Pharm week 9 Flashcards
Risk factors for peptic ulcer disease
Family history
Blood group O
Smoking – increases gastric secretion
Caffeine
NSAIDs, ASA
Psychological stress
H. pylori
treatment: triple or quadruple therapy with antibiotics and PPIs
What is GERD
Weakening of lower esophageal sphincter
Lifestyle changes to treat GERD
Weight loss
Elevate HOB
Avoid fatty and acidic foods
Do not eat 3 hours before bed
No ETOH
No smoking
proton pump inhibitor
omeprazole, esomeprazole, lansoprazole
Long term effects of omeprazole, esomeprazole, lansoprazole
pneumonia, osteoporosis, hypomagnesemia**
How long should proton pump inhibitor therapy be limited to
2 months
omeprazole, esomeprazole, lansoprazole drug interactions
increased bleeding with warfarin; increased digoxin & phenytoin levels
omeprazole, esomeprazole, lansoprazole drug interactions
increased bleeding with warfarin; increased digoxin & phenytoin levels
Lifespan considerations for proton pump inhibitors:geriatric
osteoporosis, iron and B12 deficiency, Increase intake of calcium & magnesium, Incorporate weight-bearing exercises
H2 receptor antagonist
ranitidine, famotidine, cimetidine
Nursing for H2 receptor antagonists
use in older adults can cause CNS symptoms- confusion
drug interactions for ranitidine, famotidine, cimetidine
antacids should not be given within 1 hr of H2 antagonists because it may reduce absorption
antacid
aluminum hydroxide, magnesium hydroxide, calcium carbonate
MOA of antacids
neutralizes acid
Nursing for antacids
administer 2hrs before or after other drugs; chew & drink with 8 oz water
contra-indications of antacids
bowel obstruction; caution renal patients- they cannot eliminate aluminum**
Nursing for PUD
-Avoid smoking which can delay wound healing
-Avoid food that promote gastric secretion- coffee, caffeine and decaff beverages
-Avoid ASA and NSAIDs
-Avoid ETOH which can exacerbate PUD
-Eat meals on a regular schedule in a relaxed setting and do not overeat
Prostaglandin analog/gastric protectant
misoprostol, sucralfate
use of misoprostol
prevents ulcers caused by meds (NSAIDS, ASA)
contradictions of misoprotol
pregnancy
action of sucralfate
creates a protective barrier against acid & pepsin
drug interactions with sucralfate
blocks absorption of warfarin, phenytoin, digoxin, antibiotics; take 2 hours away from these meds
What is constipation
less than 3* bowel movements per week
Causes of constipation
-Lack of exercise
-Lack of fiber
-Decreased fluid intake
-Medications: opioids, anticholinergics, antihistamines, antacids, iron
-Foods: dairy, chocolate, refined white flour
-Diseases: hypothyroidism, DM, IBS
What is diarrhea
More than 3* bowel movements a day*
Causes of diarrhea
Medications: antibiotics
Infection: C diff, VRE
Inflammation: IBS, IBD
Travel out of the country
bulk-type laxative prototype
psyllium
Nursing interventions for psyllium
mix with 8 oz of water and follow with 8 oz of water
Contraindications for psyllium
undiagnosed abdominal pain, intestinal obstruction, fecal impaction
Surfactant/emollient laxatives and action
docusate sodium: lowers surface tension to all ow penetration of water
Stimulant laxatives and action
bisacodyl senna: stimulates intestinal peristalsis
Osmostic laxatives and action
-magnesium hydroxide (MOM), magnesium citrate, sodium phosphates (Fleet’s), polyethylene glycol, lactulose
-draws water into large intestine to produce bulk and stimlulates peristalsis
antidiarrheal prototype
diphenoxylate with Atropine
adverse effects of diphenoxylate with Atropine
dizziness, drowsiness (with high doses)
contraindications of diphenoxylate with Atropine
severe dehydration, electrolyte imbalance
nursing for diphenoxylate with Atropine
drink fluids with electrolytes, avoid caffeine
drug interactions with diphenoxylate with Atropine
alcohol & CNS depressants produce sedation
OD of diphenoxylate Atropine
naloxone for respiratory depression
sulfonamide/ 5-aminosalicylate Prototype
sulfasalazine
adverse effects of sulfasalazine
n/v/d, skin rashes, blood disorders
nursing for sulfasalazine
do not administer if allergy to sulfa, ASA, or thiazide diuretics*
contraindications for sulfasalazine
sulfa or salicylate sensitivity
meds for IBS-C
lubiprostone, linaclotide
is lubiprostone and linaclotide used in women or men
women
side effects of lubiprostone and linaclotide
diarrhea, nausea
contra-indication of lubiprostone and linaclotide
bowel obstruction
nursing for lubiprostone and lincaclotide
take with food
meds for IBS-D
alosetron
is alosetron used in women or men
women
side effects of alosetron
constipation, obstruction, impaction, or perforation
contraindications for alosetron
chronic constipation, Crohns, colitis, diverticulitis
antiemetic/serotonin antagonist prototype
ondansetron: (zofran), granisetron, dolasetron
side effects of antiemetic/serotonin antagonists
headache, dizzy, diarrhea, drowsiness
contraindications of antiemetic/serotonin antagonists
dysrthmias
drug interactions with antiemetic/serotonin antagonists
CNS depressants & antipsychotics- can intensify CNS effects
Dopamine antagonists
Chlorpromazine, prochlorperazine, promethazine
Prokinetics
metoclopramide
Anticholinergics
Scopolamine patch
Antihistamines
Dimenhydrinate, diphenhydramine, hydroxyzine, meclizine
Cannabinoids
Dronabinol, nabilone
pancreatic enzymes prototype
pancrelipase
nursing for pancrelipase
do not crush or open enteric coated tablets; may sprinkle on food; give with meals and snacks*
contraindications for pancrelipase
pork allergy
drug interactions for pancrelipase
decreased absorption of iron; antacids may decrease effect of pancrelipase
these restore the normal flora of the intestine following diarrhea, particularly from antibiotic therapy
probiotic
You should not take a probiotic the same time as an antibiotic (T/F)
True
what is the only vitamin humans produce
D
it is okay to consume up to three times the daily recommended levels of all vitamins except these two
A and D
causes of undernutrition
low dietary intake, malabsorption disorders, fad diets, alcoholism, eating disorders, surgery, trauma, wasting disorders such as cancer or AIDS
lipid-soluble vitamins
vitamin A
uses of vitamin A
night blindness, slow wound healing, GI disorders
Long term effects of high amounts of vitamin A
drying and scaling of the skin, alopecia, fatigue
Which vitamin is labeled category X in pregnancy
A
MOA of folic acid
RBC, WBC, platelet production
primary use of folic acid
during pregnancy to promote normal fetal growth, reversing symptoms of deficiency from inadequate intake or alcohol abuse
drug interactions of folic acid
levels are decreased by methotrexate (mtx) and sulfonamides
nursing action of folic acid
assess CBC, folic acid levels; include food sources such as: green leafy vegetables, citrus fruits, dried beans
Mineral
magnesium sulfate, oxide, hydroxide
side effects of magnesium sulfate, oxide, hydroxide
muscle weakness, suppresses AV conduction in the heart, can cause respiratory depression, diarrhea; flushing with IV infusion
nursing actions for minerals
monitor magnesium, calcium levels, vital signs, monitor for absent DTRs, normal magnesium levels: 1.3-2.1 mEq/L; include food sources: whole grains, nuts, legumes, green leafy vegetables, bananas
Mineral OD
IV calcium gluconate
