Quiz 1 Flashcards

Question

Pt Teaching and Antacids

Answer 1

- NOT a substitute of RX drugs or continuing primary care - Tablets should be chewed thoroughly followed by glass of water or milk - Liquid preparation should be shaken before pouring

Answer 2

Change in consistency /effort, alteration from normal pattern can be cause by: - Pregnancy - iron supplements - lack of mobility - diet, - medications - anal, perineal, rectal surgery, etc.

Answer 3

see pg.973

Answer 4

Classified by either therapeutic effect or mechanism of action Contraindicate if undiagnosed abdominal pain/possible obstruction

Answer 5

Class 1- Produce watery stool in 2-6 hours Osmotic Laxatives Class 2-Produce semifluid stool in 6-12 hours - Stimulant Laxatives - Osmotic Laxatives Class 3- Produce soft stool in 1-3 days - Bulk Forming Laxatives - Surfactant Laxatives 4th class is miscellaneous

Answer 6

TAKE WITH at least 8 OZ of water Pharmacodynamic action: keep water in the stool, softening fecal mass, increasing bulk; distends colon & helps evacuation! -Helps to produce soft, formed stools after 1-3 days Adverse effects: - Esophageal obstruction - Intestinal obstruction or impaction - methylcellulose (Citrucel) - Also used in treatment of diarrhea, absorbs free fecal water - psyllium (Metamucil) Unlabeled use: cholesterol lowering agent ***********Shouldn’t be used for people with chronic constipation-cancer pts on opiods, etc. can CAUSE obstruction****************

Answer 7

Docusate -docusate sodium (Colace) or docusate calcium Pharmacodynamic action: facilitates addition of fat & water to soften stool over a few days - Prophylactic agent** - Give with a full glass of water! Pharmacodynamic action 2 effects -stimulate intestinal motility -increases water & electrolytes within intestinal lumen (decrease their absorption). + Results in 6-12 hours with oral preparations What does this mean? - Widely used and abused - Direct effect on the intestinal mucosa & stimulates peristalsis (Works in the colon) Bisacodyl (Dulcolax) - Oral works in 6-12 hours - Suppositories work in 15-60 min Anthraquinones: Senna (Senokot)- herbal source Patient teaching point: change in urine color - Oral Works in 6-12 hours * **Give at bedtime, high abuse potential**

Answer 8

``` Castor Oil (also considered as Group I) -Works in small intestine Can work quicker, but usually within 2-6 hours ```

Answer 9

Onset of action depends on dosages Pharmacodynamics: - poorly absorbed salts whose osmotic action draws water into the intestinal lumen… - + Results in 6-12 hours (2-6 hours if given in large doses) Adverse effect: substantial loss of water -Use cautiously in renal dysfunction Magnesium hydroxide: Milk of Magnesia (MOM) - Use in caution with patients with renal failure, HF - Increases effect of sulfonylureas, quinidine, and others Sodium phosphate - Causes fluid retention - Caution use in patient with renal failure, HTN, & HF Polyethylene Glycol (Miralax) - For chronic constipation - Mix with 4-8 ounces of liquid

Answer 10

pulls ammonia into stool – can help with hepatic diseases that cause ammonia build up- such as hepatic-encephalopathy - Semi-synthetic disaccharide of lactose - Metabolized by colonic bacteria into acids & CO2, draws water into stool (think osmotic pull) -Acids draw ammonia into stool for treatment of hepatic encephalopathy secondary to liver disease Pathophysiology, Lab values

Answer 11

Mineral Oil –orally or by enemea ( but long term oral can fuck up absorption) Pharmacodynamic action: emollient or lubricant -Excessive oral administration decreases absorption of fat soluble vitamins Glycerin suppositories - Gentle laxative, safe in infants, children - Re-establish bowel patterns after laxative abuse Newer Miscellaneous Laxatives Lubiprostone (Amitiza) – (oral, gel-like capsule) -Newer class (chloride channel activators) Therapeutic uses: chronic idiopathic constipation, IBS with constipation in females, & opioid induced constipation (non-cancer) Adverse effects: N/V, abdominal pain & distention, gas, headache, diarrhea, and chest tightness (rare) Plecanatide (Trulance) (oral tablet) -Indicated for chronic idiopathic constipation -MOA : pulls fluid into the intestines BLACK BOX WARNING FOR KIDS UNDER 6 , 6-18 limit use -CAN CAUSE SEVERE DEHYDRATION

Answer 12

For colonoscopy Polyethylene Glycol- Electrolyte Solutions (ex: GoLYTELY) - Isosmotic with body fluids. Water is not lost & electrolyte balance is preserved - Used primarily prior to diagnostic procedures for bowel cleansing

Answer 13

Methylnaltrexone (Relistor) – subq or oral Subcutaneous & now oral route daily -For use when laxatives have not been effective Pharmacodynamics: Peripheral acting opioid antagonist; works on the mu-opioid receptors to block constipating effect of opioids Adverse effects: abdominal pain, nausea, diarrhea, flatulence, flushing, tremors, etc. -Decreased dosing needed in renal/hepatic dysfunction

Answer 14

Make sure your patient does not have a bowel obstruction or other GI problem before administration -x-ray Do not use laxatives in the presence of undiagnosed abdominal pain! WHY??? – because pt could have an obstruction and you can kill the patient if you give a laxative by perforating their BOWEL

Answer 15

Most frequently abused over the counter drug Misconception: daily bowel movement needed for good health Patient’s misdiagnose a normal bowel pattern for constipation and self-medicate Educate Patients: -Normal bowel function Alternatives: diet high in fiber, fluids, exercise, regular bowel habits Do not use in presence of undiagnosed abdominal pain!!!!!!!

Answer 16

``` ¥ Antiemetic Agents ¥ Drugs for Motion Sickness ¥ Antidiarrheal agents ¥ Drugs for Irritable Bowel Syndrome ¥ Drugs for Inflammatory Bowel Disease ¥ Prokinetic Agents ¥ Pancreatic Enzymes ¥ Drugs for Gallstones ¥ Anorectal Preparations ¥ Drugs for Treating Obesity ```

Answer 17

Why are they given: Common Causes: - GI disorders - Infections - Drug Therapy - Pain - Emotions - Radiation - Motion sickness - Post-op - Pregnancy……

Answer 18

Vomiting Center located in the medulla Direct stimulation - Signals from sensory organs (pain, odors) - Signals from the cerebral cortex (psychic stimulation, fear, stress, anxiety) - Signals from the vestibular apparatus (vagus nerve stimulus, motion sickness) Indirect stimulation - Activation of the chemoreceptor trigger zone (CTZ) (located near the vomiting center) - Stimulated by signals from stomach and small intestine - Direct action of emetogenic compounds

Answer 19

- Serotonin - Dopamine - Acetylcholine - Histamine - Also Neurokinin

Answer 20

- Most effective agents for N/V related to chemo/radiation/anesthesia - PO, IV (more effective) Prototype: Ondansetron (Zofran) Medicate 30 to 60 minutes prior to chemotherapy -More effective when used with dexamethasone Side effects: diarrhea, HA, dizziness -Monitor for prolonged QT on EKG – special precautions in pts who have prolonged QT intervals already OTHER Serotonin receptor antagonists Granisetron (Kytril) : IV, PO, Transdermal Similar to Ondanestron Palonosetron (Aloxi) IV only - Longer acting (longer half life) - Effective for Acute & Delayed N/V Dolasetron (Anzemet) – older drug- NOT first line Can cause Dysrhythmias!!!*Do not give in the presence of hypomagnesemia or hypokalemia

Answer 21

MOA blocks Neurokinin 1 receptors Therapeutic use prevention of CINV (chemo induced N/V) When combined with other antiemetics – delayed or acute N/V ``` A 5HT3 antagonist and a glucocorticoid (steroid) Prototype Aprepitant (Emend) ``` Think suffix – pitant Adverse effects fatigue, hiccups, dizziness & diarrhea Drug Interactions inhibits several liver metabolizing enzymes (Ex: decrease levels of warfarin & oral contraceptives; increase glucocorticoid levels: may see more steroid effects in pts who also receive other steroids)

Answer 22

Phenothiazines: Prochlorperazine (Compazine) – Prototype Promethazine (Phenergan)- derivative -Giving this IV can cause serious side effects-tissue destruction -IM is better but PO is best Due to blockade of dopamine receptors, may cause extrapyramidal side effects (acute dystonia, akathisia) “Act like Dopey” ***don’t use promethazine in children <2 years old*** ***caution use in children > 2 *** - due to respiratory depression Lorazepam (Ativan), a benzodiazepine, is used in combination regimens for CINV as an adjunct therapy. **Also, helps control EPS secondary to phenothiazines**

Answer 23

Dronabinol (Marinol) – synthetic form for THC Pharmacotherapeutics: - N/V associated with cancer chemotherapy (CINV) *higher doses than when used as appetite stimulant - Appetite stimulant in patients with AIDS Unknown Mechanism of Action (MOA) -Thought to activate cannabinoid receptors Adverse effects: dissociation, dysphoria - hypotension, prolonged QT : Use caution in clients with cardiac disease - Slow onset of action - Do not take with alcohol, CNS depressants Abuse potential – DEA Schedule III Nabilone: structurally different from Marinol but acts similarly for CINV effects - risk for abuse is similar - used less - doesn’t stimulate appetite

Answer 24

-Increase tone and motility of GI tract, but as an effect of that can decrease N/V Prototype agent: Metoclopramide (Reglan) Therapeutic Uses -Nausea & Vomiting related to gastroparesis (slow GI movement), GERD, post-operatively, chemotherapy can also help in NG pts who have a lot of residual Mechanism of Action - Sensitizes tissues to the effect of acetylcholine - Increases peristalsis & gastric emptying – does not increase gastric juices - Dopamine receptor antagonist with antiemetic effects on the CTZ - Doesn’t require vagal stimulation to work- good for conditions where vagas nerve is poorly functioning. N/V, diagnostic studies of small intestine: IV Gerd- PO Off-label use for N/V in pregnancy Adverse effects - CNS depression - EPS - EDUCATE ON THESE SXS - Tardive Dyskinesia, Acute Dystonia, Parkinsonism, Akathisia - Diarrhea Why? Moves it tooooo fast Nursing Administration Traditionally, give prior to symptoms of N/V -30 minutes prior to a meal and at bed time ( 4x per day) -Do not use in bowel obstruction can lead to perforation

Answer 25

Bentyl Cholinergic nerve fibers are throughout the gastrointestinal tract and when stimulated cause increased motility and secretion of acids and enzymes. This stops that Antispasmodic agents are anticholinergic agents So what do we expect these drugs to do?? – relax smooth muscle, and decreased secretion of acids and enzymes Which side effects would you expect? - decreased urination - blurred vision - dry mouth - constipation

Answer 26

``` PNS effects when stimulated: SLUG BAM (cholinergic effects) Salivation, secretions, sweat Lacrimation Urination GI upset (diarrhea) Bradycardia, BM, Bronchoconstriction, Abdominal cramps, Anorexia Miosis (constriction of pupils) ```

Answer 27

If cholinergic agents make you “wet”, then anticholinergic agents make you ”dry” Can’t pee urinary retention Can’t see blurred vision Can’t spit dry mouth Can’t poop constipation * Avoid in the elderly if possible, watch closely * Avoid in pts with preexisting urinary retention * Avoid in MI or CHF pts.

Answer 28

Anticholinergic/Muscarinic antagonist Scopolamine -Most effective for motion sickness ( start prior to sickness begins) Adverse effects: dry mouth, blurred vision, & drowsiness Given: Po, Subcutaneous, or Transdermal Anticholinergic/Antihistamines- not first line for motion sickness due to sedation Dimenhydrinate (Dramamine) & Meclizine (Antivert)- primarily used for vertigo - Dry mouth, blurred vision, drowsiness, and sedation - educated pts on the sedation; avoid things that require alertness and coordination until they know how the drugs will affect them.

Answer 29

Diarrhea (stools of excess volume and excess fluid) -Symptom of GI disease Causes: Infection, maldigestion, medications, inflammation, and functional disorders SXS of a problem- figure out the problem Complications: -Dehydration and electrolyte imbalances What else??: Malnutrition, vascular compromise/collapse: LOW BP - arrhythmias Treatment - Diagnose & treat the cause - Replace lost fluids - Relive cramping - Decrease amount of stool *if it’s infectious diarrhea-we don’t want to stop it- because we want the toxic agent to get out* what do antidiarrheals do to gi Motility- SLOW IT DOWN

Answer 30

Prototype agent: Diphenoxylate HCl with atropine sulfate - Controlled substance - Atropine added to discourage misuse

Answer 31

Diphenoxylate HCl with atropine sulfate Acts on Mu recptors in the gut -Slows motility Contraindications: - diarrhea of infectious nature - obstructed jaundice - children under age 2 Adverse effects: related to opioids & anticholinergics (mostly in high doses) Drug interaction: MAO inhibitors Opioids: Controlled substance (Schedule V) -Atropine added to discourage misuse

Answer 32

Used in treatment of acute or chronic diarrhea (gastroenteritis) ``` -Also can be used to reduce effluent from an ileostomy ¥ Does not cross blood brain barrier ¥ Little to no abuse potential ¥ Does not contain atropine Ð Less adverse effects ``` UPDATE ON IMODIUM: Recommendation approved dosages in 24 hrs – (9-13 hr half life) At 16 mg or higher (half-life as high as 41 hrs)

Answer 33

¥ Higher abuse potential (Schedule IV) | ¥ -new drug

Answer 34

Bismuth Subsalicylate (Pepto Bismol) Anti-inflammatory and anti????? - PRN - Age related concern (ASA and Children) Adverse effects : Tongue and stool can turn black, risk for RISE syndrome in children like in aspirin Kaolin and Pectin (Kaopectate) - Absorbent property (doesn’t decrease volume, just formation) - Sometimes, bulk-forming laxatives and antibiotics All anti-diarrheals must be used with caution in patients with IBD WHY?? It can cause colon dilation (mega colon)- lead to all kinds of problems including obstruction or death.

Answer 35

Inflammatory Bowel Disease (IBD) autoimmune examples: - Ulcerative Colitis - Crohn’s Disease Irritable Bowel Syndrome (IBS) - Unknown cause - Hyper-sensitive/hyper-responsive bowel - Pain that’s relieved with defecation - Drug therapy is not great with IBS

Answer 36

Alosetron (Lotronex) (PO) -For use in women only with severe disease (last resort) What are the expected therapeutic effects?? - Decreased abdominal pain - Decrease transition time through colon - More formed stool MOA: blocks 5-HT3 receptors in lower GI tract - Fatal GI effects - Constipation obstruction perforation - Ischemic colitis- pain - Need to follow strict criteria and consent to a risk management program - Stop drug immediately if constipation or abdominal pain occur When should this drug not be taken?? Lubiprostone (Amitiza) – Chloride channel activator-IBS in women greater than 18 Linaclotide (Linzess)- associated with dehydration Other possible medications: tricyclic antidepressants, antispasmodics, anti-diarrheals, bulk forming meds, and antibiotics

Answer 37

NO curative medications Pharmacological Treatments: - 5-Aminosalicylates - inflammation - Glucocorticoids- inflammation - Immunomodulators - Immunosuppressants Antibiotics - Metronidazole (Flagyl) - Ciprofloxacin (Cipro)

Answer 38

Sulfasalazine (Azulfadine) only given PO -Anti-inflammatory effect Contraindication: be aware of sulfa allergies Nursing administration: give with food & monitor CBC (can cause anemia) Mesalamine (Asacol, Cantasa, Pentasa, Rowasa) –PO, PR, Enema -Better tolerated than sulfasalazine Others: Olsalazine (Dipentum) & Balsalazide (Colazal, Giazo)

Answer 39

-first line for flares Intravenous -Hydrocortisone, Methylprednisolone, or Dexamethasone Oral -Prednisone, Methylprednisolone, or Dexamethasone New : Budesonide- newer and can be given as extended release- helpful for Crohn’s *weight gain, infection risk, altered glucose metabolism- increased insulin needs, taper when stopping* ``` Administration and Patient Teaching Nursing Assessments? -Mood swings -Nutrient metabolism -Watch for infection – fever ```

Answer 40

Azathioprine (Imuran) & Mercaptopurine (Purixan) Watch for infection -For refractory disease, onset of action may take up to 6 months Adverse effects: pancreatitis & bone marrow suppression Monitor lab values which ones?? - WBCs Cyclosporine – renal function, drug levels Methotrexate - renal function Azathioprine and Allopurinol (gout med)- can be bad

Answer 41

Infliximab (Remicade) (IV) - Monoclonal antibody (TNF inhibitor) - For mod to severe IBD - IV infusion - Risk for hypersensitivity/infusion reaction - RISK FOR INFECTION- TB Ustekinumab (Stelara) (IV, SubQ) -Monoclonal antibody that blocks specific interleukins

Answer 42

Used for exocrine pancreatic insufficiency (EPI) - People who can’t digest food normally because their pancreas does not make enough enzymes - Normally Enzymes are secreted into the duodenum, digest fats, carbohydrates & proteins. - Deficiency of pancreatic enzymes compromise digestion especially of fats. - If pancreatic enzyme secretion is reduced, replacement therapy is needed - All drugs except Viokase tablets are delayed release capsule so they dissolve in the duodenum Deficiencies in pancreatic enzymes occur in: ¥ Cystic Fibrosis ¥ Duct Obstruction ¥ Pancreatectomy ¥ Chronic Pancreatitis (swelling of the pancreas that lasts a long time). CP may cause irreversible damage to the pancreas, including the cells that make digestive enzymes -*Fatty stools are characteristic, foul smelling* - steatorrhoea ``` Pancrelipase (Creon) -Helps break down food into fats, proteins, and carbohydrates that your body can use -Enteric coated, contains -lipase, -protease, & amylase ```

Answer 43

GIVE WITH FOOOOOOOOOOD ¥ May be from bovine or porcine source ¥ Adverse effects: abdominal discomfort, flatulence, headache, & cough. ¥ Do not crush or chew capsule; can cause irritation in the oral mucosa. ¥ How do we know if a patient is experiencing a therapeutic effect? ¥ Decrease in steatorrhoea Gallstone- stores bile, bile is composed primarily of cholesterol, and is used primarily to reduce fats and metabolize cholesterol - If gallstones can be dissolved by drugs- they will be cholesterol containing stones – 20mm in size or smaller