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190 Cards in this Set
- Front
- Back
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The GI system is the only system in the body exposed to ?
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The external enviroment
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The GI system is _____ _____
____ begins at the mouth and goes through the esophagus, stomach, and small and large intestines. |
one continous tube
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The GI system ends at the?
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Anus
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Major activies of the GI system?
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* Secretion
*Absorption *Digestion *Motility |
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Secretion of the GI system does what?
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secretes enzymes, acid, bicarbonate, and mucus
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Absorption of the GI system function
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Absorbs water and almost all of the essential nutrients needed by the body.
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Digestion function of the GI system
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Digestion of food into usable and absorbable component
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Motiltiy function of the GI system
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Motility of food and secretions through the system
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Layers of the GI Tube
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* Mucosa
* Muscularis Mucosa * Nerve Plexus * Adventitia |
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Layer of nerves in teh nerve plexus
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* Submucosal layer
* Myenteric Layer |
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Control of the GI System
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GI system is controlled by the nerve plexus
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The nerve plexus function for the GI system
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- Maintains basic electrical rhythm
- Responds to local stimuli to increase or decrease activity |
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Activity of teh Gi tract can be influenced by the
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ANS
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Intiation of GI activity depends on?
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local reflexes
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Types of secretion of the GI Tract?
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Saliva
Mucus Acid and digestive Enzymes Gastin Secretin Sodium Bicarbonate Pancreatic Enzymes Other lipases and Amylases Bile Endocrine Hormones |
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The GI system is controlled by the nerve plexus which maintains basic electrical rhythm, T or F
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True, the GI system is cotnrolled by the nerve plexus, which maintains basic electrical rhythm and responds to local simuli to increase or decrease activity
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Digestion is ?
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The process of breaking food into usable absorbable nutrients
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Digestions begins where?
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In the mouth with enzymes in the salvia
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Digestion is continued in the _____ after salvia begins the break down?
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Stomach
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Digestion int eh small intestines>
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food mixes with bile which breaks down the fat molecules
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Absorption of the GI tract?
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Is the active process of removing water, nutrients, and other elements form the GI tract
Once removed the are delivered to teh bloodstream for use in the body |
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Motility in the GI tract?
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GI tract depends on an inherent motility to keep things movign through the system
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Motilitiy continued
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In the esophagus the basic movement is perstalsis
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Motility continued
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The stomach uses its three muscle layers to produce an churning action
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Motility continued
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The small instestines use a process of segmentation
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Motility continued
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Large instestines use a process of mass movement
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Local GI reflexes
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Gastroenteric Reflex: Stimulation of the stomach by stretching
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Local GI reflexes
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Gastrocolic Reflex: stimulation fo the stomach causing increased activity in the colon.
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Local GI reflexes
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Duodenal- Colic Reflex- stimulation of the colon activity and mass movement by the presence of food or stretch in the duodenum
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Other local GI reflexes
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Ileogastric reflex
Intestinal- intestinal reflex peritoneointestinal reflex renointestinal reflex vesicointestinal reflex somatointestinal reflex |
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Centrally Mediated Reflexes of the GI tract
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Swallowing Reflex
Vomiting Reflex |
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Swallowing Reflex action
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Stimulated when a food bolus stimulates pressure receptors in teh back of the throat and pharynx
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Vomiting reflex action
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proctects the system from unwanted irritants
Stimulated by two centers of the medulla |
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Swallowing reflex action
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Stimulated whenever a food bolus stimulated pressure receptors in the back of the throat and pharynx, this sends impulse to the Medulla which stimulates a series of nerves
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Swallowing reflex action continued
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Involves more than 25 pairs of muscles and this relex cna be facilitated in a number of way if swallowing is a problem
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Meds for PUD and GERD
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H2 Receptor Antagonist
PPI Antacids |
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H2 receptor blockers names
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Rantidine
Cimetidine Famotidine |
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Indication for H2 use?
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PUD
GERD |
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MOA for H2
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*suppresses the volume and acidity of secretions from parietal cells, decrease in pepsin production
* selectively blocks histamine 2 receptor sites |
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Therapeutic Effect for H2
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Help reduce the acid in your stomach
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Pharmacokinetics for H2
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Readily absorbed after oral administration,
metabolized in the liver and excreted in the urine |
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Contraindications for H2
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known allergy to med
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Nursing Assessment for H2
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clients use of OTC meds
hepatic and renal functions |
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Cautin in H2
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pregnancy or lactation
hepatic or renal dysfunction |
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Adverse Effects of H2
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GI effects
CNS effect Cardiac arrhythmias and hyptension long term use b12 deficiency |
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Drug to Drug interactions with H2
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warfarin, phenytonin, beta blockers, ETOH, quinidine
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Antacids are used to TX
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GERD
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MOA of antacids
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neutralizes stomach acids by direct chemical reaction
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Indication of Antacids
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Symptomatic relief of upset stomach associated with hyperacidity as well as hyperactivity
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Contraindications for Antacids
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Allergy to med
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Caution in Antacids
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any condition that is exacerbated by electrolyte imbalance
GI obstruction |
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Side Effects of Antacids
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*electrolyte imblance
rebound acidity alkalosis hypercalcemia constipation diarrhea hypophophatemia |
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Drug to Drug interaction with Antacids
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affect the absorption of many other drugs
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Antacids Drugs
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Aluminum hydroxide
calcium carbonate magnesium hydroxide sodium bicarbonate |
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Pt. teaching with Antacids
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no magnesium with kidney disease
no sodium with HD take antacids 2 hours before other meds antacids may make stool appear white |
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PPI Drugs
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omperazole- Prilosec
esomeprazole lansoprazole |
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MOA of PPI
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act at specific secratory surface receptors to prevent the final step of acid production and thereby decrease the level of acid in the stomach
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Indication for PPI
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short term TX of duodenal Ulcers, GERD, erosive espho., and benign active gastric disease
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Pharmacokintics of PPI
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acid labile- acid goes up and down
Rapidly absorbed in the liver Metabolized in the liver and excreted through urine |
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Contraindication for PPI
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Allergy to med
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Caution for PPI
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pregnancy or lactation
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Adverse Effects of PPI
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CNS effects
dizziness, HA, asthenia, vertigo, insomnia, apathy, |
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Adverse Effects of PPI
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GI
Diarrhea, abd pain, tongue atrophy |
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Adverse effects of PPI Misc
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Rash, alopecia, pruritis, dry skin, back pain, and fever
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Antipeptic Agent is what drug
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Don't know
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Actions of antipeptic agent
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forms an ulcer adherent complex at the duodenal ulcer sites protecting the sites againist acid, pepsin, and bile salts
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Indications of antipeptic agents
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promote ulcer healing
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pharmacokenitics of antipeptic agents
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promote ulcer healing
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pharmacokenitics of antipeptic
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rapidly absorbed metabolized in the liver, and excreted in feces
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Contraindications for antipeptic agents
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allergy
renal failure |
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Caution for anitpeptic
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pregnancy or lactation
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adverse effects of antipeptic
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GI efffects- constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth, dizziness, sleepiness, vertigo, skin rash, back pain
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Drug to Drug interaction with antipeptic agents
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Aluminum Salts
Phenytoin Flouroquinolones Penicillamine |
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Prostaglandin MOA
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inhibits gastric acid secretions and increase bicarbonate and mucous production in the stomach, will increase the PH
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Indications of prostaglandins
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prevention of NSAID induced gastric ulcers
TX of duodenal ulcers |
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pharmokinetics of prostaglandins
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Rapidly absorbed from GI tract, metabolized in the liver, and excreted in the urine
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contraindications of prostaglandins
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pregnancy
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Caution in prostaglandins
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Lactation
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Adverse effects of prostaglandins
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N/D adb pain, flatus, vomiting, dyspepsia, and constipation.
GU effects- miscarriage, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstral disorders |
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Question
This is a drug to drug interation between the antipeptides and PCN |
False, only aluminum salts, phenytonin, flouroquinolones, or penicillamine
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Pt. who may need digestive enzyme supplements, salivary supplements
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Stroke
Salivary gland disorder Extreme surgery or the head or neck |
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Pt. who may need digestive enzyme supplements, pancreatic enzyme supplements
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common duct problems
pancreatic disease cystic fibrosis |
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MOA of saliva substitutes
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contains electolytes and carbomethycellulose to act as a thickening agent in dry mouth conditions
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MOA of pancreatic enzymes
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replacement enzymes that help the digestion and absorption of fats, proteins, and carbs
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Contraindications of saliva sub?
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Allergy
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Contraindication of pancreatic enzymes
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Allergy
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Caution saliva sub in?
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pat. with CHF, HTN, and renal failure
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Caution pancreatic enzymes in?
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pregnancy and lactation
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Saliva sub adverse effect
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complication from abn electrolytes- increased levels of Mg, NA, and K
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Pancreatic sub adverse effect
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GI irritation, N/D, abdominal cramps
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Prototype drug for H2
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Zantac or Rantidine
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Interactions with Zantac?
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reduces abs. of ketocanozole
smoking decreases effectiveness |
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Nursing Consideration for Antacids are
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assess for renal insufficency
assess for liver disease assess for cardiac HX how much and how lon monitor electrolytes take either before or after meals |
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Nursing considerations for PPI
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Prilosec or Omeperazole
monitor liver and renal functions admin 30 minutes prior to eating can be taken w/ antacids if infused to fast can cause extra side effects don't break or crush pill |
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Prototype digestive enzyme
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Pancrelipase- replacement theraphy in patients with defiecent exocrine pancreatic secreations
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Pharmokinetics for Pancrealipase
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not generally absorbed systemically
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Nursing considerations for digestive enzymes
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monitor renal and liver funct
albumin and total protein on labs |
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What H2 antagonist has been associated with antiandrogenic effects?
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Cimitidine
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Nursing Considerations for Antipeptic Agents
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renal or liver disease
GI Bleeding Weight loss electrolyte imbalance cardicac HX |
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Nursing considerations for prostaglandins
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renal or liver disease
GI Bleeding Weight loss electrolyte imbalance cardicac HX |
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Actions of drugs that affect motor activity of the GI tract
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speed up or improved movement of the intestinal contents when movement becomes slow or sluggish
* decrease movement when rapid moveement occure, diarrhea |
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Types of laxatives
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Chemical Stimulants
Bulk Stimulants Lubricants |
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Main concern with diarrhea is
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Fluid loss and malnutrition
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MOA of chemical stimulants
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chemically irritate the lining of the GI tract
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MOA of Bulk stimulants
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cause the fecal matter to increase in bulk
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MOA of Lubricants
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help the intestiinal contents move more smoothlye
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Types of Chemical Stimulants
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Cascara ( Exlax ) reliable agent that leads to intestinal evacuation
Senna (Senokot) reliable drug similar to cascara Castor Oil ( Neoloid ) old standby for thorough evacuation of the intestine Bisacodyl ( Ducolax) very popular OTC laxative |
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Types of Bulk Stimulants
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Magnesium sulfate Epsom sal.
Magnesium Citrate Magnesium Hydroxide M of M Lactulose Chronulac Polycarbophi Fibercon Psyllium Metamucil |
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Types of lubricationg laxatives
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Docusate Colace
Glycerin Sanisupp Minerl Oil Agoral Plain |
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Indications for laxatives
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short term relief of constipation
prevent straining evacuate the bowel for DX proc. removal of ingested poison adjunce in antihelmintic TX |
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Contraindication for laxative
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acute adb. disorders- constipation
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Caution for laxative
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pregnancy
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Adverse effects of laxatives
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GI- diarrhea, abd cramping, and nausea
CNS- dizziness, HA and weakness CV- sweating, palpitations, flushing, and fainting CATHARTIC DEPENDENDCY |
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Prototype for bulk laxative
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psyllim mucilloid
Metamucil |
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MOA of metamucil
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absorb water adding size to fecal mass
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Therapeutic Effect
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producing regular formed BM
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SE for Metamucil
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abd fullness, abd cramping, fainting,
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AE for metamucial
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esophageal or GI obstruction
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Caution for Metamucil
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pregnancy
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Contraindication for Metamucil
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Undiagnosed ABD pain
obstruction fecal impaction |
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PT for metamucil
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take each dose with 1-2 glasses of water
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Saline and Osmotic
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Milk of Magnesia
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Indication for MOM
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acute constipation
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MOA for MOM
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pull water into fecal mass to produce watery stool
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TX effect
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fast relief
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SE of MOM
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diarrhe
abd cramping |
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AE of MOM
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hypermagnesmia
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Caution of MOM
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prenancy
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Prototype Chemical Laxative
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Castor Oil, the old standby
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Castor Oil indication
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evacuation of the bowel for DX procedures, to remove ingested poisons from lower GI tract, and antihelminth TX
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MOA of Castor Oil
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directly stimulates the nerve plexus in the intestinal wall
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Pharmacokinetics of Castor oil
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not absorbed systemically
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Adverse Effects of Castor Oil
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Diarrhea, abdominal cramps, perianal irritation, dizziness, and CARTHARTIC DEPENDENCE
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Nursing consideration for stimulant laxatives
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Bowel pattern assessment
GI bleeding or obstruction Bowel patterns after admin of meds |
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Prototype bulk laxative
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Mag Citrate
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Indications for Mag citrate
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Short term relief of constipation to prevent straining when clinically undesirable, evacuation of the bowel for DX procedures, to remove ingested poisons from lower GI tract, and antihelminth TX
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Actions of Mag Citrate
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increases the motility of the GI tract by increasing the fluid in teh instestinal contents, enlarges bulk, stimulates stretch receptors, and activates local activity
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Adverese Effects of Mag Citrate
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Diarrhea, adb cramps, bloating, perianal irritation, dizziness
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Nursing consideration for bulk laxatives, mag citrate
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changes in bowel pattern
electrolytes drink water |
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Prototype lubricant laxative
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Mineral Oil
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Indication for mineral oil
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short term relief of constipation to prevent straining with clinically undesirable, to remove ingested posions from lower GI tract, and antihelminth TX
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MOA of mineral oil
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forms a slippery coat on teh contents of the intestinal tract
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Pharmacokinetics of mineral oil
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not absorbed chemically
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Adverse effects of Mineral Oil
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diarrhea, adb cramping, bloating, perianal irriatation, dizziness, interference of absorption of fat soluable vit., leakage of stool and staining
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Nursing consideration for lubricant laxatives
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changes in bowel pattern
Hx of hemrroids or rectal bleeding |
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Prototype for GI Stimulants
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Reglan
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Indications for use of Reglan
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relief of acute and chronic diabetic gastroparitis, USED FOR CHEMO PATIENTS
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MOA for Reglan
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blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine
leads to increased GI activity and rapid movement of food through the upper GI tract Stimulates the Parasympatheic NS |
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Indication of use for Reglan
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rapid movement of GI contents is desirable
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Pharmokinetics of Reglan
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rapidly absorbed metabolized in the liver
excreted in the urine |
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Adverse Effects of Reglan
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NVD, intestinal spasms, cramping, decreased blood pressure, and HR, weakness, and fatigue
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Druto to Drug interaction with Reglan
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Digoxin
Cyclosporine Alcohol |
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Prototype Antidiarrheal Drugs
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Loperamide Imodium
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MOA of immodium
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has a direct effect on the muscle layers of the GI tract slows peristalsis, and allows time for absorption of fluid and electrolytes
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Indications of immodium
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relief of acute or chronic diarrhea
reduction of volume of discharge from ileostomies prevention or TX of traverlers diarrhea |
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Contratindication of Immodium
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allergy
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Caution Immodium in
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pregancy
lactation Hx of GI Obstruction HX of acute abd conditions Diarrhea D/T posioning |
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Adverse Effects of immodium
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Constipation, adb distention, adb discomfort, nausea, dry mouth, toxic megacolon, fatigue, weakness, dizziness
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Pepto Bismal can be involved in salicylate toxicty
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True
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Why are laxatives to be taken on a short term basis only
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To prevent cathartic dependence
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N and V
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most common and most uncomfortable complaints
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Emetics
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Cause vomiting, not recommended for home use
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Antiemetic
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decrese or prevent nausea and vomiting
centrally acting for locally acting varying degrees of effectiveness |
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Antiemetics Phenothiazines Action
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Depresses various areas of the CNS
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Indications of Phenothiazines
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TX or N/V
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Adverse Effects of Phenothiazines
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Drowsiness
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Nonphenothiazines Action
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Acts to reduce the responsiveness of the nerve cells in teh CTZ to circulation chemicals that induce vomiting
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Indications for Nonphenothiazines
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Prevention fo N and V
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Adverse effects of Nonphenothiazines
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Drowsiness
fatigue restlessness extrapyramidal SX |
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Phenothiazines prototype
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procholorperazine
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Procholorperazine Adverse Effects:
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Drowsiness, dystonia, photophobia, blurred vision, urine discolored pink to red brown
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Prototype for Nonphenothiazines
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Metoclopramide
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Prototype for anticholernergic/ antihistamines
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Meclizine
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Indication of Meclizine
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blocks cholinergic receptors in the vomiting center, has peripheral anticholinergic effects
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Adverse effects of Meclizine
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Drowsiness
confusion dry mouth anorexia urinary frequency |
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Prototype for serotonin 5HT receptor blockers
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Ondansetron Zofran
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Indications for Zofran
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control of sever nausea and vomitng associated with emetogenic cancer, chemo, radiation therapy, treatment or postoperative nausea and vomiting
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MOA of Zofran
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Blocks specific receptor sites associted with nausea and vomiting periperhally and in the CTZ
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MOA of meclizine
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blocks cholernergic receptors in the vomiting center has peripheral anticholernergic effects
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Adverse effects of Zofran
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HA
dizziness drowsiness myalgia urinary retention constipation pain at injection site |
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Nursing consideration for Antiemetics
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becareful giving these drugs with poisoning
fluid balance weight gain or loss constipation |
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What is an anticholinergic antiemetic that is recommened for vestibular problems?
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Meclizine
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Which type of antacid ins considered safe for patients with renal failure?
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Aluminum containing antacids
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Which drug class would be sued as first line theraphy for GERD that has not resond to customary medical TX?
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PPI
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Which of te follwing statments about PPI are true
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They should be taken 30-60 minutes before meals
They are part of the TX for H. Pylori There are very few adverse effects with these drugs |
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Which drug should be avoided because of possible toxicity in the patients taking pepto bismal?
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Aspirin
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Which of the following drugs would provide rapid relief of constipation?
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MOM Magnesion Hydroxide
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Which classes of anti-nauseas medications have been proven to be effective in preventing chemotherapy induced nausea?
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Serotonin Blockers
Tetrahydrocannabinoids |
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Which statement best describes the MOA for the drug simethicone?
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It buffers the effect of pepsin on the gastric wall
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Which of the following drugs may interact with an H2 receptor antagonist?
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Ketoconazole
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