Pharm GI Flashcards
cold and strep throat
pharnyx
Acute diarrhea
Lasts from 3 days to 2 weeks
Self-limiting
Resolves without sequelae
Chronic diarrhea
Lasts for more than 3 weeks
acute diarrhea - causes
Bacterial
Viral
Drug induced Nutritional factors Protozoa
chronic diarrhea - causes
Tumors
Diabetes mellitus Addison’s disease Hyperthyroidism
Irritable bowel syndrome AIDS
anti-diarrehal - adsorbents (add pepto)
coat walls, binds to bacteria and it is eliminated.
1) bismuth subsalicylate (Pepto) activated charcoal,
3) aluminum hydroxide, others
anti-diarrheals - Antimotility drugs: anticholinergics
Decrease intestinal muscle tone and peristalsis of GI tract
Result: slows the movement of fecal matter through the GI tract
anti-diarrheals - Antimotility drugs: anticholinergics = ex (anti-belladona)
belladonna alkaloids (atropine, hyoscyamine)
Antimotility drugs: opiates
Decrease transit time through the bowel, allowing more time
for water and electrolytes to be absorbed
Reduce pain by relief of rectal spasms
anti-diarrheal - Intestinal flora modifiers
Probiotics or bacterial replacement drugs. ex- L. acidophilus (Lactinex®)
adsorbents - adverse (add hearing loss and blue gums)
Hearing loss, tinnitus, metallic taste, blue gums. space out adsorbents to decrease side effects.
Anticholinergics - adverse
Urinary retention, hesitancy, impotence
Headache, dizziness, confusion, anxiety, drowsiness,
confusion
Dry skin, flushing
Blurred vision
Hypotension, bradycardia
Adsorbents cause (don’t ADD adsorbents w/ anticoagulants)
increased bleeding time and bruising when given with anticoagulants.
Antacids can decrease effects of (antacid is anti-anti)
of anticholinergic antidiarrheal drugs
Do NOT give bismuth subsalicylate to
children or teenagers with chickenpox or influenza because of
the risk of reye’s syndrome
Do not administer anticholinergics to patients with a history of (I’m not anti-graves or glaucoma)
narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon
Use adsorbents carefully in
elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion
constipation
Symptom, not a disease
Lactulose - hyperosmotic (lactulose levels ammonia)
also used to reduce elevated serum ammonia levels
stimulant - constipation (most popular one in hospitals)
senna (Senekot®)
bisacodyl (Dulcolax®)
Increases peristalsis via intestinal nerve stimulation
laxative adverse effects - bulk forming (think esophageus)
Impaction
Fluid overload
Electrolyte imbalances
Esophageal blockage
All laxatives can cause
electrolyte imbalances
laxative adverse effects - hyperosmotic
Abdominal bloating
Electrolyte imbalances Rectal irritation
laxative adverse effects - saline (salt and magnesium cause problems)
Magnesium toxicity (with renal insufficiency) Cramping
Electrolyte imbalances
Diarrhea
Increased thirst
laxative adverse effects - stimulants (moving too fast) and what about urine?
Nutrient malabsorption Skin rashes
Gastric irritation Electrolyte imbalances Discolored urine Rectal irritation
Inform patients not to take a laxative or cathartic if they are experiencing
nausea, vomiting, and/or abdominal pain
how to take laxatives
All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated. Patients should take all laxative tablets with 6 to 8 ounces of water
Patients should take bulk-forming laxatives as directed by the manufacturer with
at least
240 mL (8 ounces) of water
Give bisacodyl with water because of interactions with
milk, antacids, and juices
T. has been on warfarin therapy for 2 years and is experiencing severe diarrhea while on a visit to another country. She has a bottle of Pepto-Bismol and a package of loperamide (Imodium®). Which should she choose, if any?
loperamide (Imodium®) the pepto bismol will increase risk for bleeding
M., age 68, has renal insufficiency and tells you that he often uses milk of magnesia for quick relief of constipation. Is there a concern? Explain your answer.
Yes. Magnesium is excreted through the kidneys. If kidneys are not working magnesium can accumulate in the body
C., age 19, is experiencing severe abdominal pain and nausea, and has vomited twice. Her mother wants to give her a laxative to “clean her out.” Should she do this?
no risk of dehydration
antiacids - Aluminum Compounds - slow or fast? (the only one)
slow acting but long duration. Can cause constipation
antiacids - magnesium compound (fast or slow acting)
rapid acting and potent. can cause diahrrea.
antacids - calcium carbonate - fast or slow acting?
rapid acting and potent. can supplement dietary calcium.
antacids - sodium compounds - contraindicated in who? (think sodium and heart)
Rapid onset, short duration
Contraindicated in CHF, HTN, edema
antacid - nursing considerations - how long to separate from other drugs?
- Educate patients about s/s of GI bleeding
- Capsules and tablets should be swallowed
intact (not crushed or chewed) - Shake suspensions well
- Separate antacids from other meds by 1-2 hrs.
Magnesium Hydroxide - milk of magnesia - action (milk draws water)
Antacid, increase pH, Osmotic Laxative *
Magnesium Hydroxide - milk of magnesia - uses (milk helps GERD)
GERD, relief of hyperacidity Constipation
Cleanse the GI tract
Flush ingested toxins out
Magnesium Hydroxide - milk of magnesia - precautions
Renal Impairment
Bowel Obstructions
Fast Acting – within 6-12 hours
adverse effect - cramping
pancreatic enzymes are the
digestants most commonly used clinically
antiemetics
Determining the cause of gastric distress is essential because these drugs mask symptoms of more serious illnesses
emesis management
Serotonin Agonists
* Glucocorticoids
* Substance P, neurokinin antagonists
* Benzodiazepenes
* Dopamine Agonists
* Cannabioids
* Anticholinergics
* Antihistamines
seratonin agonists - anti-emetics (most popular one)
- Dolasetron
- Granisetron
- Ondansetron *
- Palanosetron
odansetron
Action
Serotonin receptor agonist blocks 5-HT3 receptors in vagal afferents and vomiting center
Uses
Acute emesis
Chemotherapy Postoperative
odansetron - precautions (glue dan together)
More effective when combined with
glucocorticoids (like Decadron)
odansetron - adverse effects
well tolerated
(maybe) headache / diarrhea
ipecac
Action
Stimulates CTZ and acts directly on gastric
mucosa
Use
Induces vomiting after toxic substance
Caution
Avoid vomiting if substance is caustic or petroleum
If vomiting contraindicated, activated charcoal is given
ipecac administration
Administration
◼Use ipecac syrup, not ipecac fluid extract. ◼Take with a glass of water, not with milk or
carbonated beverage.
◼Vomiting occurs in 15 to 30 minutes.
◼If vomiting does not occur, give activated
charcoal.
◼Gastric lavage may be needed if vomiting does
not occur.
treatment for uclers and GERD
Cytoprotective agents, which act locally to promote healing
* Proton pump inhibitors, which suppress gastric acid secretion and increase pH of stomach
* H2 receptor agonists, which prevent histamine from stimulating the H2 receptor
peptic ulcers - hypersecretion
Hypersecretion ◼ HCl
◼ Pepsin
◼pH of 1.5 – 3.5
peptic ulcer treatment - Mucosal Protectant
sucralfate
(Carafate ® - forms a paste to cover ulcer
Mucosal Stimulator (miso stimulates)
misoprostol
(Cytotec®) -
SUCRALFATE (CARAFATE ®) (sulcrafice for the mucus)
Action
Mucosal Protectant
Creates a thick barrier against acid and pepsin
Polymerization into a sticky gel Adheres to the gastric lining
Uses
Acute Ulcers
SUCRALFATE (CARAFATE ®) - precautions (sucra at war)
Precautions
Not absorbed systemically
Adverse effects
Impedes absorption of DPH, theophylline,
digoxin
Warfarin and fluroquinolone antibiotics
->(Administer at least 2 hours apart from these drugs)
MISOPROSTOL (CYTOTEC®) (miso mucus)
Action
Mucosal Stimulator
Analog of prostaglandinE1 Suppression of gastric acid secretion promotes bicarbonate acid secretion maintains sub-mucosal blood flow
Uses
Ulcers caused by NSAIDS & Cervical Ripening. used for abortions also
misoprestol - precautions
Precautions
Stimulates prostaglandin in the uterus Pregnancy Category X
Adverse effects Diarrhea
anti-ulcer drugs - Proton pump inhibitors
Proton pump inhibitors
Esomeprazole (Nexium®), Pantoprazole (Protonix®) Omeprazole (Prilosec®), Lansoprazole (Prevacid®)
ATPase ◼
action:
Reduce gastric acid by inhibiting hydrogen/potassium
Side effects
◼Headache, insomnia, dizziness, dry mouth, flatulence, abdominal pain
anti-ulcer - histamine (HIS tagement is causing reversible impotence)
Cimetidine (Tagamet®, Ranitidine (Zantac®)
Famotidine (Pepcid®, Nizatidine (Axid®)
Action
◼ Reduce gastric acid by blocking H2 receptors of parietal cells
in stomach
◼ Promote healing of ulcer by eliminating cause
Side effects
◼ Headaches, dizziness, diarrhea, constipation, reversible
impotence, gynecomastia
peptic ulcer - predisposing factor - the main bacteria
Helicobacter pylori (H. pylori)
Mechanical Genetic Environmental Drugs
Symptoms Aching pain
ulcer - non-drug treatment
Avoid tobacco.
Avoid alcohol.*
Avoid hot, spicy, and greasy foods.*
Take any NSAIDs, including aspirin and oral
glucocorticoids, with food or in decreased dosage. Sit upright.
Do not eat before bedtime.
Wear loose-fitting clothing.
IBS
Crohns = Lesions penetrate through entire gut wall
Ulcerative colitis
More common than Crohn’s disease
Presents with abdominal pain, cramping, and frequent
diarrhea
Inflammation restricted to rectum and colon
Entyvio - vedolizumab) - for IBS (enjoy the monoclonals)
Action: A monoclonal antibody. It works by blocking the actions of a certain natural substance (integrin) in the body. This helps to decrease swelling (inflammation) in the gut, which lessens symptoms and may slow or stop damage from these bowel disorders.
Use: For adults with moderate to severe. ulcerative colitis (UC) or Crohn’s disease (CD).
Entyvio precautions and side effects
Precautions: Common side effects may include:
fever, sore throat, flu-like symptoms
cold symptoms such as stuffy nose, sinus pain, sneezing,
cough
pain in your arms or legs
tired feeling
headache, joint pain, back pain
rash, itching
nausea.
® (vedolizumab)
Entyvio adverse effect (enjoy the TB)
Adverse effects: Infection
Tuberculosis
Vaccines
Pregnancy
Breastfeeding
IBS
Irritable bowel syndrome (IBS) a chronic gastrointestinal disorder.
Cause: currently unknown. It is thought to result from a combination of abnormal gastrointestinal (GI) tract movements and a disruption in the communication between the brain and the GI tract.
Symptoms of IBS include ◼ abdominal cramping or pain, ◼Bloating, gassiness, and
◼ altered bowel habits (alternating periods of diarrhea and constipation).
IBS -variations - IBS-D (IBS w/ diarrhea)
IBS-D is irritable bowel syndrome with diarrhea. Symptoms most common with IBS-D include:
◼ Sudden urges to have bowel movements
◼ Abdominal pain or discomfort
◼ Intestinal gas (flatulence)
◼ Loose stools
◼ Frequent stools
◼ Feeling of being unable to completely empty bowels
◼ Nausea
IBS-C is irritable bowel syndrome with constipation.
Symptoms most common with IBS-C include:
◼ Hard, lumpy stools
◼ Straining during bowel movements ◼ Infrequent stools
IBS treatment
No known cure
Mild signs and symptoms can often be controlled by managing stress and by making changes in diet and lifestyle. Teach patients to:
Avoid foods that trigger symptoms such as cruciferous vegetables (for example, cauliflower, wasabi, kale, and broccoli), and legumes (for example, black beans, edamame, soy nuts, and fava beans)
Eat high-fiber foods
Drink plenty of fluids
Exercise regularly
Get enough sleep
Viberzi® (breezy IBS-D)
Action: For use in IBS-D. Eases diarrhea by reducing muscle contractions and fluid secretion in the intestine, and increasing muscle tone in the rectum.
Use: Makes the nerves in the intestines less sensitive to stimulation.
Viberzi® precautions (breezy is bad for bowels)
Precautions: Patients should not take VIBERZI if they:
◼ Do not have a gallbladder
◼ Have or may have had a blockage in the gallbladder or a sphincter
of Oddi problem
◼ Have or had problems with alcohol abuse, alcohol addiction, or drink
more than 3 alcoholic drinks a day
◼ Have had pancreatitis or other pancreas problems, including if you
have had or may have had a blockage in your pancreas
◼ Have had an allergic reaction to VIBERZI
◼ Have severe liver problems
◼ Have had long-lasting (chronic) or severe constipation, or problems
caused by constipation
◼ Have or may have had a bowel blockage (intestinal obstruction)
VIBERZI adverse effects (breezy causes pancreatitis???)
Adverse effects:
Inflammation of the pancreas (pancreatitis).
Pancreatitis usually happens within the first week of treatment with VIBERZI, but can happen after 1 to 2 doses of VIBERZI. Risk of getting pancreatitis is increased if a patient drinks more than 3 alcoholic drinks a day.
A spasm in a muscle of the digestive system (called the sphincter of Oddi)
A patient is receiving lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the reason for the lactulose?
Reduction of high ammonia levels associated
with liver failure
The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. The purpose of the atropine in this combination is to:
discourage recreational use of the opiate diphenoxylate.
A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for four days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient?
mineral oil (bc it works faster)
chronic diarrhea associated with
Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness
bulk forming laxatives
High fiber
Absorb water to increase bulk
Distend bowel to initiate reflex bowel activity Examples:
psyllium (Metamucil®)
methylcellulose (Citrucel®)
emollients - ex (mineral and colace emollients)
Stool softeners and lubricants
Promote more water and fat in the stools
Lubricate the fecal material and intestinal walls Examples:
Stool softeners: docusate salts ( colace, surfak) mineral oil = lubricant
mineral oil can be (inhale the minerals)
aspirated into lungs
hyperosmotic - laxative (lactulose is hyper)
Increase fecal water content
Results in bowel distention, increased peristalsis, and evacuation
Examples:
Polyethylene glycol (PEG) Sorbitol, glycerin
Lactulose (also used to reduce elevated ammonia levels)
saline - laxative (selene is milky)
Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines
Results in bowel distention, increased peristalsis, and evacuation
Examples:
Magnesium hydroxide (Milk of Magnesia®) Magnesium citrate (Citroma®)
peripherally acting opioid antagonists (meth blocks opiates)
Treatment of constipation related to opioid use and bowel resection therapy
Block entrance of opioid into bowel
Strict regulations for use
Allow bowel to function normally with continued opioid use
methylnaltrexone (Relistor®) alvimopan (Entereg®
bulk forming - use when (bulky divers w/ IBS)
Acute and chronic constipation, irritable bowel syndrome, diverticulosis
emollient - use when (slide out the impaction)
Acute and chronic constipation, fecal impaction facilitation of BMs in anorectal conditions
hyperosmotic laxative use (chronically hyper)
Chronic constipation
Diagnostic and surgical preps
saline laxative use (selene is cute)
Acute Constipation
Diagnostic and surgical preps
stimulant laxative use (stimulants are cute)
Acute constipation
Diagnostic and surgical preps
adverse effects - emolients (emoly has pneumonia)
Skin rashes
Decreased absorption
of vitamins
Electrolyte imbalances Lipid pneumonia
bulk forming laxatives - take with
a full glass of water
laxatives - nursing assessment
A healthy, high-fiber 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 laxatives should be taken
whole, not crushed.
antiacids
Used to buffer or neutralize hydrochloride in the stomach and thereby increase gastric pH
* May be composed of aluminum salts, calcium carbonate, magnesium salts,
or sodium bicarbonate
(alone or in combination)
* Classified as nonsystemic or systemic
milk of magnesia - action
Antacid, increase pH, Osmotic Laxative *
digestives
Promote the process of digestion when a deficiency exists of some substance essential to that process
* Besides deficiency, other causes of digestive problems include organic disease states and reactions to emotional situations and stress
Pancreatic enzymes are the digestants most commonly used clinically
ondansetron - action and uses
Action
Serotonin receptor agonist blocks 5-HT3 receptors in vagal afferents and vomiting center
Uses
Acute emesis
Chemotherapy Postoperative
ondansetron - precautions and adverse effects (dan gives me a headache)
Precautions
More effective when combined with
glucocorticoids (like Decadron)
Adverse Effects well tolerated
(maybe) headache / diarrhea
ipecac
Action
Stimulates CTZ and acts directly on gastric
mucosa
Use
Induces vomiting after toxic substance
Caution
Avoid vomiting if substance is caustic or petroleum
If vomiting contraindicated, activated charcoal is given. always take with water.
ipecac usage
◼Use ipecac syrup, not ipecac fluid extract. ◼Take with a glass of water, not with milk or
carbonated beverage.
◼Vomiting occurs in 15 to 30 minutes.
◼If vomiting does not occur, give activated
charcoal.
◼Gastric lavage may be needed if vomiting does
not occur.
the nurse is reviewing principles of immunity. What type of immunity occurs when the body
is exposed to a relatively harmless form of an antigen, which imprints this information on the
body’s memory bank and stimulates the body’s defenses to resist any subsequent exposures (artificial is harmless)
artificial active immunity
A housekeeper has experienced a needlestick by a contaminated needle that was placed in a
trash can. The nurse expects that which drug will be used to provide passive immunity to
hepatitis B infection for this housekeeper
Hepatitis B immunoglobulin
A 72-year-old patient is to receive a pneumococcal vaccine, polyvalent (Pneumovax 23). The
nurse recognizes that which of the following statements about this vaccine is true
It is given by deep intramuscular injection or it is given by subcutaneous injection
30-year-old woman is in the clinic for her yearly gynecologic exam and asks the nurse
about the “new vaccine that prevents HPV.” She wants to receive the papillomavirus vaccine
(Gardasil). Which response by the nurse is most appropriate? (priority)
We will need to make sure you are not pregnant first
When monitoring a patient who is on immunosuppressant therapy, the nurse knows that the
drug may need to be discontinued if the leukocyte count drops below _____/mm3
3000
Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor
the patient for which common adverse effect (spores give me high blood pressure)
hypertension
Which statement about use of corticosteroids for ocular inflammation does the nurse
identify as being true
They are used during the acute phase of the injury process to prevent fibrosis and
scarring, which result in visual impairment
A patient receiving tetrahydrozoline asks how the drug works. The best response by the
nurse will include that the drug works by
promoting vasoconstriction of blood vessels in and around the eye
A 2-year-old is seen in the pediatrician’s office with a bacterial middle ear infection.
Which medication does the nurse anticipate being prescribed for the child
amoxicillin
The nurse understands that which of the following nosocomial infections pose the
highest risk for clients admitted to the hospital?
Wound and urinary tract infections
The nurse is aware that which of the following drugs is no longer currently used to
minimize an adverse effect of a radiopaque agent containing iodine
Ephedrine
Nurses may be confronted with childhood poisonings in many ways. Clues to poisoning
typically include which of the following
Severe nausea and vomiting
Which of the following conditions would contraindicate gastric lavage?
Sedative accidental poisoning
The nurse is providing teaching to a patient who will be taking the laxative docusate
(Bisocodyl). Which statement by the nurse is appropriate during this teaching session
The tablets should be taken with water
The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take
measures to prevent which potential problem that may occur with mineral oil
Lipid pneumonia
When administering a bulk-forming laxative, the nurse instructs the patient to drink
the medication mixed in a full 8-ounce glass of water. Which statement best explains
the rationale for this instruction
These laxatives may cause esophageal obstruction if taken with insufficient water
A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control his diarrhea.
When reviewing the patient’s other ordered medications, the nurse recognizes that
which medication will interact significantly with the Pepto-Bismol
digoxin
patient is about to undergo a diagnostic bowel procedure. The nurse expects which
drug to be used to induce total cleansing of the bowel
polyethylene glycol (GoLYTELY
The nurse is administering oral methylcellulose (Citrucel) and keeps in mind that a major potential concern with this drug is-
Esophageal obstruction
A patient has been receiving long-term antibiotic therapy as part of treatment for an infected leg wound. He tells the nurse that he has had “spells of diarrhea” for the last week. Which medication is most appropriate for him at this time?
L. acidophilus
A patient has been instructed to use an over-the-counter (OTC) form of the bulk-forming laxative methylcellulose (Citrucel) to prevent constipation. The nurse will advise the patient of potential adverse effects, including- (Select all that apply).
electrolyte imbalances and gas formation
A patient has been taking alosteron (Lotronex) for 3 weeks as part of treatment for irritable bowel syndrome. Today she calls the clinic to report that she has been experiencing constipation. The nurse will expect which priority action to be taken?
The drug will be discontinued immediately
A hospitalized patient is experiencing diarrhea. Which of the following does the nurse identify as adverse side effects of diphenoxylate with atropine therapy? (Select all that apply.) (just 2)
. Abdominal pain and Blurred vision
The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil?
Lipid pneumonia
When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction?
These laxatives may cause esophageal obstruction if taken with insufficient water.
A patient receiving tetrahydrozoline asks how the drug works. The best response by the nurse will include that the drug works by
promoting vasoconstriction of blood vessels in and around the eye.
The nurse would evaluate that a patient receiving sodium chloride in an intravenous solution was successfully treated for hyponatremia if which of the following symptoms resolves?
lethargy
The nurse is reviewing the use of ophthalmic preparations. Indications for the direct- and indirect-acting miotics include which condition
open- angle glaucoma
Parasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action?
Miosis
When giving latanoprost (Xalatan) eyedrops, the
nurse will advise the patient of which possible adverse effects (Xal uses latisse)
permanent eye color changes, from light eye colors to brown
The ophthalmologist has given a patient a dose of ocular
atropine drops before an eye examination. Which statement
by the nurse accurately explains to the patient the reason for
these drops
These drops will cause your pupils to dilate, which makes
the eye examination easier.”
When assessing a patient who is receiving a direct-acting
cholinergic eyedrop as part of treatment for glaucoma, the
nurse anticipates that the drug affects the pupil in which
way?
cholinergic will cause miosis, pupil constriction
