Week 8 - GI

Question 1

Appropriate use of emetics (3)

Answer 1

• To expel ingested toxins before absorption
• Should NOT be used if a caustic substance is ingested, like ammonia or bleach
• If poison is swallowed, call control center + ipecac syrup within an hour of ingestion if pt is alert

Question 2

Assessment for Diarrhea (6)

Answer 2

• History of viral or bacterial infection, drugs, food ingested
• Check vitals and fluid electrolyte balance
• Assess frequency and consistency of stool
• Assess bowel sounds
• Check history of narcotic drug abuse if opiate/opiate related antidiarrheals are prescribed
• Check for hypovolemia, hypokalemia, hyponatremia

Question 3

Diarrhea Interventions (5)

Answer 3

-Report HR above 100 or systolic decrease of 10-15 mm HG (signs of hypovolemia)
-Opiates and opiate related drugs may cause CNS depression
-Check frequency of BM, bowel sounds
-Check signs and symptoms of dehydration, fluid and electrolyte balance
Do NOT give antidiarrheals if possibility of C. Diff until C. Diff tx has started

Question 4

What could giving antidiarrheals to untreated C. Diff cause?

Answer 4

Megacolon

Question 5

Diphenoxylate/Atropine (Lomotil)

• Class
• Action
• Use

Answer 5

Class: Opiate antidiarrheal (potential for drug dependence and physical dependence)
Action: opiates diphenoxylate decrease peristalsis by blocking nerve signals to the intestinal muscles to ease painful contractions and prevent muscle spasm. Atropine = anticholinergic so it slows GI
Use: Traveler’s diarrhea

Question 6

Diphenoxylate/Atropine (Lomotil)

• Common Side Effect
• Interactions (3)
• What should you assess before starting?

Answer 6

Common side effect: constipation
Interactions: CNS depression with alcohol, sedatives, tranquilizers
-Assess for infection PRIOR to starting

Question 7

Omeprazole (Prilosec)

• Class
• Mechanism
• Use

Answer 7

Class: PPI
Mechanism: Inhibits H+ and K+ ATPase enzyme system (the gastric proton pump) to suppress gastric acid secretion into the gastric lumen
Uses: PUD/PUD prophylaxis, GERD, Zollinger Elison syndrome

Question 8

Omeprazole (Prilosec)

• Effects (4)
• Adverse effects (5)

Answer 8

Effects: H/A, dizziness, rash, elevated AST and ALT
Adverse: Risk for C. diff, risk for pneumonia, hip fractures, anemia, gastric cancers

Question 9

H. Pylori treatment

Answer 9

Dual, triple, or quadruple drug combination
Common: Metronidazole (Flagyl) + Omeprazole (Prilosec) + Clarithromycin (Macrolide)
-Can also use H2 Receptor Blockers

Question 10

Classes of Non-Prescription Anti-Emetics

Answer 10

Antihistamines, and bismuth-subsalicylate

Question 11

Three categories of Dopamine Antagonists (anti-emetics)

Answer 11

Phenothiazine, Non-Phenothiazine, Butyrphenones

Question 12

Classes of Prescription Anti-Emetics (7)

Answer 12

Antihistamine, anticholinergics, benzodiazepines, glucocorticoids, Dopamine Antagonists (phenothiazine, non-phenothiazine, butyrphenones), Serotonin (5-HT3) Receptor Antagonist, Substance P/Neurokinin1 Receptor Antagonist

Question 13

Ranitidine (Zantac) 
Class:
Mechanism: 
Use:
Side Effects (7):
Adverse Effects (4):

Answer 13

Class: H2 Receptor Blocker
Mechanism: Blocks H2 Receptors to decrease gastric secretion and concentration
Use: PUD, PUD Prophylaxis, prevents acid reflux in esophagus
Side Effects: H/A, nausea, vertigo, diarrhea or constipation, blurred vision, rash, confusion
Adverse Effects: Hepatotoxicity, cardiac dysrhythmias, blood dyscrasias, can prolong QT interval

Question 14

Zantac

• Is it potent?
• Duration of action
• Side effect/interactions

Answer 14

Potent
Longer duration of action
Few side effects and drug interactions

Question 15

Bismuth Salicylate caution

Answer 15

Caution in kids because of Aspirin content (can cause Reye’s)

Question 16

Antihistamine mechanism

Answer 16

Suppresses CNS to cause anticholinergic effects (drowsiness, blurred vision, constipation, dry mouth)

Question 17

Who should you not give antihistamines to/caution with?

Answer 17

• Avoid in narrow angle glaucoma

- Beers criteria

Question 18

Meds for motion sickness, vestibular problems

Answer 18

Antihistamine

Question 19

Which one indirectly controls N/V that may occur with cancer chemo

Answer 19

Benzodiazepine

Question 20

Which one is prokinetic and what does that mean?

Answer 20

Metoclopramide (Reglan)

Synthesizes nerve endings to acetylcholine to decrease nausea and help transit upper GI contents forward

Question 21

Which category has EPS side effects?

Answer 21

Dopamine Antagonists

Question 22

Bisocodyl (Dulcolax) 
Class: 
Use: 
Mechanism: 
Avoid in (5):

Answer 22

Class: Stimulant Laxative
Use: Constipation
Mechanism: By stimulating the bowel there is less time for colon wall to extract water –> stool softener + bowel stimulators
Avoid in (5): obstruction, abdominal pain, appendicitis, UC, diverticulitis

Question 23

Metoclopramide (Reglan)
Class: 
Mechanism: 
Uses:
Side effects (2):
Contraindication (3)

Answer 23

Class: Dopamin Antagonist (non-phenothiazine)
Mechanism: Blocks dopamine receptors to reduce response to chemicals that induce vomiting + prokinetic
Uses: Post op emesis, cancer chemo, radiation therapy
Side effects (2): high doses more sedation, more EPS in children
Contraindication (3): hemorrhage, obstruction, perforation