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STUDY CARDS > Nursing Process, Pharmacological Principles & Antidiarrheals > Flashcards

Nursing Process, Pharmacological Principles & Antidiarrheals Flashcards

1
Q

Nursing Process

A

A research-based organizational framework for professional nursing practice

Flexible, adaptable, and considered the major systematic framework for professional nursing practice

Ensures the delivery of thorough, individualized, and quality nursing care to patients
Requires critical thinking (clinical reasoning and clinical judgement)

Ongoing and constantly evolving process

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2
Q

5 Steps of the Nursing Process

Which includes goals and outcome criteria?

Which includes PT education?

A

ADPIE

P- Planning includes GOALS and Outcome criteria

Implementation- PT education

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3
Q

Assessment

List what you want to assess.

A

Data collection, review, and analysis

Medication profile:

Any and all drug use

Home or folk remedies;
natural heath products or homeopathic treatments

Alcohol, tobacco, caffeine intake

Current or past illicit drug use

Prescriptions and over-the-counter medications
Past or present health history and associated drug regimen

Family history; growth and developmental stage
Issues related to age and medication regimen

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4
Q

Define NANDA-I?

Purpose?

A

North American Nursing Diagnosis Association International (NANDA-I)

Purpose of NANDA-I is to increase the visibility of nursing’s contribution to the care of patients and to further develop, refine, and classify the information and phenomena related to nurses and professional nursing practice.

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5
Q

International Classification for Nursing Practice (ICNP)

A

Project of the International Council of Nurses

The ICNP is a framework that can be cross-mapped with other health care classification systems, creating multidisciplinary health vocabularies within information systems.

Cross-mapped with other health care classification systems such as NANDA

The Canadian Nurses Association (CNA) has endorsed the ICNP as the standard for collecting nursing data.
Disparity in opinion as to which approach is best

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6
Q

Nursing Diagnoses

Define and list the 3 step process.

A

Nursing diagnoses are used to communicate and share information about the patient and the patient’s experience.

Three-step process:

PART I: Human response to illness, injury, or significant change

PART II: Factors related to the response (“related to”)

PART III: Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”)

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7
Q

Common nursing diagnoses related to drug therapy develop from data associated with:

A

Deficient knowledge
Risk of injury
Nonadherence
Various disturbances, deficits, excesses, or impairments in bodily function

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8
Q

Planning

A

Identification of goals and outcome criteria

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9
Q

Define Goals and Outcome criteria?

A

Goals:
Objective, measurable, and realistic, with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria

Outcome criteria
Concrete descriptions of patient goals

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10
Q

Implementation

A

Implementation is guided by the preceding phases of the nursing process.

Initiation and completion of specific nursing actions as defined by nursing diagnoses, goals, and outcome criteria

Independent, collaborative, dependent

Statements of interventions include frequency, specific instructions, and any other pertinent information.

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11
Q

List the 10 rights of medication

A

MEDICATION/ DRUG
PT
DOSE
TIME
ROUTE

DOCUMENTATION
REASON
REFUSE
EVALUATION/ ASSESSMENT
PT EDUCATION

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12
Q

Time-Critical Scheduled Medications

A

Facility-defined medications:

Administer at exact time when necessary (e.g., rapid-acting insulin), otherwise within 30 minutes before or after scheduled time.

Early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm

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13
Q

Non–Time Critical Scheduled Medications

A

Daily, weekly, monthly medications: Administer within 2 hours before or after scheduled time.

Medications prescribed more frequently than daily but no greater than q4h: Administer within 1 hour before or after scheduled time.

Early or delayed administration within a specified range of either 1 or 2 hours should not cause harm

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14
Q

Medication Errors

A

Defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient, or consumer”

INCIDENT REPORT

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15
Q

Evaluation

A

Systematic, ongoing, and dynamic part of the nursing process

Determining the status of the goals and outcomes of care

Monitoring the patient’s response to drug therapy
Therapeutic, expected, and toxic responses

Clear, concise documentation

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16
Q

THE PATIENT REPORTED THAT HIS MEDICATION AT 2100 WAS MISSED

WHAT WOULD YOU DO?

A

Check MAR

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17
Q

PT taking antiepileptic medications and has NPO orders. What would you do?

A

Call the Doctor to clarify instructions

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18
Q

PT is requesting pain medications. What would you do first?

A

First assess pt’s pain and pain level

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19
Q

Drug

A

Any chemical that affects the physiological processes of a living organism

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20
Q

Pharmacology

A

Broadest term for the study or science of drugs

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21
Q

Chemical name

A

Describes the drug’s chemical composition and molecular structure

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22
Q

Generic name

A

(nonproprietary, official name)
Name given to a drug approved by Health Canada

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23
Q

Trade name

A

(proprietary name)

The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer).

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24
Q

Drug classification

3 ways to classify drugs?

A

Drugs are grouped together based on:

their similar properties

their structure

their therapeutic use

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25
Q

Example of names

A

Chemical: propionic acid

Generic: ibuprofen

Trade: Advil

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26
Q

Pharmacological Principles

A

Pharmaceutics

Pharmacokinetics

Pharmacodynamics

Pharmacogenomics (pharmacogenetics)

Pharmacotherapeutics

Pharmacognosy

Pharmacoeconomics

Toxicology

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27
Q

Pharmaceutics

A

The study of how various drug forms influence the way in which the drug affects the body

Optimal design

how the drug influence the body

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28
Q

Dissolution-dissolving of solid dosage forms and their absorption

A

Enteric coating

Thin filmed drugs (quick dissolve in buccal tissue)

Combining drugs

Time-release technology

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29
Q

Enteric coated

A

coats the drug- so that it dissolves in the intestines to protect stomach acid

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30
Q

Fastest form of oral drugs

A

liquid

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31
Q

slowest form of oral drugs

A

enteric

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32
Q

Enteric coated

A

DO NOT CRUSH/ will dissolve in stomach and disrupt the acid (so call pharmacy to send a liquid form of the drug)

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33
Q

Pharmacokinetics DEFINE

A

The study of what the body does to the drug

From the time drug is put into the body until the parent drug and metabolites have left the body

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34
Q

4 steps Pharmacokinetics

A

Absorption
Distribution
Metabolism
Excretion

Remember: “A D M E” sounds like “add me”

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35
Q

Pharmacokinetics: Absorption

Includes (3)?

A

Bioavailability, first-pass effect, routes

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36
Q

Bioavailability

A

The extent of drug absorption

extent a drug becomes completely available to its destination/ enter circulation

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37
Q

First-pass effect

A

Reduces bioavailability to <100% (inactive metabolites)

Occurs in liver

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38
Q

Types of routes

A

Enteral route- GI tract
Sublingual and buccal routes
Parenteral route
Topical route
Transdermal route
Inhalation route

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39
Q

Types of parenteral routes (7)

A

intradermally,

subcutaneously,

intravenously,

intramuscularly,

intrathecally (spinal cord)

intra-articularly( joint),

intra-arterially

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40
Q

Define enteral route

4 routes

A

The drug is absorbed into the systemic circulation through the mucosa of the stomach, small intestine, or large intestine

Oral
Sublingual
Buccal
Rectal (can also be topical)

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41
Q

What 4 ROUTES bypass the first pass effect at the liver?

A

Sublingual and buccal
Parenteral
Topical route (except rectum)

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42
Q

Parenteral route (7)

A

Intravenous (fastest delivery into the blood circulation)

Intramuscular

Subcutaneous

Intradermal- mantu test

Intra-arterial

Intrathecal- spinal cord

Intra-articular- joint

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43
Q

Which type of topical route has a first effect?

A

Rectum because it is part of the GI tract

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44
Q

Types of topical route?

A

Skin (including transdermal patches)

Eyes

Ears

Nose

Lungs (inhalation)

Rectum- HAS FIRST PASS EFFECT (part of GI tract)

Vagina

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45
Q

Pharmacokinetics: Distribution

A

Transport of a drug by the bloodstream to the drug’s site of action

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46
Q

4 places of extensive blood supply:

A

Heart
Liver
Kidneys
Brain

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47
Q

MAIN SITE OF METABOLISM

A

Liver

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48
Q

Distribution:

Albumin?

A

The most common blood protein and carries the majority of protein-bound drug molecules.

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49
Q

If a given drug binds to albumin, it is?

A

Inactive

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50
Q

Active

A

drug that is not bound

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51
Q

The unbound portion of a drug is called?

and considered?

A

Active

is considered a “free” drug

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52
Q

Low albumin levels can contribute to?

A

drug toxicity because less drug will be inactive

inactive drugs: drug binds to albumin

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53
Q

What causes drug-drug interaction?

A

Competition between drugs for binding sites, with albumin

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54
Q

A possible solution for drugs competing for binding sites and causing drug-to-drug interactions?

A

Is to change administration times between these drugs.

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55
Q

Pharmacokinetics:
Metabolism is also referred to as?

A

Also referred to as biotransformation

Biochemical alteration of a drug

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56
Q

Metabolism is a biochemical alteration of a drug into (4)

A

An inactive metabolite,

A more soluble compound,

A more potent metabolite (as in the conversion of an inactive prodrug to its active form),

Or a less active metabolite

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57
Q

What is the most responsible for metabolism?

Other organs? 5

A

The liver

Others: skeletal muscle, kidneys, lungs, plasma, intestinal mucosa

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58
Q

Cytochrome P-450 enzymes

A

(Or simply P-450 enzymes), also known as microsomal enzymes

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59
Q

Lipophilic

A

(“fat loving”)

enzymes work mostly on these

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60
Q

Hydrophilic

A

(water-loving)

easier to metabolize

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61
Q

Substrates

A

targeted drugs for specific enzymes

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62
Q

Enzyme inhibitors

A

decrease or delay metabolism

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63
Q

Enzyme inducers

A

stimulate metabolism

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64
Q

Liver/ kidney disease can lead to

A

toxicity

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65
Q

Pharmacokinetics:
Excretion

A

Elimination of drugs from the body

Liver and bowel also play a role
Renal excretion – affected by kidney disease
Biliary excretion – affected by liver disease/ bowel disease

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66
Q

Primary organ of excretion?

A

Primary organ responsible is kidney

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67
Q

What other 2 organs play a role in excretion

A

Liver and bowel also play a role

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68
Q

What does kidney disease affect?

A

renal excretion

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69
Q

what does liver and bowel disease affect

A

biliary excretion

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70
Q

Pharmacokinetics
Half-life

A

Time required for half (50%) of a given drug to be removed from the body during elimination phase

The length of time required for the concentration of a particular substance (typically a drug) to decrease to half of its starting dose in the body.

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71
Q

Pharmacokinetics:
Steady state

define
how many half lives

A

Amount of drug removed via elimination = (equals) amount absorbed with each dose

Takes about 4-5 half lives of drug administration

Steady state means consistent blood levels and correlates with maximum therapeutic benefits

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72
Q

Onset of action

A

when it starts to have an effect

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73
Q

Peak effect

A

maximal therapeutic effect

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74
Q

Duration of action

A

how long it is effective

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75
Q

The length of time until the onset and peak of action and the duration of action play an important part in determining the

A

peak level and trough level of a drug

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76
Q

What happens if the peak blood is too high?

A

drug toxicity

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77
Q

Peak level

A

highest blood level of a drug

highest concentration of a drug in the blood

highest level of drug in the blood

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78
Q

Trough level

A

lowest blood level of a drug

the lowest concentration of a drug in the blood

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79
Q

Toxicity occurs if the

A

Peak blood level of the drug is too high

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80
Q

What is used to monitor peak/trough, adequate therapeutic effects, minimize drug toxicity

A

Therapeutic drug monitoring

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81
Q

Onset

A

When the drug elicits response

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82
Q

Peak

A

Max response

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83
Q

Duration

A

How long it is effective

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84
Q

Pharmacodynamics

(2)

A

The study of what the drug does to the body

The mechanism of drug actions in living tissues (how does it work)

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85
Q

Therapeutic effect

A

A positive effect on faulty physiology.

The goal of drug therapy.

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86
Q

Mechanism of action

A

Modified cell or tissue function

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87
Q

3 types of mechanism of action

A

Receptor interactions
Enzyme interactions
Nonselective interactions

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88
Q

Receptor interactions

A

drug and receptor binding

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89
Q

Enzyme interaction

A

drug and enzyme binding

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90
Q

Nonselective interactions

A

disrupt cell processes in various ways

disrupt cell membranes; some antibiotics

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91
Q

Organ used by the first pass effect

A

Liver

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92
Q

Difference between PO and IV dose as influenced by 1st pass effect?

A

PO dose will be always higher than IV dose due to the 1st pass effect

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93
Q

Agonist receptors

A

forms a bond with specific receptors

binds to a receptor and gets a response

94
Q

Antagonists

A

block the receptor

Does NOT get a response > to block the effects

95
Q

Pharmacotherapeutics

A

The clinical use of drugs to prevent and treat diseases

96
Q

The desired therapeutic outcomes is:

Outcome goals need to be ____.

A

patient-specific, established in collaboration with the patient.

Outcome goals need to be realistic.

97
Q

Contraindications-

A

anything that makes a drug dangerous for a pt

98
Q

Types of drug therapy

(7)

A

acute, maintenance, supplemental, palliative, supportive, prophylactic, empirical

99
Q

acute

A

acute illness

100
Q

maintenance

A

chronic disease maintenance therapy- oral contraceptives

101
Q

supplemental/ replacement

A

insulin, iron

102
Q

palliative

A

comfort measures

103
Q

supportive

A

maintain integrity of body functions (fluid/electrolytes, blood products)

104
Q

phropylactic

A

VACCINE
antibiotics

105
Q

emperical

A

antibiotics before seeing a culture test

106
Q

Slowest pain relief

107
Q

Pharmacotherapeutics
Monitoring: What to look for?

A

Therapeutic action- beneficial effects

adverse effect- predictable undesirable;e effect

Therapeutic index

drug concentration/ drug levels (blood or urine specimens

Patient condition- weight, concurrent illness

108
Q

Therapeutic index

determines?

define?

A

Ratio of toxic level to therapeutic level

toxic level : therapeutic level

(determines safety of a drug);

narrow/large or low/high; “therapeutic window”

109
Q

tolerance

A

decreasing response to repeated drug doses

effects of opioid

110
Q

dependence

A

physiological or psychological need for a drug

111
Q

physical dependence

A

physiological need for a drug to avoid physical withdrawal symptoms

112
Q

Psychological dependence (addiction):

A

an obsessive desire for a drug

113
Q

Pharmacotherapeutics:

Drug interactions

A

with other drugs or food

increased or decreased effect of one drug on another

114
Q

additive effects

A

total effect of both drugs; T3/ Percocet

115
Q

synergistic effects

A

greater effect if both; one enhances the other

116
Q

antagonist effects

A

less effect if both

1 + 1= less than 2

can reduce absorption/ effect of another drug

117
Q

Incompatibility

A

cannot be given together

chemical deterioration of one or both

118
Q

adverse drug event

A

broad term for an undesirable occurrence involving medications

119
Q

medication error

A

compromise 10 rights

120
Q

adverse drug withdrawal event

A

during withdrawal

121
Q

Idiosyncratic reaction

A

unexpected occurrence in patient

122
Q

Medication processes where errors can occur:

A

Prescribing
Dispensing
Administering
Monitoring

123
Q

Teratogenic

A

Teratogenic – fetal defects

124
Q

Mutagenic

A

Mutagenic – permanent change in genes (radiation)

125
Q

Carcinogenic

A

Carcinogenic – cancer causing (excessive hormone therapies)

126
Q

Pharmacognosy

A

The process of identifying medicinal plants and their ingredients, pharmacological effects, and therapeutic efficacy

127
Q

4 main sources of pharmacognosy drugs?

A

plants, animals, minerals, and laboratory synthesis

128
Q

Pharmacoeconomics

(2)

A

Study of the economic factors influencing the cost of drug therapy

Cost–benefit analysis

129
Q

TOXICOLOGY

A

Science of poisons and unwanted responses to both drugs and chemicals

130
Q

Clinical toxicology deals specifically

A

Clinical toxicology deals specifically with the care of poisoned patients.

131
Q

Pharmacogenetics

A

The study of the genetic basis for variations in the body’s response to drugs, with a focus on variation related to a single gene

See ethnocultural implications - e.g. G6PD deficiency (drug induced hemolysis)

132
Q

What does pharmacogenomics survey?

A

surveys the entire genome for determinants of drug response

133
Q

Define diarrhea

How many per day?

A

Abnormal passage of stools with increased frequency, fluidity, and weight or with increased stool water excretion

Consists of three or more loose or liquid stools per day

134
Q

Acute diarrhea

Onset
Duration
_________ (can cause?)
resolves without?

A

Sudden onset in a previously healthy person

Lasts from 3 days to 2 weeks

Self-limiting

Resolves without sequelae (aftereffect)

135
Q

Chronic diarrhea

Duration
Associated with?
Symptoms (6)

A

Lasts for more than 3 to 4 weeks

Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness

136
Q

Causes of acute diarrhea (5)

A

bacteria, virus, drug-induced, nutritional factors, protozoa

137
Q

Causes of chronic diarrhea (6)

A

tumours, diabetes, Addison’s disease, hyperthyroidism, IBS, AIDS

138
Q

Goals of diarrhea treatment (4)

A

stopping the stool frequency

alleviates abdominal cramps

Replenish fluids and electrolytes

prevent weight loss and nutritional deficits from malabsorption

139
Q

3 KINDS OF ANTIDIARRHEALS

A

adsorbents

anti motility drugs

Probiotics

140
Q

2 types of anti motility drugs

A

opiates

anticholinergics

141
Q

Probiotics are also known as (2 different names)?

A

intestinal flora modifiers

bacterial replacement drugs

142
Q

Mechanism of actions of Adsorbents

A

Coat the walls of the gastrointestinal tract

Bind to the causative bacteria or toxin, which is then eliminated through the stool

143
Q

Absorbent drugs

1 important to know

A

Bismuth Subsalicylate
(Pepto-Bismol)

Other: activated charcoal, and antilipemic drugs, colestipol and cholestyramine

144
Q

Adsorbents are used for _______ cases

145
Q

Antichollinergis and Opiates are used for?

A

more severe cases

146
Q

Probiotic is used for?

A

antibiotic-induced diarrhea

147
Q

C- diff is not treated with?

A

antidiarrheals/ laxative

148
Q

Bismuth Subsalicylate’s chemical structure

A

a form of acetylsalicylic acid (aspirin)

its a salicylate

149
Q

Bismuth Subsalicylate

Caution in?

A

children and adolescents especially those recovering from chicken pox/ influenza due to the risk of Reye’s syndrome

150
Q

6 Adsorbents: Bismuth Subsalicylate’s adverse effects

A

Increased bleeding time- has salicylate

Constipation, dark stools

Confusion

Tinnitus

Metallic taste

Blue gums or black tongue

151
Q

How do absorbents DECREASE effectiveness of many drugs?

A

by decreasing the absorption of certain drugs

examples: digoxin, quinidine, sulphate, antihyperglycemic drugs

152
Q

Bismuth Subsalicylate when taken with WARFARIN, ASPIRIN, OR OTHER NSAIDS can cause?

IN OA?

A

increased bleeding times and bruising

can cause confusion to OA

153
Q

Adsorbents decrease the ________ of many drugs, including digoxin, quinidine sulphate, and hypoglycemic drugs.

Adsorbents cause increased bleeding time and bruising when given with?

Toxic effects of_______ are more likely when given with adsorbents.

A

absorption of many drugs

anticoagulants

methotrexate

154
Q

Oral anticoagulant, WARFARIN, when given with adsorbents results in?

WHY?

A

increased bleeding time and bruising because adsorbents binds to VITAMIN K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal flora in the bowel.

155
Q

Patients with diarrhea associated with virus/ bacterial infection treatment

Why?

A

do not give antidiarrheals

cause organisms to stay in the body longer and delay recovery

156
Q

2 example of an antimotility drug

A

anticholinergic drugs

opiates

157
Q

Mechanism of action of antimotility drug: ANTIcholinergics drug?

(2) effects and (2) results

A

slow peristalsis by reducing rhythmic contractions and smooth muscle tone of GI tract.

Result: slows the movement of fecal matter through the gastrointestinal tract

drying effect: reduces gastric secretions- constipation (slow GI tract motility)

158
Q

anticholinergic drugs are used in combination with

A

absorbents and opiates

159
Q

2 example of an anticholinergic drug

A

belladonna alkaloids (not used in Canada)

atropine sulfate

160
Q

Anticholinergics Adverse effects

A

Anticholinergics- drying

Urinary retention,

sexual dysfunction

Headache, dizziness, confusion, anxiety, drowsiness

Dry skin, flushing

Blurred vision

Hypotension, bradycardia or tachycardia; think of it as precipitating abnormal cardiac rhythms

161
Q

Antimotility drugs: opiates

(3) mechanism of action

A

decrease bowel motility

reduce pain and relieves rectal spasms

Increases transit time through the bowel, allowing more time for water and electrolytes to be absorbed

162
Q

3 medications under opiates?

A

codeine phosphate

loperamide hydrochloride

diphenoxylate hydrochloride with atropine sulphate

163
Q

Opiates Adverse effects

A

Drowsiness, dizziness, lethargy

Nausea, vomiting, constipation

Respiratory depression

Hypotension

Urinary retention
Flushing

164
Q

Opiates interactions

A

have additive CNS depressant if given with CNS depressant, alcohol, opioids, sedative, muscle relaxant

165
Q

Probiotic mechanism of action 2

A

obtained from bacterial culture

replenish bacteria that help restore the balance of normal flora
and suppress the growth of diarrhea-causing bacteria (by creating an unfavourable environment for the overgrowth of harmful organisms)

166
Q

Probiotics

2 names

2 effects

A

Also known as intestinal flora modifiers and bacterial replacement drugs

Bacterial cultures of Lactobacillus organisms work by

Supplying missing bacteria to the gastrointestinal tract

Suppressing the growth of diarrhea-causing bacteria

167
Q

1 example of probiotic

A

Lactobacillus acidophilus

168
Q

Antidiarrheals Nursing Implications

Obtain (5)

A

Obtain a thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergies.

169
Q

DO NOT GIVE_______ to children or teenagers with chicken pox or influenza because of the risk of Reye’s syndrome. (has salicylate)

A

Bismuth subsalicylate

170
Q

Use adsorbents carefully in (4)

A

older adult patients and those with decreased bleeding time

clotting disorders

recent bowel surgery

or confusion.

171
Q

Do not administer anticholinergics to patients with a history of (5)

A

narrow-angle glaucoma,

gastrointestinal obstruction,

myasthenia gravis,

paralytic ileus,

or toxic megacolon.

172
Q

Teach patients to take medications exactly as _____ and to be aware of their ____intake and ______ changes.

Assess _______, _______ and ______, and ______ _______ before, during, and after initiation of treatment.

A

Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes.

Assess fluid volume status, input and output, and mucous membranes before, during, and after initiation of treatment.

173
Q

Opiates: diphenoxylate hcl with atropine sulfate

acts on?

action 2

can cause?

A

Lomotil- little to no analgesic

opiate agonist

acts on the smooth muscle of the intestinal tract

inhibit GI motility and excessive propulsion

can cause dependency & combine with atropine to discourage recreational use (causes dry mouth, tachycardia, and anticholinergic effects)

174
Q

Opiates: Loperamide hcl

A

binds to opiate receptors in the intestinal wall

inhibit the release of ach and prostaglandin (REDUCES PERISTALSIS AND INCREASE INTESTINAL TRANSIT TIME)

increase the tone of anal sphincter which decreases incontinence and urgency

inhibit peristalsis in the intestinal wall

175
Q

antidiarrheals adverse effects

A

specific to each drug family

most are minor and non life threatening

176
Q

antidiarrheals contraindication

A

allergy, diarrhea cause by bacteria or parasites, major acute GI obstruction such as intestinal obstruction/ colitis

177
Q

antichollinergic effects are decreased when given with>

178
Q

Constipation (4)

A

Abnormally infrequent and difficult passage of feces through the lower gastrointestinal tract

A symptom, not a disease

Disorder of movement through the colon or rectum

Can be caused by a variety of diseases or drugs

179
Q

2 ways to treat constipation

A

sugical

non surgical

180
Q

non-surgical ways to treat constipation

A

Dietary (e.g., fibre supplementation)

Behavioural (e.g., increased physical activity)

Pharmacological- laxatives

181
Q

5 types of laxatives

A

Bulk forming
Emollient (stool softeners, lubricant laxatives)
Hyperosmotic
Saline
Stimulant

182
Q

laxatives

A

treats constipation by increasing fecal movement, affect fecal consistency, facilitate defecation

among misused OTC, laxative dependence, damage to bowel

183
Q

ingestion and defacation span

A

24 to 36 hrs

184
Q

Bulk-forming laxative: mechanism of action

A

High fibre

Absorb water to increase bulk

Distend bowel to initiate reflex bowel activity (promotes BM)

185
Q

1 example of Bulk-forming Laxative

A

psyllium (Metamucil®)

186
Q

Emollient laxative: mechanism of action

A

Stool softeners and lubricants

Promote more water and fat in the stools

Lubricate the fecal material and intestinal walls

187
Q

Emollient laxative 2 examples and actions

A

Stool softeners: docusate salts (Colace®)
[lower surface tension of GI fluids so that more water and fat are absorbed into the stool and intestines]

Lubricants: mineral oil
[lubricate fecal material and intestinal wall, preventing absorption of water from intestines- contents become soft- promotes bowel distention and defecation]

188
Q

Hyperosmotic laxative: mechanism of action

A

Increase fecal water content
Results in bowel distention, increased peristalsis, and evacuation

189
Q

3 examples of Hyperosmotic laxative

A

PEG

GLYCERIN

LACTULOSE

P G L

190
Q

Lactulose can also be used for?

A

also used to reduce elevated serum ammonia levels

191
Q

PEG is used for?

A

used for diagnostic procedures

192
Q

Saline laxative: mechanism of action

A

Increases osmotic pressure within the intestinal tract, causing more water to enter the intestines

Results in bowel distention, promotes peristalsis, and evacuation

193
Q

2 examples of saline laxative

A

Magnesium hydroxide (Milk of Magnesia®)

Magnesium citrate

S M (Saline Mg)

194
Q

Stimulant laxative: mechanism of action

A

stimulate nerves that innervate intestines

Increase peristalsis via intestinal nerve stimulation

195
Q

stimulant laxative 2 examples

A

senna (Senokot®)
bisacodyl (Dulcolax®)

196
Q

Peripherally Acting Opioid Antagonists

A

Treatment of constipation related to opioid use and bowel resection therapy

Block entrance of opioid into bowel

Yet to be approved by Health Canada; accessible through the Special Access Programme in some jurisdictions

Allow bowel to function normally with continued opioid use

197
Q

Bulk forming laxative: INDICATION (4)

A

Acute and chronicconstipation, IBS, diverticulosis

198
Q

Emollient laxative: INDICATION (4)

A

Acute and chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions

199
Q

Hyperosmotic laxative: INDICATION (3)

A

Chronic constipation,
diagnostic and surgical procedures

200
Q

Saline laxative: INDICATION

A

Constipation, diagnostic and surgical procedures

201
Q

Stimulant laxative: INDICATION (3)

A

Acute constipation, diagnostic and surgical procedures

202
Q

BULK FORMING adverse effects

A

Impaction
Fluid overload
Electrolyte imbalances
Gas formation
Esophageal blockage
Allergic reaction

203
Q

Emollient adverse effect

A

Skin rashes
Decreased absorption of vitamins
Electrolyte imbalances
Lipid pneumonia

204
Q

Hyperosmotic adverse effects

A

Abdominal bloating
Electrolyte imbalances
Rectal irritation
can cause dehydration to OA

205
Q

Saline adverse effects

A

Magnesium toxicity (with renal insufficiency)
Electrolyte imbalances
Cramping,
diarrhea
Increased thirst

206
Q

Senna (stimulant) medication timing consideration

A

Senna is taken an hour differently from other meds- because it lessens absorption

207
Q

Stimulant adverse effects

A

Nutrient malabsorption
Skin rashes
Gastric irritation
Electrolyte imbalances
Discoloured urine
Rectal irritation

208
Q

What adverse effects do all laxative share in common is?

A

All laxatives can cause electrolyte imbalances!

209
Q

Laxatives: Obtain a thorough history of (3)?

A

presenting symptoms, elimination patterns, and allergies.

210
Q

Laxatives: assess _____ and _____ before initating therapy

Inform patients not to take a _______ or ______ if they are experiencing nausea, vomiting, or abdominal pain.

A

Assess fluid and electrolytes before initiating therapy.

Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, or abdominal pain

211
Q

A healthy, high-fibre diet and increased fluid intake should be encouraged as an _______ to laxative use.

Long-term use of laxatives often results in decreased________ and may lead to _________.

All laxative tablets should be swallowed whole, not _____ or _____, especially if enteric-coated.

A

A healthy, high-fibre diet and increased fluid intake should be encouraged as an alternative to laxative use.

Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.

All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated.

212
Q

Patients should take all laxative TABLETS with ___ to ____ ML of water

Take BULK FORMING laxatives with at least _____mL (___ oz) of water.

A

180 to 240 mL of water

At least 240 mL (8 oz) of water

213
Q

Give ______ with water on an empty stomach because of interactions with milk, antacids, and juices.

Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible ____ or _____ loss.

Monitor for _____ effect.

A

bisacodyl

fluid/ electrolyte loss

therapuetic

214
Q

IBS

characterized by?

How do patients cope 2

A

Chronic intestinal discomfort characterized by cramps, diarrhea, or constipation

Patients usually cope with the symptoms by avoiding irritating foods or by taking over-the-counter laxatives and antidiarrheal drugs.

215
Q

Caution laxative use in pt with..

A

surgical abd
appendicitis
abd pain
N and V
fecal impaction
intestinal obstuction
weight loss aid
eating disorder

216
Q

Bulk-forming interactions (psyllium)

A

decrease absorption of abx, digoxin, warfarin, salicylate, tetracycline

217
Q

Mineral oil (emollient) interactions

A

decraese absorption of fat solluble vitamins (A, D, E, K)

218
Q

Hyperosmotic (PEG, Glycerin, Lactulose) interactions

A

increase CNS depression if given opioids, barbiturates, anesthetic, antipsychotic

219
Q

Stimulant (senna, bisacodyl) interactions

A

decrease absorption of abx, digoxin, nitro, salicylate, anticoagulant

220
Q

Bulk forming

Psyllium

used _____

action

needs to be taken with _____

contraindicated:

A

used long term (OTC)

increases water absorption, increasing the total volume of intestinal contents

produces normal stools

needs to be taken with lots of water

contraincated: intestinal obstruction, fecal impaction, abd pain, N&V

221
Q

Emollient

Docusate sodium (colace)- softeners
Mineral oil- lubricant

A

fecal softeners/ lubricate stools

softeners- lower surface tension of fluids- allow water and fat to be absorbed into the stool and intestines (do not cause defecation- helps with ease of passage)

lubricants- prevent water loss from intestines/ stools
- soften and expand stool

Oral/ enema lubricants not recommended due to aspiration

contraindicated- intestinal obstruction, abd pain, N&V

222
Q

Hyperosmotic laxatives action

PEG
Glycerin
Lactulose

A

increase the water content of feces- distention, peristalsis, evacuation

223
Q

gylcerin

A

Gylcerin- promote BM- increase osmotic pressure in the intestines- draw fluid into colon (used in children- mild effect)

224
Q

lactulose

metabolized in?

the ______ environment that draws water into the colon

reduces?

contraindicated in pt with ______ diet

A

metabolized in the large intestine

the hyperosmotic environment that draws water into the colon

reduces blood ammonia

contraindicated in pt with galactose diet

225
Q

PEG

A

used for diagnostic tests

potent- total cleansing

contraindicated- GI obstruction, gastric retention, bowel perforation, toxic colitis

226
Q

Saline laxative

Magnesium hydroxide action and produces?

A

increase osmotic pressure and draw water into the colon producing watery stool

227
Q

Magnesium hydroxide

used in ______ procedure

caution in pt with

A

unpleasant OTC

used in an endoscopic procedure

caution in pt with kidney insufficiency- causes increased MG

contraindicated- kidney disease, obstruction

228
Q

stimulant

Senna
Bisacodyl

induce _____ in entire _______

can cause ______

A

Induce peristalsis

entire GI tract

can cause dependence

229
Q

Bisacodyl

_______ used

bowel prep for ______ exam

A

OTC

commonly used

bowel prep for endoscopic exam

230
Q

Senna

______ used

____ constipation/ bowel prep for surgery/ exam

may cause abd pain

produce bowel evacuation _ to ___ hrs

A

OTC

commonly used

acute constipation/ bowel prep for surgery/ exam

may cause abd pain

produce bowel evacuation 6 to 12 hrs

STUDY CARDS (17 decks)

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