5 Nurs 2330 - Gi Drugs

Front 1

When removing client from TPN, what is important to remember?

Back 1

Take off slowly to prevent hypoglycemia

Front 2

Why does TPN require filtered IV tubing?

Back 2

To prevent potential emboli

Front 3

What is the range of kcal/mL for liquid enteral products?

Back 3

1-2 kcal/mL

Front 4

Disease specific Liquid Enteral Product for Diabetics

Back 4

Nepro

Front 5

What is the tonicity of TPN solution?

Back 5

hypertonic

Front 6

Which diseases indicate replacement of pancreatic enzymes

Back 6

- cystic fibrosis
- chronic pancreatitis
- pancreatic obstruction

Front 7

Are pancreatic enzymes given with or without meals?

Back 7

with meals

Front 8

When administering IV fluids with dextrose concentration of 25-50%, what route must be used?

Back 8

must be via central line

Front 9

What are the fat-soluble vitamins?

Back 9

A,D,E & K

Front 10

What the water-soluble vitamins?

Back 10

Bs,C,Niacin, & Folic acid

Front 11

DRI

Back 11

Dietary Reference Intakes

Front 12

Which vitamin prevents severe birth defects and is thought to have cardioprotective qualities

Back 12

folic acid

Front 13

How many minerals are necessary for human nutrition?

Back 13

22

Front 14

What is the most common mineral administered?

Back 14

Iron

Front 15

Which mineral is considered temporary? (esp. in pregnancy?)

Back 15

Fe supplements

Front 16

Mineral - Electrolyte Imbalance Agent:

MOA: combines with K+ in the colon and eliminated via the stool

Back 16

Cation Exchange Resin (ex: sodium polystyrene sulfonate (Kayexalate))

Front 17

What is the onset of action for Cation Exchange Resin (Kayexalate)?

Back 17

several hours

Front 18

Hyperkalemia is treated with Cation Exchange Resin and what IV combination therapy?

Back 18

IV D50% with regular insulin (insulin drive K+ inside cell)

Front 19

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

Back 19

Chelating Agents (metal antagonist) (deferoxamine (Desferal))

Front 20

What agent is given for lead poisoning?

Back 20

succimer (Chemet)

Front 21

When are iron preparations contraindicated?

Back 21

Anemias not associated with iron deficiency

Front 22

With route is prefered for Iron administration?

Back 22

PO route: well absorbed; Fe recycled in body

Front 23

What important method is used when administering Iron via oral route?

Back 23

drink with straw to prevent tooth stain

Front 24

Side Effects of which Mineral-Electrolyte Imbalance agent:

GI upset, black-green stool

Back 24

Iron supplements

Front 25

When should Iron supplements be taken?

Back 25

before meals to elicit better absorption

Front 26

What important method must be used when giving IM Fe dextran?

Back 26

Z-track method

Front 27

Besides hypomagnesium, what condition indicates an Mg preparation?

Back 27

convulsions associated with pregnancy

Front 28

Side Effects of which Mineral-Electrolyte Imbalance Agent:

- depressant effect on CNS, smooth, skeletal, cardiac muscle
- may cause diarrhea

Back 28

Magnesium Preparations

Front 29

When is a Magnesium preparation contraindicated?

Back 29

Renal impairment, comatose

Front 30

Besides hypokalemia, what indicates the use of Potassium preparation?

Back 30

Prevention w/ loop diuretics

Front 31

When is a Potassium preparation contraindicated?

Back 31

Renal failure, potassium-sparing diuretics

Front 32

What important method is used when administering KCL via IV route and why?

Back 32

IV route must be diluted and administered slowly via infusion pump (10 mEq/hr)

This prevents cardiotoxicity and severe pain at injection site

Front 33

Besides dietary supplementation, when is Zinc commonly administered?

Back 33

clients with wounds

Front 34

What oral, multiple mineral-electrolyte preparation is indicated for children with diarrhea to prevent dehyrdration and electrolyte depletion?

Back 34

Pedialyte

Front 35

What is the best indicator of weight

Back 35

BMI: based on height and weight

Front 36

Drug Therapy is recommended for individuals with what BMI?

Back 36

> or = 30

Front 37

Which weight loss medication is only for short-term use (up to 3 months)

Back 37

Phentermine hydrochloride (Adipex-P)

Front 38

What are some contraindications for Phentermine hydrochloride(Adipex-P)?

Back 38

HTN, CV disease, caution w/ anxiety and/or agitation

Front 39

What are some adverse effects of Phentermine hydrochloride(Adipex-P)?

Back 39

nervousness, dry mouth, constipation, HTN

Front 40

Which weight loss medication inhibits reuptake of serotonin and norepinephrine in the brain - increasing the amounts of these neurotransmitters?

Back 40

Sibutramine (Meridia)

Front 41

What are expected clinical effects of sibutramine (Meridia)?

Back 41

- satiety
- decreased food intake
- increased metabolism

Front 42

When is sibutramine (Meridia) contraindicated?

Back 42

- HTN
- CV disorders
- Hx of substance abuse
- Caution with narrow-angle glaucoma & hepatic impairment
- DM
- chronic fatigue syndrome
- GERD
- cardiovascular disease

Front 43

What are some adverse effects of sibutramine (Meridia)?

Back 43

- dry mouth
- HA
- insomnia
- nervousness
- constipation
- CV effects

Front 44

Which weight loss medication decreases absorption of dietary fat from intestines - blocks ~ 30% of fats from being absorbed

Back 44

Orlistat (Xenical)

Front 45

What are some disadvantages to taking orlistat (Xenical)?

Back 45

- frequent dosing (1 cap/meal)
- abd pain
- oily spotting
- fecal urgency
- FLATULENCE
- fatty stools
- fecal incontinence
- you get the idea...

Front 46

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

Back 46

Ephedra

Front 47

a group of upper GI disorders characterized by ulcer formation

Back 47

PUD (peptic ulcer disease)

Front 48

what percentage of the population harboring H. pylori develops ulcers?

Back 48

10%

Front 49

How do NSAIDS (aspirin) increase risk of PUD?

Back 49

these inhibit biosynthesis of prostaglandin, an enzyme that reduces stress to the gastric mucosa

Front 50

How does gastric acid increase risk of PUD?

Back 50

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.

Front 51

How does pepsin increase risk of PUD?

Back 51

Pepsin is a proteolytic enzyme that is capable of injuring gastric/duodenal cells

Front 52

How does smoking increase risk for PUD?

Back 52

smoking delays healing and increases risk of recurrence

Front 53

How does mucus protect the body from PUD?

Back 53

mucus forms a barrier to protect cells from acid & pepsin

Front 54

How does Bicarbonate protect the body from PUD?

Back 54

Bicarbonate neutralizes H+ that penetrate the mucus

Front 55

How does blood flow protect the body from PUD?

Back 55

Blood flow maintains GI mucosal integrity

Front 56

How do prostaglandins (prostaglandin E) protect the body from PUD?

Back 56

Prostaglandins stimulate secretions of mucus and bicarbonate, promote vasodilation, & suppress secretion of gastric acid

Front 57

Name the rare condition of ulcers secondary to excessive secretion of gastric acid

Back 57

Zollinger-Ellison Syndrome

Front 58

What is the antidote for Mg sulfate?

Back 58

Calcium gluconate

Front 59

Name the condition:

Regurgitation of gastric contents into the esophagus thought to be caused by incompetent esophageal sphincter

Back 59

GERD

Front 60

What is the goal pH for antacids to reach in the stomach?

Back 60

pH ~ 3.5 (if pH > 5, pepsin action will decrease as well)

Front 61

When must antacids be taken in relation to other medications?

Back 61

must be taken 1 hr before or 1 hr after other meds

Front 62

Which antacid:

large doses required - results in constipation, may result in hypophosphatemia

Back 62

Aluminum compounds

Front 63

Which antacid:

rapid onset of action - high ability to neutralize acids

Back 63

Magnesium-based antacids

Front 64

When are Magnesium-based antacids contraindicated?

Back 64

renal failure

Front 65

What are two side-effects of Magnesium-based antacids?

Back 65

- diarrhea
- hypermagnesemia

Front 66

Which antacid:

rapid onset of action, rarely used to treat ulcers

Back 66

Calcium compounds

Front 67

Which antacid might some renal pts use?

Back 67

Calcium compounds (TUMS) to increase Calcium levels

Front 68

Mylanta, Maalox, and Gelusil are antacid mixtures that use which two types?

Back 68

- aluminum hydroxide
- magnesium hydroxide

Front 69

What is the purpose of simethicone in some antacids?

Back 69

serves as antiflatulent

Front 70

What is baking soda known to induce when taken in excess?

Back 70

metabolic alkalosis

Front 71

How many antimicrobials must be used to succesfully prevent resistance?

Back 71

at least 2 drugs must be used

Front 72

What is the role of H2(histamine 2)?

Back 72

H2 is located in the parietal cells of the stomach and promote the secretion of gastric acid

Front 73

What are some indications for use of H2 receptor antagonists?

Back 73

- PUD
- GERD
- esophagitis
- GI bleed
- Zollinger-Ellison syndrome

Front 74

What are some contraindications for use of H2 receptor antagonists?

Back 74

None, however caution with children, pregnancy, elderly, renal/hepatic impairment

Front 75

Which PUD/Acid reflux drugs rarely have adverse effects at therapeutic levels?

Back 75

Histamine 2 Receptor Antagonists

Front 76

The drugs below belong to which PUD/Acid reflux drug group?

- cimetidine (Tagamet)
- ranitidine (Zantac)
- famotidine (Pepcid)

Back 76

Histamine 2 Receptor Antagonists

Front 77

What adverse effects are known with cimetidine (Tagamet) use?

Back 77

- inhibits metabolism of many drugs
- may cause gynecomastia
- confusion in the elderly

Front 78

What action is taken with patients in renal impairment concerning the use of H2 receptor antagonists?

Back 78

dose is reduced

Front 79

The drugs below belong to which PUD/Acid reflux drug group?

- amoxicillin
- clarithromycin (Biaxin)
- metronidazole (Flagyl)
- tetracycline
- omeprazole (Prilosec)

Back 79

Helicobacter pylori agents

Front 80

What is the average duration of treatment on H. pylori agents?

Back 80

14 days

Front 81

The drugs below belong to which PUD/Acid reflux drug group?

- omeprazole (Prilosec)
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- pantoprazole (Protonix)

Back 81

Proton Pump Inhibitors

Front 82

What big advantage do Proton Pump Inhibitors have over H2 receptor inhibitors?

Back 82

Proton Pump Inhibitors, given via IV see symptom resolution within 1-2 weeks whereas H2 receptor antagonists take 4-6 weeks

Front 83

What key method applies to oral proton pump inhibitor drugs?

Back 83

all must be swallowed whole

Front 84

Which oral route proton pump inhibitor does NOT need to be swallowed whole?

Back 84

lansoprazole (Prevacid) which comes in granules which easily dissolve in water

Front 85

Which PUD/Acid Reflux Disorder Drug class?

- irreversibly binds to the enzyme that generates gastric acid

Back 85

Proton Pump Inhibitors

Front 86

What are some indications for use of proton pump inhibitors?

Back 86

- PUD
- erosive gastritis
- Zollinger-Ellison syndrome
- GERD

Front 87

What are some side-effects to the use of Proton Pump inhibitors?

Back 87

minimal nausea, diarrhea, HA

Front 88

How long will it take proton pump inhibitors to heal esophagitis?

Back 88

usually within 8 weeks

Front 89

Which condition calls for lowered doses of proton pump inhibitors?

Back 89

liver impairment

Front 90

When are Prostaglandin supplements contraindicated?

Back 90

pregnancy: may cause cramps & miscarriage

Front 91

Which PUD/Acid Reflux Disease drug class is below?

- misoprostol (Cytotec)

Back 91

Prostaglandin supplement

Front 92

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

Back 92

Sucralfate

Front 93

What are the adverse effects for using sucralfates?

Back 93

rarely any because not absorbed systemically

Front 94

Important nursing implication for pts with GERD

Back 94

elevate HOB after meals and eat several small meals each day

Front 95

Below are examples of which Laxative/Cathartic group?

- methylcellulose (Citrucel)
- psyllium (Metamucil)

Back 95

Bulk-forming laxatives

Front 96

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

Back 96

Bulk-forming Laxatives

Front 97

What important method of administration applies to Bulk-forming Laxatives?

Back 97

Must be taken with at least 8 oz of water

Front 98

True or False:

Bulk-forming Laxatives can be used long-term

Back 98

True: because they act like dietary fiber

Front 99

Below are examples of which Laxative/Cathartic group?

- docusate sodium (Colace)
- docusate calcium (Surfak)

Back 99

Surfactant Laxatives (Stool Softeners)

Front 100

MOA of which Laxative/Cathartic group?

decreases surface tension of fecal mass, allows water to penetrate the fecal mass - making stools easier to expel

Back 100

Surfactant Laxatives (Stool Softeners)

Front 101

Below are examples of which Laxative/Cathartic group?

- magnesium citrate
- magnesium hydroxide (MOM)
- polyethylene glycol-electrolyte solution (CoLyte)
- sodium phosphate (Fleets enema)

Back 101

Saline Laxatives

Front 102

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

Back 102

Saline Laxatives

Front 103

When are Saline Laxatives indicated?

Back 103

- rapid evacuation of bowel contents
- constipation
- prep for endoscopic procedure

Front 104

What are some adverse effects associated with Saline Laxatives?

Back 104

- electrolyte imbalance
- dehydration

Front 105

What condition requires caution when using Saline Laxatives?

Back 105

renal impairment

Front 106

Below are examples of which Laxative/Cathartic group?

- bisacodyl (Dulcolax)
- senna (Senokot)
- Glycerin suppositories

Back 106

Stimulant Cathartics

Front 107

MOA of which Laxative/Cathartic group?

irritates the GI mucosa and pulls H2O into the bowel lumen - resulting in a watery stool

Back 107

Stimulant Cathartics

Front 108

What two important principles apply to Stimulant Cathartics?

Back 108

- should not be used > 1 week
- administer at bedtime to produce a morning stool

Front 109

What substance is used for a lubricant laxative administered via enema?

Back 109

mineral oil

Front 110

What laxative acts as hypertonic solution that pulls H2O into the intestinal lumen producing semiformed stools?

Back 110

chronulac (Lactulose)

Front 111

When is chronulac (Lactulose) indicated?

Back 111

- constipation
- hepatic encephalopathy

Front 112

True or False:

Most laxatives are plant based

Back 112

True

Front 113

What adverse side effect is related to the use of aloe as a laxative?

Back 113

severe cramping

Front 114

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"

Back 114

Laxatives/Cathartics

Front 115

Below are examples of which GI group?

- diphenolxylate (Lomotil)
- loperamide (Imodium)

Back 115

Opiate-related Antidiarrheals

Front 116

Which antidiarrheal drug is a combination of opioids and atropine (atropine if taken in high doses will produce unpleasant anticholinergic effects)

Back 116

diphenoxylate (Lomotil)

Front 117

Which antidiarrheal drug decreases GI motility; and does not penetrate the CNS

Back 117

loperamide (Imodium)

Front 118

Which type of diarrhea lasts > 48 hours and indicates antibiotics?

Back 118

Bacterial enteritis diarrhea

Front 119

What antidiarrheal is indicated for AIDS patients or patients with fistulas?

Back 119

sandostatin (Ocreatide)

Front 120

When are antidiarrheals contraindicated?

Back 120

- if cause is toxic microorganisms (Salmonella)

Front 121

Primary nursing implication when dealing with antidiarrheals?

Back 121

monitor closely to prevent electrolyte imbalance/dehydration

Front 122

Examples of which Antiemetic group?

- promethazine (Phenergan)
- prochlorperazine (Compazine)

Back 122

Phenothiazines

Front 123

MOA for which Antiemetic group?

CNS depressants; blocks dopamine receptors in the chemoreceptor trigger zone (CTZ)

Back 123

Phenothiazines

Front 124

Side Effects of which Antiemetic group?

- sedation
- cognitive impairment

Back 124

Phenothiazines

Front 125

Below are examples of which Antiemetic group?

- dimenhydrinate (Dramamine)
- hydroxyzine (Vistaril)

Back 125

Antihistamines

Front 126

MOA of which Antiemetic goup?

- block histamine receptor sites and prevents histamine action; blocks aCH receptors

Back 126

Antihistamines

Front 127

Indication for which antiemetic group?

- motion sickness

Back 127

Antihistamines

Front 128

Side effects for which Antiemetic group?

- sedation, dry mouth

Back 128

Antihistamines

Front 129

Indication for which antiemetic group?

- chemotherapy induced emesis

Back 129

Corticosteroids

Front 130

Side effects for which antiemetic group?

- mild with short-term use

Back 130

Corticosteroids

Front 131

Below are examples of which Laxative/Cathartic group?

- metoclopramide (Reglan)

Back 131

Prokinetic Agents

Front 132

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

Back 132

Prokinetic Agents

Front 133

What condition contraindicates use of Prokinetic Agents?

Back 133

Parkinsons disease

Front 134

Side Effects of which Antiemetic group?

- sedation
- restlessness
- extrapyramidal effects

Back 134

Prokinetic Agents

Front 135

Side effects for which antiemetic group?

- mild with short-term use

Back 135

Corticosteroids

Front 136

Below are examples of which Laxative/Cathartic group?

- metoclopramide (Reglan)

Back 136

Prokinetic Agents

Front 137

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

Back 137

Prokinetic Agents

Front 138

What condition contraindicates use of Prokinetic Agents?

Back 138

Parkinsons disease

Front 139

Side Effects of which Antiemetic group?

- sedation
- restlessness
- extrapyramidal effects

Back 139

Prokinetic Agents

Front 140

What are two important implications relating to Prokinetic Agents?

Back 140

- causes extrapyramidal reactions in children even in small doses
- reduces dosage in clients with renal disease

Front 141

Below are examples of which Antiemetic group?

- ondansetron (Zofran)
- granisetron (Kytril)
- dolasetron (Anzemet)
- palonosetron (Aloxi)

Back 141

Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]

Front 142

MOA of which Antiemetic group?

antagonize serotonin receptors

Back 142

Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]

Front 143

Indications for which Antiemetic group?

prevent/treat: N/V associated with chemo, radiation, anesthesia

Back 143

Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]

Front 144

Adverse effects of which Antiemetic group?

- diarrhea
- HA
- dizziness
- constipation
- muscle aches
- transient increased LFT

Back 144

Serotonin Receptor Antagonist [5-Hydroxytryptamine3 Receptor Antagonist]

Front 145

What Serotonin Receptor Antagonist has a Half-life of 40 hours making it very effective for delayed N/V after chemo (only given IV)?

Back 145

Palonosetron

Front 146

Which Antiemetic was approved by FDA for use with N/V associated with chemo & to stimulate appetite in AIDS clients?

Back 146

Dronabinol (Marinol)

Front 147

What Antiemetic is a schedule III drug(high abuse potential)?

Back 147

Dronabinol (Marinol)

Front 148

What Antiemetic is an OTC hyperosmolar solution - relaxes GI tract muscles

Back 148

Phosphorated carbohydrate solution (Emetrol)

Front 149

What Antiemetic is an anticholinergic, very effective for motion sickness (also called sea sickness patch)

Back 149

Scopolamine

Front 150

Which herb was indicated by a study as effective in preventing postoperative N/V?

Back 150

Ginger

Front 151

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

Back 151

Antiemetics

Front 152

When should antiemetics be given for motion sickness?

Back 152

~ 30 minutes before traveling

Front 153

When should antiemetics be given to prevent N/V associated with chemo/radiation?

Back 153

~30-60 minutes before treatment