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NUR 326 > module 6 > Flashcards

module 6 Flashcards

1
Q

cellular protection of the stomach

A
  • mucous and bicarb secretion
  • prostaglandin E (inhibits acid, stimulates bicarb and mucus, maintains blood flow to mucosa)
  • alkaline bile and pancreatic juices
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2
Q

cell destruction of the stomachy

A

gastric acid and pepsin (proteolytic enzyme)

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3
Q

cholinergic stimulation

A

rest and digest

  • acetlycholine is a cholinergic neurotransmitter
  • stimulates muscarinic receptors
  • increases GI motility and digestion
  • in the GI tract, acetylcholine stimulates the vagus nerve to release histamine via histamine type 2 receptors in parietal cells to increase HCL production
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4
Q

gastritis

A

inflammation of the gastric mucosa which may be due to alcohol, NSAIDS, and aspirin

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5
Q

PUD

A

peptic ulcer disease occurs when cell destructive properties are greater than cell-protective qualities

  • chronic NSAID use inhibits prostaglandins
  • stress ulcers are seen in patients with severe illnesses like trauma, sepsis, or acute respiratory distress syndrome
  • ZES
  • H. pylori
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6
Q

ZES

A

Zollinger-Ellison syndrome is a rare gastric condition in which there is a gastrin secreting tumor in the duodenum or pancreas leading to a severe peptic ulcer or erosive esophagitis. s/s: diarrhea, abdominal pain, and reoccurring ulcers
-usually ages 20-50 with a greater occurrence in males than females

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7
Q

Helicobacter pylori infection

A

an infection of a gram-negative bacteria

  • found in gastric ulcers, duodenal rulers, and gastric cancers
  • secretes urease to buffer the acidity of its own environment. it produces continuous inflammation that leads to atrophy and ulcer. increases the ph of the environment
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8
Q

ulcerogenic factors

A
  • gastric acid
  • H. pylori
  • pepsin
  • NSAIDS
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9
Q

gastric ulcers

A

more common in the 60s and 70s
s/s: asymptomatic bleeding (the first symptom is low h/h), bloating, indigestion, heartburn, nausea, dull achy pain right after eating but not right before

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10
Q

duodenal ulcer

A

can be with any age but there is an increased risk with cigarette smoking
s/s: heartburn, burning, severe stomach pain which is worse when the stomach is empty, at night, or right before food

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11
Q

GERD

A

reflux of stomach acid or bile due to the incompetent lower esophageal sphincter. More common in pregnancy and those greater than 40.

  • aggravated by foods that are fatty and chocolates, fluids such as alcohol and caffeinated beverages, medications such as beta-blockers, beta-adrenergic, nitrates, gastric distension, smoking, recumbency, and H. Pylori.
  • causes painful swallowing usually due to esophagitis or esophageal ulcer
  • when the lining thickens and becomes reddened its called barret’s esophagus
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12
Q

what are the four categories of medications used for PUD and GERD

A
  • antacids
  • histamine 2 receptor blockers
  • proton pump inhibitors
  • others
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13
Q

post marketing recall of ranitidine drugs (Zantac)

A

the FDA withdrew all rx and OTC drugs of this time because a contaminant known as NDMA was found int he medications. it was found that the impurity in these drugs increase over time and when stored at higher than room temp. it is a potential human carcinogen

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14
Q

H. Pylori eradication

A

quadruple therapy is used(with bismuth)ex: PPI + bismuth substrate + tetracycline + metronidazole (an antifungal)
triple therapy: PPI + clarithromycin + amoxicillin

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15
Q

peptobismol

A

can turn the stool gray and should not be given to children with viral illness or fever because it contains salicylates

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16
Q

Irritable bowel syndrome

A

cause: unknown
the clinical diagnosis is based on the frequency and intensity of symptoms: recurrent abdominal pain for more than 3 days and month for more than 3 months as well as changes in bowel movements(constipation and diarrhea or alternation)
-treated with cognitive behavioral therapy and anti-anxiety medication
-symptomatic treatment for constipation or diarrhea

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17
Q

inflammatory bowel disease

A
  • there are genetic risk factors
  • it is the chronic inflammation of the bowel
  • there are 2 types: ulcerative colitis (continuous inflammation along the large intestine) and Crohn’s disease ( spotty inflammation anywhere from the mouth to the anus)
  • treated with anti-inflammatory medications, steroids, and immunomodulators (TNF- alpha inhibitors). TNF is a cytokine for inflammation
  • there is also the symptomatic treatment of constipation and diarrhea.
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18
Q

ulcerative colitis

A

ages 15-35 and 60-80

  • 2% have a family history
  • risk factors: high fat diet
  • begins in the rectum and may process backward to the sigmoid colon but it confided the large intestine. mucosal and submucosal damage may be given a steroid enema.
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19
Q

crohn’s disease

A

ages 15-35

  • 10% have a family history
  • risk factors: smoking, high fat diet, low vitamin D-discontinuous pattern of lesions in the small intestine, colon, mouth, and esophagus
  • transmucosal damage (to the muscle layer) increases the risk for abscesses, fistulas, and peritonitis.
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20
Q

agents used for constipation

A

laxatives, cathartics, and others

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21
Q

age related medication concerns

A
  • changes in pharmacokinetics and pharmacodynamics
  • polypharmacy
  • anticholinergic burden
  • high alert medicines
  • increased risk for adverse drug interaction
22
Q

geriatric absorption

A
  • CHF may result in reduced blood flow to the GI tract

- achlorhydria (absence of hydrochloric acid in the gastric secretions) may change absorption of some drugs

23
Q

geriatric distribution

A
  • decrease in the total % of body water. this increases plasma concentration for lithium, digoxin and increases the risk for dehydration with diuretic therapy
  • increase fat content: lean muscle mass ratio. increases the volume of distribution for lipophilic drugs such as diazepam, resulting in markedly prolonged 1/2 life.
24
Q

geriatrics metabolism

A
  • decrease in phase I metabolism leads to a prolonged half-life for some medications.
  • decreases in first-pass metabolism leads to increase the serum concentration of oral nitrates, beta-blockers, calcium channel blockers, and estrogens
25
Q

geriatric excretion

A
  • 65% of older adults have some decline in renal function
  • potential for toxicity in medications cleared primarily by the kidneys
  • serum creatine may be normal but creatinine clearance may be reduced so formulas should be used to estimate GFR
  • formulas are imperfect so the nursing monitoring role is very important
26
Q

pharmacodynamic changes

A
  • increased sensitivity to central nervous system effects
  • increased risk for delirium
  • increased risk for psychomotor changes
  • increased risk for extrapyramidal side effects from antipsychotic medications and metoclopramide.
27
Q

polypharmacy

A
  • the majority of older adults are 5+ medications at a time
  • many of these medications have side effects and can exacerbate underlying geriatric syndromes
  • this increases the risk for adverse drug event and increases the risk of hospital admission
28
Q

warfarin/heparin

A

NSAIDS, ASA, clopidogrel = increased risk of bleeding

29
Q

ASA/ antibiotics

A

warfarin= increased risk of cleading

30
Q

ASA

A

antiplatlet or anticoagulent or fluoxetine= increased risk of bleeding

31
Q

ACE inhibitors

A

spironolactone or patassium supplement= hyperkalemia

32
Q

clarithromycin

A

many other meds= increase risk of toxicity which causes Rhabdo and prolonged OT interval

33
Q

insulin

A

and antibiotics= increased risk for hypoglycemia and hyperglycemia

34
Q

high alert medications

A 
ACE inhibitors
antiplatlets
antipsychotics
benzodiazepines
diabetes meds
dig
iron, narcotics, verapamil (high dose)
loop diuretics
NSAIDS: gih dose or long acting
opioids
tyroid meds
warfarin
35
Q

drugs with an increased potential for interactions

A 
aspirin
NSAIDS
decongestants and cold remedies
allergy medications
GI and bowel meds
antacids or antireflux meds
sleeping meds
36
Q

monitoring for diuretics

A

fluid imbalance, electrolyte imbalance especially k+, orthostatic hypot, renal function

37
Q

monitoring of warfarin

A

PT/INR or signs of bleeding or clotting

38
Q

monitoring for seizure meds

A

drug concentration and blood levels

39
Q

monitoring for ACE inhibitors

A

hyperkalemia

40
Q

monitoring for meperidine

A

active metabolite may produce seizures or psychosis if given repeatedly

41
Q

monitoring for dig

A

concentration, renal function, postassium levels

42
Q

monitoring for insulin, sulfonylreas

A

hypoglycemia

43
Q

monitoring for opioids

A

constipatiion and impaction, oversedation, inadeqATE PAIN RELIEF

44
Q

monitoring for BENZOS

A

dellifium, falls, oversedation

45
Q

monitoring for acetaminophen

A

if dose is > 3gms/day check the LFTs

46
Q

monitoring for aminoclycosides

A

serum cratinine

47
Q

monitoring for erythropoiesis stimulants (iron)

A

CBC, rion lvls, ferritin

48
Q

monitoring for lithium

A

drug levels, electrolytes, renal fx

49
Q

potentially inappropriate medications

A

expert consensus list of medicnes for which the risks outweigh the benefits

  • Beers criteria
  • home health criteria
50
Q

risk for nonadherance

A
  • seuizure meds
  • diuretics
  • cortiocsteroids
  • insulin and sulfonyluras
51
Q

inappropriate cessation

A

-seizure meds
-beta blockers
-psychoactive meds
-steroids
these drugs should not be suddenly stopped

52
Q

contributors to nonadherance

A
  • economics: assess the financial burden, introduce assistance programs, generic meds are cheaper
  • functional: visual impairment, ama, depression, substance misuse
  • comunication gaps: therapeutic alliance, comprehension
  • medication related: side effects, effectiveness, dose frequency and formulation

NUR 326 (7 decks)

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