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153 Cards in this Set

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When removing client from TPN, what is important to remember?
Take off slowly to prevent hypoglycemia
Why does TPN require filtered IV tubing?
To prevent potential emboli
What is the range of kcal/mL for liquid enteral products?
1-2 kcal/mL
Disease specific Liquid Enteral Product for Diabetics
Nepro
What is the tonicity of TPN solution?
hypertonic
Which diseases indicate replacement of pancreatic enzymes
- cystic fibrosis
- chronic pancreatitis
- pancreatic obstruction
Are pancreatic enzymes given with or without meals?
with meals
When administering IV fluids with dextrose concentration of 25-50%, what route must be used?
must be via central line
What are the fat-soluble vitamins?
A,D,E & K
What the water-soluble vitamins?
Bs,C,Niacin, & Folic acid
DRI
Dietary Reference Intakes
Which vitamin prevents severe birth defects and is thought to have cardioprotective qualities
folic acid
How many minerals are necessary for human nutrition?
22
What is the most common mineral administered?
Iron
Which mineral is considered temporary? (esp. in pregnancy?)
Fe supplements
Mineral - Electrolyte Imbalance Agent:

MOA: combines with K+ in the colon and eliminated via the stool
Cation Exchange Resin (ex: sodium polystyrene sulfonate (Kayexalate))
What is the onset of action for Cation Exchange Resin (Kayexalate)?
several hours
Hyperkalemia is treated with Cation Exchange Resin and what IV combination therapy?
IV D50% with regular insulin (insulin drive K+ inside cell)
Mineral - Electrolyte Imbalance Agent:

MOA:
PO route: combines with Fe in the bowel and prevents its absorption
Parenteral route: removes Fe from storage sites, combines with the Fe to produce H2O soluble compound that can be excreted by the kidneys
Chelating Agents (metal antagonist) (deferoxamine (Desferal))
What agent is given for lead poisoning?
succimer (Chemet)
When are iron preparations contraindicated?
Anemias not associated with iron deficiency
With route is prefered for Iron administration?
PO route: well absorbed; Fe recycled in body
What important method is used when administering Iron via oral route?
drink with straw to prevent tooth stain
Side Effects of which Mineral-Electrolyte Imbalance agent:

GI upset, black-green stool
Iron supplements
When should Iron supplements be taken?
before meals to elicit better absorption
What important method must be used when giving IM Fe dextran?
Z-track method
Besides hypomagnesium, what condition indicates an Mg preparation?
convulsions associated with pregnancy
Side Effects of which Mineral-Electrolyte Imbalance Agent:

- depressant effect on CNS, smooth, skeletal, cardiac muscle
- may cause diarrhea
Magnesium Preparations
When is a Magnesium preparation contraindicated?
Renal impairment, comatose
Besides hypokalemia, what indicates the use of Potassium preparation?
Prevention w/ loop diuretics
When is a Potassium preparation contraindicated?
Renal failure, potassium-sparing diuretics
What important method is used when administering KCL via IV route and why?
IV route must be diluted and administered slowly via infusion pump (10 mEq/hr)

This prevents cardiotoxicity and severe pain at injection site
Besides dietary supplementation, when is Zinc commonly administered?
clients with wounds
What oral, multiple mineral-electrolyte preparation is indicated for children with diarrhea to prevent dehyrdration and electrolyte depletion?
Pedialyte
What is the best indicator of weight
BMI: based on height and weight
Drug Therapy is recommended for individuals with what BMI?
> or = 30
Which weight loss medication is only for short-term use (up to 3 months)
Phentermine hydrochloride (Adipex-P)
What are some contraindications for Phentermine hydrochloride(Adipex-P)?
HTN, CV disease, caution w/ anxiety and/or agitation
What are some adverse effects of Phentermine hydrochloride(Adipex-P)?
nervousness, dry mouth, constipation, HTN
Which weight loss medication inhibits reuptake of serotonin and norepinephrine in the brain - increasing the amounts of these neurotransmitters?
Sibutramine (Meridia)
What are expected clinical effects of sibutramine (Meridia)?
- satiety
- decreased food intake
- increased metabolism
When is sibutramine (Meridia) contraindicated?
- HTN
- CV disorders
- Hx of substance abuse
- Caution with narrow-angle glaucoma & hepatic impairment
- DM
- chronic fatigue syndrome
- GERD
- cardiovascular disease
What are some adverse effects of sibutramine (Meridia)?
- dry mouth
- HA
- insomnia
- nervousness
- constipation
- CV effects
Which weight loss medication decreases absorption of dietary fat from intestines - blocks ~ 30% of fats from being absorbed
Orlistat (Xenical)
What are some disadvantages to taking orlistat (Xenical)?
- frequent dosing (1 cap/meal)
- abd pain
- oily spotting
- fecal urgency
- FLATULENCE
- fatty stools
- fecal incontinence
- you get the idea...
Below are examples of Herbal/Dietary supplements designed acheive weight loss. Which of these is no longer available due side effects such as heart-attack, stroke, or death?

- glucomannan
- guarana
- guar gum
- Ephedra
- laxatives
- Hoodia
Ephedra
a group of upper GI disorders characterized by ulcer formation
PUD (peptic ulcer disease)
what percentage of the population harboring H. pylori develops ulcers?
10%
How do NSAIDS (aspirin) increase risk of PUD?
these inhibit biosynthesis of prostaglandin, an enzyme that reduces stress to the gastric mucosa
How does gastric acid increase risk of PUD?
It is always present with ulcers; hypersecretion of gastric acids alone is enough to cause ulcers; gastric acid injures the cells of the GI mucosa and activates pepsin.
How does pepsin increase risk of PUD?
Pepsin is a proteolytic enzyme that is capable of injuring gastric/duodenal cells
How does smoking increase risk for PUD?
smoking delays healing and increases risk of recurrence
How does mucus protect the body from PUD?
mucus forms a barrier to protect cells from acid & pepsin
How does Bicarbonate protect the body from PUD?
Bicarbonate neutralizes H+ that penetrate the mucus
How does blood flow protect the body from PUD?
Blood flow maintains GI mucosal integrity
How do prostaglandins (prostaglandin E) protect the body from PUD?
Prostaglandins stimulate secretions of mucus and bicarbonate, promote vasodilation, & suppress secretion of gastric acid
Name the rare condition of ulcers secondary to excessive secretion of gastric acid
Zollinger-Ellison Syndrome
What is the antidote for Mg sulfate?
Calcium gluconate
Name the condition:

Regurgitation of gastric contents into the esophagus thought to be caused by incompetent esophageal sphincter
GERD
What is the goal pH for antacids to reach in the stomach?
pH ~ 3.5 (if pH > 5, pepsin action will decrease as well)
When must antacids be taken in relation to other medications?
must be taken 1 hr before or 1 hr after other meds
Which antacid:

large doses required - results in constipation, may result in hypophosphatemia
Aluminum compounds
Which antacid:

rapid onset of action - high ability to neutralize acids
Magnesium-based antacids
When are Magnesium-based antacids contraindicated?
renal failure
What are two side-effects of Magnesium-based antacids?
- diarrhea
- hypermagnesemia
Which antacid:

rapid onset of action, rarely used to treat ulcers
Calcium compounds
Which antacid might some renal pts use?
Calcium compounds (TUMS) to increase Calcium levels
Mylanta, Maalox, and Gelusil are antacid mixtures that use which two types?
- aluminum hydroxide
- magnesium hydroxide
What is the purpose of simethicone in some antacids?
serves as antiflatulent
What is baking soda known to induce when taken in excess?
metabolic alkalosis
How many antimicrobials must be used to succesfully prevent resistance?
at least 2 drugs must be used
What is the role of H2(histamine 2)?
H2 is located in the parietal cells of the stomach and promote the secretion of gastric acid
What are some indications for use of H2 receptor antagonists?
- PUD
- GERD
- esophagitis
- GI bleed
- Zollinger-Ellison syndrome
What are some contraindications for use of H2 receptor antagonists?
None, however caution with children, pregnancy, elderly, renal/hepatic impairment
Which PUD/Acid reflux drugs rarely have adverse effects at therapeutic levels?
Histamine 2 Receptor Antagonists
The drugs below belong to which PUD/Acid reflux drug group?

- cimetidine (Tagamet)
- ranitidine (Zantac)
- famotidine (Pepcid)
Histamine 2 Receptor Antagonists
What adverse effects are known with cimetidine (Tagamet) use?
- inhibits metabolism of many drugs
- may cause gynecomastia
- confusion in the elderly
What action is taken with patients in renal impairment concerning the use of H2 receptor antagonists?
dose is reduced
The drugs below belong to which PUD/Acid reflux drug group?

- amoxicillin
- clarithromycin (Biaxin)
- metronidazole (Flagyl)
- tetracycline
- omeprazole (Prilosec)
Helicobacter pylori agents
What is the average duration of treatment on H. pylori agents?
14 days
The drugs below belong to which PUD/Acid reflux drug group?

- omeprazole (Prilosec)
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- pantoprazole (Protonix)
Proton Pump Inhibitors
What big advantage do Proton Pump Inhibitors have over H2 receptor inhibitors?
Proton Pump Inhibitors, given via IV see symptom resolution within 1-2 weeks whereas H2 receptor antagonists take 4-6 weeks
What key method applies to oral proton pump inhibitor drugs?
all must be swallowed whole
Which oral route proton pump inhibitor does NOT need to be swallowed whole?
lansoprazole (Prevacid) which comes in granules which easily dissolve in water
Which PUD/Acid Reflux Disorder Drug class?

- irreversibly binds to the enzyme that generates gastric acid
Proton Pump Inhibitors
What are some indications for use of proton pump inhibitors?
- PUD
- erosive gastritis
- Zollinger-Ellison syndrome
- GERD
What are some side-effects to the use of Proton Pump inhibitors?
minimal nausea, diarrhea, HA
How long will it take proton pump inhibitors to heal esophagitis?
usually within 8 weeks
Which condition calls for lowered doses of proton pump inhibitors?
liver impairment
When are Prostaglandin supplements contraindicated?
pregnancy: may cause cramps & miscarriage
Which PUD/Acid Reflux Disease drug class is below?

- misoprostol (Cytotec)
Prostaglandin supplement
Which PUD/Acid Reflux Disease drug class?

MOA: unclear, thought to act locally on gastric/duodenal mucosa, binding to ulcer and forming a protective barrier
Sucralfate
What are the adverse effects for using sucralfates?
rarely any because not absorbed systemically
Important nursing implication for pts with GERD
elevate HOB after meals and eat several small meals each day
Below are examples of which Laxative/Cathartic group?

- methylcellulose (Citrucel)
- psyllium (Metamucil)
Bulk-forming laxatives
MOA of which Laxative/Cathartic group?

these nondigestible agents swell H2O to form a viscous solution that softens and increases the bulk of the stool; stimulating peristalsis
Bulk-forming Laxatives
What important method of administration applies to Bulk-forming Laxatives?
Must be taken with at least 8 oz of water
True or False:

Bulk-forming Laxatives can be used long-term
True: because they act like dietary fiber
Below are examples of which Laxative/Cathartic group?

- docusate sodium (Colace)
- docusate calcium (Surfak)
Surfactant Laxatives (Stool Softeners)
MOA of which Laxative/Cathartic group?

decreases surface tension of fecal mass, allows water to penetrate the fecal mass - making stools easier to expel
Surfactant Laxatives (Stool Softeners)
Below are examples of which Laxative/Cathartic group?

- magnesium citrate
- magnesium hydroxide (MOM)
- polyethylene glycol-electrolyte solution (CoLyte)
- sodium phosphate (Fleets enema)
Saline Laxatives
MOA of which Laxative/Cathartic group?

increases osmotic pressure in the intestinal lumen and causes the retention of water - bowels then distend and stimulate peristalsis
Saline Laxatives
When are Saline Laxatives indicated?
- rapid evacuation of bowel contents
- constipation
- prep for endoscopic procedure
What are some adverse effects associated with Saline Laxatives?
- electrolyte imbalance
- dehydration
What condition requires caution when using Saline Laxatives?
renal impairment
Below are examples of which Laxative/Cathartic group?

- bisacodyl (Dulcolax)
- senna (Senokot)
- Glycerin suppositories
Stimulant Cathartics
MOA of which Laxative/Cathartic group?

irritates the GI mucosa and pulls H2O into the bowel lumen - resulting in a watery stool
Stimulant Cathartics
What two important principles apply to Stimulant Cathartics?
- should not be used > 1 week
- administer at bedtime to produce a morning stool
What substance is used for a lubricant laxative administered via enema?
mineral oil
What laxative acts as hypertonic solution that pulls H2O into the intestinal lumen producing semiformed stools?
chronulac (Lactulose)
When is chronulac (Lactulose) indicated?
- constipation
- hepatic encephalopathy
True or False:

Most laxatives are plant based
True
What adverse side effect is related to the use of aloe as a laxative?
severe cramping
Below are Nursing Implications for which GI drug group?

- Use should be temporary
- NEVER give to someone with abd cramps/pain, nausea, vomiting
- Glycerin suppositories are best choice for children
- SCI clients need a "bowel program"
Laxatives/Cathartics
Below are examples of which GI group?

- diphenolxylate (Lomotil)
- loperamide (Imodium)
Opiate-related Antidiarrheals
Which antidiarrheal drug is a combination of opioids and atropine (atropine if taken in high doses will produce unpleasant anticholinergic effects)
diphenoxylate (Lomotil)
Which antidiarrheal drug decreases GI motility; and does not penetrate the CNS
loperamide (Imodium)
Which type of diarrhea lasts > 48 hours and indicates antibiotics?
Bacterial enteritis diarrhea
What antidiarrheal is indicated for AIDS patients or patients with fistulas?
sandostatin (Ocreatide)
When are antidiarrheals contraindicated?
- if cause is toxic microorganisms (Salmonella)
Primary nursing implication when dealing with antidiarrheals?
monitor closely to prevent electrolyte imbalance/dehydration
Examples of which Antiemetic group?

- promethazine (Phenergan)
- prochlorperazine (Compazine)
Phenothiazines
MOA for which Antiemetic group?

CNS depressants; blocks dopamine receptors in the chemoreceptor trigger zone (CTZ)
Phenothiazines
Side Effects of which Antiemetic group?

- sedation
- cognitive impairment
Phenothiazines
Below are examples of which Antiemetic group?

- dimenhydrinate (Dramamine)
- hydroxyzine (Vistaril)
Antihistamines
MOA of which Antiemetic goup?

- block histamine receptor sites and prevents histamine action; blocks aCH receptors
Antihistamines
Indication for which antiemetic group?

- motion sickness
Antihistamines
Side effects for which Antiemetic group?

- sedation, dry mouth
Antihistamines
Indication for which antiemetic group?

- chemotherapy induced emesis
Corticosteroids
Side effects for which antiemetic group?

- mild with short-term use
Corticosteroids
Below are examples of which Laxative/Cathartic group?

- metoclopramide (Reglan)
Prokinetic Agents
MOA of which Antiemetic group?

- increases GI motility by increasing release of aCH from nerve endings in GI tract
- antagonizes action of dopamine results in CNS effects
Prokinetic Agents
What condition contraindicates use of Prokinetic Agents?
Parkinsons disease
Side Effects of which Antiemetic group?

- sedation
- restlessness
- extrapyramidal effects
Prokinetic Agents
Side effects for which antiemetic group?

- mild with short-term use
Corticosteroids
Below are examples of which Laxative/Cathartic group?

- metoclopramide (Reglan)
Prokinetic Agents
MOA of which Antiemetic group?

- increases GI motility by increasing release of aCH from nerve endings in GI tract
- antagonizes action of dopamine results in CNS effects
Prokinetic Agents
What condition contraindicates use of Prokinetic Agents?
Parkinsons disease
Side Effects of which Antiemetic group?

- sedation
- restlessness
- extrapyramidal effects
Prokinetic Agents
What are two important implications relating to Prokinetic Agents?
- causes extrapyramidal reactions in children even in small doses
- reduces dosage in clients with renal disease
Below are examples of which Antiemetic group?

- ondansetron (Zofran)
- granisetron (Kytril)
- dolasetron (Anzemet)
- palonosetron (Aloxi)
Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]
MOA of which Antiemetic group?

antagonize serotonin receptors
Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]
Indications for which Antiemetic group?

prevent/treat: N/V associated with chemo, radiation, anesthesia
Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]
Adverse effects of which Antiemetic group?

- diarrhea
- HA
- dizziness
- constipation
- muscle aches
- transient increased LFT
Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]
What Serotonin Receptor Antagonist has a Half-life of 40 hours making it very effective for delayed N/V after chemo (only given IV)?
Palonosetron
Which Antiemetic was approved by FDA for use with N/V associated with chemo & to stimulate appetite in AIDS clients?
Dronabinol (Marinol)
What Antiemetic is a schedule III drug(high abuse potential)?
Dronabinol (Marinol)
What Antiemetic is an OTC hyperosmolar solution - relaxes GI tract muscles
Phosphorated carbohydrate solution (Emetrol)
What Antiemetic is an anticholinergic, very effective for motion sickness (also called sea sickness patch)
Scopolamine
Which herb was indicated by a study as effective in preventing postoperative N/V?
Ginger
Nursing Implications for which GI drug group?

- usually ordered PRN
- clients should avoid EtOH
- use with caution in elderly d/t sedation
- If hepatic impairment, decrease dose
Antiemetics
When should antiemetics be given for motion sickness?
~ 30 minutes before traveling
When should antiemetics be given to prevent N/V associated with chemo/radiation?
~30-60 minutes before treatment