Pharmacology Exam 3
What is the action of docusate sodium (Colace)?
decreases surface tension, allowing water to penetrate stools. Colace is administered posy MI or cardiovascular procedure to REDUCE STRAINING and complications (does not have laxative effect)
What is GERD?
gastroesophageal reflux disease; reflux of stomach acid/ bile into lower esophagus due to incompetent lower esophageal sphincter
What is gastritis?
inflammation of the gastric mucosa which may be causes by use of alcohol, NSAIDS, or aspirin (Gastritis is primary, PUD is secondary)
In regards to cellular protection, what is the function of Prostaglandin E?
inhibits acid and stimulates production of bicarbonate and mucous
What is the action of Biscodyl (Dulcolax)?
irritates GI mucosa and draws water into bowel lumen (Dulcolax is administered for use as bowel prep before surgery, procedure, or colonoscopy)
What is the mechanism of action of lactulose?
reduces ammonia in hepatic encephalopathy; lactulose binds with ammonia to be expelled through feces
What is the mechanism of action of sorbitol?
sorbitol is often given with Kayexalate to treat hyperkalemia or remove toxins from the body
Which statement indicates effective teaching of antibiotic use to a patient?
"I will not take antibiotics for treatment of the flu" Rationale: antibiotics are effective against bacterial infections, not viral infections
What can be used as non-pharmacological treatment for constipation?
*increase amount of physical activity *adequate diet of fiber and fluids: fruits, vegetables, whole grains *increase sorbitol: apples and prune juice *soluble fiber with gradual titration and adequate fluids * regular toileting routine: (physical activity within 1 hour of waking, hot caffeinated beverage with fiber cereal, use bathroom in morning) *biofeedback
What is the action of Histamine 2 Receptor Blockers?
*inhibits action of histamine by blocking H2 receptors to inhibit secretions that are stimulated by acetylcholine, histamine, and gastrin *used for OTC treatment of heartburn, treatment of PUD and GERD, esophagitis, stress ulcer, and ZES
What patients are contraindicated with laxative use and what patients should be avoided?
*laxatives contraindicated in patients who are immobile/ bed rest, obstruction/ impaction, undiagnosed abdominal pain *laxatives should be avoided in patients who experience dehydration and on fluid restriction
What are the main risk factors of constipation?
*levels of physical activity *diet *medication side effects: anticholinergics, antidepressants, anticonvulsants *Demographics
Which substance history of a severe allergic reaction results in the avoidance of the cephalosporins such as cefazolin, cefditorin, cefotetan, and ceftriaxone
*milk *aspirin *penicillin *calcium
Which action would the nurse take when administering azithromycin to treat sexually transmitted infections (STIs)?
*obtaining Specimens for culture before administering the first dose of the antibiotic Rationale: nurse would obtain specimens for culture before administering the first dose of the antibiotic so that the antibiotic action does not skew the culture results
What are the pharmokinetics of Antacids?
*onset is 20-60 minutes *minimal systemic absorption - patients are at risk for B12 deficiency
Who should be cautioned with taking antacids?
*patients with renal failure (creatine clearance of <30mL/min) SHOULD NOT take magnesium based antacids, SHOULD take aluminum based antacid
What are the side effects of antacids?
*prevents absorption of other medications *aluminum based= constipation *magnesium based= diarrhea *calcium based= risk for acid rebound and hypercalcemia
What is the non-pharmacological treatment for diarrhea?
*replace fluid and electrolytes with CLEAR fluids (2-3 quarts per day and should be decaffeinated and non-carbonated) *Oral rehydration solution (ORS): pedialyte *IV fluids if necessary *BRAT diet (bland foods): banana, rice, apple sauce, toast
What is Diphenoxylate w Atropine (Lomotril)
*schedule 5 week opioid *slows peristalsis by acting on smooth muscle for treatment of diarrhea *used for moderate to severe diarrhea *CAUTION - atropine toxicity or overdose (atropine is an anticholinergic) *contraindicated for use if diarrhea is due to toxins, microorgansims, antibiotic associated colitis *ADVERSE EFFECTS: be aware of RARE but serious hypotension and respiratory depression *education= DO NOT EXCEED MAX daily dose of two 5 mg tablets taken 3-4x per day (20mg)
How should H2 Receptor Blockers be administered?
*should not be taken at same time as antacids *interferes with CYP450 system - effects metabolism of drugs and supplements
What is octreotide (Sandostatin)?
*synthetic somatostatin (anterior pituitary hormone) *used for diarrhea associated with carcinoid syndrome, HIV/AIDS
What is alosetron (LOTRONEX)?
*used for irritable bowel syndrome with diarrhea *5 HT3 Receptor antagonist - increases the firmness of stools and decreases urgency/ frequency
What is important to note in Mineral Oil (Lubricant) administration?
*works in 6-8 hours *mineral oils SHOULD NOT BE TAKEN ORALLY: risk of aspiration; malabsorption of fat soluble vitamins
What are the 4 categories of drugs used to treat PUD and GERD?
1. Anatacids 2. Histamine 2 Receptor Blockers 3. Proton Pump Inhibitors (PPIs) 4. Misc: Misoprostol, Sulcrafate, antibiotic therapy for H. pylori
What are the 3 drug categories to treat constipation?
1. Laxatives (bulk forming, stool softener, lubricant) 2. Cathartics (stimulant, saline) 3. Misc. (lactulose, Lubiprostone)
What is the non-pharmacologic treatment used for GERD?
1. Positioning: do not lie patient flat after meals; avoid meals 2-3 hours before bed 2. Weight-loss 3. Diet - eliminate high fat, caffeine, chocolate, spicy food, carbonation, alcohol
What is the action of laxatives?
absorbs water, adds bulk, and stimulates peristalsis (could also potentially lower cholesterol)
What is apart of cholinergic stimulation, "rest and digest?"
acetylcholine is a cholinergic neurotransmitter that binds to cholinergic/muscarinic receptors found in parasympathetic nervous system. Cholinergic stimulation increases motility and digestion.
What is the action of Proton Pump Inhibitors?
binds to gastric proton pump to prevent release of HCL from parietal cells into stomach
What is the black box warning for alosetron (LOTRONEX)?
bowel perforation, impaction, obstruction
Which education by the nurse will prevent and reduce the risk of developing antibiotic resistant infections?
"do not skip any doses of your antibiotic"
What are the Nursing Implications for PPI's?
*Administer before food intake - MORNING DOSING *DO NOT CRUSH/CHEW - PPIs are extended release
What is the pathophysiology of Peptic Ulcer Disease?
*Chronic NSAID use *Zollinger Ellison Syndrome (ZES) *H. Pylori - bacteria which damages tissue in stomach by secreting urease and causing inflammation, leads to atrophy and ulcer
What patients are use of alosetron (lotronex) contraindicated in?
*Crohn's disease *ulcerative colitis *chronic constipation
How should antacids be administered?
*Do not give within 1-2 hours of other medication (antacids decrease absorption and metabolism of drugs) *give 1-3 hours after meals and before bedtime
how should a laxative be administered?
*Do not take within 1-2 hours of other medication *take with 6-8 oz of liquid
How should Dulcolax be administered? What is the education necessary? and when is Dulcolax administered?
*Dulcolax should be administered on an empty stomach or at bedtime *Dulcolax should not be administered for longer than one week for prevention of serum electrolyte imbalance *Dulcolax is administered as use of bowel prep before surgery/ procedure; or neurogenic bowel (bowel that has loos of normal function)
Which prescribed medication would a nurse anticipate prescribing for a patient with Clostridium Difficile associated disease.
*Fidaxomicin *Metronidazole *Vanomyocin
Which statements confirm effective antibiotic education?
*I will take the antibiotic at the same time everyday *I will take the antibiotic with food if I develop gastric distress when on antibiotic *I will notify health care provider and stop taking medication if I develop a rash or shortness of breath
What is Loperamide? Why should Loperamide use be cautioned?
*Loperamide (IMODIUM A-D) is a synthetic derivative of Meperidine to treat diarrhea *Loperamide may cause QT prolongation and Torres de Pointes (cardiac arrest) - if taken in higher doses than recommended
What are the two medications used for irritable bowel syndrome with constipation (IBS-C)?
*Lubiprostone (Amitiza) - chloride channel activator (specifically used for opiod induced constipation) *Linaclotide (Linzess)
What are the drug names classified as saline cathartics? What is saline cathartics mechanism of action?
*Mechanism of action is to increase osmotic pressure *Drug names: magnesium citrate, milk of magnesia, Polythene Glycol (PEG)
The nurse identifies which antimicrobial as safe to administer to a breastfeeding woman?
*Penicillin *Macrolides *Cephalosporins Rationale: Tetracycline and chloramphenicol should be avoided during breastfeeding
How can infection of H. Pylori be treated?
*Triple therapy: 2 antibiotics with PPI *Quadruple Therapy: 3 antibiotics with PPI
What are the drugs commonly used for PUD associated with H. pylori?
*amoxicillin *clarithromyocin *metronidazole (do not take with alcohol) *bismuth subsalicylate
Which topical medications are typically used to treat a client with acne vulgaris?
*clindomyocin *erythromyocin
What are the Symptoms of Peptic Ulcer Disease?
*decreased RBC (due to loosing blood in GI bleed) *Epigastric Pain *Discomfort *N/V *Bloody stools - ulcer in LOWER GI tract
What are the contrindications with PPIs?
*hypersensitivity *for older adults - long term use increase risk for hip fractures *pregnancy - Omezprazole (Prilosec) is category C, other PPI's are category B
What is the action of aceytlcholine?
Acetylcholine is a cholinergic neurotransmitter which binds to receptors in parasympathetic nervous system. Acetylcholine stimulates the vagus nerve which releases histamine. Histamine production causes an increase in production of HCl which creates stomach acidity
A client has an anaphylactic reaction after receiving intravenous penicillin. Which would the nurse conclude is the cause of this reaction?
Antibodies to penicillin developed after a previous exposure Rationale: hypersensitivity results form the production of antibodies in response to exposure to a certain type of foreign substance (allergy)
What is the prototype of stimulant cathartics?
Biscodyl (Ducolax)
Who should be cautioned with H2 Receptor blocker administration? What are the adverse effects?
Caution: *older adults have increased effects on CNS *renal impairment can cause increase risk for toxicity with Cimetidine (tagamet) *Hepatic Impairment - Cimetidine inhibits liver's ability to metabolize drugs Adverse Effects: *Antiandronergic Effects: * enlargement/ swelling of breast tissues in males *decrease in sperm count *Famotidine (Pepsid AC) has less adverse effects
What are the Histamine Receptor Blocker Prototypes?
Cimetidine (Tagamet) and Famotide (Pepsid AC)
What is the black box warning for Misoprostol (Prostoglandin) when treating PUD and GERD?
DO NOT give to women with childbearing potential, could cause spontaneous abortion, birth defects, or premature birth
What is the prototype of surfactant?
Docusate Sodium (Colace)
What is the difference between gastric and duodenal ulcer?
In a gastric ulcer, the pain is INCREASED after a meal. In a duodenal ulcer, the pain id DECREASED after a meal (cigarette smoking increases the risk of duodenal ulcers)
What is the diagnosis of diarrhea?
Increased liquidity or frequency of stool for greater than 3 days
What is the most common over the counter polythene glycol solution?
Miralax - should not be used over 2 weeks
Which information would be included in teaching of penicillin administration?
Notify the health care provider if diarrhea develops Rationale: Penicillin is best absorbed when taken with water on an empty stomach
What is the prototype for Proton Pump Inhibitors? (PPIs)
Omezprazole (Prilosec)
What is the action of Antacids? What is the prototype for Antacids?
Prototype: Mylanta Action: neutralizes acid by raising pH of gastric secretion (produce alkaline environment)
What is the diagnosis for irritable bowel syndrome with constipation?
Recurrent abdominal pain/ discomfort for at least 3 days in past 3 months, plus two or more of the following: *improvement with defecation *onset associated with change of frequency of stool *onset associated with change in form (appearance) of stool *less than 25% of bowel movements were lose stools (most important criteria is presence of abdominal pain and change in bowel habits)
What is the action of Sulcrafate when treating PUD or GERD?
Sulcrafate has protective barrier, does not neutralize acid