Unit 12 - Nutrition & Elimination Flashcards
3 types of cells in the stomac
chief: put out pepsinogen = breaks down to pepsin = breaks down proteins
parietal: puts out hydrochloric acid = break down food & helps kill microorganisms
enteroendocrine: stimulated by production of gastrone (hormone) and produce histamine (binds to parietal cells to create hydrochloric acid)
small intestine sections & function
*main site of absorption
duodenum, jejunum, ileum
large intestine function
*reabsorb water
describe peptic ulcer disease (PUD)
imbalance of protective (mucous & bicarbonate) vs. aggravating factors (pepsin & gastric acid)
common sites of peptic ulcers
- stomach
- large intestine (ulcerative colitis)
- distal small intestine (Chron’s disease)
describe GERD (Gastroesophageal reflux disease)
stomach acids enter esophagus usually from relaxed lower esophageal sphincter
risk factors: caffeine, alcohol, acidic foods, carbonation, obesity, smoking, nitrates, benzodiazepines, anticholinergics, beta-blockers, NSAIDS, TCA’s, opioids, levodopa, biphosphonates, estrogen, progesterone
Goal of pharm for PUD & GERD
- provide relief
- promote healing
- prevent complications
- prevent future recurrence
drugs of choice for treating PUD & GERD
proton pump inhibitors
- omeprazole
- decrease acid more than H2 blockers do
- best for long-term prevention rather than acute episode
“prazole”
proton pump inhibitors
“tidine”
H2 receptor antagonists (OTCs)
Dosage of Omeprazole
- for long term use!
- has long duration, but short half-life (irreversibly binds to proton pumps: bind to pumps on cells & never lets go, so those cells have to die and you have to get new cells with proton pumps in order to release acid again)
Therapeutic effect of Omeprazole:
- Treats heartburn, prevents PUD in patients taking NSAIDS, used in treating H. Pylori
- Irreversibly binds to H+, K+ ATPase; inhibits proton pumps from releasing acid
Contraindications/Interactions of Omeprazole:
- hepatic dysfunction
- pregnancy
- *can’t use in kids <2 yrs
Interactions:
- decrease bioavailability of meds that need acidic environment (minerals)
- decreases effectiveness of clopidogrel
Side effects of Omeprazole:
…
Nursing Considerations/Pt. teaching for Omeprazole:
…
Function of H2 receptor antagonists
- blocks acid production by blocking H2 (histamine) receptors on parietal cells
- blocks daytime, nighttime, fasting and food-stimulated secretion
H2 receptor antagonists (ranitidine) are best used for ____ - term use
short
Therapeutic effect of Ranitidine
- The treatment of PUD, GERD, and stress ulcers
- Inhibition of gastric acid secretion by inhibiting the function of the parietal cells
- inhibits acid secretion from the parietal cells in 3 different times (1. fasting 2. food related 3. night time acid secretion)
Contraindications/Interactions of Ranitidine:
- severe renal and liver disease
Interactions:
- decreased absorption with antacids
- smoking decreases effectiveness
- decreases absorption of drugs needing acidic environment
Side effects of Ranitidine:
*- confusion (geriatrics)
Nursing considerations/Pt. teaching for Ranitidine:
…
Expected therapeutic effects of Antacids:
- neutralize pH of hydrochloric acid in stomach and reduce digestive action of pepsin
- treatment of pain associated with hyperacidity in PUD, GERD, heartburn, and indigestion
prototype of antacids
- aluminum hydroxide: causes constipation
- magnesium hydroxide: causes diarrhea
- calcium carbonate: causes constipation & kidney stones
- sodium bicarbonate: systemically absorbed-hypernatremia, water, metabolic alkalosis, acid rebound, causes bloating and belching
T/F: People with heart failure, hypertension, renal/kidney problems, or on sodium restrictions can not take sodium bicarbonate antacids
T
T/F: you take Sucralfate many times a day
T
Is Sucralfate absorbed into the blood stream?
No, it stays in the GI tract until it’s excrete through feces
Classify Sucralfate
pepsin inhibitor (mucosal protective drug)
Therapeutic effect of Sucralfate
- Reacts with gastric acid to make a thick substance which adheres to the gastric or duodenal ulcer surface protecting it from further injury or irritation
- (Sucralfate coats the inside of the GI tract and forms a spackle and binds to a sore and covers it up)
- helps stimulate mscous and bicarb secretion
Side effects of Sucralfate
*- constipation
T/F: Sucralfate has an effect on acid secretion
FALSE!
Contraindications/Interactions with Sucralfate:
PPIs
Nursing Considerations/Pt. teaching for Sucralfate:
- Administer on an empty stomach
- Do not crush, chew, or break tablets
- Shake suspension very well before administering
- If patient has gastric tube avoid giving with enteral feedings as sucralfate may bind with the protein in the feeding and form a bezoar
- Instruct patient to continue therapy for the ordered 4-8 weeks to ensure healing
- Increase fluid intake, dietary roughage, and exercise to mange potential constipation
- Give other meds 2 hours before or after sucralfate
Nursing Considerations/Pt. teaching for Sucralfate:
- Administer on an empty stomach
- Do not crush, chew, or break tablets
- Shake suspension very well before administering
- If patient has gastric tube avoid giving with enteral feedings as sucralfate may bind with the protein in the feeding and form a bezoar
- Instruct patient to continue therapy for the ordered 4-8 weeks to ensure healing
- Increase fluid intake, dietary roughage, and exercise to mange potential constipation
- Give other meds 2 hours before or after sucralfate
describe constipation
- waste material staying in large intestine too long
- too much water reabsorbed
- decrease in BM’s
- hard BM’s
T/F: frequency by itself can be a definition of constipation
F, everyone has different bowel routines
When to use Prophylaxis for constipation:
- prevent straining
- meds that cause constipation
- pregnancy
- elderly with weak muscles
- patients that can’t exercise (bed-ridden)
When to use treatment for constipation:
- relief
- removal of toxic substances after overdose
- increase removal of dead parasites after helminthic therapy
- cleanse before diagnostic or surgical procedures
RULE OUT OBSTRUCTION WITH CONSTIPATION
:)
Prototype and Function of Bulk Forming
- Psyllium
- absorb water, thus adding size to the fecal mass
Prototype and Function of Stimulant
- Bisacodyl
- promote peristalsis by irritating the bowel
Prototype and Function of Stool Softener’Surfactant
- Docusate
- cause more water and fat to be absorbed into the stools
Prototype and Function of Saline & Osmotic
- Magnesium Hydroxide
- poorly absorbed in the intestine…they pull water into the fecal mass to create a more water stool
Prototype and Function of Herbal Agent
- Senna
- stimulates the bowel and increases peristalsis
Prototype for Proton Pump inhibitors
Omeprazole
Prototype for H2 receptor antagonist (H2 blocker)
ranitidine
Prototype for Miscellaneus PUD & GERD meds
Sucralfate
describe Diarrhea & 5 causes
- increase in frequency and fluidity of BM’s
- causes: infection (viral or bacterial), drugs, inflammation, foods, malabsorption
Prototype and Function of Opioids for diarrhea
- Diphenoxylate c atropine
- slow peristalsis
function of Bismuth Subsalicylate (Pepto-Bismol)
binds and absorbs the toxins so they can’t create and inflammatory response and cause diarrhea
function of Probiotics
good bacteria helps keep bad bacteria at bay
function of Psyllium
absorbs water
When can you NOT use antidiarrheals
- in people with C. Diff or poisoning
how do opioids work
slow peristalsis
side effect: constipation
What controlls nausea and vomiting
controlled in brain by vomiting center (CTZ talks to VC)
prototype and purpose of anticholinergics/antihistamines
- meclizine
- used more for treatment of vertigo and motion sickness
Prototype and function of Phenothiazines
- promethazine
- decreased N&V by blocking dopamine receptors in the chemoreceptor trigger zone
Prototype & purpose of Cannibinoids (Marijuanna)
- dronabinol
- appetite stimulant: used in people with AIDS or end-stage diseases
Prototype & purpose of Serotonin receptor antagonists
- ondansetron
- blocks serotonin at 5-HT3-receptor sites in the vagal nerve and at the chemoreceptor trigger zone (CTZ)
- used in Moms for morning sickness
T/F: Dexamethasone (Glucocorticoid) can help with N related to chemotherapy or post-surgery
T
3 life-style changes to help obesity before medications
- diet
- exercise
- behavior modification
(surgery for those c BMI > 40)
Prototype & function of lipase inhibitors
- Orlistat
- block absorption of fat (prevent lipid absorption in GI tract)
adverse effects of Orlistat
- flatus (gassy)
- oily stool
- fecal urgency
- abdominal pain
Nursing considerations/Pt. teaching for Orlistat
- give drug c or s an hour of a fatty meal
* - avoid excessive high-fat meals to minimize adverse effects
Q: Which of the following is the drug of choice for long term treatment of peptic ulcer disease? A. ranitidine B. sodium bicarbonate C. omeprazole D. docusate sodium
C. omeprazole
Q: Why does omeprazole have such a long duration if it has a short half-life?
A. It takes the liver a long time to metabolize the drug and its metabolites.
B. It irreversibly changes parietal cells so they do not secrete acid.
C. It is a large molecule so it does not easily get filtered through the kidneys.
D. It permanently coats the stomach lining to protect it.
B. It irreversibly changes parietal cells so they do not secrete acid.
Q: How does ranitidine work?
A. It blocks histamine 2 receptors on parietal cells.
B. It prevents the proton pump from releasing acid.
C. It combines with stomach acid to form a paste that coats the stomach lining.
D. It combines with stomach acid to neutralize it.
A. It blocks histamine 2 receptors on parietal cells.
Q: Which of the following classes of medications are used to treat H. Pylori?
Multiple answers: You can select more than one option
A. antibiotics
B. bismuth
C. anti-emetics
D. PPI’s
A. antibiotics
B. bismuth
D. PPI’s
Q: Which type of antacid should a person with heart failure avoid? A. aluminum hydroxide B. magnesium hydroxide C. calcium carbonate D. sodium bicarbonate
D. sodium bicarbonate
Q: What is the most common adverse effect of sucralfate? A. diarrhea B. headache C. tachycardia D. constipation
D. constipation
Q: How do opioids (narcotics) help diarrhea?
A. They slow peristalsis to allow more water absorption in the intestine.
B. They add more bulk to the stool, which absorbs water in the intestine.
C. They encourage water absorption in the stomach, so there is little to be absorbed in the intestine.
D. They encourage the growth of healthy bacteria in the intestine which balances fluid absorption .
A. They slow peristalsis to allow more water absorption in the intestine.
Q: What is the most common adverse effect of ondansetron? A. vomiting B. headache C. insomnia D. hypotension
B. headache
Q: How do phenothiazines work to help alleviate nausea?
A. They block dopamine receptors in the chemoreceptor trigger zone in the brain.
B. They block serotonin receptors in the vagal nerve.
C. They stimulate appetite to discourage nausea.
D. They block signals to the inner ear to decrease motion sickness.
A. They block dopamine receptors in the chemoreceptor trigger zone in the brain.
Q: What is an important teaching point for a person receiving orlistat?
A. Take fat-soluble vitamins at the same time as orlilstat.
B. Continue to eat a 4000 calorie per day diet.
C. Adverse effects can include flatus, abdominal pain, and fecal urgency.
D. Only eat high-fat meals so the medication will be more effective.
C. Adverse effects can include flatus, abdominal pain, and fecal urgency.
