Antacid Therapy 315

Which teaching points would a nurse share with a 33-year-old female patient who has been prescribed omeprazole delayed-release capsules for Zollinger-Ellison syndrome?

"Do not crush, chew, split, or open the omeprazole capsule." Delayed-release capsules of omeprazole should not be crushed, chewed, split, or opened. "You may experience headache and diarrhea with omeprazole." Although side effects are typically not anticipated, diarrhea and headache may occur with omeprazole. "Use contraception and alert your health care provider if you suspect you are pregnant while taking omeprazole." PPIs like omeprazole require precautious use, if any, during pregnancy. Therefore it is important that a patient who is of childbearing age uses contraception and reports any suspected pregnancy.

A nurse is caring for a patient who will be using a scopolamine patch for motion sickness. In addition to scopolamine, the patient is also taking diphenhydramine, an antihistamine, as needed for allergies. Which patient statement about scopolamine requires further intervention?

"I will apply the patch to my upper arm." This statement is inaccurate and requires further intervention. The patient should apply the scopolamine patch on a hairless area behind the ear, not on the upper arm.

Which statement by the nursing student about the mechanism of action of proton pump inhibitors (PPIs) requires further intervention?

"PPIs work by blocking histamine2 receptors, which reduces gastric acid secretion." Histamine2 receptor blockers like ranitidine, not PPIs, work to block histamine2 receptors.

Which statement regarding the pharmacokinetic profile of esomeprazole is inaccurate?

"The drug is less than 50% protein bound." This statement is inaccurate. Esomeprazole is highly protein bound (97%, not 50%).

Which statement by the nursing student in regard to the pharmacokinetic parameters of calcium carbonate requires further intervention?

"The solubility of calcium is decreased in an acidic environment."

Which time frame describes when a patient will begin to experience relief from treatment with magnesium hydroxide?

0.5 to 6 hours

In which time frame would a patient expect to experience effects from esomeprazole?

1 hour Esomeprazole's onset of action is 1 hour, which is when the patient can expect to experience some effects from the drug.

Which time frame describes how long a patient can expect the effects of aluminum hydroxide to last?

1 to 3 hours

In which time frame would a nurse expect omeprazole to reach its peak concentration?

2 hours Omeprazole reaches its peak concentration in 2 hours.

Which time frame can a nurse expect aluminum hydroxide to reach its peak concentration?

30 minutes

In which time frame would a patient expect dronabinol to begin working?

30 to 60 minutes

Which time frame can a nurse expect dexamethasone to reach its peak concentration?

5 to 10 minutes Dexamethasone reaches its peak concentration in 5 to 10 minutes.

Which length of time is the anticipated duration of action for meclizine's effects?

6 hrs

Which patients would a nurse determine require cautious use of or avoidance of esomeprazole?

A 70-year-old Asian patient with hypertension: Both older adults and patients of Asian descent require cautious use of esomeprazole. Patients of Asian descent are at increased risk for dementia. A 73-year-old Caucasian patient with osteoporosis: Cautious use, if any, is warranted in older adult patients and in those with osteoporosis as proton pump inhibitors (PPIs) can further increase the risk for hip, wrist, and spine fractures. A 29-year-old Hispanic patient who is breastfeeding: A patient who is breastfeeding ideally should not receive a PPI. A 54-year-old Caucasian patient with alcoholic cirrhosis: Patients with hepatic impairment like alcoholic cirrhosis require cautious use of esomeprazole.

Which patients would a nurse determine will likely receive a dosage reduction in cimetidine for gastroesophageal reflux disease?

A 71-year-old patient with hypertension A 71-year-old patient with hypertension will likely require a dosage reduction due to the age of the patient. Older adults have less gastric acid and therefore do not need as high of doses of histamine2 receptor blockers. A 58-year-old patient with chronic kidney disease A 58-year-old patient with chronic kidney disease will likely require a dosage reduction due to renal impairment, which can cause accumulation of the drug.

Which patients would a nurse recommend against use of ranitidine?

A patient who is breastfeeding A patient who is breastfeeding should not receive ranitidine. A patient who is in her second trimester of pregnancy A patient who is in her second trimester of pregnancy cannot safely receive ranitidine.

Which patients would a nurse determine can safely receive treatment with scopolamine?

A patient with asthma A patient with depression A patient with breast cancer

A patient who takes an antacid frequently for persistent heartburn presents with confusion and extreme muscle weakness. The patient is also having difficulty speaking. Which antacid would a nurse suspect this patient may have been receiving in excess?

Aluminum hydroxide

Which statement about the classification of antacids is accurate?

Aluminum hydroxide is a non-systemic antacid that can cause constipation.

Antiemetic Drug Therapy

Antiemetic Drug Therapy

Which phrase describes how ondansetron works to treat nausea and vomiting?

Blocks the serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals in the gastrointestinal (GI) tract Ondansetron is a serotonin antagonist that inhibits serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals in the GI tract to reduce nausea and vomiting.

Which patient parameters would a nurse ensure are assessed before a patient receives calcium carbonate?

Calcium levels Renal function Phosphate levels

A patient who is receiving omeprazole has been prescribed clopidogrel following stent placement. Which outcome does a nurse alert the health care provider about resulting from the drug interaction?

Decrease in activation of clopidogrel Evidence indicates that clopidogrel's activation may be decreased when given with omeprazole. As a result, its antiplatelet effects may be reduced.

Which outcome is anticipated as a result of histamine2 receptor blockers obstructing histamine2 receptors in the parietal cells in the stomach?

Decrease in hydrogen ions and gastric acid The concentration of both hydrogen ions and gastric acid is decreased when the histamine2 receptors are obstructed by histamine2 receptor blockers.

Which outcome would a nurse anticipate might occur when magnesium hydroxide is administered with phenytoin?

Decreased absorption and efficacy of phenytoin

A 93-year-old patient with gastroesophageal reflux disease (GERD) is prescribed esomeprazole. The patient is immobile in a skilled nursing facility, is frail, and experienced a stroke a year ago. Which adverse effects of esomeprazole will the nurse be concerned about in this patient?

Dementia: Dementia is a concern with PPI therapy, particularly in an older adult patient. Pneumonia: Pneumonia is a concern with PPI therapy, particularly as this patient is immobile. Osteoporosis: Osteoporosis is a concern with PPI therapy, especially after a stroke and due to the frail nature of the patient. Hip or vertebral fracture: Hip or vertebral fracture is a concern with PPI therapy, especially after a stroke.

Which drug interaction and outcome does the nurse anticipate will occur in Ms. Contreras with administration of esomeprazole?CASE STUDY DETAILS

Digoxin: Increased digoxin exposure Concomitant administration of esomeprazole and digoxin is expected to increase digoxin exposure measured by area under the curve (AUC).

Which side effects would the nurse advise Ms. Smith to monitor for while receiving promethazine?CASE STUDY DETAILS

Dizziness Dry mouth Blurry vision Tachycardia

Which antiemetic is excreted in urine, feces, and bile?

Dronabinol Dronabinol's excretion occurs in urine, feces, and bile.

Which statements are true about the pharmacokinetics of omeprazole and esomeprazole?

Esomeprazole is metabolized more slowly than omeprazole. This statement is accurate because esomeprazole undergoes slower metabolism than omeprazole. Esomeprazole achieves a higher blood level and has longer-lasting effects compared with omeprazole. Because esomeprazole undergoes slower metabolism, it achieves a higher blood level and has longer-lasting effects compared with omeprazole.

Which frequency would a nurse anticipate seeing promethazine prescribed for a patient with nausea and vomiting?

Every 4 to 6 hours Promethazine is typically dosed every 4 to 6 hours for nausea and vomiting.

Which conditions are histamine2 blockers used to treat?

Gastric ulcer Duodenal ulcer Gastroesophageal reflux disease

Which medical conditions would a nurse recognize that oral esomeprazole may be used to treat?

Gastroesophageal reflux disease (GERD): GERD is an approved condition for treatment with esomeprazole. Duodenal ulcers: Duodenal ulcers are an approved condition for treatment with esomeprazole. Nonsteroidal antiinflammatory drug (NSAID)-induced ulcers: NSAID-induced ulcers are an approved condition for treatment with esomeprazole. Zollinger-Ellison syndrome: Zollinger-Ellison syndrome is an approved condition for treatment with esomeprazole.

Which patient parameters would a nurse evaluate in a patient receiving meclizine?

Heart rate Intake/Output Bowel sounds Blood pressure

Before administering cimetidine to a 27-year-old female patient, which patient parameters would a nurse ensure have been assessed?

Hepatic function The patient's liver function should be assessed before administering cimetidine. Renal function The patient's kidney function should be assessed before administering cimetidine. Pregnancy status Pregnancy status should be assessed in this female patient of childbearing age before receiving cimetidine. Fluid and electrolyte status Fluid and electrolyte status should be assessed before administering cimetidine.

Histamine₂ Blocker Therapy

Histamine₂ Blocker Therapy

Which effect would a nurse monitor for in a patient who is receiving glipizide, a sulfonylurea, and aluminum hydroxide?

Hypoglycemia

Which electrolyte abnormality would a nurse monitor for in a patient receiving dexamethasone as an antiemetic who is also receiving furosemide, a loop diuretic?

Hypokalemia Glucocorticoids like dexamethasone can enhance the hypokalemic effects of loop diuretics such as furosemide.

Which dosage and administration protocol would a nurse follow with the administration of intravenous esomeprazole to Ms. Contreras?CASE STUDY DETAILS

If given as an infusion, it will be administered over 10 to 30 minutes. An infusion of esomeprazole would be administered over 10 to 30 minutes.

Which outcome would a nurse anticipate from the drug interaction that may occur in a patient who is receiving diazepam and has been newly prescribed omeprazole?

Increase in serum concentration of diazepam Diazepam's half-life is increased by 130% when given concomitantly with omeprazole. Therefore the serum concentration of diazepam is increased.

Which effect would a nurse anticipate might occur from the drug interaction between dronabinol and warfarin?

Increase in warfarin concentration The anticipated drug interaction between warfarin and dronabinol is an increase in the serum concentration of warfarin.

Which effect would a nurse anticipate may occur if a patient with warfarin is given cimetidine?

Increased anticoagulant effect When taken together, the anticoagulant effect of warfarin is increased. This increases the patient's bleeding risk. The patient's prothrombin time/international normalized ratio should be monitored more closely, as a dosage reduction in warfarin may be warranted.

Which effect would a nurse anticipate may occur if a patient taking phenytoin is given cimetidine?

Increased effect of phenytoin When taken together, cimetidine increases the concentration of phenytoin, thus increasing its effect. The patient should be monitored closely to determine whether a dosage reduction in phenytoin is warranted.

Which statement regarding the pharmacodynamic parameters of intravenous (IV) ondansetron is accurate?

Its elimination half-life is 3 to 5 hours. IV ondansetron has an elimination half-life of 3 to 5 hours.

With which medical condition would a nurse expect the health care provider to reduce the dosage of ranitidine due to potential accumulation of the drug?

Kidney disease Accumulation of ranitidine may occur with renal impairment, and a dosage reduction is needed in these patients.

Which monitoring parameters would a nurse ensure are evaluated when a 73-year-old patient who is newly prescribed cimetidine returns for a follow-up?

Lung sounds: Due to a risk for pneumonia, the older patient's lung sounds should be assessed upon follow-up for initiation with cimetidine. Liver function: Liver function should be assessed in this patient due to a risk for hepatotoxicity with cimetidine therapy. Renal function: Renal function, particularly in older patients, should be evaluated in those receiving cimetidine. Mental status change: Mental status changes should be assessed in older patients, those with renal impairment, and those who are critically ill and are receiving cimetidine.

Which patient parameters would a nurse ensure are assessed before a patient receives oral esomeprazole?

Medication history Because of the potential for drug interactions, it is important to assess a patient's medication history before administering esomeprazole. Gastrointestinal (GI) history Assessment of the patient's GI history is critical to determine if therapy with esomeprazole is appropriate. Risk for and history of osteoporosis Because proton pump inhibitors may increase the risk for developing osteoporosis, it is important to assess the risk for and the patient's history of the condition.

Which respiratory complication associated with cimetidine is a concern, as the drug increases gastric pH?

Pneumonia Pneumonia is a concern in patients receiving cimetidine. As the drug increases gastric pH, the risk for pneumonia also increases.

Proton Pump Inhibitor Therapy

Proton Pump Inhibitor Therapy

Which comparison between cimetidine and ranitidine is accurate?

Ranitidine is more potent than cimetidine. Ranitidine is 5 to 12 times more potent than cimetidine but is less potent than famotidine.

Which teaching point will a nurse share with a 63-year-old male patient who has been prescribed ranitidine for gastroesophageal reflux disease (GERD)?

Ranitidine should be separated from any other drugs the patient may be taking by at least 1 hour. This statement is true. Ranitidine and other H2RA blocker administration should be separated from other drugs by at least 1 hour.

Which antiemetic exerts its effects by binding to acetylcholine receptors to block the nausea-inducing signal from communicating to the vomiting pathway?

Scopolamine

Which antiemetic can a nurse anticipate having the longest duration of action?

Scopolamine Scopolamine has the longest duration of action of 72 hours.

Which administration point would the nurse share with Mrs. Woods in regard to magnesium hydroxide therapy?CASE STUDY DETAILS

She should shake the suspension well before administration.

Match the antiemetic with its drug class

Substance P/Neurokinin 1 Antagonists: Dexamethasone Dopamine antagonists: Aprepitant Cannabinoids: Ondansetron Antihistamine: Dronabinol

A nurse is caring for a patient who takes calcium carbonate and was recently prescribed ciprofloxacin, a quinolone, for a urinary tract infection. Which teaching point would the nurse share with this patient about administration of these drugs?

Take calcium carbonate 1 to 2 hours after ciprofloxacin.

Which instructions would the nurse provide Mr. Evans about when to take the prescribed ranitidine?CASE STUDY DETAILS

Take it at bedtime, or after evening meal. Histamine2 blockers should be taken at bedtime or after evening meal.

Which explanation would a nurse provide a patient about the avoidance of alcohol while taking promethazine?

The combination may cause excessive central nervous system (CNS) effects such as sedation. The combination of promethazine and alcohol can lead to excessive CNS depression such as sedation.

Which statement regarding the pharmacokinetics of promethazine is accurate?

The drug is easily absorbed through the gastrointestinal (GI) tract.

Which statement regarding the pharmacokinetics of ranitidine is accurate?

The drug undergoes hepatic metabolism.

Which statement regarding the pharmacokinetic parameters of aprepitant is accurate?

The drug undergoes metabolism mostly by CYP3A4 . Aprepitant undergoes extensive metabolism in the liver, mostly by CYP3A4

Which statement regarding the pharmacodynamics of cimetidine is accurate?

The elimination half-life of cimetidine is 1.5 to 2 hours.

Which statement regarding the pharmacodynamic profile of omeprazole is accurate?

The elimination half-life of omeprazole is 0.5 to 1 hour. This statement is accurate. Omeprazole has an elimination half-life of 0.5 to 1 hour.

A nurse is caring for a patient with breast cancer who is experiencing chemotherapy-induced nausea and vomiting. Which side effects and adverse effects would a nurse monitor for if the patient is receiving aprepitant?

Urticaria Thrombocytopenia Deep vein thrombosis

Which statements regarding the absorption of calcium carbonate are accurate?

a,b,d,e Absorption of calcium varies with age. During pregnancy, calcium absorption doubles. Calcium absorption is reduced in achlorhydria and uremia. The absorption of calcium depends on calcitriol and vitamin D.

Which phrases accurately describe the mechanisms of action exerted by antacids?

a.b.d Raise gastric pH Lower pepsin activity Neutralize stomach acidity

Which patients would a nurse determine require cautious use or avoidance of aluminum hydroxide?

b-e A 29-year-old patient who is pregnant A 71-year-old patient with dyslipidemia A 55-year-old patient with chronic kidney disease A 29-year-old patient with hypophosphatemia

Which patients would a nurse determine cannot safely receive therapy with promethazine?

c.d A 1-year-old child with profuse vomiting. Children under the age of 2 years should not receive therapy with promethazine because of a risk for fatal respiratory depression. A 31-year-old patient who is breastfeeding Women who are breastfeeding should not take promethazine.

Which patients would a nurse determine have precautions to treatment with calcium carbonate?

d,e A patient with hypoparathyroid disease A patient with renal dysfunction on dialysis