GI- Pharm Exam 2
A client who is receiving chemotherapy for lung cancer has nausea and vomiting because of the therapy. The client wants to know if it is true that smoking marijuana will help. What is the nurse's best response?
"There are some tetrahydrocannabinol (THC)-based medications that contain marijuana that control chemotherapy-induced nausea and vomiting in some people." Rationale: THC, an ingredient in marijuana, acts as an antiemetic in some people and can be absorbed through the gastrointestinal tract or inhaled. THC-based medications, dronabinol (Marinol) and nabilone (Cesamet), are available by prescription to control nausea and vomiting resulting from cancer chemotherapy. The statement, "Smoking marijuana is not legal in any state," does not answer the client's question and is inaccurate. Marijuana is not injected. THC is an effective antiemetic for some clients.
A healthcare provider prescribes oral aluminum-magnesium hydroxide and intravenous ranitidine for a client with traumatic burns and crush injuries. The client asks how these medications work. What is the nurse's best response?
"They limit acidity in the gastrointestinal tract." Rationale: Stress from burns and crush injuries increases gastric acid production and contributes to Curling ulcer formation. Ranitidine (an H2 receptor antagonist) reduces gastric acid formation, and aluminum-magnesium hydroxide (an antacid) neutralizes gastric acid once it is formed. These drugs reduce gastrointestinal acidity, but do not decrease bowel irritability. Stating that they "are effective in clients with multiple trauma" does not answer the client's question about how the medications work. These drugs do not work in the same way as antidiarrhea medications, which work to slow gastrointestinal motility.
What are the #1 and #2 causes of peptic ulcer disease?
#1 is H pylori #2 is NSAIDs
What *OTC* classification of medications may be used to treat nausea?
*Antihistamines:* -Diphenhydramine (Benedryl) -Dimenhydrinate (Dramamine)
How is PUD/H. pylori treated?
*Tri-therapy*: 2 antibiotics with proton pump inhibitor (PPI (omeprazole))
Medication class used for bowel prep...
*osmotic* (lactulose, polyethylene glycol (MiraLAX))
What patient education concerning PPI's should be included?
-Long term use of PPI can cause hypocalcemia resulting in osteoporosis/fractures. PPI should be taken with calcium. -Take before breakfast
What are complications of inappropriate laxative use?
-dehydration -fluid and electrolyte imbalance -cardiac dysrhythmias
Name lifestyle modifications for the treatment of GERD.
-weight loss -no tobacco -no alcohol -avoiding hot, spicy, greasy foods -avoiding NSAIDs
Name classes of medications to help you poop...
1. Osmotics (lactulose, polythelene glycol) 2. Stimulants (Bisocodyl) 3.Opioid antagonist 4. Surfactant stool softner (Docusate) 5. Bulk forming (Psyllium) 6. Herbal (senna, castor oil)
Which medications are associated commonly with upper gastrointestinal (GI) bleeding? Select all that apply.
1.Acetylsalicylic acid (Aspirin) 2.Methylprednisolone (Solu-Medrol) 4.Ibuprofen (Advil) Rationale: Nonsteroidal antiinflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone, are known causes of drug-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding.
name *antihistamines* and their indication and their effect on the body.
1.Scopalamine 2.Diphenhydramine (Benedryl) 3.Dimenhydramine (Dramamine) -Treats N&V -They are anticholinergics (drying effect--be careful in older adults)
Your patient will be given chemotherapy at 1400. What time should you give an anti-emetic?
1300-1330 30-60mins before
How long will a patient with a duodenal ulcer need medication therapy?
4 -8 weeks with either a PPI or H2 receptor blocker (Ranitidine)
The patient continues to have s/s of constipation. A digital rectal exam reveals a fecal impaction. The patient continues to have pain and abdominal cramping. Which medication would the nurse anticipate being ordered next? A) enema B) Fluid bolus C) additional morphine dose for the pain D) Metamucil
A
What education will the nurse provide about the colace? A) This medication will make it easier to pass a stool B) This medication is often used for colonoscopy prep because it evacuates stool completely C) This medication often causes electrolyte imbalances and diarrhea D) This will increase fiber in the stool which increases the bulk and facilitates passing stool
A
When administering the enema, the patient begins to feel cramping. What would the nurse do next? A) slow the rate of enema infusion by lowering the bag or rolling the clamp B) check a heart rate C) Ask the patient if they feel like they can pass a stool D) Elevate the HOB
A
Your patient is complaining of abdominal pain. She had an open laproscopic surgery 3 days prior. Her abdominal pain is worse today. She reports cramping. She is passing gas. She has not had a BM since before surgery. She has not been tolerating oral fluids well since her surgery. She has been receiving some IVF. Over the last 24 hours, her fluid intake was 1000 mL and her output was 720 (averaging 30 mL/hr) The nurse is reviewing her post-operative medication list. Which medication would the nurse identify as being mostly like to contribute to constipation? A) Morphine B) Ibuprofen C) Promethazine (Phenergan) D) Cefazolin
A
After an acute episode of gastrointestinal (GI) bleeding, a client is diagnosed with a gastric ulcer. The client receives a prescription for ranitidine 150 mg twice a day. What concern prompts the nurse to contact the health care provider about the prescription?
An administration route is not specified. Rationale: It is necessary to clarify the route of administration because ranitidine can be given by mouth, intravenously, or intramuscularly; the health care provider's prescription is incomplete. Ranitidine usually is given with meals. Ranitidine is used to decrease gastric acid and is helpful for clients with a peptic ulcer. 150 mg twice a day is the usual dose of ranitidine when given twice a day.
A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, what does the nurse reinforce?
Antacids commonly interfere with the absorption of other drugs Rationale: Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.
promethazine is a...
Antiemetic
A client is prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD). Which instruction would the nurse give to the client about when to take this medication?
At bedtime Rationale: Ranitidine is administered typically in a single dose at bedtime. This medication is used for 4 to 6 weeks in combination with other therapy; it is not used as needed, with meals, or when indigestion occurs.
Name an example of a stimulant laxative and patient education associated with this type of laxative.
Bisacodyl -Patient should be still for 15 mins and hold medication in booty for 30-45mins -Can lead to dependance -Side effects: cramping, abd pain
Which OTC anti-diarrheal cannot be given to children under 12? Why?
Bismuth salicylate (Pepto Bismol) Contains aspirin so there is a risk for reyes syndrome
What type of medication used to treat constipation is given as a suppository?
Bisocodyl (stimulant)
What is the benefit for probiotic use after antibiotic associated diarrhea?
Builds up good bacterial flora in the GI tract that was taken away by the antibiotics
Your patient has been prescribed two medications: -Bisacodyl suppository X1 now -Docusate sodium (Colace) 100 mg PO daily What education would the nurse provide about the bisacodyl suppository? A) This will break the stool into small pieces B) The stool will become softer C) This increases peristalsis and promotes passing the stool D) This medication rarely causes abdominal cramping and diarrhea
C
Name an *OTC* medication that may be used to treat GERD, but has potential side effects with long-term use.
Calcium carbonate ("Tums") Too many Tums= hypercalcemia= kidney stones.
The patient states "I forgot the name, but this medication doesn't make me go, but makes it easier to go." What medication is this patient likely describing?
Docusate (Calace)
Your patient is not currently constipated, but is starting an opioid for pain. What class of medication would likely be prescribed to PREVENT constipation?
Docusate (Colace) (surfactant stool softener)
A health care provider prescribes psyllium 3.5 g twice a day for constipation. What is most important for the nurse to teach this client?
Each dose should be taken with a full glass of water. Rationale: Because this drug has a strong affinity for fluids, it will swell in the intestine. The large bulk stimulates peristalsis. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna (Senokot), a stimulant laxative, may discolor urine, not psyllium. Psyllium, a bulk forming laxative, is among the safest laxatives on the market. It is useful with prolonged therapy because it is not systemically absorbed and is not potent in its action. Prolonged use of lubricant or saline/osmotic laxatives can inhibit the absorption of some fat-soluble vitamins.
What key assessment is necessary prior to the use of any laxative?
Ensure they have bowel sounds before giving laxative or you can cause a bowel obstruction
A healthcare provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy does the nurse conclude is the most likely cause of the diarrhea?
Esomeprazole Rationale: Esomeprazole, a proton pump inhibitor, may cause diarrhea related to a higher risk for Clostridium difficile intestinal infection. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.
Differentiate between meal and med timing for H2 receptor blocker vs. Proton Pump Inhibitors
H2 Blocker (ranitidine)= give after meals PPI (omeprazole)= give 20-30min *before* meals Rationale: H2 blocker (decreases acid production with food); PPI (proton pump gets activated by food, needs blocked BEFORE it is activated)
What PUD/GERD medication should be avoided with antacids? When can an antacid be taken with a H2receptor antagonist?
H2 Blockers should *not* be given with antacids ex. ranitidine
Name 2 instructions you would give your patient with bisacodyl?
Ideally, hold the stool for 30 - 45 min. Need to lie still for at least 15 minutes. This irritates and shifts fluid into the colon. *(Can lead to dependence)*
What is Reglans action? What is the black box warning?
Increase GI motility Black box warning: Tardive Dyskinesia
Ranitidine has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by which mechanism?
Inhibiting the histamine at H2 receptors Rationale: Ranitidine inhibits histamine at H2 receptor sites in parietal cells, which limits gastric secretion. Lowering the gastric pH is not the direct action of this drug. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the drug prevents its erosion by gastric secretions.
What anti-diarrhea is considered a controlled substance? Name an indication for its use.
Lomotil Schedule 5 Drug (controlled substance (atropine)) that slows peristalsis.
Name antidirrheals
Lomotil Loperamide Bismuth subsalicylate(Pepto) Psyllium ("fiber")
A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action?
Lowers the surface tension of feces Rationale: The detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces. Lubricating the feces in the gastrointestinal (GI) tract is the action of lubricant laxatives such as mineral oil. Creating an osmotic effect in the GI tract is the action of saline laxatives, such as magnesium hydroxide, or other osmotics such as lactulose. Stimulating motor activity of the GI tract is the action of peristaltic stimulants, such as cascara.
If your patient wants to take an antacid, what would you tell them about the timing of their dosage
Many can impact absorption of other drugs, don't take within 2 hours of other drugs (unless OK-ed by MD)
The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect?
Mild abd cramping Rationale: Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.
A client admitted with a myocardial infarction is prescribed docusate and morphine and takes digoxin and fluoxetine at home. Which drug should the nurse recognize as a risk factor for straining due to constipation?
Morphine Rationale: Morphine is an opioid. Opioids decrease intestinal peristalsis, which may precipitate constipation; straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart. Digoxin is unrelated to intestinal peristalsis and the potential for constipation. Docusate sodium is a stool softener which would relieve, not cause, constipation. A side effect of fluoxetine is diarrhea, not constipation.
A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist? Select all that apply.
Nizatidine (Axid) Ranitidine (Zantac) Famotidine (Pepcid Rationale: Nizatidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Ranitidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Famotidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD
Which antiemetic is classified as a Serotonin Antagonist, and what is an indication for its use?
Ondansetron (Zofran) 1st line treatment for n&v due to chemo
name the serotonin antagonists discussed and its side effects
Ondansetron (Zofran) dizziness, drowsy, headache, constipation, diarrhea
Name the routes that ondansetron can be given
PO, IV, IM, ODT (oral disintegrating)
Sucralfate is a_______ and must be given____
Pepsin inhibitor that must be given in the *stomach*
What medication can be used to treat both diarrhea and constipation? What patient teaching is necessary for this drug?
Psyllium Must take medication with fluids
A health care provider prescribes ranitidine for a client with heartburn. During a teaching session, which information will the nurse share with the client about how this drug works?
Ranitidine reduces gastric acidity in the stomach. Rationale: Ranitidine (Zantac) inhibits histamine at H2 receptor sites in the stomach, resulting in reduced gastric acid secretion. Ranitidine reduces, rather than neutralizes, gastric acidity. Ranitidine does not increase gastrointestinal peristalsis, and it does not completely stop production of hydrochloric acid in the stomach.
Identify a medications that are used to *prevent* constipation and patient education associated with how this drug works.
Surfactant stool softeners (Docusate (Colace)) "does not make you go but makes it easer to go." by absorbing more water and fat into stool.
What cardiac condition may be a side effect with serotonin receptor ANTagonists?
aka ondansetron... prolonged QT syndrome
Which anti-ulcer drug acts very rapidly, but only lasts 2 hours
anti-acids (alka selzter, calcium carbonate (Tums), etc.)
Phenergan is an
anti-emetic
Your patient has c. difficile related diarrhea. What is contraindicated?
antidiarrheals (loperamide, lomotil, etc.)
When administering a enema what should the nurse be mindful of?
avoid adminstering too fast it can cause discomfort. if discomfort occurs, slow down.
You are caring for a patient who has diarrhea. He was seen 4 days ago, and prescribed diphenoxylate with atropine (Lomotil). He calls today to report that he is still having frequent episodes of diarrhea. He states he does not feel well. How you would you interpret this? When you know a patient has had prolonged or severe diarrhea, what assessments are important to perform? What are some contraindications for the use of lomotil? What schedule is lomotil?
case study ch 42??
Side effects of impaction
diarrhea abd pain
side effects to promethazine
drying EPS TD (tardive dykinesia) dizzy sleepy
Non medicinal constipation treatments...
fiber, water, increased activity
Chronic constipation can lead to..
impaction
What is GERD?
inflammation of esophagus caused by gastric acid in stomach "heartburn"
What are good sources of fiber?
oatmeal apple salad
What is PUD?
peptic ulcer disease is hypersecretion of hydrochloric acid (Hcl)
What type of medication can help symptoms of antibiotic associated diarrhea?
probiotics
How do histamine H2 receptor antagonists work to treat PUD?
reduces acid secretion in the stomach
Which medication used for motion sickness is placed as a patch behind the ear?
scopolamine patch -must be prescribed -last 3 days
Which medication when given by mouth coats and covers an ulcer to protect it?
sucralfate (Carafate)
Decadron is used for _____ with ______.
vomiting with brain tumors/IICP short term use only
Probiotics can be found in
yogurt