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66 Cards in this Set

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________ is a symptom of numerous conditions that increase bowel motility cause secretion or retention of fluids in the intestinal lumen and cause inflammation or irritation of the gastrointestinal (GI ) tract.
diarrhea
Escherichia coli 0157:H7 related hemmorrhagic colitis most commonly occurs with the ingestion of undercooked __________ _________
ground beef
A serious complication of Ecoli 0157:57 colitis is _________ _____ syndrome (HUS) which is characterized by thrombocytopenia microangiopathic hemolytic anemia and renal failure.
hemolytic uremic
So called travelers diarrhea is usually caused by an ___________ strain of E coli (ETEC)
enterotoxigenic
Consumption of improper prepared poultry may result in diarrhea due to infection with ___________ _________
campylobacter jejuni
Structural analog of the antimycrobacterial drug rifampin
Rifaxmin (Xifaxan)
Useful in treating diarrhea due to bile salt accumulation in conditions such as Crohns disease or surgical excision of the ileum
Cholestyramine or colestipol (bile binding drugs)
Synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles
Loperamide (Imodium)
Most often used as bulk forming laxatives
Polycarbophil and psyllium
Synthetic form of somatostatin a hormone produced in the anterior pituitary gland and in the pancreas
Octreotide acetate
How do people contract Salmonella?
Salmonella infection may occur wen contaminated poultry and other meats eggs and dairy products are ingested. Elderly clients are especially susceptible to Salmonella associated colitis
How to people contract shigella?
Several strains of shigella may produce diarrhea. Infection most often results from direct person to person contact but it may occur via food or water contamination. Hand wasthing is especially important in preventing the spread of shigella from person to person
How does a lack of digestive enzymes or a deficiency of pancreatic enzymes affect digestion?
Deficiency of pancreatic enzymes inhibits digestion and absorption of carbohydrates proteins and fats. Deficiency of lactase which breaks down lactose to simple sugars (ex. glucose and galactose) that can be absorbed by GI mucosa inhibits digestion of milk and milk products. Lactase deficiency commonly occurs among people of African or Asian descent.
What is the mechanism by which inflammatory bowel disorders cause diarrhea?
IBS is a functional disorder of intestinal motility with no evidence of inflammation or tissue changes. A change in bowel pattern (constipation, diarrhea or combination of both) accompanied by abdominal pain bloating and distention is the presenting symptom. The cause is unknown; however, activation of 5-HT3 (serotonin) receptors which affect the regulation of visceral pain colnic motility and GI secretion is though to be involved in the pathophysiology of IBS.
Mr. Adler is diagnosed with bacterial gastroenteritis. On which of the following factors will treatment be based?

a. Symptomatology

b. Causative agent and susceptibility tests

c. Number of days with diarrhea

d. The country in which the organism originates
b. In bacterial gastroenteritis or diarrhea the choice of anti bacterial drug depends on the causative organism and susceptibility of tests.
Specific therapy of diarrhea is directed at the cause of the symptom. Which of the following treatments may be applied? (select all that apply)

a. Enzymatic replacement therapy

b. Bile salt binding drugs

c. Corticosteroids

d. 5 HT3 receptor antagonists
a, b, d.

Specific therapy for diarrhea is directed at the cause of the symptom and may include enzymatic replacement therapy, bile salt binding drugs antibacterial agents and 5 HT3 receptor antagonists.
Polycarbophil is used to treat diarrhea by adsorbing toxins and water, thereby _________ the fluidity of stools.
decreasing
Mr and Mrs Anderson present to the physicians office with travelers diarrhea. Which of the following would you expect the physician to order?

a. Cholestryamine

b. Psyllium

c. Octreotide acetate

d. Bismuth Subsalicylate
d. Bismuth subsalicylate is antisecretory antimicrobial and possibly anti-inflammatory effects. It is used in the control of travelers diarrhea and relief of abdominal cramping.
Mr. Everley is diagnosed with carcinoid syndrome. Which of the following would you expect the physician to order?

a. Cholestyramine

b. Octreotide

c. Bismuth subsalicytlate

d. Psyllium
b. Octreotide a synthetic form of somatostatin decreases GI secretion and motility. It is used for diarrhea associated with carcinoid syndrome intestinal tumors or HIV AIDS and diarrhea that does not respond to other antidiarrheal drugs.
The most effective non specific therapy for symptomatic treatment of diarrhea is __________ an opiate derivatives.
Opiates
_________ is the frequent expulsion of liquid or semi-liquid stools resulting from increased bowel motility increased secretion or retention of fluids in the intestinal lumen or inflammation and irritation of the GI tract.
Diarrhea
Mrs. Edwards is diagnosed with temporary acute diarrhea. He other diagnoses include diabetes mellitus dysrhythmia and hepatic impairment. The physician orders loperamide. Based on her diagnoses which of the following signs would you observe for in this patient?

a. Signs of electrolyte imbalance

b. Signs of hemorrhage

c. Signs of hypercalcemia

d. Signs of CNS toxicity.
d. With loperamide monitor clients with hepatic impairment for signs of CNS toxicity. Loperamide normally undergoes extensive first pass metabolism which may be lessened by liver disease. As a result a larger portion of the dose reaches the systemic circulation and may cause adverse effects.
A physician orders diphenoxylate to treat a client who has severe hepatorenal disease. On what basis should you question his order?

a. It may precipitate hepatic coma.

b. It may precipitate hyperkalemia

c. It may precipitate hypercalcemia

d. It may precipitate hyperglycemia
a. Dephenoxylate should be used with extreme caution in clients with severe hepatorenal disesese because hepatic coma may be precipitated.
When administering diphenoxylate to children you should observe for signs of which of the following conditions?

a. Atropine overdose

b. Opioid overdose

c. Fluid and electrolyte imbalance

d. Hypertensive crisis
a. Diphenoxylate contains atropine and signs of atropine over dose may occur with usual doses. Diphenoxylate is contraindicated in children younger than 2yrs of age.
In diarrhea cased by enzyme deficiency, ______________ are given rather than antidiarrheal drugs
Pancreatic enzymes
Which of the following doses of morphine is considered effective to treat diarrheal episodes?

a. 2 mg

b. 4 mg

c. 6 mg

d. 1.25 mg
b. The following oral drugs and dosages are approximately equivalent in antidiarrheal effectiveness: 4mg morphine 30mg codeine 10 mL paregoric, 5 mg diphenoxylate, and 2 mg loperamide.
In antibiotic associated colitis which of the following is the initial treatment?

a. Imodium

b. Stopping the causative drug

c. administering a medication that will slow peristalsis

d. Administering a low dose opioid.
b. In antibiotic associated colitis stopping the causative drug is the initial treatment. If symptoms do not improve within 3 to 4 days oral metronidazole or vancomycin is given for 7 to 10 days.
Mrs Franklin develops antibiotic induced colitis. The symptoms have worsened within the past 72hrs. Which of the following would you expect the physician to order as the initial drug of choice?

a. Loperamide

b. Bismuth subsalicylate

c. Metronidazole

d. Psyllium
c. In antibiotic associated colitis stopping the causative drug is the initial treatment. If symptoms do not improve within 3 to 4 days oral metronidazole or vancmycin is given for 7 to 10 days.
In ulcerative colitis which of the following is one of the drugs of choice?


a. Loperamide

b. Psyllium

c. Metronidazole

d. Sulfonamide
d. In ulcerative colitis sulfonamides adrenal corticosteroids and other anti - inflammatory agents such as balsalazide (colazal), mesalamine (pentasa) and olsalazine (dipentum) are the drugs of choice
For symptomatic treatment of diarrhea which of the following drugs would be initial choices for treatment?

a. Diphenoxylate with atropine

b. Psyllium

c. Metronidazole

d. Loperamide
a and d For symptomatic treatment of diarrhea diphenoxylate with atropine (lomotil ) or loperamide (Imodium) is probably the drug of choice for most people.
The choice of antidiarrheal agent depends largely on the cause severity and ______________ of the diarrhea
Duration
In most cases of acute nonspecific diarrhea in adults fluid losses are not sever and clients need only simple replacement of fluids and electrolytes lost in stool. Which of the following is an acceptable replacement fluid during the first 24hrs?

a. 2 to 3L of clear liquids

b. 1 to 2L of clear liquids

c. .5 to 1L of clear liquids

. 3 to 4L of clear liquids
c.
a. In most cases of acute non specific diarrhea in adults fluid losses are not sever and clients need only simple replacement of fluids and electrolytes lost in the stool. Acceptable replacement of fluids during the 1st 24hrs include 2 to 3L of clear liquids.
Contraindications to the use of antidiarrheal drugs caused by which of the following? (select all that apply)

a. Toxic materials

b. Microorganisms that pentrate intestinal mucosa

c. unknown origin

d. Antibiotic associated colitis
a, b, d Contraindications to the use of antidiarrheal drugs include diarrhea caused by toxic materials microorganisms that penetrate intestinal and antibiotic associated colitis.
_________ is an antiprotozoal agent used specifically for treating diarrhea resulting form infection with Giardia Lambilia or Cryptosporidium parvum.
Nitazoxanide (Alinia)
Occurs with under cooked ground beef can lead to HUS. HUS presents with thrombocytopenia (TUS), microgiobathic hemolyhtic anemia, Renal failure.
Escherichia coli 0157:H7
Caused by entrerotoxigenic strain of E. coli (ETEC)
Travelers Diarrhea
Caused by improperly cooked poultry. Most common bacterial organism in infectious diarrhea. Symptoms vomiting, fever, abdominal discomfort.
Campylobacter Jejuni
Occurs when contaminated poultry and other meats are ingested. Elderly are most susceptible.
Salmonella
May produce diarrhea is spread by person to person contact by may also occur via food or water contamination.
Shigella
Contamination of raw shellfish and oysters
Vibrio Valnificus and Vibrio parachae molyticus
Contamination of inadequately reheated or heated meats
Clostridium perfringens
Contamination of processed meats and custard filled pastries.
Staphylococcus aureus
Contamination of rice and bean sprouts.
Bacillus cereus
Contamination of hot dogs, and lunch meats. Individuals at most risk are new borns, pregnant women, older people, immune compromised patients.
Listeria moncytogenes
___________________________ is a serious condition that results from oral or parenteral antibiotic therapy. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially gram-positive, anaerobic Clostridium difficile organisms.
Antibiotic-associated colitis (also called pseudomembranous colitis)
________________ is a synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles
Loperamide (Imodium)
______________ is a synthetic form of somatostatin, a hormone produced in the anterior pituitary gland and in the pancreas. The drug may be effective in diarrhea because it decreases GI secretion and motility. It is used for diarrhea associated with carcinoid syndrome, intestinal tumors, HIV/AIDS, and diarrhea that does not respond to other antidiarrheal drugs.
Octreotide acetate
_________________is a synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles. Because loperamide does not penetrate the central nervous system (CNS) well, it does not cause the CNS effects associated with opioid use and lacks potential for abuse
Loperamide (Imodium)
________________ and ____________ are most often used as bulk-forming laxatives. They are occasionally used in diarrhea to adsorb toxins and water, decreasing the fluidity of stools.
Polycarbophil (e.g., FiberCon) and psyllium
Bile-binding drugs such as _____________ or ___________ are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn's disease or surgical excision of the ileum
cholestyramine or colestipol
__________________is a structural analog of the antimycobacterial drug, rifampin. It is a nonsystemic antibiotic that remains in the gut and is not absorbed into the bloodstream. It was specifically developed to treat travelers' diarrhea due to noninvasive strains of E. coli in patients older than 12 years of age. It should not be used for diarrhea in the presence of fever or bloody stools or for diarrhea due to pathogens other than E. coli
Rifaximin (Xifaxan)
Morphine is the active ingredient. Paregoric contains 0.4 mg/mL of morphine.

A Schedule III drug alone and a Schedule V in the small amounts combined with other drugs.

Recommended doses and short-term use do not produce euphoria, analgesia, or dependence.
Paregoric
A derivative of meperidine (Demerol)

Commonly prescribed; decreases intestinal motility

In recommended doses, does not produce euphoria, analgesia, or dependence. In high doses, produces morphine-like effects, including euphoria, dependence, and respiratory depression
Diphenoxylate with atropine sulfate (Lomotil)
A derivative of meperidine; decreases intestinal motility

As effective as diphenoxylate, with fewer adverse effects in recommended doses. High doses may produce morphine-like effects.

Naloxone (Narcan) is the antidote for overdose.
Loperamide (Imodium)
This antibacterial agent is used to treat Traveler's diarrhea acquired in SE Asia. Regardless of destination, may be preferred antibiotic for children and those unable to take quinolones.
Azithromycin
Used to treat susceptible strains of Escherichia coli, Campylobacter jejuni, and Shigella species
Ciprofloxacin
Used to treat intestinal amebiasis caused by Entamoeba histolytica.
Erythromycin
Used to treat diarrhea caused by susceptible strains of E. coli or Shigella organisms

Traveler's diarrhea
Trimethoprim-sulfamethoxazole (TMP-SMX) (Bactrim, Septra)
Used to treat diarrhea and colitis caused by C. difficile organism
Vancomycin
For women with diarrhea-predominant irritable bowel syndrome(IBS)
Alosetron (Lotronex)
Has antimicrobial, antisecretory, and possibly anti-inflammatory effects. Control of diarrhea, including traveler's diarrhea, and relief of abdominal cramping
Bismuth subsalicylate (Pepto-Bismol)
Binds and inactivates bile salts in the intestine. Diarrhea due to bile salts reaching the colon and causing a cathartic effect. “Bile salt diarrhea” is associated with Crohn's disease or surgical excision of the ileum.
Cholestyramine (Questran) or Colestipol (Colestid)
Diarrhea associated with carcinoid tumors, HIV/AIDS, cancer chemotherapy or radiation, or diarrhea unresponsive to other drugs
Octreotide (Sandostatin)
Diarrhea and malabsorption due to deficiency of pancreatic enzymes
Pancreatin or pancrelipase (Viokase, Pancrease, Cotazym)
Absorbs water and toxins and decreases fluidity of stools. Possibly effective for symptomatic treatment of diarrhea.
Polycarbophil preparations (FiberCon)
Diphenoxylate and loperamide are contraindicated in children younger than _______ years of age.
2