Unit 3: GU Drugs, GI Drugs, Vitamines/minerals, Endocrine Drugs

Question 1

Omeprazole (Prilosec)*

Answer 1

• Proton Pump Inhibitors (PPI) r/t duondenal, gastric ulcers, GERD
• Disables hydrogen secretion to bind w/ cl-, blocking all acid secretion on partial cells in the gastric lumen of the stomach.
• Take about 30 minutes before meals.
• SE: CV events or long term use of proton inhibit connections.

Question 2

famotidine (Pepcid -ac)*

Answer 2

• Antacid, Antiulcer, Histamine 2 Antagonists r/t duodenal/gastric ulcers, GERD
• Block H2 receptors in stomach, reduce gastric acid secretion.
• Take with meal, an 1 hr before/2 hr after other antacids (Though best to avoid meds taken in conjunction).

Question 3

bismuth subsalicylate (Pepto-bismol, Kaopectate)

Answer 3

• antdiarrheal, Absorbants
• Coats the GI tract walls by binding with bacteria and toxins in the gut to be excreted by stool.
• SE: blackened tongue, black stool, tinnitus
• Can use for several differing things r/t GI upset: Heart burn, indigestion, upset stomach, nausea, diarrhea.

Question 4

diphenoxylate with atropine sulfate (Lomotil), loperamide (Imodium)

Answer 4

• Opiates, antidiarrheal
• Slow bowel motility to slow progression of stool through the GI tract and reduce pain from spasms.
• Monitor for constipation as drugs contain anticholinergic effects (anti-parasympathetic effects)

Question 5

psyllium seed (Metamucil)*

Answer 5

• Bulk forming laxatives
• used in bulking up loose or hard stool as it acts like dietary fiber in the GI tract.
• Absorbs water and distends the bowel.
• Interferes with other meds, so shouldn’t be taken within an 1 hr or 2 hrs with those other meds.
• Take with a full glass of water: mixed in a glass of water along with an additional glass of water to keep the colon flushed out of potential goop build up.

Question 6

docusate sodium (Colace)

Answer 6

• Emollient Laxatives, Stool softeners
• promote water and fat absorption into stool to make it bigger, softer, and easier to pass.
• Lubricant laxatives, mineral oil (Fleet’s Enema), petroleum oil based that can be given orally (drink to keep GI lubricated) or rectally (enema).

Question 7

Magnesium salts (Milk of magnesia (MOM - hydroxide), magnesium citrate, Epsom salts): Saline Laxatives

Answer 7

• Anything that is considered a salt.
• Increasing osmotic pressure by pulling water into the small intestine to make stool effectively easier to pass.
• Increases water and electrolyte secretions either through oral or rectal use.

Question 8

Polyethylene glycol (Miralax), lactulose (Cephulac)

Answer 8

• Hyperosmotic Laxatives
• Increases water content (osmotic pressure) to distend the bowel, increase peristalsis.
• Use large amounts for clear visualization of the bowel (colonoscopy)
• Does not affect electrolytes as it doesn’t tend to cause dehydration for being fairly gentle.
• Most pts use to reduce blood ammonia (for hepatic encephalopathy) of endstage liver disease.

Question 9

senna (Sennakot)*

Answer 9

• Stimulant Laxatives, pill or tea, very effective.
• Stimulates the nerves (endings) innervating the intestines and can cause cramping as becomes irritated.
• Increases perstalsis and fluid in colon

Question 10

ondansetron (Zoftan)

Answer 10

• Serotonin Blocker (Antagonist), antimetic, IV + pill (swallow/dissolvable solute tab)
• Blocks serotonin receptors in the GI tract, CTZ, vomitting center.
• Effective preventative of n/v from chemo/radiation therapy with a big dose before and after as it doesnt stop vomiting once it start.
• Used to be for moringsickness, but shown to cause fetal heart abnormalities.

Question 11

promethazine (Phenergan)*

Answer 11

• Neuroleptic Agents, antimetic
• Blocks dopamine receptors in CTZ to balance w/ acetalcoline in CNS for coordinated movement.
• May result in: orthostatic hypotension, anticoloinergic properties (dry mouth + tachycardia), sedating, extrapyramidal symptoms: pseudoparkinsons, Tardive dyskinesia, akathisia, acute dystonia

Question 12

metoclopramide (Reglan) *

Answer 12

• Prokinetic agents, antimetic r/t when they get really sick to their stomach
• Block dopamine receptors in CTZ ans increase GI motility (gastric emptying)
• Not first for nausea med, commonly used for gastropuresis (diabetic neurotherapy), having peristalsis slow down.
• Give 30 min before meals and at bedtime (PO), to help gastric emptying to decrease n/v from gastropuresis.
• Cause: hypotension, sedation, dry mouth, EPS (extrapryamidal Sx) anticolenergic effects
• BBW: associated with extra parental Sx, parkinson like symptoms, + tardive dyskinesia.

Question 13

Estrogens and Progestins

Answer 13

• Given exodgenously, same effect as endogenous hormones.
• Uses: hormone replacement therapy for menopause, birth control (tricks the body into thinking its pregnant), tx of disorders r/t low hormone levels (supplement to menopause)
• estrogen: conjugated estrogen (Premarin) inhibits ovulation while increasing risk of (cervical) cancer, blood clots (mostly c >35 or if a smoker), dementia (BBW).
• progestin: medroxyprogesterone acetate (Provera, Depo-Provera slow release IM injection into a little muscle tissue pod), inhibits ovulation, uterine contractions, and increases risk of CV complications (BBW) , bone loss (BBW) as hormone replacement/birth control ^ progestin.

Question 14

Testosterone

Answer 14

• Adrogen Deficiency, anabolic steroid
• Decreased levels of testosterone = decreased levels of body hair, genital size, collagen growth (muscle mass)
• Side effect: acne, change in libido, hair loss, HA.
• Do not have with liver failure.

Question 15

sildenafil (Viagra)*, tadalafil (Cialis), vardenafil (Levitra)

Answer 15

• Erectile Dysfunction
• Vasodilation of smooth muscle of corpus cavernosum increasing blood flow to the penis.
• Side effects include HA, dizziness, dyspepia, can cause dangerous dropp in BP.
• Important care must be taken with use of alcohol, other meds, and hypertensive drugs.
• Asking if using nitrate, nitroglicerin for angina (contraindicated), as they may not be honest bout using viagra.

Question 16

Begnign Prostetic Hypertrophy (Hyperplasia - BPH)*

Answer 16

• (Benign) Overgrowth of the prostate gland leading to obstruction of the uretha creating the inability to void and need resection.
• finasteride (proscar)* 5-alpha reductase inhibitors:
  > inhibits metabolism of testosterone to decrease prostate cell production
  > Should not be touched if pregnant or trying to become pregnant as it can harm a male fetus.
• tamsulosin (Flomax) Alpha 1 adrenergic blocker, can be given to help pass kidney stones easier.
  > Relaxes muscles in prostate and neck of bladder to enhance ability to urinate with decreased vascular smooth muscle contraction.
  > May result in postural hypotension - locazlized effect vs. systemic effect.

Question 17

oxybutynin (Ditropan)

Answer 17

• Urinary Antispasmodics, anticholinergic
• relaxating smooth muscle inhibiting acetalcholine at muscarinic receptors.
• PNS stimulates urination, blocking would block urinary spacisty of the bladder.
• Causes: urinary retention leading to ^ risk of UTI, drowsiness, dizziness, blurred vision, dry mouth, nausea, urinary hesitancy, decreased sweating, constipation.

Question 18

Vitamin D

Answer 18

• Fat-soluble vitamin, necessary for bone growth as it is involved with absoption of Ca2+.
• Deficiency leads to soft malformed bones known as osteomalasia for adults and rickets for kids.
• Role in preventkng cancer, Type II DM, hypertension, + pain associated with fibermialgia.
• Inactive Vitamins D2 (ergocalciferol) and vitamine D3 (cholecalciferol) are mostly fiven in a clinical setting and is synthesized in the skin when exposes ro UV light.
• So given as a supplement, converts them in via pathways, kidneys, liver into their active form, calcitriol which can also be taken directly in this form but not common.
• Found: fortified milk/cereals, fatty fish, eggs.

Question 19

Vitamine K

Answer 19

• Fat-soluble vitamine, necessary for synthesis of several clotting factors and some may be synthesized by the normal flora of the colon.
• warfarin interupts the synthesis as an antidote
• Deficiency: newborns for 24hr, adults who do not eat leafy green veggies, or who undergo long term antibiotic therapy.
• found: dark leafy greens (kale, spinach, soy beans/canola oils)

Question 20

Vitamin B1 (thiamine)

Answer 20

• Water-Soluble vitamins, needed for synthesis of ATP (energy production), in the metabolism of glucose, and a role in cellular metabolism.
• Deficiency: Berry Berry (rare) is associated with alcoholism from inadequate intake ans impaired liver function affecting the bodies ability to store the vitamins + damage to the intestinal mucosa significantly impairs absorption.
• Deficiency S/S: polagra (diarrhea, dementia, dermatitus) reversible with a nutrient rich diet, muscle weakeness/wasting, sensory + motor conduction problems, + disease can lead to heart failure + death.
• Pt with alcohol withdrawl may require IM injection to follow with oral doses.
• Found: pork, beef, liver, salmon, black beans, wheat germ.

Question 21

Vitamin B3 (Niacin)

Answer 21

• Water soluble vitamin, helps with memory, arthritis, hyperlipidima.
• required in large dose Tx with many enzymes to co-enzyme for metabolism + production involvement for steroid, hormones, + fatty acids.
• May result in hypotension, flushing (with almost anyone that takes these)
• Deficiency S/S - polagra (diarrhea, dementia, dermatitus) reversible with nutrient rich diet.
• Should not be taken with hepatic impairment.
• Found: liver, fatty fish, tea, poultry, whole grains, coffee.

Question 22

Vitamin B12 (Cyanocobalamin)

Answer 22

• Water soluble vitamin needed for synthesis of DNA, RNA, Myalin, RBC production (formation - especially with B9).
• For PO absorbtion from food, require intinsic factor, lacking could lead to pernishemia or partial/total gastrectomy (removal of the stomach)
• Cannot absorb including gastric bypass of the stomach doesnt work for digestion and require regular IM injections for the rest of their lives.
• Deficiency: result in anemia and irreversible neurologic effect, e.g. parastegia
• Sources: meat, cheese, eggs

Question 23

Vitamin B9 (folate, Folic acid)

Answer 23

• Works with B12 for RBC production.
• Involved in protein synthesis (amino acids, DNA, RNA, heme) + neural tube development of the fetus.
• Deficiency: develop spineabidifida during pregnancy (baby can be born without a closed neural tube in spinal abnormalities)
• Sources: liver, leafy greens, dried legumes, seeds, nuts

Question 24

Vitamin C (Ascorbic Acid)

Answer 24

• Water soluble vitamin, powerful antioxidant necessary for tissue integritty, wound healing, synthesis of epinephrine/norepinephrine/seratonin, required for collagen formation.
• Prophyletic use can decrease duration of a cold when taken befor onset of Sc, but not cure.
• Deficiency: tissue that holds the body together would be weak and lack integrity, scurvy disease with s/s bleeding gums, hair loss and deatb by internal bleeding due to the breakdown of collagen and joints that hold us together.
• Best to get it from the diet: citrust being tbe best form.

Question 25

Iron (Ferrous sulfate*, ferrous gluconate, iron dextran)

Answer 25

• Mineral needed for formation of heme for O2 to bind with in RBCs for transport through the body as the GI is effective in recycling warnout RBCs and absorbing iron so it doesnt take a huge amount (women 3.5 g/men 4g) to limit the risk of toxicity (pediatrics more concerning for this).
• Supplementation in iron - deficiency anemia as absorbative features become overriden as we take large amount of soluble iron.
• Vitamin C helps with absorption and shouls not pair with iron.
• May change color of stool (dark green), resulting in constipation, keeping an eye for blood visible in stool.
• Should be taken on an empty stomach for best absoption but can be taken with food if isnt tolerated.
• Taking oral liquid iron with straw to avoid teeth staining, but should be administered IM using a Z-track (pull/push skin) technique to avoid leaking to avoid skin staining.

Question 26

Potassium (Potassium chloride)

Answer 26

• Mineral normal range 3.5-5.3 mEq/dL, major role in cardiac muscle contraction.
• Chief intracellular ion is 95% inside cells to help maintain rluid balance and responsible for electrixal potentials in nerves and muscles (Ma2+ can help with these when K+ is deficient).
• Supplement in combination K+ wasting diuretic - furosamide and manor
• Hypokalemka is deficiency: low serum where supplementation is needed (diuresis, vomiting, diarrhea) but need a lab draw to show.
• S/S: musculoskeletal weakness + cardiac arrhythmias that can become fatal when out of range.

Question 27

Magnesium (magnesium oxide, magnesium sulfate)

Answer 27

• Critical to nerve impulses, muscle contraction, maintaining normal heart rhythm, as a laxative.
• In large doses, used to prevent seizures in pre-eclampsia/eclampsia of pregnancy.
• Important in metabolism, energy transfer, cellualr function, DNA/protein synthesis, degredation, insulin action.
• Deficiency r/t diabetes + malabsorption disorders.
• Hypomagnesemia is deficiency while diarrhea can result.
• Intracellular ion that can influence the transport lf K+ across cell membrane.

Question 28

Hypoglycemia

Answer 28

• Blood not sweet enough, abnormally low glucose levels (<60 mg/dl) and can be causes by antidiabetic agents (very common side effect)
• Tx: chronic needs a low carb (CHO), and high protein diet, glucose tab/gel, 4oz of orange juice, and even soda as it works quick but not optimal (needing something to immediately bring blood glucose up).
• If pt is not going to eat within an hr, want to give a complex carb, far, + protein to keep blood sugar up for that time.
• After Tx, check back in 15 min to make sure blood sugar raised as it should.
• s/s: confusion/drowsy, diaphoresis (sweating), hunger, tremors (shaky), HA, kinda irritable, convulsions, and can get seizures of go into a coma if blood sugars drop too low.

Question 29

Insuline as a class

Answer 29

• Endogenous insulin action
• different onsets, peaks, and durations, may have long-acting, rapid/short-acting insuline, or may use a sliding scale which is not as peoactive at keeping blood sugar in control as it just chases a high blood sugar.
• Goal of tx is to mimic insulin secretion of non-diabetic.
• Adverse effect: Hypoglycemia
• Nurse action: always check CBG (capillary blood glucose) before giving within the next 30min-1hr and check dose with 2 nurses.
• Safe at room temp for 28 days (date when opened), can be kept unopened in a refrigerator for up to a year.
• Draw cup clear to cloudy if mixing in samw syringe, administering subcutaneously (reference chart to rotate sites but stay in vicinity).

Question 30

insulin glargine (Lantus)*

Answer 30

• Action: Long acting
• Cannot be mixed with any other type of insuline as it has to do with the acidity of the solution that it is, so it has to be inactivated or it will impair.
• Onset: 1.5 hr, no peak, Duration: 24 hr
• Mostly taken at night, bed time while some take it in the morning and it is important to be taken at the same time everyday.

Question 31

metformin (Glucophage)*

Answer 31

• Biguanides, the med that everyone gets placed on first as Type 2 DM only.
• Inhibits glucose production (from liver- glycogenolysis), glucose absorption (from small intestine), and ^ sensitivty to insuline at a cellular level (making insulin uptake more readily).
• adverse effects: n/v, no renal/liver disease
• nursing actions: give with meals, monitor blood glucose
• If med has been used for a while and pt is stable, they can check CBG once or every couple of weeks instead.

Question 32

glipizide (Glucotrol)*

Answer 32

• Sulfonyureas, can be comvined with metformin as they work well together.
• Stimulates insuline secretion from the pancreas beta cells by squeazing what ever function for last bit of insulin.
• Cause: blood-related (agranulocytosis, hemolytic anemia, thrombocytopenia), hypoglycemia.
• Nurse actions: monitor blood sugar (CBG reading before giving med), give 30 min before meal as we want it to work by the time pt works

Question 33

Glucagon*

Answer 33

• Glucose elevating drugs, synthesis form of endogenous hormone with same affect to increase blood glucose.
• intravenous dextrose (D-50 a so it is 50% of dextrose) is given IV as it is a synthetic form lf glucagon similar to what is produced by alpha cells in the pancreas.
• Causes: Hyperglycemia
• Nurse action: give only as a protocol for severe levels of hypoglycemia either SQ, IM, IV

Question 34

Insuline: action/onset/peak/duration/when

Answer 34

• insulin lispro (Humalog): rapid acting action, 15 min onset, 30-90min peak, 3-5 hr duration, typically given right before or right as meal is given.
• regular insulin (Humulin/Novolin R): short acting action, 30-60min onset, 2-4 hr peak, 5-7 hr duration, given 30-60 min before meal.
• NPH (humulin/Novolin R): intermediate acting action, 1-2 hr onset, 2-4 hr peak, 14 hr onset, given 2x day as its a low peak.
• Insuline glargine (Lantus): long acting action, 1.5 hr onset, no peak, 24 he duration, mostly at night and some in the morning but need to take the same time everyday.

Question 35

levothyroxine (Synthroid)*

Answer 35

• Thyroid agent that is generally synthetic, working like a endogenous hormone to increase metabolic rate.
• Side effects: insomnia, hyperthyroid effect (toxicity), ^ body temp, ^ HR.
• Nursing actions: give in morning before food as it can easily interact with meds and nutrients in food, monitor thyroid function labs, keep on the same brand name for a smaller margine of error than the generic preperation of the drug.

Question 36

Calcium preparations

Answer 36

• medications (Ergocalciferol, cholecalciferol, calcitriol) affecting bone metabolism (r/t parathyroid) with calcium preparations.
• supplementation to maintain bone calcium
• paeathyroid hormone work against calcitonin to create an increase of serum calcium as the body starts pulling calcium from bone breakdown.
• Pt’s with hyperparathyroidism will have elevated Ca2+ level but decreased bone mass.
• adverse effects: renal calculi (kidney stones), hypercalcemia
• teach: ^ fluids to break up calcium salts to prevent kidney stones and look for s/s of hypercalcemia.

Question 37

alendronate (Fosamax)

Answer 37

• Medications affecting bone metabolism (parathyroid related)
• biphosphonate that inhibits bone resorption by inhibiting osteoclast activity (osteoporosis)
• To avoid esophageal eorsion, must be taken before food, with a glas of water, and patient must sit up for 30 min after dose.

Question 38

Antacid

Answer 38

• Neutralize stomach acid (increase pH) but can lead to rebound acid production.
• Stimulates mucus, PHO3, prostaglandin secretion
• Aluminum hydroxide-magnesium hydroxide-simethicone
• Calcium Carbonate - may cause gas
• Magnesium hydroxide - may cause laxative effect