Medications For Disorders Of The Gallbladder, Liver, Biliary Tract, And Exocrine Pancreas

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gemcitabine hydrochloride

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Brand Name: Gemzar

Actions Exhibits antitumor activity; indicated as first-line treatment of locally advanced or metastatic adenocarcinoma of the pancreas

Side effects: Myelosuppression; nausea and vomiting; macular papular pruritic rash

Nursing interventions Monitor: CBC. Provide antiemetic to control nausea and vomiting. Provide relief measures to control pruritus

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Lactulose

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Brand Name: Chronulac, Cephulac

Actions: Acidifies colonic contents, thus decreasing absorption of ammonia from gut; also has cathartic laxative properties; primarily used in hepatic encephalopathy

Side Effects: Nausea, vomiting, diarrhea

Nursing Interventions Titrate dose to three or four loose stools per day; monitor for dehydration; monitor for serum ammonia levels and improved mental status

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Spironolactone

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Brand Name Aldactone

Action: Competes with aldosterone at receptor sites in distal tubule, resulting in excretion of sodium chloride and water and retention of potassium and phosphate; used in cirrhosis of the liver with ascites

Side Effects Headache, confusion, diarrhea, bleeding, dysrhythmias, impotence, hypokalemia

NURSING INTERVENTIONS Assess electrolytes, sodium, chloride, potassium, BUN, serum creatinine. Weigh daily; monitor I&O. Administer in the morning to avoid interference with sleep

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meperidine

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Brand NAme: Demerol

Action: Binds to opiate receptors in CNS; alters perception of and response to painful stimuli, while producing generalized CNS depression; used for biliary pain because morphine may cause spasms of the sphincter of Oddi

Side effects: Sedation, confusion, respiratory depression, hypotension, bradycardia, nausea, vomiting, urinary retention

Nursing interventions: Assess type, location, intensity of pain before and 1 hr after administration. If respiratory rate is <10 breaths/min, assess level of sedation

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propantheline

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Brand Name: Pro-BanthineAction: Antisecretory and antispasmodic agent; slows GI motility through anticholinergic activity; decreases pancreatic activity

Side effects: Drowsiness, confusion, dry mouth, constipation, urinary retention, tachycardia, blurred vision

Nursing interventions: Avoid use with other CNS depressants or alcohol; avoid driving or other activities until accustomed to effects; may cause hypotension when given intravenously; do not use in patients with Parkinson's disease

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vasopressin

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Brand Name: Pitressin

Action: Synthetic pituitary agent; antidiuretic effects on kidney; a potent vasoconstrictor; used to treat bleeding esophageal varices

Side effects: Hypertension; ischemia to heart, mesenteric organs, and kidneys; angina; myocardial infarction; water retention; hyponatremia

Nursing interventions: Use with caution in older adults and in patients with known coronary artery disease or known CHF; discontinue if chest pain develops; monitor urinary output and serum sodium

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neomycin

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Brand Name: Mycifradin, MyciguentAction: Inhibits protein synthesis in bacteria at the level of the 30S ribosome subunit; decreases the number of ammonia-producing bacteria in the gut as part of management of hepatic encephalopathy

Side effects: Ototoxicity; local stinging, burning; nephrotoxicity

Monitor neurologic status and renal function

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cholestyramine

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Brand Name: QuestranActions: Binds bile acids in the GI tract, forming an insoluble complex; relief of pruritus associated with elevated levels of bile acids

Side effects: Nausea, constipation, abdominal discomfort

Assess severity of pruritus and skin integrity

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pancrelipase

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Brand Name: Pancrease, Cotazym

Action: Increased digestion of fats, carbohydrate, and proteins in the GI tract; treatment of pancreatic insufficiency associated with chronic pancreatitis, pancreatectomy.

Side effects: Diarrhea, nausea, stomach cramps, abdominal painAssess patient's nutritional status; monitor stools for high fat content;

assess patient for allergy to pork; administer immediately before meals or with meals

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carbamazepine

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Brand: Tegretol

Class: Anticonvulsants

It can treat seizures, nerve pain, and bipolar disorder.

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ondansetron

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Brand name: Zofran

Class: Antiemetics

It can prevent nausea and vomiting.

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dexamethasone

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Brand name: Decadron

Class: Glucocorticoids

Steroid

It can treat inflammation.

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hydroxyzine

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Brands: Vistaril, Atarax

Class: Antihistamine

It can treat anxiety, nausea, vomiting, allergies, skin rash, hives, and itching. It can also be used with anesthesia before medical procedures.

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amitriptyline

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Tricyclic antidepressants:

Nerve pain medication and antidepressant

It can treat depression.

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diazepam

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Valium

Antianxiety agents:

Anxiolytic and sedative

It can treat anxiety, muscle spasms, and seizures.

Controlled substance

Can cause paranoid or suicidal ideation and impair memory, judgment, and coordination.Combining with other substances, particularly alcohol, can slow breathing and possibly lead to death.