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Nursing Semester 2 > Monica - Final Exam: Acid-controlling/Anti-emetic drugs > Flashcards

Monica - Final Exam: Acid-controlling/Anti-emetic drugs Flashcards

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1
Q

Describe the mechanical functions of the GI tract (from opening of stomach to the duodenum):

A
  1. Lower esophageal sphincter - ring of smooth muscle that prevents backflow of stomach contents
  2. food is churned into chyme (pulpy acidic fluid)
  3. peristalsis moves chyme to the pylorus
  4. pyloric sphincter provides entry into the duodenum
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2
Q

List the cells and chemicals that function within the stomach:

A
  1. parietal cells: HCl, intrinsic factor
  2. chief cells: pepsinogen
  3. mucus neck cells: mucus, HCO3-
  4. prostaglandins: stiumulate mucus, HCO3- secretion; promote repair and blood flow
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3
Q

Disruption in any of the chemical functions of the stomach can lead to an imbalance that increases the risk of:

A

damage to the lining of the stomach (peptic ulcer disease).

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4
Q

Parietal cells secrete ____, which activates ______, and secrete _____, which promotes the absorption of _____.

A

HCl - pepsinogen

intrinsic factor - B12

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5
Q

How is pepsinogen converted to pepsin?

A

acidity

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6
Q

How are mucus neck cells cytoprotective?

A

Mucus and HCO3- neutralize acid and form a protective layer over the gastric lining to prevent damage.

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7
Q

Parietal cells can secrete _ - _ liters of HCl per day.

A

1 - 3 liters/day

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8
Q

What is the function of prostaglandins in the stomach?

A
  • stimulate secretion of mucus and HCO3

- inflammatory response: promotes repair and blood flow

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9
Q

GI diagnostic studies (4)

A
  1. EGD
  2. Upper GI series w/ barium swallow
  3. Lower GI series w/ barium enema
  4. Colonoscopy
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10
Q

EGD and colonoscopy

A

esophagogastroduodenoscopy: scope of esophagus, stomach, and dueodenum
colonoscopy: scope of the entire colon

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11
Q

Upper GI series w/ barium swallow

A

fluoroscopic x-ray using oral contrast to see the movement through the upper GI tract

ex. dx aspiration pneumonia

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12
Q

Lower GI series w/ barium enema

A

fluoroscopic x-ray using rectal contrast to visualize movement through lower GI tract

ex. polyps, obstructions, diverticuli, strictures caused by colon cancer

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13
Q

What is PUD?

A

Peptic ulcer disease: lesion or erosion in the stomach or duodenum

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14
Q

PUD: causes

A
  • hypersecretion of acid
  • ineffective mucus/HCO3- production
  • poor cellular repair
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15
Q

PUD: risk factors (6)

A
  1. family hx
  2. meds: corticosteroids, NSAIDs, platelet inhibitors
  3. smoking
  4. alcohol
  5. caffeine intake - acidic
  6. H. pylori - corkscrew-shaped bacteria that screws into stomach lining
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16
Q

How do corticosteroids increase the risk of PUD?

A

inhibit the inflammatory response - less blood flow and repair of damaged cells…

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17
Q

How do NSAIDs increase the risk of PUD?

A 
aspirin and ibuprofen 
inhibit COX-1  and COX-2 enzymes:
- COX-1 protects stomach mucosal lining
- COX-2 promotes prostaglandins
Thus,
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18
Q

PUD: symptoms

A
  • gnawing/buring pain
  • discomfort 1 - 3 hours after meals
  • discomfort worse w/ empty stomach
  • risk of bleeding (bright red blood in emesis; dark stools)
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19
Q

For people with PUD, why might gastic discomfort lessen after eating?

A

Food acts as a protective barrier and the LES closes preventing acid backflow into the esophagus.

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20
Q

GERD

A

Gastroesophageal reflux disease:

- stomach acid enters the esophagus (heartburn) d/t weakening of the LES

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21
Q

GERD increases the risk of:

A

esophageal lining erosion, that could lead to ulceration and possibly over time:

  • respiratory problems: chronic cough, aspiration pneumonia
  • lifestyle changes: inablility to lay flat; sleep upright
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22
Q

GERD: symptoms

A
  • dysphagia
  • dyspepsia
  • heartburn
  • belching
  • nausea
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23
Q

Heartburn can feel like a:

A

cardiac event.

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24
Q

If a patient presents to the ER with chest pain, the physician will want to rule out _______ first.

A

R/O a cardiac event FIRST! Then determine if there is a GERD issue.

*sometimes given meds for GERD to relieve those possible symptoms and distinguish them from cardiac symptoms

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25
Q

Factors that worsen GERD:

A
  • large meals
  • acidic food and drinks
  • spicy foods
  • smoking, alcohol
  • obesity
  • NSAIDs, corticosteroids
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26
Q

How does obesity worsen GERD?

A

Increased weight places pressure on the LES.

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27
Q

How does a large meal worsen GERD?

A

All that food doesn’t fit in the tum tum placing pressure on the LES and backing into the esophagus.

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28
Q

acidic food and drinks to avoid:

A

citrus, tomato-based, coffee

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29
Q

How do NSAIDs and corticosteroids worsen GERD?

A

especially long-term use

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30
Q

Lifestyle changes to help manage GERD:

A
  • elevate HOB
  • smaller meals
  • lose weight
  • smoking/alcohol cessation
  • if taking aspirin or corticosteroids long-term, also take preventative meds
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31
Q

Pharmacotherapy, along with ________, are needed to relieve symptoms, promote healing, and prevent reoccurances of ulcers.

A

lifestyle modifications

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32
Q

3 drug classes for suppressing or neutralizing gastic acid:

A
  1. proton-pump inhibitors
  2. H2-receptor antagonists/blockers
  3. antacids

**may affect absorption of other drugs/nutrients

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33
Q

Gastric acid is essential in the absorptions of (vitamins/minerals):

A

B12, vit C, folic acid, iron

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34
Q

proton pump inhibitor: drug

A

pantoprazole (Protonix)

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35
Q

pantoprazole: classification

A

proton pump inhibitor

36
Q

PPIs: indication

A
  • ulcer management

- GERD

37
Q

PPIs: action and effect

A

A: blocks H+-K+ ATPase pump located on parietal cells
E: decreased acid production

38
Q

PPIs: form/route, implementation

A

IV, PO (capsule, sprinkles); 1xday

  • swallowed whole
  • sprinkled on food
  • give 30 min before meals
  • *most designed to last ALL day
39
Q

Why does pantoprazole need to be given before meals?

A

b/c the hydrogen-potassium pump is activated by food

40
Q

PPIs block __% of acid.

A

95% - is it TOO effective??

41
Q

There is a positive correlation between PPIs and _______ because:

A

C. dificile - 65% risk of acquiring C. dif-diarrhea

- b/c bacteria that is normally killed by the acidic environment of the stomach survives and overgrows

42
Q

PPIs: adverse effects

A
  • C. dif-associated diarrhea
  • respiratory infections
  • osteoporosis
43
Q

Are PPIs too effective?

A
  • benefits w/in 3-5 days
  • 95% of acid blocked
  • heal 90% of ulcer w/in 4-9 weeks
44
Q

How do PPIs cause osteoporosis?

A

The interfere with the absorption/metabolism of calcium.

45
Q

With both PPIs and H2 blockers, avoid concurrent use with:

A

antacids - b/c both need acid for absorption

46
Q

H2 blockers: drug

A

ranitidine (Zantac)

47
Q

ranitidine: classification

A

Histamine receptor antagonist (H2 blocker)

48
Q

H2 blockers: action and effect

A

A: interferes with acid production by blocking histamine-2 receptors
E: decreased secretion of gastric acid

49
Q

H2 blockers: indication

A
  • short-term tx of duodenal and gastric ulcers
  • maintenance therapy after healing
  • GERD and dyspepsia
50
Q

H2 blockers: implementation

A
  • avoid concurrent use w/ antacids

- administer w/ meals and bedtime: 3-4 x per day to be effective

51
Q

Antacids are indicated for prevention or healing of ulcers.

A

FALSE!! **only for neurtralizing stomach acid and providing temporary relief from heartbur and indigestion

52
Q

antacids: action

A
  • stimulate prostaglandin production

- increase mucus and HCO3 secretion

53
Q

Antacids can contain the following minerals:

A
  1. magnesium
  2. aluminum
  3. aluminum + magnesium
  4. calcium
54
Q

Magnesium-containing antacid:

A

Milk of magnesia (laxative)

55
Q

Adverse effect of MOM

A

diarrhea

56
Q

Aluminum-containing antacid:

A

Amphogel

57
Q

Adverse effect of Amphogel

A

constipation

58
Q

Amphogel may inhibit absorption of:

A

iron

59
Q

Aluminum-containing w/ magnesim antacid:

A

Maalox, Mylanta

60
Q

Adverse effect of Maalox, Mylanta

A

constipation, diarrhea

61
Q

Why should CKD patients avoid Maalox/Mylanta?

A

d/t increased risk of calcium loss

- hyperphosphatemia

62
Q

Mylanta/Maalox increase the risk of ___ loss.

A

calcium loss - leading to osteoporosis

63
Q

calcium-containing antacid:

A

Tums

64
Q

Adverse effects of Tums

A

constipation, kidney stones

65
Q

If a patient has a bottle of Tums at their bedside what should the RN do?

A

Question why they are taking it and how much they are taking. It could impact their health.

66
Q

MOM contains:

A

Magnesium

67
Q

Amphogel contains:

A

aluminum

68
Q

Mylanta and Maalox contain:

A

aluminum + magnesium

69
Q

Tums contains:

A

calcium

70
Q

Simethicone is an __________, sometimes added to _____ preparations.

A

anti-flatulent; antacids (Mylanta…)

71
Q

simethicone: indication

A

relief of excess gas

72
Q

simethicone: action and effect

A

A: coalescence of gas bubbles for easier expulsion and relief of distention/discomfort
E: passage of gas thru belching or flatus

73
Q

Sucralfate is a _____ ______ that prevents:

A

gatrointestinal protectant (mucosal protectant) that prevents further ulcer erosion.

74
Q

Sucralfate has nothing to do with gastric acid.

A

TRUE - action: aluminum salt of sulfated sucrose reacts with gastric acid to form a thick paste, which adheres to the ulcer surface.

75
Q

sucralfate: indication

A

short-term therapy of ulcers - up to 8 wks

76
Q

sucralfate: AE

A

constipation

77
Q

sucralfate: implementation

A
  • give 1 hour before a meal and at bedtime (4xday)

- not given concurently w/ antacids, H2-blockers, PPIs b/c needs HCl to be activated

78
Q

vomiting

A

forcible emptying or expulsion of gastric acid

79
Q

vomiting pathway

A

*vomiting center in the lower medulla initiates and controls the act of emesis. It receives signals from digestive tract, inner ear, and chemoreceptor trigger zone (CTZ)

80
Q

anti-emetic drugs (4)

A
  1. promethazine
  2. prochlorperazine
  3. metoclopramide
  4. ondansetron
81
Q

promethazine: action

A

blocks the effects of histamine receptors and CTZ

82
Q

prochlorperazine: action

A

alters the effects of dopamine receptors and depresses CTZ

83
Q

metoclopramide: action

A
  • blocks dopamine receptors in CTZ

- accelerates gastric emptying

84
Q

ondansetron: action

A

blocks effects of serotonin receptors in CTZ

85
Q

anti-emetics: adverse effects

A

extrapyramidal reactions, constipation, dry mouth, sedation, drowsiness, HA

Nursing Semester 2 (7 decks)

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