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NURS 424 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Albuterol: classification

A

Short acting beta2 receptor agonist

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2
Q

Albuterol: indications

A

Asthma, COPD

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3
Q

Albuterol: MOA

A

Acts on smooth muscle of the bronchi to reverse bronchospasm –> decreases airway resistance and residual volume –> increases vital capacity and airflow

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4
Q

Albuterol: onset

A

Within 5 minutes

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5
Q

Albuterol: caution and contraindications

A

Should be avoided in arrhythmias that cause tachycardia and pheochromocytoma (severe HTN)

Caution w/ CVD, DM, glaucoma, hyperthyroidism

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6
Q

Can albuterol be used in pregnancy and lactation?

A

Benefits outweigh risks in pregnancy (approved in peds)

Compatible w/ lactation

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7
Q

Albuterol: adverse effects

A

Tachycardia, dizziness, palpitations, tremors, nervousness, HA

Mild effect on beta1 receptors –> heart effects

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8
Q

Salmeterol (Serevent): classification

A

Long-acting beta2 receptor agonist

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9
Q

Salmeterol (Serevent): indications

A

Asthma, COPD

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10
Q

Salmeterol (Serevent): MOA

A

Relaxes bronchial smooth muscle by selective action on beta2 receptors

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11
Q

Can salmeterol (Serevent) be used without an asthma controller medication?

A

NO - need to be used along with asthma controller medication such as inhaled steroid

Used alone could cause respiratory asthma related death

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12
Q

Salmeterol (Serevent): caution and contraindications

A

Caution in patients with CVD, DM, hyperthyroidism, glaucoma

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13
Q

Can salmeterol (Serevent) be used in pregnancy and lactation?

A

Benefits outweigh the risks in pregnancy, safe in lactation

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14
Q

Salmeterol (Serevent): adverse effects

A

Tachycardia, palpitations, tremors, nervousness, HA

Overuse may lead to increase adverse effects and paradoxical effects

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15
Q

Theophylline: classification

A

Xanthine derivative

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16
Q

Theophylline: indications

A

Asthma (NOT first line), COPD

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17
Q

Theophylline: MOA

A

Inhibits specific phosphodiesterase –> increase cAMP –> relaxation of bronchial smooth muscle and pulmonary vessel relaxation

Increases force of diaphragmatic muscle

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18
Q

Theophylline: caution and contraindications

A

Avoid in patients with hypersensitivity to any xanthine, PUD, underlying seizure disorder

Closely monitor with CVD

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19
Q

Can theophylline be used in pregnancy and lactation?

A

Asses risks and benefits in pregnancy

Approved in pediatrics

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20
Q

Theophylline: adverse effects

A

Tachycardia, palpitations, irritability, gastric irritation, HA

If blood levels are >20, may see N/V/D, insomnia, greater irritability

If >30, seizures, arrhythmias, death

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21
Q

Theophylline TI

A

10-20 mcg/mL

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22
Q

Theophylline: patient education

A

Similar structure to caffeine and smoking increases excretion –> avoid smoking and caffeine

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23
Q

Ipratropium bromide (Atrovent): classification

A

Short acting anticholinergics

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24
Q

Ipratropium bromide (Atrovent): indications

A

Asthma exacerbation, COPD

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25
Ipratropium bromide (Atrovent): MOA
Blocks action of ACTH at muscarinic cholinergic receptors in bronchial smooth muscle --> bronchodilation
26
Ipratropium bromide (Atrovent): onset
15 minutes
27
``` True/False Ipratropium bromide (Atrovent) is given in combination with albuterol ```
True - ONLY used for asthma exacerbation if combined with albuterol
28
Ipratropium bromide (Atrovent): caution and contraindications
Avoid in patients with urinary retention, BPH, closed-angle glaucoma
29
Is ipratropium bromide (Atrovent) compatible with pregnancy and lactation?
ONLY if clearly indicated in pregnancy Compatible with lactation
30
Ipratropium bromide (Atrovent): adverse effects
Cough, dry mouth, mouth and throat irritation, dyspepsia, N/V
31
Tiotropium bromide (Spiriva): classification
Long-acting anticholinergic
32
Tiotropium bromide (Spiriva): indications
Asthma, COPD
33
Tiotropium bromide (Spiriva): MOA
Inhibits muscarinic M3 receptors in the lungs --> smooth muscle bronchodilation
34
Tiotropium bromide (Spiriva): caution and contraindications
Avoid in patients with urinary retention, BPH, closed-angle glaucoma
35
Can tiotropium bromide (Spiriva) be used during asthma exacerbations?
NO
36
Can tiotropium bromide (Spiriva) be used with pregnancy and lactation?
Use ONLY if clearly indicated in pregnancy Compatible with lactation Approved for kids >6 years old
37
Tiotropium bromide (Spiriva): adverse effects
Dry mouth, pharyngitis, URI, HA, mouth irritation
38
What should providers monitor for in children who take leukotriene modifiers?
Neuropsychiatric events
39
Montelukast (Singulair): classification
Leukotriene modifier
40
Montelukast (Singulair): indications
Chronic asthma, allergic rhinitis
41
Montelukast (Singulair): MOA
Inhibits the CysLT1 receptor (correlated with pathophysiology of asthma) --> decrease airway edema, smooth muscle contraction
42
Can montelukast (Singulair) be used for asthma exacerbations?
NO
43
Montelukast (Singulair): caution and contraindications
Zafirlukast should NOT be used in active liver disease
44
Can montelukast (Singulair) be used with pregnancy and lactation?
Pregnancy - yes Lactation - NO Montelukast can be used in children >1 years, Zafirlukast >5 years
45
Montelukast (Singulair): adverse effects
HA, GI upset, myalgia
46
Zileuton (Zyflo): classification
Leukotriene modifier
47
Zileuton (Zyflo): indications
Chronic asthma
48
Zileuton (Zyflo): MOA
Inhibits 5-lipoxygenase which catabolizes formation of leukotrienes from arachidonic acid Decreases inflammation, edema, mucous secretion, bronchoconstriction
49
Zileuton (Zyflo): caution and contraindications
Should NOT be used in active liver disease
50
Can zileuton (Zyflo) by used for asthma exacerbations?
NO
51
Can zileuton (Zyflo) be used in pregnancy and lactation?
NO - use montelukast
52
Zileuton (Zyflo): adverse effects
HA, dyspepsia, increased serum ALT, myalgia, URI
53
Fluticasone (Flovent or Flonase): classification
Corticosteroid
54
Fluticasone (Flovent or Flonase): indications
Asthma, COPD, allergic rhinitis
55
Fluticasone (Flovent or Flonase): MOA
Extremely potent vasoconstrictive and anti-inflammatory activity
56
Flovent: MOA
Inhaled; inhibits IgE in mast cell migration of inflammatory cells into the bronchioles
57
Flonase: MOA
Intranasal; decreases inflammation of nasal mucosa alone
58
Fluticasone (Flovent or Flonase): onset
3-7 days
59
Fluticasone (Flovent or Flonase): caution and contraindications
Caution in those with active infection
60
Can fluticasone (Flovent or Flonase) be used during pregnancy and lactation?
Pregnancy and lactation: compatible Evaluate age of ped patient in relation to drug used
61
Can fluticasone (Flovent or Flonase) be used for asthma exacerbations?
NO
62
Fluticasone (Flovent or Flonase): adverse effects
Xerostomia, hoarseness, mouth and throat irritation, flushing, bad taste, oral candidiasis, rash and urticaria (rare)
63
Cromolyn sodium: classification
Inhaled anti-inflammatory agent
64
Cromolyn sodium: indications
Asthma, bronchospasm prophylaxis, allergic rhinitis
65
Cromolyn sodium: MOA
Inhibits antigen-induced bronchospasm and blocks release of histamine by inhibiting mast cell degranulation
66
Can cromolyn sodium be used during pregnancy and lactation?
Other inhaled agents preferred in pregnancy and lactation (e.g. intranasal formulations) Approved in children >2 years old
67
Can cromolyn sodium be used for asthma exacerbations?
NO
68
Azelastine (Astepro) and Olopatadine (Patanase): classification
Inhaled antihistamine
69
Azelastine (Astepro) and Olopatadine (Patanase): indications
Seasonal allergic rhinitis, vasomotor rhinitis
70
Azelastine (Astepro) and Olopatadine (Patanase): MOA
Inhibits release of histamine by competing with histamine at H1 receptor sites Improves mucous transport
71
Azelastine (Astepro) and Olopatadine (Patanase): caution and contraindications
DO NOT combine with CNS depressants Avoid driving or operating heavy machinery while using
72
Can Azelastine (Astepro) and Olopatadine (Patanase) be used in pregnancy and lactation?
NO but approved in pediatrics (but not first option d/t somnolence)
73
Azelastine (Astepro) and Olopatadine (Patanase): adverse effects
Somnolence (greater with azelastine), bitter taste, HA, nasal irritation
74
Diphenhydramine (Benadryl): classification
First-generation antihistamine (causes drowsiness)
75
Diphenhydramine (Benadryl): indications
Allergic rhinitis, hypersensitivity reactions, urticaria and angioedema, insomnia, motion sickness, antiemetics
76
Diphenhydramine (Benadryl): MOA
Competitively antagonizes the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels, and respiratory tract
77
Diphenhydramine (Benadryl): onset
15-30 minutes
78
Diphenhydramine (Benadryl): caution and contraindications
Not to be combined with CNS depressants Avoid in patients with narrow angle glaucoma, BPH, those with thickened respiratory secretions Caution in elderly (BEERS criteria)
79
Can diphenhydramine (Benadryl) be used in pregnancy, pediatrics, and lactation?
Avoid premature infants, newborns, and young children --> paradoxical effects Use alternative agents for pregnancy and lactation
80
Diphenhydramine (Benadryl): adverse effects
Sedation, dizziness, confusion, ataxia, urinary retention, paradoxical excitation, dry mouth, tremor, blurred vision
81
First vs second generation antihistamines
Second gens cause no drowsiness (avoids crossing BBB), longer acting
82
Cetirizine, Loratadine, Fexofenadine: classification
Second generation antihistamines
83
Cetirizine, Loratadine, Fexofenadine: indications
Respiratory allergies, urticaria
84
Cetirizine, Loratadine, Fexofenadine: MOA
Competitively antagonizes the effects of histamine at peripheral H1 receptor sites at the GI tract, blood vessels, respiratory tract
85
Which second generation antihistamine has the fastest onset and least metabolized by the P450 system?
Cetirizine --> avoid in patients with chronic liver disease
86
Cetirizine, Loratadine, Fexofenadine: caution and contraindications
Additive drowsiness when combined with CNS depressants
87
Can Cetirizine, Loratadine, and Fexofenadine be used in pregnancy and lactation?
Caution in pregnancy and lactation
88
Cetirizine, Loratadine, Fexofenadine: adverse effects
HA, drowsiness, nervousness
89
What classification of medication are decongestants?
Alpha adrenergic agonists (sympathomimetic)
90
What is the most commonly used systemic decongestant?
Pseudoephedrine
91
Systemic decongestant MOA
Vasoconstriction by stimulating alpha receptors within mucosa of respiratory tract and mucus membranes
92
True/False | Pseudoephedrine has mild CNS stimulant effects
True - increased HR, force of contraction, cardiac output
93
Topical decongestant MOA
Intense vasoconstriction when applied directly to swollen mucous membranes of nasal passage
94
Decongestant: caution and contraindications
Avoid in severe HTN and CAD (oral) Avoid in combination with beta blockers
95
Can decongestants be used in pregnancy and lactation?
Not recommended for children <4 years (oral), pregnancy, and lactation
96
Decongestant: adverse effects
Anxiety, restlessness, HA, insomnia, psychological disturbances, tremors, HTN, tachycardia
97
Dexotromethorphan, codeine, benzonatate: classification
Antitussives (cough meds)
98
Dexotromethorphan: MOA
Acts centrally in the medulla to elevate the threshold for coughing (structurally related to codeine) Okay with pregnancy and lactation
99
Codeine: MOA
Direct effect on cough receptors in the medulla
100
Benzonatate: MOA
Related to anesthetic tetracaine and thought to anesthetize the stretch receptors in the respiratory passages (calms cough)
101
Benzonatate: patient education
Not recommended in pregnancy and lactation Swallow tablet whole, don't chew
102
Antitussive: caution and contraindication
Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema Avoid benzonatate in allergies to tetracaine or related compounds Risk of abuse with codeine and dextromethorphan CNS depressants when combined with codeine and dextromethorphan can cause additive CNS depression
103
Antitussive: adverse effects
Dextromethorphan and codeine: drowsiness, dizziness, GI upset Benzonatate: chest numbness, dizziness, GI upset, HA, "chilly" sensation
104
Guaifenesin: classification
Expectorant
105
Guaifenesin: MOA
Increase output of respiratory tract by decreasing adhesiveness and surface tension --> productive cough
106
Antacid formulations
Aluminum hydroxide, magnesium hydroxide, calcium carbonate
107
Antacid: indications
Hyperacidity, PUD, mild GERD
108
Antacid: MOA
Weak bases that react with HCl acid to form salt and water, reduce gastric acidity and increase pH
109
Antacid: caution and contraindications
Should not be used in abdominal pain of unknown etiology Avoid aluminum and magnesium based antacids in renal impairment Avoid calcium based in hypercalcemia Caution in patients who are on sodium restriction (e.g. HF)
110
Can antacids be used with pregnancy and lactation?
Yes
111
Antacid: adverse effects
Aluminum and calcium based: constipation Magnesium based: diarrhea
112
Antacid: drug interactions
Antacids should be separated from other meds by at least TWO hours
113
Sucralfate (Carafate): classification
Cytoprotective agents
114
Sucralfate (Carafate): indications
Prophylaxis and treatment of duodenal ulcers associated with NSAID use and treatment for duodenal ulcers from other causes
115
Sucralfate (Carafate): MOA
Selectively binds to necrotic ulcer tissue, covering it and acting as a barrier for outside stimuli (such as acids)
116
Sucralfate (Carafate): caution and contraindications
Caution in geriatric patients with creatinine clearance less than 30 mL/min
117
Can sucralfate (Carafate) be used in pregnancy and lactation?
Yes Limited data in children
118
Sucralfate (Carafate): adverse effects
Constipation, dizziness, gastric discomfort Separate meds by at least two hours
119
Misoprostol (Cytotec): classification
Cytoprotective agent
120
Misoprostol (Cytotec): indications
Prophylaxis and treatment of duodenal ulcers associated with NSAID use
121
Misoprostol (Cytotec): MOA
Inhibition of gastric secretion through inhibition of histamine stimulated cAMP Mucosal protective qualities by increasing mucus and bicarbonate
122
Misoprostol (Cytotec): caution and contraindications
Caution in renal impairment
123
Can misoprostol (Cytotec) be used in pregnancy and lactation?
AVOID in pregnancy and lactation (can cause abortion birth defects) Safety and efficacy not established in peds
124
Misoprostol (Cytotec): adverse effects
Diarrhea, abdominal pain, nausea, postmenopausal bleeding, HA
125
Ranitidine and Famotidine (Pepcid): classification
Histamine 2 receptor antagonist
126
Ranitidine and Famotidine (Pepcid): indications
Mild intermittent GERD, PUD, heartburn
127
Ranitidine and Famotidine (Pepcid): onset
30 minutes
128
Ranitidine and Famotidine (Pepcid): MOA
Reversible competitive inhibition of histamine at H2 receptors of gastric parietal cells --> inhibits gastric acid secretion Parietal cells = acetylcholine, gastrin, histamine
129
Ranitidine and Famotidine (Pepcid): caution and contraindications
Caution in renal impairment
130
Can Ranitidine and Famotidine (Pepcid) be used in pregnancy and lactation?
Yes and in peds
131
Ranitidine and Famotidine (Pepcid): adverse effects
HA, dizziness, confusion
132
Omeprazole, Pantoprazole, Esomeprazole: classification
PPI
133
Omeprazole, Pantoprazole, Esomeprazole: indications
Duodenal and gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, GERD
134
Omeprazole, Pantoprazole, Esomeprazole: MOA
Inhibits gastric proton pumps (H+/K+ ATPase) on parietal cells to suppress acid secretion
135
Omeprazole, Pantoprazole, Esomeprazole: caution and contraindications
BLACK BOX WARNING: don't combine omeprazole and clopidrogel (increases effectiveness of clopidrogel) Caution in elderly and those with hepatic dysfunction
136
Can Omeprazole, Pantoprazole, Esomeprazole be used in pregnancy and lactation?
Yes and for peds
137
Omeprazole, Pantoprazole, Esomeprazole: adverse effects
Nausea, diarrhea, HA, GI disturbances, bone fractures Increased risk for c. diff infection, hypomagnesemia, vitamin B12 deficiency
138
Omeprazole, Pantoprazole, Esomeprazole: patient education
Take 30-60 minutes before meals (preferably in the morning) Slower onset than histamine 2 receptor antagonists
139
First line therapy for h. pylori infection
Triple therapy - PPI once or twice daily Amoxicillin 1 g bid Clarithromycin 500 mg bid
140
Triple therapy for h. pylori infection for patients with amoxicillin in penicillin allergy
PPI once or twice daily Metronidazole 500 mg bid Clarithromycin 500 mg bid
141
Examples of anti motility agents
Diphenoxylate/atropine Loperamide
142
Diphenoxylate/atropine: MOA
Inhibits excessive GI motility and GI propulsion
143
Why is atropine added to diphenoxylate (anti motility agent)?
Provides anticholinergic effect that decreases secretion in the bowel and slows peristalsis
144
Diphenoxylate/atropine: adverse effect
Euphoria and dependence
145
Loperamide: MOA
Acts through opioid receptors to inhibit peristalsis and prolongs gastric time Reduces fecal volume and diminishes loss of fluid and electrolytes
146
Loperamide: contraindication
Active bacterial bowel infection
147
Examples of anti secretory meds
Bismuth subsalicylate, kaolin and pectin, polycarbophil (FiberCon)
148
Bismuth subsalicylate, kaolin and pectin, polycarbophil (FiberCon): indications
Acute diarrhea, IBS with diarrhea predominance
149
Bismuth subsalicylate: MOA
Exhibits both anti secretory and antimicrobial action and may have some anti-inflammatory action as well
150
Kaolin and pectin: MOA
Kaolin - clay like powder that attracts and holds bacteria Pectin - thicken stool by absorbing moisture
151
Polycarbophil (FiberCon): MOA
Provides bulk to stools by absorbing water in GI tract
152
Diphenoxylate/atropine (Lomotil): adverse effects
Dry mouth, dry eyes, urinary retention, blurred vision, drowsiness, dizziness
153
Diphenoxylate/atropine (Lomotil): contraindications
Patients with liver disease, fever, bloody stool, fecal leukocytes Scheduled V substance
154
Loperamide (Imodium): adverse effects
Abdominal discomfort, constipation, drowsiness, dry mouth
155
Loperamide (Imodium): contraindications
Patients with fever, blood stools, fecal leukocytes May cause drowsiness (avoid driving or other activities that require alertness)
156
Bismuth subsalicylate: adverse effects
Black stools, darkening of tongue, tinnitus
157
Bismuth subsalicylate: contraindications
Aspirin sensitive or taking medications that interact with warfarin NOT recommended for peds d/t presence of salicylate component (Reye syndrome)
158
Polycarbophil (FiberCon): adverse effects
Stomach upset, bloating, gas
159
Polycarbophil (FiberCon): contraindications
Potential for drug interactions with tetracycline or quinolones
160
Kaolin and pectin: adverse effects
Constipation, feeling of fullness, stomach bloating, gas
161
Kaolin and pectin: contraindications
DO NOT use with children
162
Ondansetron (Zofran): classification
5HT3 receptor antagonist
163
Ondansetron (Zofran): MOA
Blocks serotonin both peripherally on vagal nerve terminals and centrally in CTZ
164
Ondansetron (Zofran): caution and contraindications
Caution in QT prolongation, concurrent use with other serotonin meds, pregnancy and lactation Okay in children >6 months
165
Ondansetron (Zofran): adverse effects
HA, constipation, fatigue
166
Dramamine, Meclizine: classification
Antihistamines
167
Dramamine, Meclizine: MOA
Competes with histamine for H1 receptor sites, black CTZ, diminish vestibular stimulation, depress labyrinthine function through central anticholinergic activity
168
Dramamine, Meclizine: adverse effects
Drowsiness, dry mouth, blurred vision, urinary retention, paradoxical excitation in children may occur
169
Dramamine, Meclizine: caution and contraindications
NOT combined with CNS depressants Avoid in patients with narrow angle glaucoma, BPH, those with thickened respiratory secretions Avoid in elderly patients (increased risk for confusion and CNS depression)
170
Can Dramamine and Meclizine be used with pregnancy and lactation?
Dramamine can be used in children older than 2 years; Meclizine in children >12 years Compatible with pregnancy, avoid in lactation
171
Scopolamine (Transderm Scop): classification
Anticholinergic
172
Scopolamine (Transderm Scop): MOA
Blocks the action of acetylcholine at the parasympathetic sites in smooth muscle, CNS, and secretory glands (decreased GI motility)
173
When should scopolamine (Transderm Scop) patches be applied?
Administer four hours before desired onset (can stay on for 72 hours)
174
Scopolamine (Transderm Scop): adverse effects
Drowsiness, dry mouth, blurred vision, urinary retention, dilated pupils
175
Scopolamine (Transderm Scop): caution and contraindications
Avoid in patients with narrow angle glaucoma, BPH, thickened respiratory secretions Caution in renal impairment Avoid in elderly patients (increased risk for confusion and CNS depression)
176
Can scopolamine (Transderm Scop) be used with pregnancy and lactation?
Avoid in pregnancy and lactation; no use in peds
177
Promethazine, Prochlorperazine: classification
Phenothiazine
178
Promethazine, Prochlorperazine: MOA
Blocks dopamine receptors in the CTZ as well as cholinergic, alpha 1 adrenergic, and histamine 1 receptors
179
Promethazine, Prochlorperazine: adverse effects
Sedation, EPS reactions, agranulocytosis, dry mouth, blurred vision, constipation, bradycardia, hypotension,
180
Promethazine: adverse effects
Fatal respiratory depression in children younger than 2 years
181
Prochlorperazine: contraindications
Patients with leukopenia, neutropenia, agranulocytosis
182
Promethazine, Prochlorperazine: caution and contraindications
Not combined with CNS depressants Avoid in patients with narrow angle glaucoma, BPH, thickened respiratory secretions Avoid in elderly patients (increased risk for confusion and CNS depression)
183
Can Promethazine and Prochlorperazine be used in pregnancy and lactation?
Other agents preferred in pregnancy, AVOID in lactation
184
Dronabinol (Marinol): classification
Cannabinoids
185
Dronabinol (Marinol): MOA
Activates CB1 receptors in the brain --> prevents pro-emetic effects of endogenous compounds such as dopamine and serotonin
186
Dronabinol (Marinol): adverse effects
Depression, dizziness, paranoid thoughts, somnolence, palpitations, tachycardia, hypotension
187
Dronabinol (Marinol): caution and contraindications
Caution in patients with seizure disorder, cardiac disorder, high potential for abuse
188
Can dronabinol (Marinol) be used with pregnancy and lactation?
Avoid in pregnancy and lactation Caution in pediatric patients younger than 12 years; not recommended for use younger than 6 years
189
Metoclopramide (Reglan): classification
Prokinetic agent
190
Metoclopramide (Reglan): MOA
Dopamine receptor antagonist in the CNS leading to prevention of nausea Stimulates motility in the upper GI tract
191
Metoclopramide (Reglan): adverse effects
BLACK BOX WARNING: EPS effects, depression, drowsiness, dizziness, diarrhea, hypoglycemia
192
Metoclopramide (Reglan): caution and contraindications
Caution in renal impairment, prolongs QT prolongation High potential for abuse Avoid use in Parkinson's disease, if bowel obstruction is suspected/active
193
Can Metoclopramide (Reglan) be used with pregnancy and lactation?
Okay in pregnancy but caution in lactation Approved in pediatrics
194
Senna (Senokot): classification
GI stimulant
195
Senna (Senokot): MOA
Stimulates myenteric plexus --> prostaglandin release --> increase cAMP
196
Senna (Senokot): adverse effects
Abdominal cramping, electrolyte imbalance, N/V/D
197
Senna (Senokot): caution and contraindications
Caution in severe CVD, bowel obstruction suspected/active
198
Can Senna (Senokot) be used with pregnancy and lactation?
May be used in pregnancy and lactation EXCEPT castor oil
199
Which GI stimulant can be used in children older than six years?
Bisacodyl
200
Which GI stimulant can be used in children older than two years?
Senna and castor oil
201
Psyllium (Metamucil): classification
Bulk laxative
202
Psyllium (Metamucil): MOA
Soluble fiber that absorbs water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time
203
Psyllium (Metamucil): caution and contraindications
Narrowed esophageal or intestinal lumen
204
Psyllium (Metamucil): adverse effects
Abdominal cramping, bloating, esophageal or intestinal obstruction (rare)
205
Which form of laxative is first line for constipation?
Psyllium (Metamucil), but has a slow response --> not ideal for acute cases
206
Magnesium hydroxide and polyethylene glycol: classification
Osmotic
207
Magnesium hydroxide and polyethylene glycol: MOA
Draws water into intestinal lumen to increase intraluminal pressure --> distends colon and increases peristalsis
208
Magnesium hydroxide and polyethylene glycol: adverse effects
Abdominal cramping, N/D, bloating
209
Which osmotic laxative has the fastest onset: magnesium hydroxide or polyethylene glycol?
Magnesium hydroxide
210
Magnesium hydroxide and polyethylene glycol: caution and contraindications
Caution with lactulose in diabetic patients, caution with magnesium based preparations and renal impairment
211
Can Magnesium hydroxide and polyethylene glycol be used with pregnancy and lactation?
Okay in pregnancy and lactation Approved in peds if >2 years
212
Docusate sodium (Colace): classification
Stool softener
213
Docusate sodium (Colace): MOA
Reduces surface tension of oil-water interface on the stool --> facilitates admixture of fat and water into stool --> emollient action
214
Can docusate sodium (Colace) be used with pregnancy and lactation?
Compatible with pregnancy and lactation Approved in children >2 years
215
Docusate sodium (Colace): adverse effects
Overly loose stools
216
Mineral oil: classification
Lubricant (laxative class)
217
Mineral oil: MOA
Eases passage of stool by decreasing water absorption and lubricating the intestine
218
Mineral oil: caution and contraindications
Avoid in pregnancy and lactation; avoid in elderly
219
Mineral oil: adverse drug effects
Abdominal cramping, N/V/D, oily rectal leakage
220
Lubiprostone (Amitiza): classification
Chloride channel activators
221
Lubiprostone (Amitiza): MOA
Activates chloride channels in the GI epithelial lining, producing chloride rich secretions that soften stool and increase motility
222
Lubiprostone (Amitiza): caution and contraindications
Known or suspected bowel obstruction NOT recommended in peds or pregnancy
223
Lubiprostone (Amitiza): adverse effects
HA, N/D, abdominal pain and bloating
224
Methylnaltrexone (Relistor): classification
Opioid receptor antagonist
225
Methylnaltrexone (Relistor): MOA
Antagonist at mu receptors in GI tract
226
Methylnaltrexone (Relistor): caution and contraindications
Known or suspected bowel obstruction Caution in pregnancy and NOT recommended in peds
227
Methylnaltrexone (Relistor): adverse effects
Flatulence, N/D, abdominal pain, bloating

NURS 424 (35 decks)

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