opioid can be given via PCA (patient controlled analgesia)?

A

Fentanyl- dont let anyone else but pt push it!

92
Q

What should the nurse monitor for in a pt with PCA fentanyl?

A

S/s overdose—- have naloxone ready

93
Q

Opioid antagonist

A

Narcan (naloxone, naltrexone), antidote to opioid agonists, starts working in 1-2 min

94
Q

A/E of Naloxone/ Narcan

A

Withdrawal symptoms (immediate), drowsiness, decreased respirations

95
Q

Withdrawal s/s seen on Narcan

A

Tremors, sweating, HTN, tachycardia, N/V

96
Q

Headaches are a symptom caused by

A

Dilation and inflammation of intracranial blood vessels

97
Q

What drugs are used for headaches?

A

Triptans

98
Q

Triptans

A

“-triptan”
Serotonin receptor agonists, 1st line med for migraine, abortive therapy (stops migraine) by constricting blood vessels and suppressing inflammation- dont use more than 2 times a week

99
Q

What route is the fastest in treating a migraine in triptans

A

IV and nasal forms faster than oral

100
Q

S/E and A/E for triptans

A

Chest s/s not dangerous and coronary vasospasm (ED!), fatigue, tingling sensations, avoid in pregnancy and Hx of CAD

101
Q

Pt teaching for triptans

A

Take when migraine first is sensed, second dose hrs later if s/s persist, do not exceed 100 mg in single dose or 200 mg in a day
Subcutaneous- how to admin, no more than 2 injections in 24 hours
Nasal spray- admin as a single dose may repeat in 2 hours
Lie down in a dark, quiet room

102
Q

Antiemetics are given

A

To suppress nausea and dominating; commonly used for chemotherapy induced N/V (CINV)

103
Q

Antiemetics are better used ______ than _______

A

Prophylactically reactively

104
Q

When should antiemetics be given for chemo pts?

A

About 30 min before therapy and around the clock

105
Q

What foods should a nauseas and vomiting avoid?

A

High fat foods

106
Q

Hydroxyzine

A

First-generation antihistamine- sedation (anxiety); oral / IM
side and a/e: anticholinergic effects, sedation (can’t see, can’t pee, can’t poop, can’t spit)

107
Q

Doxylamine and pyridoxine (B6) are given

A

To pregnant women for morning sickness

108
Q

What is scopolamine

A

Anticholinergic Used for motion sickness, transdermal patch behind the ear for 3 days, apply 4 hours before motion activity

109
Q

What patients are contraindications for scopolamine?

A

Glaucoma and BPH pts

110
Q

Side effects/Adverse effects for antihistamines and anticholinergics

A

Fatigue, dizziness, drowsiness(bc first gen antihistamine), dry mouth, blurred vision, urinary retention, constipation

111
Q

Nursing considerations for antihistamines and anticholinergics

A

Increase fluids, fiber, and exercise (constipation), I&O, monitor for bladder distention (bladder scanner, may need straight cath), BM monitor, teach to avoid heat bc can’t sweat, and use hard candy or mints for dry mouth

112
Q

Ondansetron

A

5-HT3/ serotonin receptor antagonist
Used for N/V, CINV
PO/IV
Side and A/E: headache, constipation, malaise, diarrhea, drowsiness, dizziness, prolonged QT interval that can lead to serious dysrhythmias

113
Q

What can a pt on Ondansetron take for a HA?

A

Acetaminophen

114
Q

What pts are contraindicated for Ondansetron?

A

Those with long QT syndrome (diagnosed with EKG and telemetry)

115
Q

What is the normal dose of Ondansetron, and if it does not work (in a hospital setting) what can be done?

A

4 mg; call provider and ask for another dose

116
Q

What is the Ondansetron dose for a chemo pt?

A

16 mg over 15 min via IV pump

117
Q

Phenothiazines/ Dopamine antagonist

A

First-generation (typical) antipsychotics, blocks dopamine, M1 muscarinic & H1 histamine- blocking effects
Depresses the CNS used for N/V and to treat schizophrenia or psychosis

118
Q

Promethazine is used for

A

N/V, contraindicated in children below 2 years (black box warning)
Side/adverse effects: anticholinergic effects, photosensitivity, drowsiness, sedation, hypotension, and confusion. Extravasation

119
Q

What can Promethazine cause (s/s abnormalities)

A

Extrapyramidal symptoms

120
Q

What are extrapyramidal symptoms?

A

Restlessness, anxiety, spasms (face and neck)

121
Q

What should you do if a pt exhibits extrapyramidal symptoms

A

Stop the med immediately

122
Q

What should be avoided when on Promethazine?

A

Other CNS depressants (i.e. alcohol and opioids)

123
Q

Can RF and LF pt take Promethazine?

A

Yes, doses need to be lowered

124
Q

How should Promethazine be given via IV?

A

With IV pump and fluids diluted to about 10 mL for about over 10 min

125
Q

What is the max dose for Promethazine

A

25 mg

126
Q

Why can Promethazine not be given subcutaneously?

A

Causes extravasation

127
Q

What is required of an IV for promethazine?

A

20G above the wrist

128
Q

Aprepitant

A

Substance P/ Neurokinin 1 Antagonist
Inhibits substance P/neurokinin in the brain
Has extended duration of action (peak=4 hrs)

129
Q

Side and adverse effects of Aprepitant

A

Fatigue, weakness, dizziness, abnormal heart rhythm, headache, hiccups, possible liver damage, pain at IV site

130
Q

Dronabinol

A

Cannabinoid, related to marijuana, potential for abuse
Antiemetic but also used as an appetite stimulate in cancer/AIDS patients
PO

131
Q

Side effects/ adverse effects of dronabinol

A

Drowsiness, confusion, dizziness

132
Q

What are contraindications for dronabinol?

A

Pts with mental health disorders (can make s/s worse)

133
Q

Laxative effect

A

Production of soft, formed stool over a period of 1 or more days; relatively mild

134
Q

Catharsis

A

Prompt, fluid evacuation of the bowel; fast and intense—- cramping and straining (stimulant)

135
Q

Contraindications for laxatives

A

Symptoms of appendicitis, regional enteritis, diverticulitis, and ulcerative colitis. Acute surgical abd, fecal impact ion/ bowel obstruction; bowel perforation, habitual use, use in caution in pregnancy and lactation

136
Q

What is important to remember when it comes to laxatives

A

Always assess at least once every shift

137
Q

Psyllium husk

A

Bulk-forming OTC mix with water (full 8 oz and then follow with 8 oz)
Safest laxative ; about 2 weeks, risk for electrolyte imbalances, decrease diarrhea in diverticulosis and IBS, control loose stool-ileostomy/colostomy - promote defecation in older adults

138
Q

S/a effects of psyllium husk

A

Flatulence, bloating, cramping(s/e)
Esophageal or Bowery obstruction (if not enough water)

139
Q

What kinds of patients is psyllium husk safe for?

A

Cardiac pt, those who are able to swallow

140
Q

Docusate Sodium

A

Surfactant laxative(stool softener); relieves constipation and prevents painful elimination and straining, decreases risk for fecal impaction
Increases water and electrolytes in intestines

141
Q

S/a effects for Docusate Sodium

A

No serious adverse rxns, s/e= diarrhea, abd cramps, edema

142
Q

What laxatives are most frequently abused?

A

Cathartics

143
Q

Bisacodyl, castor oil, senna

A

Stimulant laxatives (cathartics) that cause direct stimulators effect on intestinal mucosa

144
Q

S/a effects of bisacodyl, castor oil, or senna

A

GI irritation , rectal burning sensation, proctitis
Senna s/e=reddish/brown urine

145
Q

Saline laxatives

A

Magnesium hydroxide and magnesium citrate

146
Q

Magnesium hydroxide and magnesium citrate are_________

A

Milder and slower acting laxatives

147
Q

You should cautiously use saline laxatives in

A

Renal dysfunction pts

148
Q

Complications of saline laxatives

A

Absorbed systematically = dehydration, hypermagnesemia, sodium retention
Exacerbates HF, HTN, edema

149
Q

Osmotic laxatives

A

Polyethylene glycol (miralax) and polyethylene glycol electrolyte solution (golytely); cautiously use in those with a Hx of seizures

150
Q

S/a effects of osmotic laxatives

A

GI effects, dehydration s/s, CNS effects (dizziness, HA), sweating, palpitations, flushing and fainting, dry mouth

151
Q

Polyethylene glycol electrolyte solution (Golytlely) is used for

A

Bowel prep for procedures , must finish all of it clear liquid diet

152
Q

Lactulose

A

Hyperosmotic laxative tx for constipation and prevention/tx for portal-systemic encephalopathy(increases ammonia levels)

153
Q

use lactulose cautioulsy in those with

A

Diabetes

154
Q

Lactulose ins contraindicated in those with

A

Appendicitis, a true surgical abd, fecal impaction, intestinal obstruction

155
Q

Dopamine atagonist, prokinetic agent

A

Metoclopramide- antiemetic effect

156
Q

How does metoclopramide work?

A

Increases the rate of gastric emptying, used for diabetic gastroparesis

157
Q

Contraindications for metoclopramide

A

Bowel perf, obstruction/ hemorrhage

158
Q

A/e for metoclopramide

A

EPS, sedation, drowsiness, depression, insomnia, diarrhea

159
Q

What can you give for extrapyramidal symptoms from metoclopramide?

A

Benadryl

160
Q

Causes for laxative abuse

A

Misconception that movements must occur daily

161
Q

Consequences of laxative dependence

A

Diminished defamatory reflexes, reliance on laxatives

162
Q

Tx for laxative abuse

A

Abruptly withdraw ALL LAXATIVES