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54 Cards in this Set

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what's the ideal antacid?
magnesium hydroxide
rapid acting, high capacity for neutralizing HCl, & long duration of axn.
Which antacids cause constipation?
aluminum and calcium based
Which antacids are bad for renal insufficient pt?
Magnesium based.
Which antacids can cause diarrhea?
magnesium based
What are some commonly used classes of anti-diarrheal drugs?
opioid, anticholinergic, & bulk forming
Why shouldn't you give antacids @ the same time as other drugs?
many drugs are absorbed when in acidic environment. Also antacids bind to other drugs in the GI tract and interfere w/ abs.
what's the most effective class for chemo patient n/v?
selective serotonin antagonists
ondansetron(Zofran)
Granisetron(Kytril)
what is a nursing intervention with psyllium (Fiberall)?
must be well hydrated. b/c forms a gel w/ the water.
What is the action of laxatives and stool softener vs a cathartic?
cathartic quickly produces a semi-liquid to liquid stool whereas the others produce a soft formed stool.
When are laxatives contraindicated?
undiagnosed abd pain, intestinal obstruction, fecal impaction
what to use in diabetic keto-acidosis to bring up pH?
sodium bicarbonate
what drug/drug interaction is important w/ Aluminum based antacids?
Tetracycline, Warfarin, Digoxin.
What can sodium bicarbonate do systemically as well as treat acidosis?
aggrevate HTN and heart failure
What can excess magnesium do?
accumulate and cause CNS depression
When to administer antacids?
one hr before meals or 3 hours after and @ bedtime
Antiulcer meds - name some classifications...
histamine 2 receptor antagonists...proton pump inhibitors...antacids...cytoprotective agents
name some H2 receptor antagonists
1. ranitidine (Zantac)
2. Famotidine (Pepcid)
3. Cimetidine(Tagamet)
what does H2 receptor antagonists do?
suppresses the secretion of gastric acid and decreases the pepsin
What are the uses for H2 receptor antagonists?
PUD, GERD, prevents recurrence of ulcers, prevents stress ulcers, treats heartburn
Nursing intervention for H2receptor antagonists?
lower the dose in elderly and caution w/ renal impairment...
name some H2 receptor antagonists...
iii. DRUGS:
1. ranitidine (Zantac)
2. Famotidine (Pepcid)
3. Cimetidine(Tagamet)
Adverse effects of histamine 2 receptor antagonists...
Tagamet: inhibits drug metabolizing enzymes and thus can increase serum level of warfarin, phenytoin, theophylline, and lidocaine. 2. Zantac and Pepcid have few drug interactions, don’t inhibit enzymes, and can be take w/ or without food.
NURSING INTERVENTIONS: H2 RECEPTOR ANTAGONISTS
don’t administer within an hr of other drugs ESPECIALLY TAGAMET!
WHAT DO PROTON PUMP INHIBITORS DO?
Suppress gastric acid secretion by inh the enzyme system in the gastric cells. USE: PUD, GERD, erosive esophagitis, combined w/ two antibacterials to eradicate H-pylori.
PROTON PUMP INHIBITORS CAUTION
iii. CAUTION:
1. w/ severe hepatic dysfunction
2.Serum lvl of phenytoin, warfarin and diazepam may increase
NAME SOME PROTON PUMP INHIBITORS...
iv. DRUGS:
1. Omeprazole (Prilosec)
2. Lansoprazole (Prevacid)
3. Rabeprazole (Aciphex)
4. Pantoprazole (Protonix)
5. Esomeprazole (Nexium)
ADVERSE EFFECTS OF h+PUMP INH
A/E:
1. Prevacid= diarrhea
2. Prilosec = colic/pain in stomach
N/I FOR H+PUMP INH.
N/I:
1. qd usually some bid dosing
2. assess for epigastric pain/diarrhea
3. schedule drugs to avoid interactions
4. administer 30m to 1h b4 food!!
SUCRALFATE
activated by stomach acid to form a gel that coats and protects the ulcer surface
1. 4-8 wk tx – taken 1h preprandial (b4food) & @ bedtime (hs)
2. Sucralfate(Carafate) – cytoprotective agent
3. schedule 2h apart from other p.o. drugs !!!
WHAT'S THE MOST EFFECTIVE anti-diarrheal?
opioids: diphenoxylate+atropine=Lomotil
What are the antidiarrheals we need to know?
d. DRUGS: Otc and rx
i. Diphenoxylate (opiod)
ii. Atropine (anticholinergic)
iii. Lomotil (atropine 0.25mg + diphenoxylate 2.5mg) combination
iv. Loperamide (Imodium)
v. Psyllium (Fiberall, Metamucil)
What are some adverse effects of antidiarrheals?
e. A/E: antidiarrheals can cause constipation esp. bulk forming agents (give w/ plenty of h20 – prevent obstruction!!) Remember A/E of opioid and anticholinergics discussed earlier in the semester!!!!
i. Anticholinergic SE – dry mouth, blurred vision, can’s SPSS (Can’t: see pee sh*& spit)
ii. Opioid: drowsiness, sedation, drowsiness, resp depression, agitation, seizures
anti-hyperglycemic categories to know
biguanide(GLUCOPHAGE); ALPHAGLUCOSIDASE INHIBITOR(PRECOSE&GLYSET); THIAZOLIDINEDIONES(actos& avandia)
what is the mechanism of thiazolidinediones?
enhances the insulin action @ the cell receptor and post receptor sites and decreases insulin resistance.
what does the alph-glucosidase inhibitor do?
Works in small intestine to inhibit the enzyme alpha glucosidase to decrease carb metabolism and reduce teh rate of glucose absorption postprandially. Also it inhibits alpha amylase in the pancreas from using carbs as well.
what does the biguanides do?
prevents the liver making glycogen from non carbohydrates thus preventing excess glucose production.
name the types of insulin
rapid (humalog) - short (regular) - intermediate (NPH) - long acting(ultralente) - premixed (70/30 & 50/50)
what insulin works in
10-20 min
peaks in 30-90 min
and lasts 3-5h
rapid acting(humalog and novalog)
which insulin works in 30-60; peaks @ 2-4h; and lasts for 6-8h
short acting(regular)
which insulin starts in 1-4h; peaks @ 6-12; and lasts 24 h
intermediate(NPH or Lente)
Which insulin starts @ 4-6h; peaks in 18-20h; and lasts 24-36h?
long-acting: ultralente
what is a premixed insulin?
70/30 & 50/50 (nph and R) mixed: starts in 30m,peaks 8-12h, lasts 16-24h
Sulfonylureas
increase insulin from the pancreas and enhance the number and performance of insulin receptors on fat & muscle cells
What are some 1st generation sulfonylureas?
tolinase and diabinese
What is the 2nd generation of the sulfonylureas?
glucotrol, Micronase/Diabeta, amaryl.
insulin is a naturally occuring hormone.
produced/excreted from the islets of Langerhan's Beta cells. facilitates the passage of glucose in the liver and muscles.
all TPN pt?
must have insulin
Which anti-glycemic reduces intestinal absorption of glucose, improves lipid profiles, and reduces hepatic function by inhibiting glycogenolysis?
biguanides: glucophage(metformin)
name some thizolidinediones...
pioglitazone(actos) and rosiglitazone*(avandia)
what is the action of thiazolidinediones?
enhances insulin action @ the cell recptor and post receptor site and decreases insulin resistance.
What does acarbose adn miglitol do?
alpha glucosidase inhibitors: inh enzymes in SI and pancrease to lower complex carbohydrate metabolism. Lowers postprandial sugar absorption.
If serum creatinine is below 2.0mg/dL what shoudl you do if they are ordered alpha glucosidase ihnhibitors.
Do not give w/o physician approval.
how many hours b4 a procedure with contrast dye must glucophage be d/c
48h
which insulin can be given iv
regular