Karch Chapter 57: Drugs Affecting Gastrointestinal Secretions
Which H-2 antagonist would the nurse identify as most potent?
famotidine
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?
gynecomastia
Cimetidine is more likely to cause ________________________ than other H2RAs.
gynecomastia and mental confusion
A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is:
headache
After teaching a client who is receiving sucralfate about the drug, which statement indicates that the teaching has been successful?
"I should eat a high-fiber diet"
An older client has been prescribed omeprazole for the treatment of gastroesophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine?
"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population."
______________________________________ are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
Proton pump inhibitors such as omeprazole
The health care provider has prescribed ranitidine for a hospitalized client on a unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the client?
Rinatidine
The following data identified during a nursing assessment and interview. When considering risks for the development of a peptic ulcer, which situation should the nurse discuss with the client?
Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.
A 75-year-old client is treating an ulcer with antacids. Based on the client's age, the nurse expects the health care provider to prescribe a dose of antacid that compares with the average prescribed dose in what way?
Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.
Common side effects seen with proton pump therapy
dizziness, headache, and cough
Omeprazole must be administered _____________ meals
about an hour before meals
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
alopecia
Why is hypersensitivity to pork a contraindication for pancrelipase?
because the drug is derived from pork
Which agent is associated with antiandrogenic effects, including gynecomastia and galactorrhea?
cimetidine
The treatment of choice for H. pylori infection is a PPI and ________________________________________________
clarithromycin plus either amoxicillin or metronidazole.
When antacids are given to the patient, the nurse should observe the patient for ________________________.
concentrated urine and restlessness.
The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects?
constipation
Client taking magnesium- and sodium-containing antacids can have
diarrhea
Caution must be used with large doses of pancrelipase because they may cause ______________________
nausea, abdominal cramps, and diarrhea
Can omeprazole be crushed up or cut in half?
no, must be swallowed whole
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
omeprazole
Pancrelipase is contraindicated in patients who are hypersensitive to ___________________
pork protein or enzymes
The nurse instructs the patient to use over-the-counter ranitidine (Zantac) instead of cimetidine (Tagamet). What risk is decreased when using ranitidine over cimetidine?
Drug-to-drug interaction
Carter, age 2, is diagnosed with cystic fibrosis; the physician places him on pancrelipase. What would be the most appropriate diagnosis for Carter related to his medication regimen?
Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes
A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms most likely be resolved?
1-2 weeks
A patient is in the intensive care unit and being administered ranitidine (Zantac) parenterally. How long will it take for ranitidine (Zantac) to reach peak blood levels?
15 minutes
How long will it take for ranitidine to reach peak blood levels when administered parenterally?
15 minutes
A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?
30 minutes
A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?
Closely monitor the patient for confusion and dizziness
______________________________ have occurred with extremely high doses of pancrelipase
Hyperuricosuria and hyperuricemia
_________________ can be seen with the use of fiber laxatives such as Metamucil.
Increased flatulence
A 35-year-old man is at his follow-up visit for GERD. Antacids have not been effective for his reflux, and the health care provider is prescribing a proton pump inhibitor. Why might the provider prescribe a PPI rather than an H2RA?
PPIs suppress acid more strongly and for a longer time.
A 30-year-old nonpregnant patient is prescribed misoprostol. Which of the following should the nurse instruct the patient as part of the teaching plan?
The nurse should instruct the patient to use a reliable contraceptive to avoid pregnancy during the course of treatment as it can cause birth defects.
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:
an hour before meals
When the patient is receiving an ________________, the nurse monitors the patient frequently for continued reports of pain, sour taste, spitting blood, or coffee-ground-colored emesis.
antiemetic
A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to clients with which condition?
hepatic disease
Ranitidine and cimetidine are both H2RAs used in the treatment of peptic ulcer disease. Of the two, ranitidine is preferred in critically ill clients because it is less likely to:
interfere with metabolism of other drugs
A client is diagnosed with peptic ulcer disease complicated by H. pylori. What is the rationale for adding bismuth to the client's medication regimen?
protects gastric mucosa from stomach acid
A client has a magnesium-based antacid prescribed for administration as needed. Which condition contraindicates the administration of this classification of medications?
renal dysfunction
Magnesium-based antacids are contraindicated in clients with __________________
renal failure
When the patient is administered prolonged doses of metoclopramide, the nurse reports any sign of ____________________________________ to the PHCP.
tardive dyskinesia or extrapyramidal symptoms
