chapter 57 pharm
Pancrelipase would most likely be used to treat a patient with cystic fibrosis.
true
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."
The nurse is caring for a patient who has been prescribed a saliva substitute . The patient asks why this medication is necessary. What would be the most appropriate response?
"This medication helps people that have a condition that creates a lack of saliva."
The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine rather than cimetidine?
Drug-to-drug interaction
proton pump inhibitors Pharmacokinetics
-Acid labile, rapidly absorbed in the GI tract -Metabolized in the liver and excreted in the urine
proton pump inhibitors indications
-Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, and benign active gastric disease -Long-term treatment of pathological hypersecretory conditions
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
A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms be resolved?
1 to 2 weeks
The nurse is caring for a client diagnosed with cancer. The nurse should perform which assessment(s) for safe administration of the ondansetron? Select all that apply.
1. Determine if the client takes any antidepressants or antipsychotic drugs for possible interactions. 2. Assess if the client has any nausea or vomiting, and if so the number of episodes and amount of vomitus. 3. Obtain baseline vital signs and renal profile with electrolytes at baseline to compare with later labs.
histamine 2 adverse effect
1. GI: diarrhea or constipation 2. CNS: dizziness, headache, somnolence, confusion, or even hallucinations, Cardiac arrhythmias, hypotension, gynecomastia, and impotence
histamine 2 antagonists caution
1.Pregnancy or lactation 2. Hepatic or renal dysfunction
For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be?
20 mg bid
A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?
30 minutes
Proton Pump Inhibitors actions
Act at specific secretory surface receptors to prevent the final step of acid production and thereby decrease the level of acid in the stomach
A client with ulcers has asked the nurse if it would be acceptable to take bismuth subsalicylate. Before recommending an over-the-counter (OTC) formulation of bismuth subsalicylate, the nurse should conduct which client assessment?
Allergy status
A critical care nurse is preparing to administer an intragastric drip of an antacid to a client through a nasogastric tube. How should the nurse MOST accurately titrate the dose and frequency?
By aspirating stomach contents and measuring the pH
A group of students are reviewing the signs and symptoms of systemic alkalosis that can occur as a result of using sodium bicarbonate. The students demonstrate a need for additional teaching when they identify which as a possible manifestation?
Constipation
The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects?
Constipation
Proton Pump Inhibitors adverse GI effects
Diarrhea, abdominal pain, and tongue atrophy, nausea and vomiting
prototype cimetidine adverse effects
Dizziness, confusion, headache, somnolence, cardiac arrhythmias, cardiac arrest, diarrhea, impotence, gynecomastia, rash.
Proton Pump Inhibitors adverse CNS effects
Dizziness, headache, asthenia, vertigo, insomnia, apathy, dream abnormality
The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine over cimetidine?
Drug-to-drug interaction
gastrointestinal protectant Prototype- sucralfate (Carafate) action
Forms an ulcer-adherent complex at the duodenal ulcer site, protecting the ulcer from acid, bile salts, and pepsin, promoting healing of the ulcer; also inhibits pepsin activity in gastric juices.
Proton Pump Inhibitors prolonged use includes risk of
Gastric cancer Bone loss Decreased Ca++ levels Decreased Mg++ levels leading to HTN C-difficile diarrhea and pneumonia
Sodium Bicarbonate adverse effects
Gastric rupture, systemic alkalosis (headache, nausea, irritability, weakness, tetany, confusion), hypokalemia (secondary to intracellular shifting of potassium), gastric acid rebound.
A male client is taking cimetidine. Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?
Gynecomastia
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?
Gynecomastia
Prototype Proton Pump Inhibitors adverse effects
Headache, dizziness, vertigo, insomnia, rash, diarrhea, abdominal pain, nausea, vomiting, upper respiratory infection symptoms, cough.
A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition?
Hepatic disease
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
The nurse should be aware that ranitidine achieves a therapeutic effect by which means?
Inhibiting the secretion of gastric acid
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
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
Which drug treats heartburn by neutralizing the acidity of the stomach by combining with hydrochloric acid (HCL) and increasing the pH of the stomach acid?
Magaldrate (Riopan)
Prostaglandin GU effects
Miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders
the leading cause of peptic ulcers in the us is the use of
NSAIDS
Prostaglandin GI effects
Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, and constipation
Sodium Bicarbonate action
Neutralizes or reduces gastric acidity, resulting in an increase in gastric pH, which inhibits the proteolytic activity of pepsin
A client has a history of liver dysfunction. Which histamine-2 receptor antagonist would the nurse expect to be prescribed?
Nizatidine
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
Omeprazole
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
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
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.
A female client is self-administering cimetidine. What is the home care nurse's most important assessment of this client?
Potential drug-drug interactions
Proton Pump Inhibitors cautions
Pregnancy or lactation
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?
Proton pump inhibitors
Proton Pump Inhibitors other less common effects
Rash, alopecia, pruritis, dry skin, back pain, and fever
anatacids adverse effects
Relate to their effects on acid-base levels and electrolytes Rebound acidity Alkalosis Hypercalcemia Constipation or diarrhea Hypophosphatemia
The client has a magnesium-based antacid prescribed for administration before meals. The nurse knows to withhold the medication if the client exhibits what?
Renal dysfunction
A nurse in a health care facility is caring for a patient who is administered milk of magnesia to control constipation. Which nursing diagnosis should the care plan for this patient include?
Risk for imbalanced fluid volume
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
gastrointestinal protectant Prototype- sucralfate (Carafate) indication
Short-term treatment and maintenance treatment of active duodenal ulcer; treatment of oral and esophageal ulcers due to radiation, chemotherapy, or sclerotherapy.
protoype Cimetidine Indications
Short-term treatment of active duodenal or benign gastric ulcers; treatment of pathological hypersecretory conditions; prophylaxis of stress-induced ulcers; treatment of erosive gastroesophageal reflux; relief of symptoms of heartburn and acid indigestion
Prototype Proton Pump Inhibitors omeprazole indications
Short-term treatment of active duodenal ulcer or active benign gastric ulcer; treatment of heartburn or symptoms of gastroesophageal reflux; treatment of pathological hypersecretory syndromes; eradication of Helicobacter pylori infection as part of combination therapy.
gastrointestinal protectant Prototype- sucralfate (Carafate) adverse effects
Sleeplessness, dizziness, vertigo, insomnia, rash, constipation, diarrhea, nausea, indigestion, dry mouth, back pain.
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
Which antacids would the nurse identify as being contraindicated in clients with heart failure?
Sodium bicarbonate
Prototype Proton Pump Inhibitors omeprazole action
Specifically inhibits the H+, K+-ATPase enzyme system on the secretory surface of gastric parietal cells, blocking the final step in acid production and decreasing gastric acid levels.
antacids indications
Symptomatic relief of upset stomach associated with hyperacidity, as well as hyperactivity
drug-drug interactions for histamine 2
Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine, theophylline, chloroquine, benzodiazepines, nifedipine, pentoxifylline, tricyclics, procainamide, and carbamazepine
A female client has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse?
Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine."
48 yo pt with a peptic ulcer you would
administer meds with meals and at bedtime
Antacids drug-drug interactions
affect the absorption of many other drugs
Proton Pump Inhibitors contraindications
allergy
prostaglandin contraindications
allergy pregnancy
Antacids: Contraindications
allergy, renal failure, electrolyte imbalances (from the accumulation of electrolytes in antacid itself), GI obstruction (may stimulate motility when it is undesirable)
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
alopecia
Antacids list
aluminum salts calcium salts magnesium salts sodium bicarbonate (prototype)
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:
an hour before meals.
Antacids: Cautions
any condition that can be exacerbated by electrolyte imbalanve
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
Famotidine in only H2 antagonist approved in
children
the first drug in the Pharmacokinetics class to be developed was
cimetidine
Proton Pump Inhibitors upper respiratory tract symptoms
cough, stuffy nose, hoarseness, and epistaxis
The nurse is caring for a client who is prescribed esomeprazole. The client informs the nurse that he is also taking sucralfate. The nurse would anticipate which effect as a possibility when these two drugs are administered?
decreased absorption of the esomeprazole
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
Proton Pump Inhibitors list
dexlansoPRAZOLE esomePRAZOLE lansoPRAZOLE omePRAZOLE (prototype) pantoPRAZOLE rabePRAZOLE
the underlying causes of GI disorders can ranges from
dietary excess, stress, hiatal hernia, esophageal reflux, and adverse drug effects to the more serious peptic ulcer disease.
Proton Pump Inhibitors
drug that blocks the H+, K+-ATPase enzyme system on the secretory surface of the gastric parietal cells, thus interfering with the final step of acid production and lowering acid levels in the stomach
gastrointestinal protectant
drug that coat any injured area in the stomach to prevent further injury from acid
The nurse should be aware that the combination of omeprazole and warfarin creates a risk of what adverse reaction?
hemorrhage
the drugs used to treat gastroesophageal reflux disease (GERD) and ulcer disease include
histamine-2 (H2) antagonists, which block the release of hydrochloric acid in response to gastrin
chronic ulcers may be the result of
impaired mucous lining and infection by Helicobacter pylori bacteria.
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
Ranitidine and cimetidine are both H2RAs used in the treatment of peptic ulcer disease. Of the two, ranitidine is preferred in critically ill clients because it is less likely to:
interfere with the metabolism of other drugs.
histamine 2 antagonists contraindications
known allergy
Prostaglandin caution
lactation hepatic or renal impairment
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.
Misoprostol is abortifacient and should Never be used during
pregnancy
Nursing Considerations for Patients Receiving Antacids : implementation
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. Have the patient chew tablets thoroughly and follow with water to ensure that therapeutic levels reach the stomach to decrease acidity.
A nurse is teaching a client about omeprazole, which has been prescribed as part of a regimen to treat an H. pylori infection. What statement, made by the client, suggests that the client understands proper use of the drug?
"I need to swallow the drug whole.
histamine-2 antagonists
CimeTIDINE (protypes FamoTIDINE NizaTIDINE RaniTIDNE
What H2 antagonist has been associated with antiandrongenic effects?
Cimetidine
Which agent would a nurse identify as the prototype histamine-2 receptor antagonist?
Cimetidine
Which would a nurse anticipate as having antiandrogenic effects?
Cimetidine
A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?
Closely monitor the patient for confusion and dizziness.
A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?
Infection with H. pylori
Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?
Omeprazole
48 yo pt with a peptic ulcer you would teach that
The drug that has been prescribed for you, ranitidine, is called an H2 antagonist. An H2 antagonist decreases the amount of acid that is produced in the stomach. It is used to treat conditions that are aggravated by excess acid.
Prototype Proton Pump Inhibitors drug to drug interactions
There is a risk of increased serum levels and increased toxicity of benzodiazepines, phenytoin, and warfarin if these are combined with these drugs;
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
histamine-2 (H2) antagonist
drug that blocks the H2 receptor sites; used to decrease acid production in the stomach (H2 sites are stimulated to cause the release of acid from the parietal cells in response to gastrin or parasympathetic stimulation)
Ulcer patients present with a predictable description of
gnawing, burning pain often occurring a few hours after meals.
Antacids
group of inorganic chemicals that neutralize stomach acid
cimetidine has been associated with antiandrogenic effects, including
gynecomastia and galactorrhea
A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is:
headache
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
gastrointestinal protectant Prototype- sucralfate (Carafate) route
oral (onset 30 min and duration is 5hours)
Prototype Proton Pump Inhibitors omeprazole route
oral (onset varies)
prototype cimetidine route
oral (onset varies), IM, and IV (rapid onset)
Sodium Bicarbonate routes
oral (rapid onset) and IV (immediate onset)
erosions in the lining of the stomach and adjacent areas of the GI tract are called
peptic ulcers.
A client is prescribed ranitidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has:
renal disease
gastrointestinal protectant Prototype- sucralfate (Carafate) administration
schedule- 1 Gm ac & hs
A client who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess:
serum phosphate level.
acute ulcers =
stress ulcers
Gastrointestinal protectant
sucralfate (prototypes)
sodium biacarbonate indication
symptomatic relief of upset stomach from hyperacidity; prophylaxis for GI bleeding and stress ulcers; adjunctive treatment of severe diarrhea; also used for treatment of metabolic acidosis; may also be used to treat certain drug intoxications to minimize uric acid crystallization.
Combination antibiotics have been found to be quite effective in
treating some patients with chronic ulcers
