Pharmacology - Prep U - Chapter 57

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 Ranitidine causes fewer drug interactions than cimetidine. Ranitidine possesses the following adverse effects: headache, diarrhea, and bradycardia.

The nurse should explain that metoclopramide (Reglan) decreases nausea and vomiting by which of the following actions?

Inhibiting stimulation of the vomiting center in the brain Reglan inhibits stimulation of the vomiting center in the brain. This medication also increases the amplitude of gastric contractions and gastric motility while decreasing gastric emptying time.

Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

gynecomastia Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine.

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." Constipation is the most frequently seen adverse effect; thus, the client should increase his fiber intake to prevent constipation. Diarrhea is possible, but constipation is more likely. The client should drink fluids and use sugarless lozenges to help with a dry mouth. Fluid intake also will help to prevent constipation.

A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. What is one of the preferred antibiotics?

Amoxicillin The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects?

Constipation The nurse should warn a client taking aluminum- and calcium-containing antacids about constipation, which can be associated with taking products containing either medication. Client taking magnesium- and sodium-containing antacids can have diarrhea. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.

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?

Headache Adverse effects with H2RAs such as ranitidine are typically uncommon and mild with the usual doses and duration of treatment. However, effects can include diarrhea or constipation, headache, dizziness, muscle aches, and fatigue.

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 Sucralfate is well tolerated by older adults. PPIs are also well tolerated, but long-term use (greater than 1 year) is associated with increased risk of hip fractures in adults older than 50 years of age. The risk of fractures increases the longer the medications are taken. The risk of hip fractures is also greater in those taking higher dosages of PPIs.

A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?

Omeprazole Omeprazole is a proton pump inhibitor which is used as part of combination therapy to treat H. pylori infections. Magaldrate is an antacid that is used to relieve GI hyperacidity. Sucralfate is a GI protectant that is used as short-term treatment of duodenal ulcers. Cimetidine is a H-2 receptor antagonist used to treat duodenal and benign gastric ulcers.

A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?

Proton pump inhibitors The treatment of choice for Helicobacter pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

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. The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach. While the other situations may contribute to GI distress, NSAID used in primary risk factor for this client.

Pancrelipase would most likely be used to treat a patient with cystic fibrosis.

True

Because of the possible adverse effects of long-term proton pump inhibitor (PPI) use, the nurse practitioner should focus on what assessment in a 72-year-old client?

bone density Long-term use of PPIs is associated with increased risk of hip fractures in people older than 50 years of age; the risk of fractures increases the longer the medications are taken and is greater in people who take higher dosages of PPIs. Bone density assessment may thus be warranted. None of the other options are associated with this class of medications.

An older adult's has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect?

constipation With the antacid which contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.

The nurse is teaching a client about lansoprazole prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease?

inhibiting acid secretion Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.

Which would a nurse anticipate as having antiandrogenic effects?

Cimetidine Cimetidine has been associated with antiandrogenic effects such as gynecomastia and galactorrhea.

Which agent is associated with antiandrogenic effects?

Cimetidine Cimetidine was the first drug in this class to be developed and has been associated with antiandrogenic effects including gynecomastia and galactorrhea. Ranitidine, famotidine, and nizatidine are not associated with these effects.

After teaching a group of students about proton pump inhibitors, the instructor determines that the students have understood the information when they identify which agent as the prototype proton pump inhibitor?

Omeprazole Omeprazole is considered the prototype proton pump inhibitor.

A nurse is teaching a client about his prescribed lansoprazole. The nurse instructs the client to take the drug at which time?

1 hour before eating Proton pump inhibitors such as lansoprazole should be swallowed whole at least 1 hour before eating. The proton pump inhibitors suppress gastric acid secretion by blocking the final step in the production of gastric acid by the gastric mucosa. After meals will inhibit suppression of gastric acid. On rising and at bedtime are not optimal times to take lansoprazole.

A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms most likely be resolved?

1 to 2 weeks The symptoms of gastroesophageal reflux disease will be resolved in 1 to 2 weeks after the start of the proton pump inhibitor medication regime. It will not take 4 weeks, 1 month, or 6 weeks to see a change with the proton pump inhibitor.

A patient is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the patient's symptoms be abolished?

1-2 weeks The symptoms of gastroesophageal reflux disease will be abolished in 1-2 weeks after the start of the proton pump inhibitor medication regime. It will not take 4 weeks, 1 month, or 6 weeks to see a change with the proton pump inhibitor.

A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?

2 tablets The required dosage is 200 mcg. Available tablets contain 100 mcg of the drug. Therefore, the nurse should administer two tablets each time to the client.

A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?

30 minutes Sucralfate has an onset of action of 30 minutes and a duration of 5 hours.

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

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

A female client self-administers magnesium antacids. She presents to the office with symptoms of dizziness and weakness. The nurse knows that these symptoms are secondary to what common adverse effect of magnesium antacids?

Diarrhea Magnesium antacids have high neutralizing capacity and may cause diarrhea and hypermagnesemia.

Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply:

Lansoprazole (Prevacid) Omeprazole (Prilosec) The proton pump inhibitors, like omeprazole (Prilosec) and lansoprazole (Prevacid), are commonly used in combination with certain antibiotics in the treatment of H. pylori.

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. Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases.

A client is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which disease is a result of cellular destruction of the gastrointestinal tract from this medication?

Peptic ulcer disease Cell destruction will occur from the ingestion of NSAIDs, which can lead to the development of peptic ulcer disease. Nonsteroidal anti-inflammatory agents do not cause esophageal cancer, bowel obstruction, or liver cancer.

A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the client's safety. What would be an appropriate nursing diagnosis?

Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations The appropriate nursing diagnosis related to safety would be Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations. Diarrhea related to adverse effects of drug therapy and Acute Pain related to adverse drug effects, headache are appropriate nursing diagnosis for a patient taking ranitidine, but are not related to safety. Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy would be appropriate for a client taking an aluminum hydroxide with magnesium hydroxide antacid (Maalox, Mylanta).

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 than the average prescribed dose Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.

Client teaching should include what instruction about antacids?

Take antacid 1 hour before other medications. Administer the drug apart from any other oral medications approximately 1 hour before or 2 hours after to ensure adequate absorption of the other medications.

What is the rationale for using two antimicrobials when treating a Helicobacter pylori infection?

Two antimicrobials are needed to prevent the emergence of drug-resistant H. pylori organisms. Effective combinations include two antimicrobials. For the antimicrobial component, two of the following drugs—amoxicillin, clarithromycin, metronidazole, or tetracycline—are used. A single antimicrobial agent is not used because of concern about emergence of drug-resistant H. pylori organisms. None of the other options present accurate information regarding the need to prescribe dual antimicrobials in this situation.

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

an hour before meals. Sucralfate, a gastrointestinal protectant, must be given time to act before significant gastric activity, and it requires an acidic environment to be effective. For these reasons, sucralfate should be given an hour before meals and antacids.

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

are pregnant. Misoprostol is contraindicated during pregnancy because it may cause abortion, premature birth, or birth defects. It is also contraindicated in women of childbearing potential who are not using effective contraception.

How should the critical care nurse most accurately titrate the dose and frequency of administration of an intragastric drip of an antacid through a nasogastric tube?

by aspirating stomach contents and measuring the pH For clients with a nasogastric tube in place, antacid dosage may be titrated by aspirating stomach contents, determining pH, and then basing the dose on the pH. Accurate measurement of gastric pH cannot be determined from the buccal mucosa or urine.

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 No absolute contraindications exist, but cimetidine should be used cautiously in clients with impaired hepatic and renal function. The client with cancer, hypertension, and diabetes mellitus can take cimetidine safely.

The nurse should be aware that ranitidine achieves a therapeutic effect by which means?

inhibiting the secretion of gastric acid The histamine2 receptor antagonists (H2RAs) inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin. These drugs, such as ranitidine, do not change the pH of secretions, bind to the proton pumps, or decrease gastric motility.

A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for:

metabolic alkalosis. Overuse of antacids containing calcium carbonate can cause alkalosis and raise urine pH.

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. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.

A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?

"Quitting smoking will significantly increase the chance that this drug will heal your ulcer." Smoking reverses the drug-induced inhibition of nocturnal gastric acid production and hinders ulcer healing. Cigarette smoking also is related closely to ulcer recurrence. Ranitidine should not be taken simultaneously with antacids and it does not eradicate H. pylori. It is not necessary to eat multiple small meals during the day.

When educating a client prescribed a histamine-2 antagonists, which of the following should be avoided? Select all that apply.

caffeine alcohol cigarettes The instruction should include ways to decrease acid production (such as avoiding cigarettes, acid stimulating foods, alcohol, and caffeine). Fibrous foods are not considered acid stimulating.

The nurse is caring for four clients. Which client would benefit most from misoprostol, a synthetic prostaglandin E analog?

An 83-year-old male with rheumatoid arthritis Misoprostol is prescribed for concurrent use with NSAIDs to prevent NSAID-induced erosion and ulceration of the gastric mucosa. The client with rheumatoid arthritis likely uses NSAIDs frequently, placing him at risk of developing gastric ulcers and making him a candidate for misoprostol.

Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?

Drug-drug interactions Ranitidine, which is longer acting and more potent than cimetidine, is not associated with the antiandrongenic adverse effects or the marked slowing of metabolism in the liver, as cimetidine is, and therefore does not interfere with the metabolism of other drugs.

A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the midepigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?

Infection with H. pylori Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).

Which teaching intervention is most important to share with the client prescribed misoprostol?

Use effective contraceptive measures. Misoprostol is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. While reporting postmenopausal bleeding, this medication is not associated with that adverse reaction. The medication should be administered two to four times per day.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

decreases production of gastric secretions Several types of drugs are used, alone and in various combinations. Antacids neutralize gastric acid and decrease pepsin production, antimicrobials and bismuth can eliminate H. pylori infection, histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) decrease gastric acid secretion, sucralfate provides a barrier between mucosal erosions or ulcers and gastric secretions, and misoprostol restores prostaglandin activity.

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 Omeprazole is available over the counter; lansoprazole, rabeprazole, and esomeprazole are prescription medications.

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?

Use a reliable contraceptive. 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 nurse should instruct the patient taking proton pump inhibitors not to chew, open, or crush the tablet but to swallow the tablet whole at least one hour before eating. The nurse needs to inform the patient to take the drug for motion sickness about one hour before travel.

The nurse should be aware that the combination of omeprazole and warfarin creates a risk of what adverse reaction?

hemorrhage Omeprazole increases blood levels of the anticoagulant warfarin thus creating a risk for bleeding. Such an elevation in warfarin would not increase the risk for the development of any of the other options.

A client, with recent abdominal pain and a 40-pack per year smoking history, is prescribed a treatment regimen for a diagnosis of duodenal ulcer. What important teaching would the nurse include in relation to treatment?

smoking effects on the healing of ulcers Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of nonsmokers. The treatment is focused on healing, and smoking will impede the achievement of that goal. Acute not chronic pain is the focus of the client's concerns. Medication should be taken until discontinued by the health care provider. While a discussion concerning the health dangers associated with smoking is appropriate, such information is not related to the client's current health issue.