Quiz #10: CH 41 - 43

use non drug measures first when treating constipation such as...

-increase fluids (along w/fiber) 6-10 8oz glasses daily -indrease dietary fiber (along w/fluids) -increase consumption of pro-biotic foods -establish regular bowel routine (plane & time) -regular exercise/movement

The goal of therapy for nausea and vomiting is to ___ (Often multiple drug types are used synergistically to treat chronic nausea and emesis syndromes)

1. Prevent emesis and it's associated fluid/e-lyte shifts 2. Minimize nutritional disturbances

There are 4 treatment classifications for GERD & PUD. Please list them.

1. Proton Pump Inhibitors (PPIs) 2. Histamine 2 Receptor Blockers 3. Antacids 4. Antibiotics

What are the drug classes used to treat nausea and vomiting?

1. Serotonin receptor antagonists 2. Antihistamines and anticholinergics 3. Phenothiazines 4. Corticosteroids, benzodiazepines, cannabinoids, other

What are some other contributors to ulcers and inflammation?

1. secretion of excess gastric acid 2. hyposecretion of adequate mucus 3.NSAIDS (most common in those who are not infected w/ H.Pylori)

What 2 things can lead to peptic ulcer disease?

1. too much acid 2. not enough mucous

Administer aluminum antacids at least __ hours before or after other drugs because absorption could be affected

2

The small intestine is about ______ long

20-22 ft

The large intestine is about ___ ft long

5

____ Uses -cancer therapy (chemo & radiation) -post-operative nausea - hyperemesis gravidarum (emesis of pregnancy)

5-HT3 Serotonin Receptor Antagonist

_____: Blocks -5-HT3 receptors in GI tract -CTZ center in brain -Vomiting center in Medulla of the brain

5-HT3 Serotonin Receptor Antagonist

The A/E effects of _____ are very mild. Dolasetron (Anzemet) has a B.B. warning for cardiac dysrhythmiad

5HT3 Serotonin Receptor Antagonist

Ondansetron (Zofran) is the prototype drug for ____ (Given all the time in hospital)

5HT3 Serotonin Receptor Antagonists

_____: Bismuth subsalicylate (Pepto-Bismol) -SE similar to aspirin -use with caution in children (Rey's syndrome) -causes temporary darkening of the tongue and stool

Adsorbants

___ chemically combine with acids to raise stomach pH

Alkaline antacids

____ is the prototype drug for Antacids -antiheartburn agent -instant temporary fix

Aluminum hydroxide (AlternaGel)

____: primary use: relief of heartburn due to PUD or GERD -A/E: minor, constipation -long term use can result in phosphate depletion (those at risk malnourished, alcoholics, renal disese) -contraindicated in suspected bowel obstructin

Antacids

Do not use _____ therapy if constipation should be avoided

Anti diarrheal

What is the 3 step process of treating IBS?

Anti-inflammatory drugs, Glucocorticoids, immunosuppressants

___ eradicate H.Pylori, the primary cause of peptic ulcers

Antibiotics

_____: -Donnatal (contains atropine, hyoscyamine, phenobarbitol & scopalolomine) -slows GI motility -causes anticholinergic side effects

Anticholinergic/Belladonna Alkaloids

______ (for nausea) -Scopolamine - used for anti cholinergic side effects - anti-nausea effect due to decreased GI secretions - available and patch, mostly given for motion sickness and end of life

Anticholinergics

______ are contraindicated in urinary retention, increased IOP (glaucoma), etc. - not appropriate for elderly due to increased confusion / delirium risk

Anticholinergics

When patients are on ______ therapy be sure to assess fluid and electrolyte status, blood in stool, patients ability to get out of bed safely

Antidiarrheal

Nurses role in ___therapy: -asses symptoms that precipitated vomiting -if sedation and continued vomiting occur, nasogastric tube with suction may be indicated, pt safety is a concern because of drowsiness, assess for fall risk, immediately report vomiting of blood, do not use OTC antiemetics for prolonged periods

Antiemetic

______ drugs for treatment of nausea and vomiting

Antiemetics

_____: -Mecilzine (Antivert), Hydroxyzine (Vistaril, Atarax) -works secondary to and need to watch for anticholinergics effects -given for motion sickness and inner ear disturbances (Antivert)

Antihistamines

Vitamin __ -food sources: enriched whole grain products, liver, beans, yeast -deficiencies: Beriberi-Neurological complications -Wernicke's encephalopathy - causes poor diet, liver disease, alcoholism -purpose/use: treatment of deficiency

B1 Thiamine

Vitamin ____: -synthesized by microorganisms present in the body -food sources: liver, kidney, fish, shellfish, poultry, dairy -function: two different coenzymes required for metabolism - Deficiency vegan/vegetarian lifestyle without proper supplementation - pernicious anemia-leads to neurologic damaage/anemia -oral absorption requires intrinsic factor production

B12 Cyanocobalamin

Vitamin ___: -sources: green leafy vegetables, yeast, enriched whole grain products -functions: required to activate Vitamin B6 pyridoxine, needed for normal respiratory function -deficiency cause by alcoholism, malabsorption syndromes; symptoms-cutaneous, oral and corneal changes -purpose/use: prevention/treatment of deficiency -large doses will turn urine a yellow-orange color

B2 Riboflavin

Vitamin ____: sources:enriched whole grain products -synthesized from tryptophan -functions: basis of co-enzyme required for lipid, protein and purine metabolism -deficiency: pellagra-neurological deficits, glossitis (red shiny tongue) -purpose/use: prevention/treatment of deficiency; antihyperlipemic

B3 Niacin

Vitamin ___: -sources: whole grains, fish, organ meats, poultry, meats, eggs, peanuts, nuts, vegetables, bananas -deficiency: caused by poor absorption of drug use (isoniazid, hydralazine, etc) -purpose/use: prevent/treat deficicney, relive morning sickness -toxic effects with large doses (neurotoxic)

B6 Pridoxine

Vitamin ____ -sources: green leafy vegetables, citrus fruits -function/purpose: co enzyme in DNA synthesis & RBC production -given prenataly to promote fetal growth -deficiency causes anemia -A/E: hypersensitivity, flushed feeling -may mask signs of Vitamin B12 deficiency

B9-Folic Acid

___ compounds inhibit bacterial growth and prevent H.Pylori from adhering to gastric mucosa

Bismuth

psyllium mucillid (Metamucil) is the prototype drug for ___ -Bulk type laxative

Bulk Forming laxatives

____: -MOA: swells & increases size of fecal mass -primary use: to promote passage of stool -A/E: gas-bloating/flatus, abdominal cramps, bowel obstruction if given without adequate fluid (min 8oz / dose)

Bulk forming laxatives

Vitamin ____: -sources: citrus fruits, strawberries, tomatoes, potatoes, cruciferous vegetables -indications: prevention and treatment of deficiency state-Scurvy -urinary acidifier -purpose/use: required for collaen synthesis (wound healing/tissue repair), erythropoiesis -enhance absorption of iron -aids in resistance to infections -megadoses may cause urinary stones -stopping mega doses causes rebound scurvy symptoms

C-Ascorbic Acid

Mg & calcium based products are contraindicatied with ___

CRF (chronic renal failure)

____: Lubiprostone (Amitiza) -activates chloride channels in gut to increase chloride rich fluids into intestine, stimulating GI motility and evaculation of stool -Uses-Irritable bowl syndrome (IBS) assoc with chronic constipation

Chloride Channel Activator

Surfactant:____ -decreases surface tension, allowing water into stool -detergent effect-mixing lipids into stool -AKA: stool softeners -main goal is to prevent straining to defecate

Docusate (Colace)

Low acid, gas, parasites, hiatal hernia, pregnancy, obesity, tight fittings, wrong posture, larger meals, smoking, medicine, h.pylori, excess exercise, magnesium deficiency & salt ove use are some things that may cause ___

GERD

Treatment of ___ & ___ is similar -primary goal is to reduce gastric acid secretion

GERD;PUD

___ Ulcers: -less common type of ulcer -more common in over-60 age group -symptoms: dull achy pain, often right after a meal, anorexia, weight loss, vomiting -due to mucous being thinner

Gastric

_____ (GERD): -loose sphincter between esophagus and stomach -acidic stomach contents move up into esophagus; causing intense burning (heartburn) and may lead to esophageal ulcers, esophagitis or strictures -Lifestyle changes can improve GERD symptoms

Gastroesophageal Reflux Disease

____: usually given as a suppository, very mild -draws water into the gut increasing bulk, softening stool and increasin urge to defecate

Glycerin

Antibiotics are typically used to treat ___ infection (gram - bacteria) and are combined with PPIs for greater effect

H.Pylori

____: -primary cause of peptic ulcers -gram-negative bacterium

H.Pylori

Do not give antacids with ____ (can give 1-2 hr before)

H2 receptor agonist

____: -smoking decreases effect -monitor CBC-anemias with long term use -persistent epigastric pain may be s/s of more serious disease

H2 receptor blockers

_____: -primary use: treat PUD -A/E: possible reduction in RBC, WBC and platelets, headache most common -impotence or loss of libido in men

H2-Receptor Agonist

____ is in infection in the mucous layer of the stomach

Helicobacter pylori (H.Pylori)

____ occupy the histamine receptors and prevent acid secretion

Histamine /H2-receptor agonist

Be sure to monitor ___ & ___ every 6 months when pt's are using PPIs long term and obtain pt's smoking history

LFT (liver function test) & serum gastrin

____: -saline & osmotic laxative -nonabsorbable sugar that pulls water from body into bowel -decreases ammonia levels (NH3) -used for constipation and hepatic encephalopathy

Lactulose (Cephulac)

_____: Mg citrate and milk of magnesia -saline laxative -increse osmotic pressure inside the bowel causing retention of fluid in stool, distention of the bowel and increased peristalsis/decreased transmit time -use with caution in CHF & renal failure due to water/electrolyte disturbances this drug class causes

Magnesium Products

___ causes muscles in the upper intestine to contract

Metoclopramide (Reglan)

Lubricant: _____ works by "greasing" the gut so stool slides out easier -may interfere with absorption of fat soluble vitamins -may cause lipid pneumonia -given PO or by enema

Mineral Oil

___ inhibits acid and stimulates production of mucus

Misoprostol (Cytotec)

____ can cause ulcers. Be sure to take this type of medication with food

NSAIDS

___& ____ is common in chemotherapy and post-surgical medication side effects

Nausea; vomiting

______ & _____ (emesis) -associated with many conditions: Infection, poisoning, psychological factors, pain -changes in body position

Nausea; vomiting

_____ -Loperamide, Diphenoxylate with atropine sulfate (Lomotil) -uses SE of opioids to slow GI motility/inhibition of peristalsis (atropine = cholinergic)

Opiates

____: A/E: HA, nausea, diarrhea, rash, abdominal pain (long term use associated with increased risk of gastric cancer) -Do no crush, may open caps and sprinkle granules on applesauce -take 30 min before meal for best effect (to coat stomach) -high dose or prolonged use can increase risk of C.diff infection -educate on non-drug measures to relieve upper GI sx -may be administered same time as antacid

PPI

_____: Has a longer, potent, and more irreversible action than H2 blockers -primary use: short term 4-8 week therapy for peptic ulcers and GERD (blocks production of acid)

PPIs

____: -primary use: as replacement therapy for patients with insufficient pancreatic exocrine secretions -A/E: GI symptoms of N/V/D -can cause metabolic symptom of hyperuricosuria

Pancreatic Enzyme Replacement

_____: contains lipase, protease, and amylase of pork origin -facilitatres conversion of lipids into glycerol and fatty acids -converts starches into dextrin and sugars -converts proteins and peptides

Pancreatic Enzyme Replacement

pancrelipase (Creon, Pancreaze, Zymase) is prototype drug for ____

Pancreatic Enzyme Replacement

Prochlorperazine (Compazine) is the prototype drug for ______

Phenothiazine Antidopaminergics

_____: - blocks dopamine receptors in brain and inhibits signals to vomiting center in medulla -primary use for severe nausea and vomiting -A/E: dry mouth, sedation, constipation, orthostatic hypotension, tachycardia, EPS are serious concern with prolonged therapy

Phenothiazine Antidopaminergics

_____: saline laxative -Mirilax (constipation): preparation similar to bulk forming mix into at least 8oz fluids and ingest -GoLytely (pre-procedure bowel cleansing) contains PEG and electrolytes to help prevent the E-lyte loss associated with massive bowel cleanse (ex: medication induced massive diarrhea)

Polyethylene Glycol (PEG)

Moderate to severe nausea is treated with ____

Prescription drugs

____ is the antibiotic used to treat H.Pylori -Omeprazole, amoxicillin, clarithromycin_

Prevpac

_____ -good vs bad bacteria -most commonly used are strains of Lactobacillus

Probiotics

______: -Metoclopramide (Reglan) -Indications: delayed gastric emptying, GERD and intractable nausea and vomiting (not commonly used for N&V alone) - A/E: EPS symptoms, tardive dyskinesia, occur usually with long term or high dose use - therapeutic effect is stimulation of peristalsis

Prokinetics

____:bind to the enzyme H+, K+, -ATPase and prevent acid from being secreted

Proton Pump Inhibitors (PPIs)

____: _herbal agent -may cause non-patholoic discoloration of urine

Senna(Ex-lax, Senokot)

_____: Bisacodyl (Dulcolax) -irritate GI mucosa and pull water into lg bowel lumen (increases peristalsis) -uses: pre surgery bowel prep, chronic constipation -A/E: GI cramping, N/D, weakness -give PO or per rectum as suppository -causes laxative abuse/dependence esp in elderly

Stimulant Cathartics

___ coats ulcer and protects it from further erosion

Sucralfate (Carafate)

____: -Dronabinol (Marinol) - Derivative of marijuana (synthetic THC) - Schedule III -Indications: chemotherapy induced N&V, increases appetite along with supression of nausea in cachexia (due to AIDS, cancer, extreme old age) -May cause psychiatric problems -potential for abuse may cause withdrawal sx

Tetrahydrocannabinoids

Patients with diarrhea skin will appear red, dry, sores/blisters. Why?

This is the result of severe diarrhea which leads to dehydration

Excessive _____ can result in: - dehydration and significant weight loss - severe acid-base disturbances that can lead to vascular collapse

Vomiting

What are the drug classes used for treatment of diarrhea?

adsorbants, anticholinergics/belladonna alkaloids, opiates, and probiotics

____ treat underlying cause, not just sx laxative abuse, spicy foods, lack of digestive enzymes (pancreatitis/lactose intolerance), IBS syndrome (chrons, ulcerative colitis), drugs, cancer, intestinal infection/infestation

antidiarrheals

observe older adults using bulk forming laxatives for possible ___

aspiration

Do not give ___ in pt's with suspected obstruction (this will worsen sx)

bulk forming laxatives

Give ___ 1 hour before or 2-4 hours after other drugs (may interfere with absorption of other drugs)

bulk forming laxatives

Give ___ immediately after mixing with fluid, otherwise will turn into a warm fiber popsicle

bulk forming laxatives

What are the classes of medications used to treat constipation?

bulk forming laxatives stool softener saline & osmotics, stimulant/cathartics

___ is a related term that implies a stronger and more complete bowel emptying

cathartic

___ is the frequent passage of hard, small stools -common condition caused by insufficient dietary fiber and slow motility of waste material through the large intestine -symptom of underlying condition

constipation

calcium products may cause ___

constipation

diarrhea can lead to ___ & ___

dehydration; electrolyte imbalance

Mg & aluminum based products may cause ___

diarrhea

___ is an increase in the frequency and fluidity of bowel movements that occurs when the colon fails to reabsorb enough water -type of body defense -eliminates toxins and pathogens -eliminates certain medications and infections

diarrhea

____ ulcer: -more common than gastric ulcer -most commonly in 30-50 age group -usual symptom: gnawing or burning, upper abdominal pain; occurs 1-3 hrs after a meal -pain worse when stomach empty

duodenal

____ -induce vomiting -should only be used in emergency situations -used only when pt is alert, risk of aspiration -when pt is comatose, gastric lavage tube is placed and attached to suction to empty gastric contents -some poisions and caustic chemicals should not be vomited

emetics

___ ulcers hurt when eating because the nerve endings are exposed

gastric

When a pt has peptic ulcer disease, they can have a lesion in the stomach called a ___ ulcer, or a lesion in the small intestine called a ___ ulcer.

gastric; duodenal

___ are natural products that are available OTC and are widely used for self treatment of constipation. -most common is senna, a potent herb that irritates the bowel and increases peristalsis

herbal agents

___ (kidneys unable to excrete excess magnesium) may occur in pt's using antacid therapy

hypermagnesemia

The ___ intestine is responsible for the reabsorption of water

large

___ and ___ are drugs given to promote emptying of the large intestine by adding more bulk or water to the colon contents, lubricating the fecal mass, or stimulating peristalsis

laxatives; cathartics

___ and ___: -treat or prevent constipation -prepare bowel for surgery or diagnostic procedures -promote emptying of large intestine -only give if bowel sounds are active -contraindicated in diarrheal disease -teach pt's about correct use

laxatives; cathartics

Misc drus including ____, which acts by lubricatig the stool and the colon mucosa

mineral oil

___ is the prototype drug for Proton Pump Inhibitors (PPIs) -antiulcer drug

omeprazole (Prilosec)

When pt's are using ___ be sure to assess for use of foods that stimulate gastric and pancreatic secretions, monitor presence, amt and type of pain, respiratroy status, elevated serum and urinary amylase and elevated serum bilirubin, pt's nutritional and hydration status and for signs of infection, check for pork allergy

pancreatic enzyme replacement therapy

Pharmacotherapy for ____: -replaces enzymes -supportive drugs for reduction of pain and gastric acid secretion

pancreatitis

Patient's with ___ may experience burning, gnawing/aches, feel hungry, may be thin

peptic ulcer disease

Several risk factors have been associated with ___ ___ ___ (PUD) such as blood group O, smoking tobaco, caffeine, drugs (corticosteroids, NSAIDS, platelet inhibitors), excessive psychological stress, close family history of PUD, infection with Helicobacter pylori (H.Pylori).

peptic ulcer disease

H2 receptor agonist are contraindicated in ___

porhyria (build up of natrual chemicals), OTC admin to children under 12

___ is the prototype drug for H2 / Histamine Receptor Blockers -antiulcer drug -used for GERD, PUD, and as prophylaxis for stress related gastric acidity (hospitilization) -blocks acid production

ranitidine (Zantac)

Be sure to assess pt's using antacid therapy for signs of____

renal insufficiency

___ also called osmotic laxatives, are not absorbed into the intestine, they pull water into the fecal mass to create a more watery stool

saline cathartics

Mg Citrate can be purchased OTC for ___

severe diarrhea

When patients are laying down a long time, their stomachs will ___

slow down

The ___ intestine is the location for most nutrient and drug absorption.

small

___ is given in hospitals for stool, because ammonia is high -high levels of ammonia can cause severe diarrhea

sorbitol

____ promote peristalsis by irritating the bowel mucosa

stimulant laxatives

____ or surfactant laxatives cause more water and fat to be absored into the stool. Most often used to prevent constipation

stool softeners