Pharm 11

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."

Which statement by a patient receiving pancrelipase indicates that the patient has understood his instructions?

"I should take the drug with meals and snacks."

A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, "I take it as soon as I feel heartburn coming on, but it doesn't seem to help at all." How should the nurse best respond to this patient's statement?

"Prilosec will help your heartburn but it's not designed to provide immediate relief of specific episodes of heartburn."

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."

Before administering alosetron, the nurse should ensure that the client has been made aware of what potentially severe adverse effect?

*bowel obstruction

Histamine 2 Receptor Antagonists

-Block the release of hydrochloric acid in response to gastrin. This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production -Parietal cells = 3 main receptor sites on parietal cells that all contribute to production of hydrochloric acid = Histamine, Acetylcholine, & Gastrin

Proton Pump Inhibitors (PPIs)

-Blocks the final step of acid production, lowering the acid levels in the stomach -Short term treatment of active duodenal ulcers, GERD, erosive esophagitis and benign active gastric ulcers -Long term treatment of pathological hypersecretory conditions

Digestive Enzyme Supplements Implementation & Rationale -

-Have the patient swish a saliva substitute around the mouth as needed for dry mouth and throat to coat the mouth and ensure therapeutic effectiveness of the drug. -Monitor swallowing because it may be impaired due to the underlying medical conditions or decrease in lubricating effects related to low saliva levels, and additional therapy may be needed. -Administer pancreatic enzymes with meals and snacks so that enzyme is available when it is needed. Avoid spilling powder on the skin because it may be irritating. -Do not crush the capsule or allow the patient to chew it; it must be swallowed whole to ensure full therapeutic effects. -Assess nutritional status if there are GI effects to arrange for appropriate measures to relieve discomfort and ensure nutrition, such as frequent small meals. -Obtain laboratory specimens as indicated to evaluate electrolyte levels and pancreatic enzyme levels. -Offer support and encouragement to help the patient cope with the disease and the drug regimen. -Provide thorough patient teaching, including the drug name and prescribed dosage; schedule for administration; the technique for using saliva substitute; the importance of taking pancreatic enzymes with meals and snacks; the need to take the pancreatic enzyme whole and not to crush or chew the capsule; dietary measures to follow; signs and symptoms of adverse effects and measures to minimize or prevent them; danger signs that need to be reported to the healthcare provider immediately; the need for periodic monitoring, including laboratory tests to evaluate electrolyte levels (with saliva substitute) to evaluate for possible imbalances or pancreatic enzyme levels (with pancreatic enzymes) to evaluate the effectiveness of therapy; and the importance of complying with therapy and follow-up to enhance patient knowledge about drug therapy and to promote compliance.

Actions of Drugs Used to Affect Motor Activity of the GI Tract

-SHORT TERM RELIEF Speed up or improve movement of intestinal contents when movement becomes slow or sluggish (constipation) Increase the tone of the GI tract and stimulate motility throughout the system Decrease movement along the GI tract when rapid movement decreases the time for absorption of nutrients (diarrhea)

Histamine 2 Receptor Antagonists indications

-Short-term treatment of active duodenal ulcer or benign gastric ulcer -Treatment of pathological hypersecretory conditions such as Zollinger-Ellison syndrome -Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients -Treatment of erosive gastroesophageal reflux -Relief of symptoms of heartburn, acid indigestion, and sour stomach (OTC preparations)

Drugs used to treat gastroesophageal reflux disease and ulcer disease

-decrease GI secretory activity -block the action of GI secretions -OR form protective coverings on the GI lining to prevent erosion

Encopresis =

-leakage of watery stool is the soiling of underwear with stool by children who are past the age of toilet training. Because each child achieves bowel control at his or her own rate, medical professionals do not consider stool soiling to be a medical condition unless the child is at least 4 years old.

Centrally Mediated Reflexes of the GI Tract

1- Swallowing Reflex Stimulated when a food bolus stimulates pressure receptors in the back of the throat and pharynx 2- Vomiting Reflex Protects the system from unwanted irritants Stimulated by two centers in the medulla

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

The nursing instructor is discussing the use of histamine2 receptor antagonists in the treatment of peptic ulcer disease. According to the instructor, which of the following is a typical dosing schedule of famotidine during the first few weeks of treatment for gastric ulcer in patients with normal renal function?

20 mg bid

Antacids

A group of inorganic chemicals that neutralize stomach acid. They neutralize stomach acid by direct chemical reaction. They are recommended for symptomatic relief of upset stomach associated with hyperacidity, as well as hyperacidity associated with peptic ulcer

Antacid adverse effects

Administering an antacid frequently causes acid rebound, in which the stomach produces more acid in response to the alkaline environment. Neutralizing the stomach contents to an alkaline level stimulates gastrin production to cause an increase in acid production and return the stomach to its normal acidic state. -Alkalosis especially with sodium bicarbonate -Alkalosis with resultant metabolic changes (nausea, vomiting, neuromuscular changes, headache, irritability, muscle twitching, and even coma) may occur.

Histamine 2 Receptor Antagonists adverse effects and caution

Adverse Effects- GI effects [diarrhea & constipation] caution- pregnancy and renal/hepatic dysfunction

Digestive Enzyme Supplements - Pancrelipase (Creon, Pancrease) = PO with each meal & snack

Aids digestion and absorption of fats, proteins, and carbohydrates in conditions that result in lack of this enzyme; used as replacement therapy in pts with CF

When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?

Alopecia Rationale: Alopecia can occur with proton pump therapy, but it is not a common adverse effect. Common adverse effects include dizziness, headache, and cough.

Alsosetron [Lotronex] - Irritable Bowel Syndrome Drug

Alosetron (Lotronex) was the first drug to provide relief to patients with irritable bowel syndrome. This drug, a serotonin 5-HT antagonist, blocks specific serotonin receptors in the enteric nervous system of the GI tract, which leads to decreased perception of abdominal pain and discomfort, decreased GI motility, and increased colon transit time. In late 2000, alosetron was pulled from the market after less than 1 year of availability. Reports of ischemic colitis, mesenteric colitis, and even death in patients who were using the drug led to this decision. In July 2002, after hearing lots of testimony and reading many petitions from patients, the FDA agreed to approve the release of the drug for marketing. This is the first time in the history of the FDA that a drug pulled from the market because of safety concerns has been rereleased. The prescribing information now includes a black box warning alerting users to the proper use and a patient medication guide. Restrictions have been applied to the use of the drug, and patients who use it must read and sign a patient-physician agreement. The use of Lotronex should be discontinued immediately if the patient develops constipation or symptoms of ischemic colitis. ****It is approved for women with IBS with diarrhea being the predominant complaint.****

Antipeptic Agent drug drug interaction

Aluminum salts - risk of high aluminum levels and aluminum toxicity Phenytoin, fluoroquinolone, or penicillamine - decreased levels and drug effectiveness

A client with a diagnosis of peptic ulcer disease has begun taking sucralfate. The nurse should caution the client against the concurrent use of which classification of medications?

Antacids

Antacid caution -

Any condition that can be exacerbated by electrolyte imbalance GI obstruction renal dysfunction

The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea?

Aspirin

Metoclopramide (Reglan) - Gastrointestinal Stimulant

Blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine Leads to increased GI activity and rapid movement of food through the upper GI tract -DONT USE WITH ALCOHOL

Types of Laxatives-

Chemical Stimulants- Chemically irritate the lining of the GI tract Bulk Stimulants-Cause the fecal matter to increase in bulk Lubricants-Help the intestinal contents move more smoothly

Antipeptic Agent - gastrointestional protectants

Coat any injured area in the stomach to prevent further injury from acid -forms an ulcer adherent complex at duodenal and ulcer sites, protecting the sites against acid, pepsin, and bile salts

Bismuth Subsalicylate (Pepto-Bismol): liquid PO - Antidiarrheal Drug

Coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and diarrhea Be cautious of viral infections in kids before giving. Treatment of traveler's diarrhea, prevention of cramping and distention associated with dietary excess and some viral infections -CONSULT DRUG GUIDE FOR DRUG DRUG

GI Overstimulation

Constipation (underactivity) Diarrhea (overactivity)

A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient's safety, which of the following would be a priority nursing action?

Coordinate bone density testing for the patient.

PPIs Nursing Diagnoses

Diarrhea related to GI effects Risk for constipation related to GI effects Imbalanced nutrition: less than body requirements related to GI effects Disturbed sensory perception (kinesthetic, auditory) related to CNS effects Risk for injury related to CNS effects Deficient knowledge regarding drug therapy

When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause?

E. coli

Children and gastro secretion agents

Famotidine and ranitidine are the H2 antagonists approved for use in children. Lansoprazole has established pediatric doses if a proton pump inhibitor is most appropriate. Antacids may be used in children who complain of an upset stomach or who are receiving therapy known to increase acid production; 5 to 15 mL every 1 to 3 hours is usually an effective dose.

Mineral Oil (Agoral Plain) = liquid PO - Lubricating Laxative

Forms a slippery coat on the contents of the intestinal tract Short term treatment constipation Interference with fat soluble vitamins ADEK Leakage of stool and staining

Antipeptic Agent Adverse Effects

GI effects - Constipation[most common]

Adverse Effects PPIs

GI effects can include diarrhea, abdominal pain, nausea, vomiting, dry mouth, and tongue atrophy.

High levels of acid in the gastrointestinal (GI) tract decrease the secretion of which of the following enzymes?

Gastrin

An infant is brought to the pediatric clinic. The mother tells the nurse the child is constipated and she doesn't know what to do. What would the nurse tell the mother is the safest and most effective way to treat constipation in children prior to bowel training?

Glycerin suppositories

Docusate (Colace) = PO - Lubricating Laxative

Has a detergent action on the surface of the intestinal bolus, making a softer stool Prophylaxis in patients who shouldn't strain Pregnancy, Surgery, MI

Loperamide (Imodium): PO - Antidiarrheal Drug

Has a direct effect on the muscle layers of the GI tract; slows peristalsis and allows increased time for absorption of fluid and electrolytes Short term treatment of diarrhea associated with dietary problems, viral infections -CONSULT DRUG GUIDE FOR DRUG DRUG

A client is receiving sodium bicarbonate orally. Which of the following would lead the nurse to suspect that the client is developing systemic alkalosis? (Select all that apply.)

Headache Confusion Irritability Tetany

Which of the following would a nurse expect to administer if the goal of therapy is to block the release of hydrochloric acid in the stomach?

Histamine-2 receptor antagonist

Glycerin (Sani-Supp) = liquid suppository - Lubricating Laxative

Hyperosmolar laxative used to gently evacuate the rectum without systemic effects higher in the GI tract Short term treatment constipation If a laxative is needed, glycerin suppositories are the best choice for infants and young children.

A client is taking an antacid that contains aluminum salts. The nurse would monitor the client for which of the following?

Hypophosphatemia

Use of Laxative and Antidiarrheal Agents with Children

If a laxative is needed, glycerin suppositories are the best choice for infants and young children. Children with encopresis, however, are often given senna preparations or mineral oil to help them to evacuate the massive stool. Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is needed.

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

Motility

In the esophagus, the basic movement is peristalsis. The stomach uses its three muscle layers to produce a churning action. Small intestines use a process of segmentation. Large intestines use a process of mass movement.

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?

Increased fracture risk

A 75-year-old client is diagnosed with type 2 diabetes mellitus, hypertension, osteoporosis, and gastric ulcer disease. She is prescribed PPIs. The nurse is aware that long-term (greater than 1 year) administration of PPIs may lead to what problem for this client?

Increased risk for hip fractures

Ms. Law has been taking omeprazole for the last 10 years. What is the risk to the patient from long-term use of omeprazole?

Increased risk of gastric cancer

Histamine 2 Receptor Antagonists Drug-to-Drug Interactions

Increased serum levels and toxic reactions may occur. Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine, theophylline, chloroquine, benzodiazepines, nifedipine, pentoxifylline, tricyclics, procainamide, and carbamazepine

Dexpanthenol (Ilopan) = IM, IV - Gastrointestinal Stimulant

Increases acetylcholine levels and stimulates the parasympathetic system Prevention of intestinal atony or loss of intestinal or loss of intestinal muscle tone in postoperative situations in adults -DONT USE WITH ALCOHOL

Prostaglandins actions

Inhibits gastric acid secretion and increases bicarbonate and mucous production in the stomach

Digestion

Is the process of breaking food into usable, absorbable nutrients Begins in the mouth with enzymes in the salvia The stomach continues the digestion process In the small intestines, the food mixes with bile which breaks down the fat molecules

A prescriber adds psyllium to the medication administration record for a client experiencing diarrhea. Which is the best rationale for the addition of psyllium?

It absorbs toxins and water, decreasing fluidity of stools.

Which of the following best reflects the gastrointestinal system?

It is comprised of one continuous, long tube.

Which of the following would be the proton pump inhibitor of choice for a child with GERD?

Lansoprazole

Which of the following is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?

Laxatives may reduce absorption of other drugs present in the GI tract.

Psyllium (Metamucil) = packet Bulk Stimulant

Mild laxative, short-term treatment of constipation

Prostaglandin adverse effects

Miscarriages Abortifacient = women should have negative serum pregnancy test within 2 weeks of beginning treatment & use barrier contraceptives Women taking this drug should be notified both verbally and written of the adverse effects

Adults and gastro secretion agents

Misoprostol is an abortifacient and should never be used during pregnancy. Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives. If antacids are used, they should be spaced 1 to 2 hours before or after the use of other drugs.

A nurse is reviewing information about proton pump inhibitors. The nurse recognizes that which of the following is available as an over-the-counter agent?

Omeprazole

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.

Digestive Enzyme Supplements Indications

Replacement therapy

GI Accessory Organs

Pancreas - produces insulin & enzymes to help break down food Liver - filters blood from gi tract, metabolizes, secretes bile Gallbladder - stores bile

Most digestive processes occur in the small intestine. The nurse is reviewing with a client who has had gastrointestinal surgery that these intestinal enzymes are proteins that act as catalysts, which promote and speed up chemical reactions. Based on this information, which enzyme would be the best response from the client about the enzymes that are responsible for facilitating the formation of proteins into amino acids?

Pepsin and Trypsin

A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to-

Pork

Prostaglandin Contraindications

Pregnancy

Prostaglandins Indications

Prevention of NSAID-induced gastric ulcers Treatment of duodenal ulcers

Prostaglandins

Protect the stomach lining synthetic prostaglandin E1 analogue misoprostol (Cytotec) = PO Prevention of NSAID-induced ulcers in adults at high risk for development of these gastric ulcers, under investigation for treatment of duodenal ulcers in pts who are unresponsive to H2 antagonists, used in combination therapy with mifepristone as an abortifacient Misoprostol is an abortifacient and should never be used during pregnancy. Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives.

Which of the following best reflects the rationale for using histamine-2 receptor antagonists for stress ulcer prophylaxis?

Protects the stomach lining via acid blockage

A female client presents to the physician's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client?

Rebound acidity

A 32-year-old female executive comes to the clinic with severe heartburn. The physician prescribes omeprazole (Prilosec). The patient asks the nurse when the pain will go away. What is an appropriate response by the nurse?

Recommended time for therapy is usually between 2 and 8 weeks.

Antidiarrheal Drug Indications

Relief of symptoms of acute or chronic diarrhea Reduction of volume of discharge from ileostomies Prevention and treatment of traveler's diarrhea

Types of Secretions of the GI Tract

Saliva - begins digestion in mouth, facilitates swallowing Mucus - protective, produced in mouth/esophagus/stomach

Digestive Enzyme Supplements Actions

Saliva substitute - Contains electrolytes and carboxymethylcellulose to act as a thickening agent in dry mouth conditions Pancreatic enzymes are replacement enzymes that help the digestion and absorption of fats, proteins, and carbohydrates

Major Activities of the GI System

Secretion: Of enzymes, acid, bicarbonate, and mucus Absorption: Of water and almost all of the essential nutrients needed by the body Digestion: Of food into usable and absorbable component Motility: Movement of food and secretions through the system

Sucralfate (Carafate) = PO on empty stomach

Short-term treatment of duodenal ulcers;maintenance of duodenal ulcers [at reduced dose] after healing in adults; treatment of oral and esophageal ulcers due to radiation, chemo, or sclerotherapy; currently under investigation for treatment of gastric ulcers, gastric damage induced by NSAIDs, prevention of stress ulcers in acutely ill individuals

A 75-year-old client is treating his ulcer with antacids. Based on the client's age, the nurse expects the physician to prescribe a dose of antacid that compares with the average prescribed dose in what way?

Smaller than the average prescribed dose

A patient reports chronic abdominal pain. The patient has a 40-pack year history but reports a decrease in smoking to approximately ½ pack/day. The physician, after thorough assessment and evaluation and labs, prescribes a treatment regimen for duodenal ulcer. What important teaching would the nurse include in relation to treatment?

Smoking's effects on healing

Which of the following antacids is contraindicated in patients with congestive heart failure? (Choose one)

Sodium bicarbonate (Bellans)

Swallowing Reflex

Stimulated whenever a food bolus stimulates pressure receptors in the back of the throat and pharynx. This sends impulses to the medulla, which stimulates a series of nerves. Involves more than 25 pairs of muscles This reflex can be facilitated in a number of ways if swallowing is a problem. Icing on the tongue Icing the sternal notch or back of neck

Opium Derivatives (Paregoric): PO - Antidiarrheal Drug

Stimulates spasm within the GI tract, stops peristalsis and diarrhea Short term treatment of cramping and diarrhea -CONSULT DRUG GUIDE FOR DRUG DRUG

Digestive Enzyme Supplements

Substances produced in the GI tract to break down foods into usable nutrients

Antacids - Sodium bicarbonate (Bell-ans) = PO

Symptomatic relief of GI hyperacidity; minimization of uric acid crystalluria, adjunctive treatment in severe diarrhea Sodium bicarbonate, the oldest drug in this group, is readily available in many preparations, including baking soda powder, tablets, solutions, and as an injectable for treating systemic acidosis.

Antacid - Aluminum salts (Amphojel, and others) = PO

Symptomatic relief of GI hyperacidity; treatment of hyperphosphatemia, prevention of formation of phosphate urinary stones. Aluminum salts, available as tablets, capsules, suspensions, and liquid form, do not cause acid rebound but are not very effective in neutralizing acid.

True or false - parietal cells to release hydrochloric acid

TRUE

Stimulation of the Chemoreceptor Trigger Zone (CTZ)

Tactile stimulation of the back of the throat Excessive stomach distention Increasing intracranial pressure by direct stimulation Stimulation of the vestibular receptors in the inner ear Stimulation of stretch receptors in the uterus and bladder Intense pain fiber stimulation Direct stimulation by various chemicals Once triggered = salivation increases, mucus production increases, gastric acid production decreases, sweating, increased HR, deeper respirations

The GI system

The GI system is the only system in the body open to the external environment Composed of one continuous tube Begins at the mouth and ends at the anus

Older adults and gastro secretion agents

The dose for older adults should be started at a lower level than recommended for younger adults. These patients also need to be alerted to the potential for toxic effects when using OTC preparations that may contain the same ingredients as many of these agents. Proton pump inhibitors may be the best choice for treating GERD in older patients because of fewer adverse effects and better therapeutic response with these drugs.

Drug-Drug Interactions PPIs

There is a risk of increased serum levels and increased toxicity of benzodiazepines, phenytoin, and warfarin if these are combined with these drugs; patients should be monitored closely. -sucralfate is not absorbed in the presence of PPIs and must be spaced at least 30 min apart

Histamine 2 Receptor Antagonists - Famotidine (Pepcid) = PO, IV

Treatment of duodenal ulcer, benign gastric ulcer, pathological hypersecretory syndrome, GERD; relief of symptoms of heartburn, acid indigestion, sour stomach in adults. -PO or IV at bedtime because of increased symptoms, 10mg PO for prevention of relief of heartburn; reduce dose in renal-impaired or geriatric patients. Pediatric 1-16 y/o Drowsiness can occur -Peak 1-3 hours and duration of 6-15 hours.

Calcium carbonate also known as - Magnesium salts also known as -

Tums milk of magnesia

A 23-year-old female patient is prescribed misoprostol (Cytotec). Which of the following patient teaching interventions is most important?

Use effective contraceptive measures

Bisacodyl (Dulcolax): PO or in water via enema - Chemical Stimulant

Very popular OTC laxative Emptying of GI tract before some surgeries or diagnostic tests [e.g. barium enema] prevention of constipation & straining after GI surgery, MI, & obstetrical delivery; short-term treatment of constipation

Which of the following should be included in client teaching as a means of avoiding constipation? Select all that apply.

a) Eat foods high in bulk or roughage. c) Drink plenty of fluids. d) Be active and exercise daily.

Choice Multiple question - Select all answer choices that apply. An instructor is describing the action of pancreatic enzymes on substances. Which of the following would the instructor include as being acted on by these enzymes? Select all that apply.

a) Sugars b) Proteins c) Fats

acid rebound

administrating a antacid frequently causes this. The stomach produces more acid in response to the alkaline environment

Stress ulcers

also called acute ulcers are often seen in situations that involve acute physiological stress such as trauma, burns, or prolonged illness. The activity of the sns during stress decreases blood flow to the GI tract which leads to weakening of the mucosal layer of the stomach and erosion by acid in the stomach.

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered

an hour before meals.

Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in patients who-

are pregnant.

A 73-year-old woman has scheduled an appointment with her nurse practitioner to discuss her recurrent constipation. The woman states that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly. How should the nurse best respond to this patient's statements?

b) "Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation."

Your patient is being sent home with orders for a laxative PRN. You are doing patient teaching on the use of a laxative. What will you inform the patient is one of the most common adverse effects of a laxative?

b) Abdominal cramping

The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.)

b) Decreased activity d) Use of opioid medications e) Change in bowel routines

he nurse is preparing to administer dexpanthenol to a client based on the understanding that this drug acts in which manner?

b) Increasing acetylcholine levels

You are interviewing the latest admission to your GI floor. The patient requests a magnesium citrate "cocktail" every night to "keep her regular." Her request is evidence of potential:

b) Laxative abuse.

What form of laxative would likely be prescribed to manage long-term constipation?

bulk-forming laxative plus increased water intake

Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse's first suggestion?

c) A bulk-forming (fiber) laxative

When administering a bulk laxative to a client, which of the following actions is important for the nurse to take?

c) Administer the laxative with a full glass of water or juice.

In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid?

c) Increasing mass and water content of stool, promoting evacuation

A hospice patient is receiving opioids for treatment of cancer pain. Which laxative will assist in the prevention of constipation?

c) Stimulant

Aluminum & Calcium

constipation

A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the patient about which of the following adverse effect(s)?

d) Constipation

You are preparing to administer a stimulant cathartic to your client. What adverse effect of this medication would you inform your client of?

d) Diarrhea

The nurse may advise a patient to get which of the following after a myocardial infarction to prevent straining during defecation? (Choose one)

d) Docusate (Colace)

Magnesium

diarrhea, not good for kidney pts

What is an effect of histamine release that is related to ulcer formation?

stimulates gastric acid secretion

The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months?

electrolyte levels

peptic ulcer

erosion into the inner lining of the stomach or duodenum

ulcer disease

erosions in the lining of the stomach and adjacent areas of the GI tract are called PEPTIC ULCERS. s/s - gnawing and burning pain a few hours after meals (usually fatty meals) It is often believed that chronic ulcers may be a result of impaired mucus lining and infection because of H. Pylori (treated with PPI/antibiotics).

Calcium

kidney stones & rebound hyperacidity

Cathartic dependency

overuse of laxatives that can lead to the need for strong stimuli to initiate movement in the intestines; local reflexes become resistant to normal stimuli after prolonged use of harsher stimulants, leading to further laxative use.

Pancreatic Enzymes, Other Lipases, and Amylases - breaks down proteins/fats/sugars

pancreatic enzymes chymotrypsin and trypsin (to break down proteins to smaller amino acids) other lipases (to break down fat) amylases (to break down sugars).

Calcium Carbonate

produces gas & belching, often combined with simethicone

A female client comes to the clinic with reports of burning pain in the stomach. She states that she thinks she had a virus 48 hours ago and she vomited many times. She hasn't vomited in 24 hours. She asks the physician to give her a prescription for omeprazole because she saw an ad on TV that said it would heal stomach pain. The nurse assists the client in understanding that PPIs are considered drugs of choice for treatment of what conditions? (Select all that apply.)

• Duodenal ulcers • Zollinger-Ellison syndrome • Gastric ulcers

When caring for an older adult client taking an antacid, the nurse should institute which safety precautions? Select all that apply.

• Fall risk • Bed alarm • Strict intake and output

In preparing a teaching plan for a patient who is to receive misoprostol, which of the following would the nurse include as possible adverse effects? Select all that apply.

• Flatulence • Dyspepsia • Excessive vaginal bleeding • Dysmenorrhea