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Pharm > Pharm exam 4 > Flashcards

Pharm exam 4 Flashcards

1
Q

Men’s Health (4)

A

-testosterone is the primary male hormone
-Androgens (male hormones, primarily testosterone)
-seminiferous tubules: site of spermatogenesis
-testes: produce male sex hormones

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2
Q

Testosterone (5)

A

-Responsible for normal development and maintenance of primary and secondary male sex characteristics
-Development of bone and muscle tissue
-Inhibition of protein catabolism (metabolic breakdown)
-Retention of various electrolytes
-Stimulates the production of blood cells

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3
Q

anabolic steroids (6)

A

-synthetic derivatives of testosterone
-anabolic= synthesis of tissue and increasing tissue formation
-Schedule III, great potential for misuse
-approved indications
-adjunctive tx to promote weight gain after extensive surgery, trauma, chronic diseases, anemia, hereditary angioedema, metastatic breast cancer
-side effects:
-sterility, CV disease, liver cancer, psychological and physical dependence

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4
Q

finasteride (androgen inhibitors) indications (2)

A

-BPH
-male pattern baldness

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5
Q

finasteride (androgen inhibitors) MOA (2)

A

-block effects of natural (endogenous) androgens
-inhibits 5-alpha reductase

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6
Q

finasteride (androgen inhibitors) side effects (10)

A

-teratogenic: pregnant/possibly pregnant women should not touch
-decrease BP
-increased risk of high-grade prostate cancer
-may cause ED during or after tx
-loss of libido
-hypersensitivity
-gynecomastia
-severe myopathy
-50% decrease in PSA
-ejaculatory dysfx

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7
Q

finasteride (androgen inhibitors) nursing (9)

A

-teratogenic; women must wear gloves to handle/ administer
-therapeutic fx may take up to 6 mos. To manifest
-digital rectal exams should be done prior to and during tx
-assess s/s of BPH (problems with urination)
-administration with or without food
-teach:
-may cause ED during or after tx
-increased risk of prostate cancer
-Obtain baseline vital signs, weight, height, and serum electrolyte levels.
-Assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications.
-Assess PSA level and perform digital rectal examination before beginning any drugs for treatment of prostate disease
-Assess current medications for potential interactions.

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8
Q

oxybutynin class

A

anticholinergic aka cholinergic-blocking drugs, parasympatholytics, and antimuscarinic drugs

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9
Q

finasteride class

A

androgen inhibitor

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10
Q

oxybutynin indications (5)a

A

-frequent urination
-urgency
-nocturia
-urge incontinence
-overactive bladder

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11
Q

oxybutynin (anticholinergic) MOA (3)

A

-blocks / inhibits the actions of acetylcholine (ACh) in the parasympathetic nervous system (PNS)
-When these drugs bind to receptors, they inhibit nerve transmission at these receptors
-this stops spasms in GU tract

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12
Q

oxybutynin (anticholinergic) side effects (6)

A

-dry mouth
-nausea
-urinary retention
-dizziness
-drowsiness
-constipation

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13
Q

oxybutynin (anticholinergic) nursing–12

A

-Obtain baseline vital signs, weight, height, and serum electrolyte levels.
-Assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications.
-Assess current medications for potential interactions.
-monitor I/O
-take IR tabs on empty stomach
-take XL tabs regardless of meals
-do not take with alcohol or other CNS depressants
-antidote: physostigmine
-pts. may be hypersensitive to light
-increase fluids, chew gum, frequent mouthcare for dry mouth
-increased risk of heat stroke, pts should avoid physical exertion and heat
-teach to increase fluids and salt intake

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14
Q

oxybutynin (anticholinergic) contraindications –6

A

-allergy
-angle-closure glaucoma
-acute asthma or other respiratory distress
-myasthenia gravis
-acute cardiovascular instability
-GI or GU tract obstruction (including BPH)

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15
Q

phenazopyridine class

A

urinary analgesic

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16
Q

phenazopyridine (urinary analgesic) indications–2

A

-pain, itching, burning, urinary frequency or urgency associated with UTI or procedure
-given with antibiotic to fight infection

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17
Q

phenazopyridine (urinary analgesic) MOA–2

A
  • inhibits nerve fibers in the bladder that respond to mechanical stimuli
    -hinders kinases responsible for cell growth, metabolism, and nociception
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18
Q

phenazopyridine (urinary analgesic) side effects

A

-bright reddish orange urine

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19
Q

phenazopyridine (urinary analgesic) nursing –6

A

-Obtain baseline vital signs, weight, height, and serum electrolyte levels.
-Assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications.
-Assess current medications for potential interactions
-OTC
-teach pt. to stop taking when sx relieved (finish antibiotics though)
-urine will be reddish orange
-notify HCP if rash, skin discoloration, unusual tiredness

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20
Q

testosterone class

A

hormone

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21
Q

testosterone (hormone) actions —3

A

-Responsible for:
- normal development and maintenance of primary and secondary male sex characteristics
-Inhibition of protein catabolism (metabolic breakdown)
-Retention of various electrolytes

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22
Q

testosterone (hormone) MOA–5

A

-Anabolic activity: synthesis of tissue and increasing tissue formation
-Stimulates the production of blood cells (Enhanced erythropoiesis)
-Stimulate increased synthesis of body proteins, aiding in the formation of muscular and skeletal proteins
-Stimulate normal growth and development of the male sex organs
-Development and maintenance of male secondary sex characteristics

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23
Q

testosterone (hormone) side effects–3

A

-fluid retention
-DVT, PE
-heart attack

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24
Q

testosterone (hormone) nursing –10

A

-Long-term dosage forms can last from 2 to 3 days to 2 to 4 weeks
-Oral forms have a high first-pass effect.
(Methyltestosterone,
Fluoxymesterone)
-transdermal forms available (patches, gels)
-Obtain baseline vital signs, weight, height, and serum electrolyte levels.
-Assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications.
-Assess PSA level and perform digital rectal examination before beginning any drugs for treatment of prostate disease
-Assess current medications for potential interactions.
-Transdermal Testoderm patches are applied to the scrotal skin.
-Transdermal Androderm patches are applied to the skin on the body, never to scrotal skin
-Follow exact instructions for sublingual, buccal, and oral forms

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25
Q

zolpidem class

A

hypnotic

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26
Q

zolpidem (hypnotic) indications–2

A

-difficulty initiating sleep
-Many side effects, to be used for short term treatment

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27
Q

zolpidem (hypnotic) MOA

A

depress CNS by binding to GABA receptors

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28
Q

zolpidem (hypnotic) side effects –3

A

-may perform tasks while asleep
-daytime drowsiness
-dizziness

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29
Q

zolpidem (hypnotic) nursing–6

A

-May perform tasks ”while asleep”. You need 7-8 hours of sleep when you start this medication.
-Withdrawals are possible when you stop abruptly
-Do not drink alcohol while using
-reduce external stimuli before taking
-take at bedtime and go to bed immediately after taking
-assess:
-sleep pattern
-potential for
abuse

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30
Q

melatonin class–2

A

hormone, supplement

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31
Q

melatonin (hormone/supplement) indications

A

difficulty initiating sleep

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32
Q

melatonin (hormone/supplement) MOA

A

hormone involved in sleep/wake cycle

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33
Q

melatonin (hormone/supplement) side effects–4

A

-headache
-daytime drowsiness
-dizziness
-nausea

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34
Q

melatonin (hormone/supplement) nursing –5

A

-teach:
-don’t drive or use heavy machinery <5hrs after taking
-talk to HCP before taking
-short-term use only
-try to improve sleep routine before taking
-take @bedtime

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35
Q

ondansetron class

A

serotonin antagonist

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36
Q

Ondansetron (serotonin antagonist) indications

A

n/v (including induced by pregnancy, chemo, radiation, or anaesthesia)

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37
Q

Ondansetron (serotonin antagonist) MOA

A

Block serotonin receptors in the GI tract, CTZ, and VC

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38
Q

Ondansetron (serotonin antagonist) side effects–4

A

-h/a
-diarrhea
-dizziness
-dysrhythmia (widened QT
interval)

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39
Q

Ondansetron (serotonin antagonist) nursing–9

A

-Can be given PO, IM or IV
-Watch for widened QT interval
-No significant drug interactions
-caution with clients that have electrolyte imbalances
-May place on cardiac monitor to watch for dysrhythmia
-Also monitor for
-h/a
-diarrhea
-dizziness
-serotonin syndrome (high BP, tachycardia, fever, sweating, dilated pupils, diarrhea, seizures, extensive muscle breakdown)

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40
Q

prochlorperazine class

A

anti-emetic

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41
Q

Prochlorperazine (anti-emetic) indications

A

-n/v related surgery, cancer, chemotherapy, toxins

-also used for psychotic d/o, intractable hiccups

-can be used in children

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42
Q

Prochlorperazine (anti-emetic) MOA

A

Block dopamine receptors in the CTZ

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43
Q

Prochlorperazine (anti-emetic) side effects–5

A

-Extrapyramidal reactions
-Anticholinergic effects
-Hypotension
-sedation
-Contraindicated if seizure, coma, encephalopathy, bone marrow suppression

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44
Q

Prochlorperazine (anti-emetic) nursing–6

A

-available as oral, rectal, and injection
-Cautious assessment for dehydration
-Monitor for extrapyramidal reactions
-Monitor for anticholinergic symptoms
-Monitor for ↓BP & sedation
-Monitor for orthostatic hypotension & safety

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45
Q

Meclizine hydrochloride class

A

anti-emetic, antihistamine

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46
Q

Meclizine hydrochloride (anti-emetic, antihistamine) indications –5

A

-n/v
-motion sickness
-nonprroductive cough
-allergy sx
-sedation

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47
Q

Meclizine hydrochloride (anti-emetic, antihistamine) MOA

A
  • Prevents nausea and vomiting by reducing the activity of the center in the brain that controls nausea
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48
Q

Meclizine hydrochloride (anti-emetic, antihistamine) side effects–8

A
  • Drowsiness
    -Fatigue
    -Headache
    -Blurred vision
    -Dry Mouth
    -Constipation
    -Urinary retention
    -Contraindicated if shock, liver disease, or lactation
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49
Q

Meclizine hydrochloride (anti-emetic, antihistamine) nursing except monitoring

A

-PO
- Be cautious with using if history of closed angle glaucoma
- May increase risk for dementia
- Teach to take before motion sickness occurs
-Safety

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50
Q

Meclizine hydrochloride (anti-emetic, antihistamine) nursing monitoring–7

A

-hypotension
-headache
-fatigue
-blurred vision
-dry mouth
-constipation
-urinary retention

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51
Q

metoclopramide class

A

dopamine antagonist / prokinetic agent

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52
Q

Metoclopramide (dopamine antagonist / prokinetic agent) indications

A

-GERD
-delayed gastric emptying

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53
Q

Metoclopramide (dopamine antagonist / prokinetic agent) MOA–2

A

-Block dopamine receptors in the CTZ, cause CTZ to be desensitized to impulses it receives from the gastrointestinal (GI) tract

-Also stimulates peristalsis in GI tract, enhancing emptying of stomach contents

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54
Q

Metoclopramide (dopamine antagonist / prokinetic agent) side effects–9

A

-Tardive dyskinesia
-drowsiness
-headache
-dizziness
-trouble sleeping
-agitation
-bradycardia
-hypotension
-Contraindicated if seizure disorder, bowel obstruction, perforation of bowel, ETOH, procainamide

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55
Q

Metoclopramide (dopamine antagonist / prokinetic agent) nursing

A

PO or IV
-Severe adverse effects if not used correctly
-Long-term use may cause irreversible tardive dyskinesia
-Monitor for s/s seizure
-Monitor for bowel function
-Monitor for tardive dyskinesia (may be permanent)
-Monitor BP and heart rate
-Monitor for headache, drowsiness, agitation and trouble sleeping

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56
Q

dimenhydrinate class (2)

A

antihistamine / anticholineregic

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57
Q

dimenhydrinate (antihistamine / anticholineregic) indication—1

A

suppression of motion sickness

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58
Q

dimenhydrinate (antihistamine / anticholineregic) MOA

A

Blocks receptors for acetylcholine in addition to receptors for histamines

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59
Q

dimenhydrinate (antihistamine / anticholineregic) side effects–5

A
  • Constipation
    -Sedation
    -Urinary retention
    -dry mouth
    -blurred vision
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60
Q

dimenhydrinate (antihistamine / anticholineregic) nursing –3

A
  • Available OTC, usually oral
  • Monitor for adverse effects and teach patient same
    -Avoid use w/CNS depressants
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61
Q

scopolamine class

A

antihistamine

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62
Q

scopolamine (antihistamine) indications–3

A

-motion sickness
-post-op n/v
-anticholinergic effects at end of life

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63
Q

scopolamine (antihistamine) MOA –2

A
  • Bind to and block ACh receptors in the inner ear labyrinth, Block transmission of nauseating stimuli to CTZ
  • Block transmission of nauseating stimuli from the reticular formation to the VC
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64
Q

scopolamine (antihistamine) side effects–6

A
  • Dry mouth
    -Blurred vision
    -Drowsiness
    -Urinary retention
    -Constipation
    -Disorientation
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65
Q

scopolamine (antihistamine)
nursing excluding monitoring and precautions

A
  • Available in oral, subcutaneous and transdermal form
  • Most common = 72-hour transdermal patch, releases 1 mg
    -contradicted if glaucoma
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66
Q

scopolamine (antihistamine) nursing monitoring (2) and precautions (5)

A
  • Monitor for:
    -Safety
    -Closed angle glaucoma
  • Precautions:
    -Renal & liver impairment
    -slow gastric motility
    -seizures
    -urinary retention
    -psychosis
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67
Q

antiemetics assessment–3 / monitoring–2

A
  • Assess complete nausea and vomiting history, including precipitating factors -Assess current medications, include OTC (ginger)
    -Assess for contraindications and potential drug interactions
  • Monitor for therapeutic effects
  • Monitor for adverse effects
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68
Q

anti-emetics teaching–5

A

-Many of these drugs cause severe drowsiness -Warn patients about driving or performing any hazardous tasks
- Taking antiemetics with alcohol may cause severe CNS depression - Teach patients to change positions slowly to avoid hypotensive effects - For chemotherapy, antiemetics are often given 30 to 60 minutes before chemotherapy begins

69
Q

BPH s/s–5

A

-urinary hesitancy
-urinary urgency
-increased frequency of urination
-dysuria
-nocturia

70
Q

BPH tx–3

A

-surgery
-watchful waiting
-drug tx

71
Q

classes of drugs for BPH (2)

A

-5-alpha-reductase inhibitors (finasteride)
-Alpha1-adrenergic antagonist (blocks alpha 1 receptors, relaxing smooth muscle in bladder neck)
-decreases blood pressure

72
Q

3 types of cells in stomach glands

A

-parietal
-chief
-mucous

73
Q

PUD def:

A

upper GI d/o caused by imbalance between mucosal and aggressive factors

74
Q

PUD aggressive factors –5

A

-H. pylori
-NSAIDs
-acid
-pepsin
-smoking

75
Q

PUD defensive (mucosal) factors –4

A

-mucus
-bicarbonate
-blood flow
-prostaglandins

76
Q

GI cells that secrete prostaglandins

A

parietal cells

77
Q

what produces HCL when stimulated

A

proton pump

78
Q

PUD serious complications

A

-hemorrhage
-perforation

79
Q

PUD tx

A

-alleviate sx
-promote healing
-prevent complications
-prevent recurrence
-drugs create conditions for healing, do not cure themselves

80
Q

classes of drugs for PUD tx and desired effects

A

-antibiotics: eradicate H.pylori
-anti-secretory agents (H2 receptor antagonists or PPI): reduce gastric acidity
-mucosal protectants: enhance mucosal defenses
-anti-secretory agents that enhance mucosal defenses
-antacids: reduce gastric acidity

81
Q

antibiotics for ulcers H. pylori

A

-eradication rates are good for 10-day course, slightly better if 14 day
-at least 2 antibiotics prescribed at once (up to 3) to reduce risk of resistance developing
-ex: metronidazole, tetracycline
-usually given with bismuth subsalicylate

82
Q

bismuth subsalicylate (pepto Bismol) MOA

A

-lyses H.pylori by disrupting it’s cell wall, lysing it
- May inhibit urease activity and may prevent H. pylori from adhering to the gastric surface

83
Q

bismuth subsalicylate (pepto Bismol) indication–2

A

-acid reflux
-n/v/d

84
Q
  • bismuth subsalicylate (pepto Bismol) side effects
A

-long term tx:
- Possible risk of neurologic injury
- risk for Reye’s syndrome in children

85
Q

bismuth subsalicylate (pepto Bismol) nursing

A

-OTC
-stool and tongue may turn black

86
Q

Famotidine class

A

(Histamine 2 (H2) receptor antagonists)

87
Q

Famotidine (Histamine 2 (H2) receptor antagonists) indications –5

A
  • Short-term treatment of gastric/duodenal ulcers
  • Prophylaxis of recurrent duodenal ulcers
  • Treatment of Zollinger-Ellison syndrome and hypersecretory states
  • Treatment of GERD
  • Over-the-counter (OTC): Treatment of heartburn, acid indigestion, sour stomach
88
Q

Famotidine (Histamine 2 (H2) receptor antagonists) MOA–3

A
  • block H2 receptors on parietal cells of stomach lining
  • Increase in pH of stomach
  • Promote healing by suppressing secretion of gastric acid
89
Q

Famotidine (Histamine 2 (H2) receptor antagonists) side effects –4

A
  • Serious side effects are uncommon
  • Possible increased risk for pneumonia caused by elevation of pH
  • CNS effects in elderly patients include confusion and disorientation – use cautiously
  • Thrombocytopenia – monitor for
90
Q

Famotidine (Histamine 2 (H2) receptor antagonists) nursing–2

A
  • Do not administer with antacids – space 1 to 2 hours apart
    -oral or IV
91
Q

omeprazole class

A

Proton Pump Inhibitor (PPI)

92
Q

omeprazole (proton pump inhibitors (PPIs)) MOA

A
  • Inhibits gastric secretion
92
Q

omeprazole (proton pump inhibitors (PPIs)) indications

A
  • GERD, erosive esophagitis, short-term treatment of active duodenal and benign gastric ulcers
  • Zollinger-Ellison syndrome
  • NSAID induced ulcers
  • Stress ulcer prophylaxis
  • H. pylori–induced ulcers (Given with an antibiotic)
93
Q

omeprazole (proton pump inhibitors (PPIs)) side effects–10

A

-well tolerated for short-term
- Rebound acid hypersecretion
-Vitamin B12 insufficiency
-Pneumonia
-Headache
-GI effects
-Fractures
-Hypomagnesemia
-C. difficile infection
-Gastric cancer

94
Q

omeprazole (proton pump inhibitors (PPIs)) interactions –5

A
  • ↑ levels of diazepam and phenytoin
    -↑ chance of bleeding w/warfarin
    -Can ↓effect of clopidogrel
    -Sucralfate may delay the absorption
    -Food may ↓ absorption
95
Q

sucralfate (mucosal barrier fortifier) indications–3

A
  • Peptic ulcers
    -Stress ulcers
    -maintenance therapy
96
Q

sucralfate (mucosal barrier fortifier) MOA–2

A
  • Creates a protective barrier against acid and pepsin for up to 6 hours
  • Little absorption from the gut
97
Q

sucralfate (mucosal barrier fortifier) side effects–3

A
  • Constipation
    -nausea
    -dry mouth
98
Q

sucralfate (mucosal barrier fortifier) nursing–2

A
  • Administered 4x/day oral
  • Given on empty stomach, 1 hour before meals/bedtime
99
Q

sucralfate (mucosal barrier fortifier) interactions–4

A

May impair absorption of other drugs - Do not give with other medications
-Give other drugs at least 2 hours before sucralfate
-Antacids may interfere with effects of sucralfate
-binds with phosphate

100
Q

misoprostol class

A

Prostaglandin E analog

101
Q

misoprostol (prostaglandin E analog) indications

A
  • Only approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy
102
Q

Misoprostol (prostaglandin E analog) MOA

A
  • Prevents NSAID-induced ulcers by serving as a replacement for endogenous prostaglandins
103
Q

misoprostol (prostaglandin E analog) side effects

A

-teratogenic
- Most common:
-Dose-related diarrhea
-h/a
-abdominal pain
-vaginal bleeding

104
Q

misoprostol (prostaglandin E analog) nursing

A
  • Administered oral 4x/day w/meals
    -assess pt. for possible pregnancy
    – Antacids may reduce absorption
  • Contraindicated:
    -If allergy
    -During pregnancy: Category X
105
Q

-antacids MOA–4

A

-React with gastric acid to produce neutral salts or salts of low acidity
-Reduce destruction of gut wall by neutralizing acid
-May also enhance mucosal protection by stimulating production of prostaglandins
-Except for sodium bicarbonate, antacids do not alter systemic pH

106
Q

antacids side effects

A
  • Aluminum hydroxide: Constipation
    -Magnesium hydroxide: sodium loading
107
Q

-antacids nursing except cautions and contraindications–5

A

-Assess for allergies and conditions that may restrict the use of antacids, such as:
-Fluid imbalances, renal disease,
HF
-GI obstruction, pregnancy
-Give meds 1 to 2 hours after an
antacid
-Ensure chewable tablets are chewed thoroughly and liquid forms are shaken well before giving
-Give w/ 8 oz of water to enhance absorption (except for “rapid-dissolve” forms)
-Monitor for adverse effects, effects from long term use, and therapeutic effect

108
Q

antacids precaution (1) and contraindications (4)

A

-Contraindications:
-allergy
-renal failure
-GI obstruction
-electrolyte
imbalance
Caution: renal impairment

109
Q

antacids drug interactions

A

-caution: interferes with the body’s absorption of other drugs
-Chelation: chemical binding, or inactivation, of another drug
-produces insoluble complexes resulting in decreased drug absorption
-Cimetidine
-Ranitidine
-Sucralfate
-tetracyclines
-warfarin
-digoxin
-causes increased stomach pH which:
-increases absorption of basic
drugs
-decreases absorption of acidic
drugs
-causes increased pH of urine,
which:
-increases excretion of
acidic drugs
-decreases excretion of
basic drugs

110
Q

treatment of constipation

A

-surgical
-nonsurgical treatments
-dietary (adequate
fiber intake)
-behavioral/lifestyle
(exercise)
-pharmacologic

111
Q

pharmacologic tx of constipation (5)

A

-bulk forming
-stimulant
-hyperosmotic
-saline
-emollient

112
Q

constipation med MOAs –4

A

-Effect on stool consistency
-Increased movement of stools through the colon
-Increased # of stools through the colon
-Amount/timing of bowel movements via rectum

113
Q

laxative indications–8

A

-Promote BM (constipation, bedrest, pregnancy, pain medications)
-Prevent obstruction
-Soften stool, reduce painful BM
-Prevent straining (cardiac patients, ↑ICP)
-Loss of perianal/abdominal muscle tone (older adults, stroke)
-Obtain stool sample
-Remove parasites, toxic substances, ammonia
-Empty bowel before a procedure or surgery

114
Q

laxative nursing–5

A
  • Obtain a thorough history of symptoms, elimination patterns, and allergies
  • Assess fluid and electrolytes, vs, BS before initiating therapy
  • Teach patients not to take laxative if N/V or abdominal pain
  • Encourage fluids and fiber in diet
  • Teach patients that long term use of laxatives can reduce bowel tone, lead to dependency/abuse
115
Q

psyllium class

A

bulk forming agent

116
Q

Psyllium (bulk forming agents) indication–3

A

-IBS
-diverticulosis
-constipation

117
Q

Psyllium (bulk forming agents) MOA

A

-Absorb water into intestine to increase bulk and distend bowel to initiate reflex bowel activity = BM

118
Q

Psyllium (bulk forming agents) side effects–4

A

-Few systemic effects because not systemically absorbed
-Gas
-allergic reaction
-electrolyte imbalance

119
Q

Psyllium (bulk forming agents) nursing–4

A

-Contraindicated if obstruction, fecal impaction, N/V, abdominal pain
-OTC; Safe for long term use
-Oral dosing, powder, wafer
-Usually works in 1-3 days (teach)

120
Q

Bisacodyl class

A

stimulant laxatives

121
Q

Bisacodyl (stimulant laxatives) indication–1

A

constipation

122
Q

Bisacodyl (stimulant laxatives) MOA–1

A
  • Increases peristalsis via intestinal nerve stimulation
123
Q

Bisacodyl (stimulant laxatives) side effects

A
  • Nutrient malabsorption,
    -skin rashes
  • GI irritation
    -electrolyte imbalances (↓K)
    -discolored urine
    -rectal irritation
  • Prolonged use – proctitis of rectum
124
Q
  • Bisacodyl (stimulant laxatives) nursing–7
A
  • Available as oral tablet, rectal suppository
  • Most likely type to cause dependence
  • Available OTC
  • Usually works in 6 – 12 hours (rectal suppository is 15 min – 1 hr)
  • Produces semi-fluid stool
  • Used for bowel prep before procedures, surgery
  • Assess for abuse potential
125
Q

senna class

A

stimulant laxative

126
Q

Senna (stimulant laxatives) indications–2

A

-constipation
-bowel prep

127
Q

Senna (stimulant laxatives) MOA–1

A
  • Increases peristalsis via intestinal nerve stimulation
128
Q

Senna (stimulant laxatives) side effects–7

A
  • Nutrient malabsorption
    -skin rashes
  • GI irritation
    -electrolyte imbalances (↓K)
    -discolored urine
    -rectal irritation
  • Prolonged use – proctitis of rectum
129
Q

Senna (stimulant laxatives) nursing–7

A
  • Available as oral tablet, rectal suppository
  • Most likely type to cause dependence
  • Available OTC
  • Usually works in 6 – 12 hours (rectal suppository is 15 min – 1 hr)
  • Produces semi-fluid stool
  • Used for bowel prep before procedures, surgery
  • Assess for abuse potential
130
Q

lactulose class

A

osmotic laxative

131
Q

lactulose (osmotic laxatives) indications–3

A

-Constipation
-bowel prep
-hepatic encephalopathy

132
Q

lactulose (osmotic laxatives) MOA

A

-Uses osmosis to draw water into intestine to soften and ↑ mass of stool, stretching musculature, which results in peristalsis
-↓ serum ammonia by converting to ammonium and excreting

133
Q

lactulose (osmotic laxatives) side effects–4

A

-Bloating
-rectal irritation
-electrolyte imbalance
-abdominal pain

134
Q

lactulose (osmotic laxatives) nursing–7

A

-Available oral and rectal
-Onset is 24 hours
-Contraindicated if low lactose diet
-caution in older patients
-administer with juice, water to increase palatability
-Normal oral dose color is orange
-Monitor electrolytes with extended use

135
Q

Polyethylene glycol class

A

osmotic laxative

136
Q

Polyethylene glycol (osmotic laxatives) indications–2

A

-Bowel prep
-constipation

137
Q

Polyethylene glycol (osmotic laxatives) MOA

A

-Uses osmosis to draw water into intestine to soften and increase mass of stool, results in peristalsis

138
Q

Polyethylene glycol (osmotic laxatives) side effects –6

A

-Abdominal cramping
-bloating
-flatulence
-dehydration
-electrolyte imbalance
-rectal irritation

139
Q

Polyethylene glycol (osmotic laxatives) nursing (minus contraindications) –5

A

-Can be used daily, as needed
-onset 4+ hrs.
-Monitor electrolytes, safety
-encourage fluids
-administer with flavored drinks

140
Q

Polyethylene glycol (osmotic laxatives) contraindications–4

A

-GI obstruction
-gastric retention
-bowel perforation
-ileus

141
Q

Milk of Magnesia and Magnesium Citrate class

A

osmotic laxatives

142
Q

Milk of Magnesia and Magnesium Citrate (osmotic laxatives) indications–2

A

-rapidly evacuate bowel for endoscopy
-remove unabsorbed poisons from GI tract

143
Q

Milk of Magnesia and Magnesium Citrate (osmotic laxatives) MOA

A

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

144
Q

Milk of Magnesia and Magnesium Citrate (osmotic laxatives) side effects

A

-dehydration
-fluid deficits

145
Q

Milk of Magnesia and Magnesium Citrate (osmotic laxatives) nursing–6

A
  • MOM: Available oral, liquid or tablet, OTC; Has unpleasant taste
  • Use with caution in renal insufficiency
  • Contraindicated if renal failure, abdominal pain, N/V, obstruction, rectal bleeding
  • Monitor for dehydration, fluids
  • Use with caution in older adults
  • Safety is priority
146
Q

Docusate sodium class

A

emollient laxative

147
Q

Docusate sodium (emollient laxatives) indications–4

A
  • Constipation
    -fecal impaction
    -facilitate BM
    -prevent opioid-induced constipation
148
Q

Docusate sodium (emollient laxatives) MOA

A
  • Acts as fecal softener by lowering surface tension of stool to allow penetration of water
149
Q

Docusate sodium (emollient laxatives) side effects–5

A
  • Rashes
    -decreased absorption of vitamins
    -electrolyte imbalances
    -abdominal cramping
    -abdominal pain
150
Q

Docusate sodium (emollient laxatives) nursing–4

A
  • Available OTC, oral dosing
  • Onset is 1 -3 days
  • Produces soft stool
  • Monitor for Intestinal obstruction, fecal impaction, N/V
151
Q

acute vs chronic diarrhea

A

acute: 3 -14 days
chronic: 3-4 weeks

152
Q

chronic diarrhea causes–6

A
  • Tumors
    -Diabetes mellitus
    -Addison’s disease
    -Hyperthyroidism
    -Irritable bowel syndrome
    -AIDS
153
Q

diarrhea tx MOAs–4

A
  • Stopping the stool frequency
    -Alleviating the abdominal cramps
    -Replenishing fluids and electrolytes
    -Preventing weight loss and nutritional deficits from malabsorption
154
Q

all antidiarrheal nursing considerations—4

A

-Obtain history of bowel patterns, general state of health, and recent history of illness or dietary changes
-Assess fluid volume status, I&O, vs, labs, and mucous membranes before, during, and after treatment
-Teach patients signs and symptoms to report
-Teach patients to take as prescribed and to monitor fluid /dietary intake

155
Q

loperamide class

A

anti-diarrheal agent

156
Q

Loperamide (anti-diarrheal agent) MOA–1

A

Inhibits peristalsis in the intestinal wall and intestinal secretion, decreasing number of stools and water content

157
Q

Loperamide (anti-diarrheal agent) side effect–1

A

none at directed dosage (black box warning for higher dosage causing serious heart problems)

158
Q

Loperamide (anti-diarrheal agent) nursing

A
  • Available OTC, oral
  • Contraindicated:
    -severe ulcerative colitis
    -pseudomembranous colitis
    -diarrhea associated with E coli
159
Q

Diphenoxylate/atropine class

A

anti-diarrheal agent

160
Q

Diphenoxylate/atropine (anti-diarrheal agent) MOA–1

A

-Activate opioid receptors in GI tract, inhibits GI motility & peristalsis → Allows more time for absorption of water and electrolytes → Stool becomes more formed, volume is ↓, and frequency of stool is ↓

161
Q

Diphenoxylate/atropine (anti-diarrheal agent) side effects

A

-Dry mouth
-abdominal pain
-tachycardia
-blurred vision
-CNS depression
-constipation

162
Q

Diphenoxylate/atropine (anti-diarrheal agent) nursing–6

A

-Requires a prescription, Schedule V medication
-Oral administration
-Contraindicated: Diarrhea due to:
-toxigenic bacteria
-pseudomembranous colitis
- teach patient to avoid ETOH, other CNS depressants; can enhance CNS depressant activity when combined
-Use with caution in older adults
-monitor for constipation

163
Q

Dicyclomine hydrochloride class

A

anti-spasmodic (aka anticholinergic)

164
Q

Dicyclomine hydrochloride (anti-spasmodic (aka anticholinergic)) indications

A

-IBS
-cramping

165
Q

Dicyclomine hydrochloride (anti-spasmodic (aka anticholinergic)) MOA

A

Anticholinergic (slows intestinal motility)

166
Q

Dicyclomine hydrochloride (anti-spasmodic (aka anticholinergic)) side effects

A

-Constipation
-tachycardia
-delirium
-confusion

167
Q

Dicyclomine hydrochloride (anti-spasmodic (aka anticholinergic)) nursing–7

A

-Available oral and IM injectable
-Contraindicated:
-If sensitivity to
anticholinergics
-angle closure glaucoma
-GI obstruction
-myasthenia gravis
-paralytic ileus
-toxic megacolon
-caution in elderly

Pharm (6 decks)

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