NUR 112 Pharmacology: GI Drugs

Diuretics drugs

+ Loop: Lasix (furosemide) - side effect: Hypokalemia, Ototoxicity +Thiazide: HCTZ (hydrochlorothiazide) - Side: effect Hypokalemia +Potassium Sparing: Aldactone (spironolactone) - Side effect: Hyperkalemia

The nurse is teaching a client who is taking a loop diuretic about foods that are high in potassium. Which food would the nurse emphasize? Select all that apply 1. Bananas 2. Apricots 3. Roasted chicken 4. Macaroni and cheese 5. Baked potatoes with skins

1. Bananas 2. Apricots 5. Baked potatoes with skins

Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema? 1. Furosemide 2. Chlorothiazide 3. Spironolactone 4. Acetazolamide

1. Furosemide Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium; is available for intravenous administration; and is more effective than chlorothiazide, spironolactone, and acetazolamide.

Which suggestion would the nurse provide to the mother whose child has been constipated for 3 days? Select all that apply 1. Give laxatives to the child 2. Reduce the child's fluid intake 3. Include dairy products in the child's diet daily 4. Increase the child's physical activity 5. Include food with a high fiber content in the child's diet

1. Give laxatives to the child 4. Increase the child's physical activity 5. Include food with a high fiber content in the child's diet

Hydrochlorothiazide (HCTZ) has been prescribed for a client with hypertension. The client reports hearing that furosemide is more effective and requests a prescription change. How will the nurse respond? 1. HCTZ has fewer side effects 2. HCTZ does not cause dizziness 3. HCTZ is only taken when needed 4. HCTZ does not cause dehydration.

1. HCTZ has fewer side effects Side effects from thiazide generally are minor and rarely result in discontinuation of therapy.

Which therapy would the nurse manager recommend for young children with viral infection-related diarrhea? 1) A bananas, rice, applesauce, and tea/toast (BRAT) diet until after the diarrhea has stopped 2) An antiviral agent until the prescription is finished 3) Oral dehydration therapy (ORT) until fluid balance is restored. 4) Antidiarrheal agent after each stool until stools become formed

3) Oral dehydration therapy (ORT) until fluid balance is restored.

A client with irritable bowel syndrome has instructions to take psyllium for constipation. Which statement is important for the nurse to include in the teaching plan? 1. Urine may be discolored 2. Stop taking the laxative once a bowel movement occurs 3. Each dose should be taken with a full glass of water or juice 4. Daily use many inhibit the absorption of some fat-soluble vitamins.

3. Each dose should be taken with a full glass of water or juice This bulk-forming laxative works by absorbing water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction.

A client is receiving furosemide to relieve edema. The nurse will monitor the client for which adverse effect? 1. Hypernatremia 2. Elevated blood urea nitrogen 3. Hypokalemia 4. Increase in the urine specific gravity

3. Hypokalemia Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium.

A client with severe diarrhea is prescribed intravenous fluids, sodium bicarbonate, and an antidiarrhea medication. Which antidiarrheal medication would the nurse anticipate administering? 1. Psyllium 2. Bisacodyl 3. Loperamide 4. Docusate sodium

3. Loperamide Loperamide inhibits peristalsis and prolong transit time by its effect on the nerves in the muscle wall of the intestines.

A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 day ago upon admission, with prescription for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action will the nurse take next? 1. Send another blood sample to the laboratory to retest the serum potassium level. 2. Notify the health care provider that the potassium level is above normal 3. Notify the health care provider that the potassium level is below normal 4. No action is required because the potassium level is within normal limits

3. Notify the health care provider that the potassium level is below normal The health care provider should be notified immediately because the client's potassium is below. The notmal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5-5.0 mmol/L).

Which medication requires the nurse to monitor the client for sign of hyperkalemia? 1. Furosemide 2. Metolazone 3. Spironolactone 4. Hydrochlorothiazide

3. Spironolactone Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect.

A client has had a recent brain attack (cerebrovascular accident/stroke). Which preventative would the nurse anticipate will be prescribed daily to avoid straining due to constipation? 1. Stimulant laxatives such as bisacodyle 2. Tap-water enemas 3. Stool softener 4. Saline laxative such as magnesium citrate.

3. Stool softener A stool softener can soften stool and promote defecation, thus avoiding the Valsava maneuver.

After the nurse provides education about hydrochlorothiazide, the client will agree to notify the health care provider regarding the development of which symptom? 1) Insomnia 2) Nasal congestion 3) Increased thirst 4) Generalized weakness

4) Generalized weakness Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy.

A client was prescribed furosemide. The nurse would instruct the client to include which food in the diet? 1. Liver 2. Apples 3. Cabbage 4. Bananas

4. Bananas Furosemide is a loop diuretic that increase potassium excretion by preventing renal absorption. Bananas have a significant amount of potassium. Bananas: 450 mg.

Which client statement indicate that the teaching about furosemide in understood? Select all that apply 1. It may take 2or 3 days for this medication to take effect 2. I should wear dark glasses when outdoors during the day 3. I should avoid lying flat in bed 4. I need to change my position slowly 5. I should eat more food that is high potassium

4. I need to change my position slowly 5. I should eat more food that is high potassium

Which assessment is necessary for the nurse to complete in a client with chronic kidney disease receiving loop diuretics? 1. Hemoglobin levels 2. Occurrence of nausea 3. Presence of constipation 4. Intake and output measurement

4. Intake and output measurement Diuretics are administered to increase urine output, so the measure of intake and output are very important to diuretic use.

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this medication has which action? 1. Lubricates the feces 2. Creates an osmotic effect 3. Stimulates motor activity 4. Softens the feces.

4. Softens the feces.

When the client taking a loop diuretic asks the nurse why changing positions slowly is necessary, which response will the nurse provide? 1. Your high blood pressure may cause headaches with position changes. 2. You will experience potassium fluctuations that will affect your balance. 3. You will need to rush to the bathroom while on the diuretic and we want to ensure you are safe. 4. Your blood pressure may drop with position changes, leading to dizziness and risk of falling.

4. Your blood pressure may drop with position changes, leading to dizziness and risk of falling. Loop diuretics can lead to dehydration and orthostatic hypotension, which can increase dizziness and risk of falls.

Nursing Actions/Teaching about grey or black stool

Access bleeding in stool. Teach patient that stool may turn to black color.

Nursing Actions/Teaching for Dizziness

Access dizziness. Tech patient to call help, sit a side before getting up

Laxatives action

Based on type, but usually increase fluid content in stool or increase GI motility.

Diuretics action

Blocks reabsorption of Na and Cl resulting in increased urine output and decreased BP. Decrease fluid in vessel to reduce BP.

Antiemetics: Action

Blocks the effects of histamine resulting in decreased secretions and nausea/vomiting

Laxatives drugs (1)

Bulk-forming-Metamucil (psyllium) absorb water increasing bulk of stool often used for preventing constipation

Nursing Actions/Teaching for Zofran

Can cause EKG changes, Monitor EKG, and heart rate

Nursing Actions/Teaching about cramping

Cramping Monitor cramping. Teach patient that it causes cramping

Diuretics Side Effects

Dehydration Electrolyte Imbalance Hypotension

Laxatives side effects

Diarrhea Cramping Chronic use of laxatives can cause bowel to lose its tone leading to constipation because bowel does not function as well.

Nursing Actions/Teaching about Diarrhea

Diarrhea. Monitor defecation. bowel movement. Hold medication. Teach patent about diarrhea

Antiemetics side effects

Dizziness Vital signs changes

Anti Diarrheal drugs (2)

Imodium (loperamide) May cause drowsiness

Anti Diarrheal drugs (3)

Lomotil (diphenoxylate with atropine) May cause drowsiness

Antiemetics Precaution / Contradictions

May cause hypotension if used with antihypertensive drugs or alcohol, increased CNS depression if used with other CNS depressants. Avoid with hypersensitivity

Nursing Actions/Teaching for Hypotension

Monitor BP prior to administering medication. Hold if blood pressure low. Teach patient about safety. ex: BP 158/98 (yes), 138/86 (yes), 126/76 (yes), 90/32 (no) Teach patient about safety issue. Teach patient do not get up by themselves, tangling the bed before get out form bed because BP might drop. Patient will feel light headache or dizziness

Nursing Actions/Teaching for Hyperkalemia

Monitor K+ level. Teach patient to decrease food which have rich K+ (3.5-5.5 normal rage of K+)

Nursing Actions/Teaching for Hypokalemia

Monitor K+ level. Teach patient to increase food which have rich K+ (3.5-5.5 normal rage of K+)

Nursing Actions/Teaching for Electrolyte Imbalance

Monitor electrolytes (especially Na, Cl, and K+) and glucose (blood and urine), check the labs. Teach patient to increase K+ food with thiazides and loop diuretics and to decrease food with K+ for those taking potassium sparing diuretics. Teach patient the importance of following dietary guidelines.

Nursing Actions/Teaching for Dehydration

Monitor for signs &symptoms of dehydration. Check In& out, skin turgor, mucous membrane. Teach the patient to drink plenty of fluids, unless on a fluid restriction (CHF, renal failure, etc....), teach patient monitor signs &symptoms of dehydration

Nursing Actions/Teaching for Ototoxicity

Monitor hearing lose of the ears. Teach patient to report signs &symptoms. (only loop diuretics)

Nursing Actions/Teaching about drowsiness

Monitor vital signs. Teach patient to safety

Imodium and Lomotil are made from opioid. Do they have any risk of dependency?

No. Imodium and Lomotil are opioid drugs with little to risk of dependence Opioid type medications are more effective in treating severe diarrhea! These drugs although opioids have a very low risk of dependency and usually do not have many significant side effects.

Which juices have potassium-rich fruit ?

Orange juice. Tomato juice. Prune juice. Apricot juice. Grapefruit juice

Laxatives drugs (4)

Osmotic Milk of Magnesia (magnesium hydroxide) MiraLax (polyethylene glycol) Can cause flatulence and cramping

Laxatives Precaution / Contradictions

Over use can lead to dependency Avoid if suspected bowel obstruction, diarrhea and suspected appendicitis

Anti Diarrheal drugs (1)

Pepto-Bismol (bismuth salt) Over the counter, absorbs toxins, adjunctive therapy for peptic ulcers due to H. pylori (Helicobacter pylori bacteria) Stool may be grey or black Pepto-Bismol works by binding and absorbing toxins

Antiemetics drugs (1) and side effect

Phenergan (promethazine) Sedation, photosensitivity, neuroleptic malignant syndrome Monitor IV site closely, dilute if giving IV Available in many forms!

Nursing Actions/Teaching for Phenergan

Phenergan can cause abscess, be sure to give deep IM (Intramuscular injections) Monitor for neuroleptic malignant syndrome- monitor: fever, tachycardia (pulse more than 100), changes to BP, fever, fatique, muscle stiffness ------discontinue and call MD Sedation Monitor vital signs. Teach patient to call photosensitivity Patient is sensitive to light. Teach patient that they will be sensitive to light. If they work outside, they will be sunburn easily.

Diuretics Precaution / Contradictions

Precaution: Use caution with elderly, pregnancy and mild electrolyte imbalance Contradictions: Avoid with Severe electrolyte imbalance

Anti Diarrheal side effect

Rebound constipation Dry mouth Abdominal pain

Antiemetics drugs (2) and side effect

Reglan (metoclopramide) extrapyramidal reactions like Pakinson symptom including tremor, slurred speech, tick in mouth ------discontinue and call MD After surgery - stimulates GI motility

Anti Diarrheal action

Relax smooth muscle of colon and slow transit of stool through the large intestine

Laxatives drugs (2)

Stimulant-Dulcolax (biscodyl) Cramping common Stimulant-increase peristalsis and can cause cramping

Laxatives drugs (3)

Stool softeners-Colace (docusate) Cramping less common cause more water and fat to be absorbed into stools, often used postop to prevent straining

Anti Diarrheal Precaution / Contradictions

Use caution with liver disease

Antiemetics drugs (3) and side effect

Zofran (ondansetron) Can cause EKG changes, monitor HR and EKG Often used to treat chemotherapy induced nausea

Nursing Actions/Teaching for Reglan

extrapyramidal reactions like Pakinson symptom including tremor, slurred speech, tick in mouth ------discontinue and call MD

Nursing Actions/Teaching for Vital signs changes

nurse check & monitor vital signs.