Pharm Exam 3

What type of laxative is Psyllium (Metamucil)

Bulk type laxative. Insoluble fiber not absorbed from the GI tract.

This type of laxative contain fibers and is preferred for prevention and treatment of constipation. Slow in action

Bulk-forming laxative

Define steatorrhea

Bulky, fatty, foul-smelling stools

How does omeprazole reduce acid secretion in the stomach?

By binding irreversibly to the enzyme H+, K+ - ATPase (it acts as a pump to release acid)

Difference in absorption between calcium-based antacids and aluminum compounds?

Calcium-based can be absorbed and cause systemic effects. Aluminum compounds are minimally absorbed.

Prototype for Hemostatic

Aminocaproic Acid (Amicar) A clot stabilizer

When is the extrinsic pathway activated?

When blood leaks and enters tissue spaces.

The most common adverse effect of Alteplase

Bleeding, which may occur at needle puncture sites or internally. Intracranial bleeding is rare.

What are anticoagulants?

Drugs that are used to prolong bleeding time which prevents thrombi from forming or enlarging. ex: heparin and lovenox.

Define laxatives

Drugs that promote bowel movements. Widely used to prevent and treat constipation.

Steve, a 45 year old man, is more likely to develop which ulcer?

Duodenal

heparin black box warning

Epidural or spinal hematomas may occur in clients with epidural or lumbar puncture

The US is more likely to have problems with vitamin (excess/deficiency).

Excess

Causes of DVT

Extended immobility, Trauma, Surgery, Hyper-coagulability states, Drugs.

Antacids heal ulcers and treat H. Pylori. (T/F)

False

Heparin dissolves clots True or False

False, prevents formation of clots and enlargement of preexisting ones.

Longterm treatment is needed for duodenal ulcers (T/F)

False. Heal spontaneously, but frequently reoccur after months of remission. long-term medical follow up is not needed.

Ondansetron is to be prescribed to be taken prn. (T/F)

False. Given prophylactically according to a schedule.

Metoclopramide (Reglan) helps in (faster/slower) emptying of the stomach, and blocks food from re-entering the esophagus from the stomach.

Faster

This class of vitamins are absorbed in the GI tract with lipids and are stored in liver.

Fat-soluble vitamins

High amounts of these vitamins can be toxic and cause hypervitaminosis.

Fat-soluble vitamins Vitamins A, D, E, K

If waste material remains in the colon for an extended period, too much water will be reabsorbed, leading to small, hard stools: Leading to ______ _______ and complete obstruction of the bowel.

Fecal impaction

This is used for iron deficiency anemia

Ferrous sulfate (Iron)

The final product of the coagulation cascade is a _______ clot that stops blood loss, also called ______.

Fibrin; thrombus

Diarrhea may lead to _____ , acid base, or _______ disorder. This is especially important in children and elderly.

Fluid ; Electrolyte

warfarin black box warning

May cause major or fatal bleeding. Regular monitoring of INR is required.

Drug on drug interactions for psyllium

May decrease the absorption and effects or warfarin, digoxin, antibiotics

Possible causes of thrombocytopenia

May occur with any condition that suppresses bone marrow function and from immunosuppression therapy, folic acid or vitamin B12 deficiencies, and liver failure.

For better absorption iron preparations should be administered 1 hour before or 2 hours after ________

Meals

What does black tarry stools indicate?

Melena -Upper GI -Occult blood test is positive -Originates from esophagus, stomach or duodenum

Administration of psyllium (Metamucil)

Mix with at least 8oz of fluid and administer immediately. Follow by another 8oz of fluids.

How is diarrhea treated?

Most OTC products are effective at returning elimination patterns to normal. For chronic or severe cases, the opioids are most effective as antidiarrheal medication. (Also depends on etiologic factors. Antibiotic would be given for infectious disease, etc)

Diphenoxylate with atropine overdose is treated with _____

Narcan

Metoclopramide (Reglan) is used to treat what?

Nausea and vomiting. Short term therapy.

Adverse effects of Sulfasalazine (5-ASA)

Nausea/vomiting, anorexia, dyspepsia, abdominal pain, skin rash, headache

it is necessary to have adequate folic acid in pregnancy. Low levels are associated with ____ ____ defects.

Neural tube defects (NTD)

H2 receptor blockers such as ranitidine is contraindicated in children less than ____ .

12 years old

symptoms of duodenal ulcer

- Burning upper abdominal pain that occurs 1 to 3 hours -Pain worse on empty stomach. Better with eating. - Nighttime pain -Nausea/vomiting If erosion is deeper into mucosa : -Bright red blood in vomit -Black tarry stools

Other OTC antidiarrheals include

-Loperamide (Imodium) -Bismuth subsalicylate (Pepto-Bismol) -Probiotic supplements containing lactobacillus (a Norman bacteria in the gut)

causes of diarrhea

-Medications (like antibiotics) -lactose -infections of the bowel -ulcerative colitis -Crohn's disease -IBS

Heparin admin alerts for subcutaneous injection

-Never aspirate -Never massage

Gastric ulcer symptoms

-Pain may be relieved by food, but may continue afterwards. -Anorexia -Weight loss -nausea/vomiting

Administration alerts for sulfasalazine (5-ASA)

- Do not administer to patients with allergies to sulfonamide antibiotics or furosemide. - Not approved for children under the age of 2. - Do not crush of chew extended-release tablets.

Administration alerts/contraindications for diphenoxylate with atropine (Lomotil) include

- measure the drug accurately when given to children. - Correct severe dehydration or electrolyte imbalance before administration -Will produce addictive sedation when alcohol is consumed.

Drug on drug reactions with sulfasalazine (Azulfidine)

-Affects the absorption of Digoxin and increase the effect of warfarin. - May decrease the absorption of iron and folic acid.

What are benefits to using low-molecular weight heparin

-Duration of action is 2 to 4 times longer than heparin -Produce more stable response than heparin -Fewer follow up labs are needed -caregiver/patient can be trained to give injections themselves -Less likely to cause thrombocytopenia Have become preferred drugs for clotting disorders, including prophylaxis of DVT following surgery.

Lifestyle changes for PUD

-Eliminate alcohol, tobacco, and NSAIDs -Switch to acetaminophen or a selective COX-2 inhibitor -Loose weight

Adverse effects of ferrous sulfate

-GI upset -Constipation -Diarrhea -Dark stool

Indications for warfarin

-Prevention of clots that may cause stroke, MI, DVT, PE - May be given to patients with Afib to prevent clots

Goals of PUD treatment

-Provide immediate relief from symptoms -Promote healing of the ulcer-Prevent future recurrence of the disease

Bleeding precautions

-Switch to a soft toothbrush and inspect gums after brushing. -Use an electric razor, holding prolonged pressure over small nicks. -No rectal meds or temperatures -Minimize finger sticks or other punctures. -Be cautious preparing food with knives. -Avoid contact sports, amusement park rides, or other physical activities that may cause intense or violent bumping, jostling, or injury. -Make the home environment as safe as possible to avoid bumps/bruises/falls.

On discontinuation of therapy, the anticoagulant activity of warfarin may persist for how long?

10 days

Effect of a single dose of aspirin may persist for as long as ______

1 week. This is why aspirin is help for 1 week before operations to invasive procedures.

Normal range for a PT (prothrombin) level

10-12

Onset of action for omeprazole; How long does it last?

1-2 hours; lasts up to 72 hours.

Several doses of psyllium may be needed over __ to __ days.

1-3 days

6 groups of laxatives

1. Bulk forming 2. Saline cathartics (osmotic) 3. Stimulant 4. Surfactant (stool softener 5. Herbal agents 6. Opioid antagonists

What is the process of hemostasis?

1. Vessel injury 2. Vessel spasm 3. Platelets adhere to injury site and aggregate to form plug 4. Insoluble fibrin strands form and coagulate

The stomach content is very acidic having a pH of ___ to ___.

1.5 - 3.5 pH of 7 is neutral

We want patient on heparin to have ___ to ___ times the normal value of aPTT to achieve a therapeutic effect and prevent blood clots.

1.5-2.5

What could cause milk-alkali syndrome?

Administering calcium carbonate antacids with milk or any items with vitamin D

Administer aluminum antacids at least _____ hours before or after other drugs. Why?

2 hours. Absorption of drugs could be affected. Also can interfere with absorption of dietary iron.

The therapeutic effect of INR range is ___

2-3

Fibrinolysis is initiated within ___ to ___ hours after clot formation and continues until the clot is dissolved.

24-48

Chronic constipation include fewer than ______ bowel movements a week

3

Ondansetron should be started at least ____ minutes prior to chemotherapy or radiation therapy and continued for _____ _____ after therapy.

30 minutes ; Several days

Normal range for aPTT

30-40 seconds

Fat soluble vitamins

A, D, E, K

Adequate healing of the ulcer with ranitidine takes how long

4 to 8 weeks.

How long does is usually take for severe symptoms of heparin-induced thrombocytopenia to appear after start of therapy?

5 to 10 days.

The first step of IBD treatment is usually with 5- _____ _____ medications because they are safe and well-established therapies for the disorder.

5-aminosalicylic acid (5-ASA)

How long it takes for clotting to occur in our body?

6 minutes

What is hemostasis?

A complex process involving a large number of clotting factors that are activated in a series of sequential steps.

The end product of the coagulation cascade is:

A fibrin clot

When to administer ranitidine?

After meals

Risk factors for Peptic Ulcer disease include: Select all that apply. A. Drug use like corticosteroids, (NSAIDs), and platelet inhibitors B. Consumption of green vegetable and bananas C. Family history of PUD D. Infection with Helicobacter pylori

A. Drug use like corticosteroids, (NSAIDs), and platelet inhibitors C. Family history of PUD D. Infection with Helicobacter pylori

A patient has developed a duodenal ulcer. As the nurse, you know that which of the following is the primary cause of peptic ulcer formation? A. Helicobacter pylori B. NSAIDs C. Milk D. Spicy food

A. Helicobacter pylori

Which adverse effect of warfarin will the nurse identify as a reason for a client with a partial occlusion of the left common artery to seek medical consultation? (select all that apply) A. Hematuria B. Hemoptysis C. Delayed clotting from minor cuts and scrapes D. Bleeding from gum when brushing teeth E. Vomiting coffee-ground emesis

A. Hematuria B. Hemoptysis E. Vomiting coffee-ground emesis

A patient, who is receiving continuous IV Heparin, has an aPTT of 105 seconds. What is your next nursing action per protocol? A. Hold the infusion and check the protocol because the aPTT is too high. B. Continue with the infusion because no change is needed based on this aPTT C. Increase the drip rate per protocol because the aPTT is too low. D. Draw aPTT level in one hour

A. Hold the infusion and check the protocol because the aPTT is too high.

You're providing discharge teaching to a patient who will be going home on Warfarin (Coumadin). Which statements by the patient demonstrate they understood the educational material provided? Select all that apply: A. I will avoid drinking any alcoholic beverages B. When I shave I will be sure to use an electric razor C. I will switch and use a hard bristle toothbrush D. I will be sure that I eat a diet rich in spinach, kale, and broccoli

A. I will avoid drinking any alcoholic beverages B. When I shave I will be sure to use an electric razor

Which statement indicates to the nurse providing discharge medication education to a client prescribed warfarin that teaching was effective? A. I will avoid taking aspirin and NSAIDs B. I will need to develop a more sedentary routine C. I will need to have regular blood counts to guide warfarin dosage D. Before going to the dentist, I will ask my pop for antibiotics

A. I will avoid taking aspirin and NSAIDs

Heparin is an anticoagulant. What family of anticoagulant medications does this drug belong to? A. Indirect thrombin inhibitors B. Vitamin K antagonists C. Factor Xa inhibitors D. Direct thrombin inhibitors

A. Indirect thrombin inhibitors

Which test result would the nurse use to determine whether the daily dose is therapeutic when a client with a venous thrombosis is receiving warfarin? A. International Normalized Ratio (INR) B. Accelerated partial thromboplastin time (aPTT) C. Bleeding time D. Sedimentation rate

A. International Normalized Ratio (INR)

Which of the following is correct about Diphenoxylate with Atropine (Lomotil)? Select all that apply. A. It might cause dizziness or drowsiness B. Diphenoxylate should be discontinued as soon as the diarrhea symptoms resolve. C. Narcan is administered in case of overdose D. It is safe to take with alcohol and monoamine oxidase inhibitors (MAOIs)

A. It might cause dizziness or drowsiness B. Diphenoxylate should be discontinued as soon as the diarrhea symptoms resolve. C. Narcan is administered in case of overdose

Which drug action will the nurse include when describing the purpose of heparin in a client who develops thrombophlebitis in the right calf and is prescribed bed rest and initiated on an IV infusion of heparin? A. It prevents extension of the clot B. It reduces the size of the thrombus C. It dissolves the clot in the vein D. It facilitates absorption of the red blood cells

A. It prevents extension of the clot

Antiheartburn/Antacid prototype that neutralizes stomach content, not calcium-based.

Aluminum hydroxide (AlternaGEL)

The aim of heparin therapy is to : (select all that apply) A. Prolong coagulation time B. Prevent the enlargement of existing clots C. Dissolve newly formed clots D. Prevent the formation of new clots

A. Prolong coagulation time B. Prevent the enlargement of existing clots D. Prevent the formation of new clots

Your patient, who is prescribed Warfarin for blood clots, has an INR of 1. As the nurse you know that this means? A. The medication is not effective at preventing blood clots. B. The patient is at risk for bleeding. C. This is the expected therapeutic dose D. The patient is experiencing Warfarin toxicity.

A. The medication is not effective at preventing blood clots.

Which of the following vitamins require a daily intake and cannot be stored? Select all that apply A. Vitamin C B. Vitamin B C. Vitamin A D. Vitamin K

A. Vitamin C B. Vitamin B

When would the nurse plan to administer pancrelipase to a child with cystic fibrosis? A. With meals and snacks B. In the morning and at bedtime C. On awakening and every 3 hours while the child is awake D. After each bowel movement and after postural drainage is performed

A. With meals and snacks

All of the following groups might have Folic acid deficiency. Select all that apply A. Women of childbearing age B. Vegetarian people C. Chronic alcohol dependence D. People who overcook their food

A. Women of childbearing age C. Chronic alcohol dependence D. People who overcook their food

Pancrelipase a pancreatic enzyme is given in chronic pancreatitis to: A. help digest fats B. prevent constipation C. help digest carbohydrates D. treat pancreatitis

A. help digest fats

Physician should be notified of the following conditions by a patient on anticoagulation therapy: (Select all that apply) A: Coffee ground emesis B: Nocturia C: Black, Tarry stools D: Hematuria E: Bleeding that won't stop with appropriate pressure (small-medium cuts hold pressure for 5 minutes)

A: Coffee ground emesis C: Black, Tarry stools D: Hematuria E: Bleeding that won't stop with appropriate pressure (small-medium cuts hold pressure for 5 minutes)

Laxatives are administered to treat constipation and to : Accelerate the movement of ingested ________ following poisoning. Evacuate ______ _______ in the intestinal tract following anthelminthic therapy. Cleanse the ________ prior to diagnostic or surgical procedures of the colon or genitourinary tract.

Accelerate the movement of ingested toxins following poisoning. Evacuate dead parasites in the intestinal tract following anthelminthic therapy. Cleanse the bowel prior to diagnostic or surgical procedures of the colon or genitourinary tract.

The lab value used to adjust the rate of a heparin infusion is called the _____.

Activated partial thromboplastin time (aPTT)

What is the difference between H1 receptors and H2 receptors?

Activation of H1 receptors produces the classic symptoms of inflammation and allergy. H2 receptors are responsible for increasing acid secretion in the stomach.

Contraindications for Alteplase

Active internal bleeding, history of stroke or head injury within the past 3 months, recent trauma or surgery, severe uncontrolled HTN, intracranial neoplasm, or arteriovenous malformation.

What pharmacologic class is Aluminum Hydroxide (AlternaGEL)

Antacid

What are antiacids?

Antacids are alkaline substances that are used to neutralize stomach acid.(Tums)

How are peptic ulcers treated?

Antibiotic medications to kill H. pylori -Proton pump inhibitors -H2 receptor antagonists -Antacids

_________ are used to treat nausea and vomiting.

Antiemetics

What is step two of heparin action?

Antithrombin III inactivates Thrombin

Antiplatelet drugs include

Aspirin, ADP blockers, glycoprotein IIB/IIIA receptor antagonists

Which measure would the nurse take when administering enoxaparin subcutaneously? A. Push over 2 minutes B. Administer in the abdomen C. Massage site after administration D. Remove air pocket from prepackaged syringe before administration

B. Administer in the abdomen

Which of the following statements about warfarin are incorrect? (select all that apply) A. "This medication will help dissolve the blood clot." B. "This medication will prevent another blood clot from forming." C. "This medication will help prevent the blood clot from becoming bigger in size." D. "This medication starts working immediately after the first dose."

B. "This medication will prevent another blood clot from forming." C. "This medication will help prevent the blood clot from becoming bigger in size." D. "This medication starts working immediately after the first dose."

Which patients below are NOT candidates for Warfarin (Coumadin)? Select all that apply: A. 55-year-old female with a heart valve replacement. B. 45-year-old male patient with alcoholism and an active GI ulcer. C. 36-year-old female with a deep vein thrombosis. D. 52-year-old male with liver cirrhosis waiting for a liver transplant

B. 45-year-old male patient with alcoholism and an active GI ulcer. D. 52-year-old male with liver cirrhosis waiting for a liver transplant

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply: A. A 45-year-old female patient with a pulmonary embolism B. A 36-year-old male patient with active peptic ulcer disease C. A 43-year-old female with uncontrolled atrial fibrillation D. A 55-year-old male patient who is post-op day 1 from brain surgery

B. A 36-year-old male patient with active peptic ulcer disease D. A 55-year-old male patient who is post-op day 1 from brain surgery

Which technique will the nurse employ to prevent excessive bruising when administering subcutaneous heparin? A. Administer the injection vie the Z track method B. Avoid massaging the injection site after the injection C. Use 2ml of sterile normal saline to dilute the heparin D. Inject the medication into the cactus laterals muscle in the thigh

B. Avoid massaging the injection site after the injection

Which statement is important for the nurse to teach a client prescribed psyllium 3.5g twice a day for constipation? A. Urine may be discolored B. Each dose should be taken with a full glass of water C. Use only when necessary because it can cause dependence D. Daily use may inhibit absorption of some fat soluble vitamins

B. Each dose should be taken with a full glass of water

A postpartum client receiving a continuous heparin infusion for a deep vein thrombosis has an activated partial time (aPTT) of 128 seconds. Which action would the nurse take in response to the situation? A. Increase the IV rate heparin B. Interrupt the infusion and notify the pop of the aPTT result C. Document the result on the medical record and recheck the aPTT in 4 hours D. Call the primary health care provider to obtain a prescription for a low-molecular-weight heparin.

B. Interrupt the infusion and notify the pop of the aPTT result

Which of the following statements is correct about life style changes for the treatment of PUD. Select all that apply A. Taking antacids once daily B. Losing weight C. Eliminating alcohol, tobacco, and NSAID D. Switching to acetaminophen or a selective COX-2 inhibitor

B. Losing weight C. Eliminating alcohol, tobacco, and NSAID D. Switching to acetaminophen or a selective COX-2 inhibitor

If patients are being anticoagulated, they will need to be put on what precautions

Bleeding precautions

A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip? A. EKG B. Patient's weight C. Patient's height D. PT/INR

B. Patient's weight

What is the antidote for heparin? A. Narcan B. Protamine Sulfate C. Vitamin K D. Atropine

B. Protamine Sulfate

What lab values should be monitored when patient is taking Ferrous Sulfate for iron deficiency anemia. A. White blood cells count (WBC) B. Red Blood Cells (RBC), Hematocrit (HCT) and hemoglobin (Hgb) C. Vitamin B9, and Vitamin D D. Guiac stool test

B. Red Blood Cells (RBC), Hematocrit (HCT) and hemoglobin (Hgb)

Which of the following is true about Sulfasalazine (Azulfidine). Select all that apply A. This drug is approved for children under age 2. B. Sulfasalazine can increase insulin secretion and worsen hypoglycemia in diabetic patient C. Sulfasalazine should be used with caution in patients with hepatic impairment because the drug can cause hepatotoxicity D. Has anti-inflammatory properties, given to treat mild to moderate symptoms of ulcerative colitis

B. Sulfasalazine can increase insulin secretion and worsen hypoglycemia in diabetic patient C. Sulfasalazine should be used with caution in patients with hepatic impairment because the drug can cause hepatotoxicity D. Has anti-inflammatory properties, given to treat mild to moderate symptoms of ulcerative colitis

Which rationale explains the purpose of administering diphenoxylate hydrochloride to clients with acquired immunodeficiency syndrome (AIDS) A. To manage pain B. To manage diarrhea C. To manage candidate esophagitis D. To manage behavioral problems

B. To manage diarrhea

Which antidote would the nurse anticipate administering to a client whose lab report established a warfarin overdose? A. Physostigmine B. Vitamin K C. Iron dextran D. Protamine sulfate

B. Vitamin K

Taking folic acid may decrease availability of which vitamin?

B12

Do not give Ferrous Sulfate tablets or capsules within 1 hour of _______

Bedtime

When is best to administer omeprazole?

Before breakfast on an empty stomach or 30 minutes before meals.

Action of bismuth subsalicylate

Binds and absorbs toxins

Which lab value would the nurse use to determine whether a client is receiving a therapeutic dose of IV heparin? A. International normalized ratio (INR) is between 2 and 3 B. Prothrombin time (PT) is 2.5 times the control value C. Activated partial thromboplastin time (aPTT) is 70 seconds D. Activated clotting time (ACT) is in the range of 70-120 seconds

C. Activated partial thromboplastin time (aPTT) is 70 seconds

Which prescribed medication will the nurse administer to ensure a bowel movement before discharge for a client who has not had a bowel movement since surgery. which was 4 days ago? A. Lactulose B. Docusate sodium C. Bisacodyl suppository D. Psyllium

C. Bisacodyl suppository

Patients with a history of this procedure may need their vitamin levels monitored closely. A. Colonoscopy B. Cholecystectomy C. Gastric bypass D. Cardiac procedures

C. Gastric bypass

Which category of drugs prevents/treats constipation by the osmotic drawing of water from extravascular space to intestinal lumen? A. Stimulants B. Bulk-forming agents C. Hyperosmotic agents D. Lubricants

C. Hyperosmotic agents

Clopidogrel (Plavix) mode of action is best explained by which statement? A. It inhibits the action of vitamin K, thus the synthesis of clotting factors in the liver B. It inhibits active factor X thus decreases platelets aggregation C. It blocks the Adenosine diphosphate receptors (ADP) thus inhibiting platelets aggregation D. It inhibits the formation of thromboxane A2 and platelets aggregation

C. It blocks the Adenosine diphosphate receptors (ADP) thus inhibiting platelets aggregation

The nurse teaching a pregnant client regarding the necessity for a folic acid supplement. Folic acid taken in the first trimester of pregnancy helps reduce risk for which neonatal disorder? A. Phenylketonuria B. Down syndrome C. Neural tube defects D. Erythroblastosis fetalis

C. Neural tube defects

A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following? A. Check the food diary. B. Monitor for any signs of renal failure. C. Observe for signs of bleeding. D. Observe for neurological changes.

C. Observe for signs of bleeding.

Which would the nurse instruct the client with iron deficiency anemia to drink with daily ferrous sulfate supplements? A. Water B. Skim milk C. Orange juice D. A strawberry milkshake

C. Orange juice

The main action of Psyllium (Metamucil) is: A. Psyllium is a stool softener. it causes more water and fat to be absorbed into the stools. B. Psyllium pulls water into the fecal mass to create a more watery stool C. Psyllium swells and increases the size of the fecal mass, promoting the passage of stool. D. psyllium irritates the bowel and increases peristalsis

C. Psyllium swells and increases the size of the fecal mass, promoting the passage of stool.

A client is taking Omeprazole (Prilosec). The nurse determines that the client is acheiving the therapeutic effect if which of the following is stated by the client: A. The absence of constipation. B. Relief of nausea and vomiting. C. Relief from heartburn and epigastric pain D. Decrease diarrheal episodes.

C. Relief from heartburn and epigastric pain

Heparin is classified as _____ heparin, and enoxaparin is classified as _____ heparin. A. Fractionated ; high molecular weight B. Fractionated ; low molecular weight C. Unfractionated; low molecular weight D. Unfractionated; high molecular weight

C. Unfractionated; low molecular weight

Ondansetron is to be used with caution in _____ patients because it prolongs the QT interval and can cause _______.

Cardiac; Dysrhythmias

The term that implies a stronger and more complete bowel emptying. (preceding colonoscopy or barium enema)

Cathartic

Treatment for diarrhea is based on _______ .

Cause

The gastric glands of the stomach include these cells

Chief and Parietal

Pepsinogen, an inactive form of the enzyme pepsin is secreted by the __________ cells in the stomach.

Chief cells

Pharmacotherapy for constipation is justified by what symptoms?

Chronic, infrequent, painful bone movements, and severe straining.

Common side effects of antacids?

Constipation, Nausea/Vomiting, Stomach cramps, Diarrhea, Abdominal distention (aka-seltzer)

How long should patients follow bleeding precautions?

Continue for one month following discontinuation.

During step three of heparin action, Thrombin inhibits what?

Conversion of Fibrinogen to Fibrin

Ulcers in the distal (terminal) portion of the small intestine with symptoms of abdominal pain, cramping, and diarrhea.

Crohn's disease.

A patient is taking Warfarin (Coumadin). What order received from the physician requires that you ask for an order clarification? A. Draw CBC in the morning B. Check PT/INR daily C. Ambulate three times a day D. Administer prednisone IM daily

D. Administer prednisone IM daily

Which information would the nurse reinforce when teaching a client with GERD about antacid therapy? A. Antacids should be taken 1 hour before meals B. These should be scheduled at 4 hour intervals. C. Antacid tablets are just as fast and effective as the liquid forms D. Antacids commonly interfere with the absorption of other medications

D. Antacids commonly interfere with the absorption of other medications

Which of the following statements describes the action of antacids? A. Antacids block the production of gastric acid B. Antacids enhance the action of acetylcholine C. Antacids block dopamine D. Antacids neutralize gastric acid

D. Antacids neutralize gastric acid

Which condition is treated with a proton pump inhibitor? A. Diarrhea B. Vomiting C. Cardiac dysrhythmias D. GERD

D. GERD

Which mechanism is specifically responsible for the action of the medication ranitidine? A. Inhibiting proton pumps B. Promoting the release of gastrin C. Regenerating the gastric mucosa D. Inhibiting the histamine at H2 receptors

D. Inhibiting the histamine at H2 receptors

The nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Which response by the nurse explains how folic acid would help? A. It lessens the sickling of red blood cells B. It prevent vast-occlusive crises C. It helps decrease the cellular oxygen need D. It will promote production of hemoglobin

D. It will promote production of hemoglobin

Which medication will the nurse be prepared to administer to a client admitted to the hospital with a diagnosis of deep vein thrombosis who is prescribed IV heparin sodium if the client experiences excessive bleeding? A. Vitamin K B. Oprelvekin C. Warfarin sodium D. Protamine sulfate

D. Protamine sulfate

A client has been prescribed pancrelipase (Pancrease). Which of the following symptoms would prompt the nurse that the medication is having its therapeutic effect? A. Negative abdominal pain B. An absence of constipation C. An absence of diarrhea D. Reduction of excess fat in feces.

D. Reduction of excess fat in feces.

Which mechanism would a nurse recall when caring for a client prescribed bisacodyl for constipation? A. producing bulk B. Softening feces C. Lubricating feces D. Stimulating peristalsis

D. Stimulating peristalsis

You are observing the patient administer their scheduled dose of Heparin to confirm that the patient knows how to do it correctly. What action by the patient requires you to re-educate them about how to administer Heparin? A. The patient rotated the injection site from the previous dose of Heparin B. The patient injects the needle into the fatty tissue of the abdomen C. The patient does not massage the injection site after administering the medication D. The patient aspirates before injecting t

D. The patient aspirates before injecting the drug

For which purpose would enoxaparin 40mg subcutaneously daily be prescribed for a client who had abdominal surgery? A. To control postoperative fever B. To provide a constant source of mild analgesia C. To limit the post surgical inflammatory response D. To provide prophylaxis against postoperative thrombus formation

D. To provide prophylaxis against postoperative thrombus formation

Surfactant, emollient-stool softener

Docusate sodium (colace) - given to post-op patients to prevent straining. -Available OTC - Minimal interactions

Warfarin (Coumadin) is an anticoagulant. What family of anticoagulant medication does this drug belong to? A. Indirect thrombin inhibitors B. Factor Xa inhibitors C. Direct thrombin inhibitors D. Vitamin K antagonists

D. Vitamin K antagonists

What blood test is used to monitor the coagulation effect of Heparin A. PT B. INR C. Platelets count D. aPTT

D. aPTT

The antidote for acute iron intoxication is _________

Desferal

May be considered a type of body defense, getting rid of the body toxins and pathogens.

Diarrhea

What can contribute to vitamin deficiencies?

Diet Alcohol abuse Drug abuse

Mary, a 65 year old woman, is more likely to develop which ulcer?

Gastric

NSAID related ulcers are more likely to be gastric or duodenal?

Gastric

What can increase the absorption of ferrous sulfate?

Give with foods high in vitamin C, such as orange juice and strawberries

Route of admin for aminocaproic acid

Given IV in actor hemorrhage; Also available in tablet form

Primary cause of peptic ulcers

Gram-negative bacillus (H.Pylori)

What is the primary cause of PUD?

H. Pylori infection.

Duodenal ulcers are most likely to be associated with what?

H. Pylori infections.

The ____- receptor antagonists are effective at suppressing the volume and acidity or ______ cell secretions.

H2 ; Parietal ranitidine (Zantac)

Pharmacologic class of ranitidine (Zantac)

H2-receptor antagonist

Most common adverse effect of ranitidine?

Headache

_____________ are used to promote the formation of clots in patients with excessive bleeding from surgical sites.

Hemostatics (antifibrinolytics)

What labs to monitor for warfarin

PT/INR

What is step one of heparin action?

Heparin binds with Antithrombin III

_____________________ is a serious complication that occurs in up to 30% of patients taking heparin.

Heparin-induced thrombocytopenia (HIT).

Type of laxative that is available OTC, like Senna, irritates the bowel and increases peristalsis.

Herbal agents. Ex: Senna, castor oil, flaxseeds, and dandelion

What is inflammatory bowel disease?

IBD is characterized by the presence of ulcers in the distal (terminal) portion of the small intestine (Crohn's disease) or mucosal erosions in the large intestine (ulcerative colitis).

What is irritable bowel syndrome?

IBS (spastic colon of mucous colitis) is a common disorder of the lower GI tract.

Heparin onset of action IV and Subcutaneous

IV : immediate Subcutaneous: within 1 hour

When is the intrinsic pathway activated?

In response to injury

Heparin-induced thrombocytopenia (HIT) causes an (increase/decrease) in adverse thromboembolic effects.

Increase. The patient may experience serious and even life-threatening thrombosis.

What could cause false positives for urine protein?

Increased creatinine, AST, and ALT.

Treatment for constipation prior to drug therapy

Increased dietary fiber, fluid intake, and physical activity.

What family of anticoagulant medications does heparin belong?

Indirect thrombin inhibitor

Warfarin action

Inhibiting the action of vitamin K.

Uses for omeprazole

PUD, GERD, Zollinger-Ellison syndrome

Sulfasalazine (Azulfidine) can increase ______ secretion and worsen _____.

Insulin ; hypoglycemia

What two pathways lead to coagulation?

Intrinsic and Extrinsic

Parietal cells secrete ________ _________ , which is essential for the absorption of vitamin B12

Intrinsic factor

What body organ is responsible for the production of clotting factors?

Liver

What labs to monitor while taking H2-receptor blockers? (ranitidine)

Liver and kidney function tests

Can antacids be used to heal ulcers or treat H. Pylori?

No

Can you crush iron tablet or empty contents of capsules when administrating?

No.

Do you remove the bubble in the prefilled syringe of a LMWH?

No. The bubble seals the med into the tissues, prevents it from spreading in the SQ space, and decreases hematomas.

antiemetic prototype

Ondansetron (Zofran) Available in PO, IV, IM, Oral, Transdermal patches, and orally disintegrating tablets.

Type of laxative used to treat chronic constipation in patients with advanced illness who are receiving opioids for palliative care.

Opioid antagonists

Long-term use of PPIs increases the risk for what and what causes this risk?

Osteoporosis-related fractures of hip, wrist, or spine. (Because they interfere with calcium absorption) Kidney diseases such as interstitial nephritis Micronutrients deficiency - B12 and hypomagnesemia Concurrent use with warfarin may increase the likelihood of bleeding.

Give (PPI/H-2 receptor antagonist) before meals.

PPI. H-2 receptor antagonists are given after meals.

Describe proton pump inhibitors

PPIs act by blocking the enzyme responsible for secreting hydrochloric acid in the stomach. They are the drugs of choice for short-term therapy of PUD and GERD.

cause of pancreatitis

Pancreatitis results when digestive enzymes remain in the pancreas rather than being released into the duodenum. The enzymes escape to the surrounding tissue, causing inflammation of the pancreas.

A patient with chronic pancreatitis is given what medication to prevent steatorrhea?

Pancrelipase

Pancrelipase (Pancreatic enzymes) contain ______ , protease, and ______ of pork origin.

Pancrelipase (Pancreatic enzymes) contain Lipase , protease, and amylase of pork origin.

________ cells of the stomach secrete hydrochloric acid (HCL)

Parietal

Dosage calculations with low-molecular weight heparins are fixed and based on

Patient weight and clinical indication

Dosage calculations for heparin are based on

Patient weight, aPTT value, and clinical indication.

OTC examples of antiemetics

Peppermint or ginger; Antihistamines and anticholinergic such as Benadryl, scopolamine, and dramamine.

Folic acid is found in ______ products.

Plant products, especially green leafy vegetables and citrus fruits.

Aminocaproic acid inactivates _______ , the precursor of the enzyme plasmin that digests the fibrin clot.

Plasminogen

Doses of pancrelipase should be taken just _____ to meals or ____ meals.

Prior; With

Action of sucralfate (Carafate)

Produces a thick, gel-like substance that coats the ulcer, protecting it against further erosion and promoting healing. *does not affect the secretion of gastric acid*

What are thrombolytics?

Promote fibrinolysis,(clot destruction) by converting plasminogen to plasmin. Able to dissolve the insoluble fibers within the clot. Administered when intravascular clot is already formed.

What happens if psyllium is taken with insufficient water?

Psyllium may swell in the esophagus and cause an obstruction.

How often should sucralfate be taken?

QID

Folic acid is necessary for

RBC formation

What is Zollinger-Ellison syndrome

Rare condition characterized by gastrin-producing tumors in the duodenum and/or pancreas that lead to over-secretion of gastrin, which lead to gastric and duodenal ulcers. Therapy for these patients are longer periods of time compared to short term treatment of PUD

Contraindications of warfarin therapy

Recent trauma, active internal bleeding, bleeding disorders, intracranial hemorrhage, severe HTN, bacterial endocarditis, severe liver or kidney disease.

Pharmacotherapy for hemophilia includes

Replacing the missing clotting factor through periodic infusions

What is the role of Vitamin K in coagulation?

Required in order for the liver to make four of the clotting factors.

This type of laxatives pull water into the fecal mass to create a more watery stool.

Saline cathartics (osmotic laxatives)

Which type of laxative is used for a colonoscopy?

Saline cathartics (osmotic laxatives)

Ondansetron block _______ receptors in the GI tract, as well as the chemoreceptor trigger zone in the _____.

Serotonin; Brain.

How long does it take to for warfarin to reach maximum effect?

Several days

How long is ferrous sulfate treatment needed to replenish the storage depots for iron?

Several months

How long are PPIs used for PUD?

Short -term usually 4-8 weeks. Most patients are symptom free after 2 weeks of therapy.

Antidiarrheal medications (should/should not) be used to treat diarrhea caused by poisoning or infection to be expelled from the body.

Should not

______ decreases the effectiveness of ranitidine.

Smoking

Mucosal erosions in the large intestine with symptoms of abdominal cramping with frequent bowel movements, weight loss, bloody diarrhea, high fever, and dehydration.

Ulcerative colitis

This type of laxative promote peristalsis by irritating the bowel mucosa.

Stimulant laxative *May cause laxative dependence and depletion of fluid/electrolytes

This drug for PUD consists of sucrose plus aluminum hydroxide.

Sucralfate (Carafate)

This anti-inflammatory medication inhibits the mediators of inflammation in the colon such as prostaglandins and leukotrienes.

Sulfasalazine (Azulfidine) (5-ASA) Used for treatment of Inflammatory bowel disease

This type of laxative causes more water and fat to be absorbed into the stools. Used post-op to prevent patient from straining.

Surfactant (stool softener)

Early symptoms of milk-alkali syndrome

Symptoms of hypercalcemia which include headache, urinary frequency, anorexia, nausea, and fatigue.

By warfarin inhibiting the action of vitamin k, what is suppressed?

The hepatic synthesis of coagulation factors II, VII, IX, and X is suppressed.

Vitamins are classified by?

Their ability to mix with water.

What is different with the mechanism of action with low-molecular weight heparins compared to traditional heparin?

Their inhibition is more specific to active factor X.

What is the function of antiplatelet drugs?

They produce an anticoagulant effect by interfering with platelet aggression. Used to prevent clot formation in arteries. Ex: aspirin and Plavix.

What type of drug is Alteplase (Activase)

Thrombolytic Drug for dissolving clots

Treatment of H.Pylori (gram-negative bacillus)

Tri-therapy (two antibiotics and one PPI) for 7-14 day regimen. examples: Clarithromycin, amoxicillin, and omeprazole Clarithromycin (Biaxin), metronidazole (Flagyl), and omeprazole or lansoprazole.

Antacids act fast and their effect lasts for 2-3 hours (T/F)

True

The most common side effect of ferrous sulfate are GI upset and constipation (T/F)

True

The most common type of anemia is iron-deficiency anemia (T/F)

True

Usually patients have multiple vitamin deficiencies, instead of just one. (T/F)

True Symptoms of vitamin deficiency are non-specific

Pancrelipase may increase serum or urinary levels of ____ ____.

Uric acid

Foods high in _________ , such as strawberries,can increase the absorption of iron

Vitamin C

What is the antidote to warfarin?

Vitamin K

Pharmacologic class of warfarin

Vitamin K antagonist

Older adults mat have vitamin ____ deficiency from atrophy and decreased stomach acid production. What does this lead to?

Vitamin b12 deficiency which can lead to pernicious anemia

water soluble vitamins

Vitamins B and C

This class of vitamins that are absorbed in GI tract and dissolve in blood, then excess are excreted in urine.

Water-soluble vitamins

Main cause of GERD

Weakened lower esophageal sphincter

Can antacids be given with omeprazole?

Yes

Would an aPTT of 60 seconds be a normal range for a patient on heparin?

Yes, because it is 2 times the normal range of 30.

Is long term medical follow up needed for gastric ulcers?

Yes. Medical follow up should continue for several years because a small percentage of the erosions become cancerous.

What technique do you use when giving ferrous sulfate IM?

Z- track method

What is antithrombin III?

a protein in plasma that inactivates thrombin and inhibits coagulation

What is the pyloric sphincter?

a ring of smooth muscle located at the entrance to the small intestine which regulates the flow of substances leaving the stomach.

Define constipation

a. A decrease in the frequency of bowel movements.

State the laboratory tests used to diagnose a bleeding disorder

a. Prothrombin time (PT) b. Thrombin time c. Activated partial thromboplastin time (aPTT) d. Platelet count

Symptoms of IBS

abdominal pain, bloating, excessive gas, and colickly cramping

Milk-alkai syndrome may result in

acute kidney injury (AKI)

Chronic pancreatitis is associated with _______ abuse

alcohol

A patient with hemophilia A is having a dental surgery. What may commonly be prescribed following this procedure?

aminocaproic acid It is most commonly prescribed following surgery to reduce postoperative bleeding.

Natural defenses to protect the stomach mucosa from high acidic fluid includes: In the duodenum, stomach contents are further neutralized by _______ from ______ and biliary secretions.

bicarbonate; pancreatic

Aminocaproic acid is prescribed in situations in which there is excessive _________ because clots are being dissolved ____________ .

bleeding; prematurely

Adverse effects of aluminum hydroxide

constipation, hypophosphatemia

Antacids, proton-pump inhibitors, or calcium supplements (decrease/increase) iron absorption.

decrease

What is the role of plasmin in destruction of the clot?

digests the fibrin strands

Antidiarrheal, opioid with atropine

diphenoxylate with atropine (Lomotil) *slows peristalsis * acts within 45 to 60 minutes

anticholinergic effects of atropine may occur in higher doses of diphenoxylate with atropine (lomotil). These symptoms may include :

drowsiness, dry mouth, and tachycardia

types of peptic ulcers

duodenal ulcers and gastric ulcers

examples of PPI's include?

esomeprazole (Nexium), lansoprazole (Prevaid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (AcipHex)

Antacids act (fast/slow) and last only for __ - __ hours.

fast; 2-3 hours

Coagulation occurs when _____ threads create a meshwork to for a ______ .

fibrin; clot

What is the process of blood clot removal in the body called?

fibrinolysis

Vitamin B9 is also known as

folic acid

Role of hydrochloric acid (HCI)

helps break down food, activates pepsinogen, and kills microbes that may have been ingested.

What are hemophilias?

hereditary bleeding disorders caused by lack of clotting factors.

Electrolyte imbalance possible with calcium carbonate (Tums)

hypercalcemia

Electrolyte imbalance possible with sodium bicarbonate (aka-seltzer, baking soda)

hypernatremia, metabolic alkalosis

High doses may result in what adverse effects for men?

impotence or loss of libido

Psyllium swells and _________ the size of the fecal mass, which promotes the passage of stool.

increases

Heparin Pharmacologic Class

indirect thrombin inhibitor

When administrating ferrous sulfate through IV, be carful to prevent _______.

infiltration iron is highly irritating to tissues.

What is pancreatitis?

inflammation of the pancreas

The heparin molecule has been shortened and modified to create a class of drugs called

low-molecular weight heparins (LMWHs) dalteparin(Fragmin) and enoxaparin (Lovenox)

Antacids ______ stomach acid.

neutralize

Anti-ulcer drugs that limit HCI secretions target what cells

parietal cells

Which cells secrete the intrinsic factor?

parietal cells

The enzyme tissue plasminogen activator (TPA) activates _________ to plasmin.

plasminogen.

What is thrombocytopenia?

platelet deficiency

What is the antidote for enoxaprin (Lovenox)

protamine sulfate

What is the antidote for heparin?

protamine sulfate

Pharmacologic class of omeprazole (Prilosec)

proton pump inhibitor

What is the cardiac sphincter?

ring of smooth muscle that prevents the stomach contents from moving backwards, a condition known as esophageal reflux.

Role of parietal cells

secrete 1 - 3 L of hydrochloric acid (HCI) each day

Role of chief cells

secrete pepsinogen, an inactive form of the enzyme pepsin that chemically breakdown proteins.

Define thrombus

stationary blood clot

Bisacodyl (dulcolax) is a _____ laxative.

stimulant May cause cramping. Comes in suppository or oral tablet form.

Define GERD ("Gastroesophageal Reflux Disease")

the acidic contents of the stomach move upward into the esophagus.

When collagen is exposed at the site of injury, the damaged cells initiate a series of complex reactions called

the coagulation cascade

Natural defenses to protect the stomach mucosa from high acidic fluid includes: Stomach cells secrete a ____ ____ layer and ______ ions to neutralize the HCI.

thick mucus layer; bicarbonate ions

Stomach cells secrete a ______ ______ layer and _________ ions to neutralize the HCl.

thick mucus; bicarbonate

What patients are at higher risk for bleeding due to abnormal coagulation?

those with liver impairment

What is the most common coagulation disorder?

thrombocytopenia

Define embolus

traveling blood clot

Diarrhea is not a disease by a symptom of an _________ ________ .

underlying disorder

what does coffee ground emesis indicate?

upper GI bleed

The most commonly prescribed oral anticoagulant

warfarin (Coumadin)

What are the risk factors for Peptic ulcer disease (PUD)?

· Close family history of PUD · Blood group O · Smoking tobacco (increases gastric acid secretion) · Consumption of beverages and food that contain caffeine. · Drugs, particularly corticosteroids, NSAIDS, and platelet inhibitors (such as aspirin) · Excessive psychologic stress · Infection with H. Pylori