Term
| Types of acid-controlling drugs |
|
Definition
-Antacids
-H2 antagonists
-Proton pump inhibitors |
|
|
Term
| Mechanism of Action for Antacids |
|
Definition
-Neutralize stomach acid
-Antacids DO NOT prevent the overproduction of acid
-Antacids DO neutralize the acid once it is in the stomach |
|
|
Term
|
Definition
Reduction of pain associated with acid-related
disorders
¢Raising gastric pH from 1.3 to 1.6 neutralizes 50% of the gastric acid
¢Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid
¢Reducing acidity reduces pain |
|
|
Term
| OTC Antacids are available as |
|
Definition
Capsules and tablets
Powders
Chewable tablets
Suspensions
Effervescent granules and tablets |
|
|
Term
antacids can be used alone or in combination methods
some combination methods are.. |
|
Definition
¢Aluminum salts
¢Magnesium salts
¢Calcium salts
¢Sodium bicarbonate |
|
|
Term
|
Definition
¢Have constipating effects
¢Often used with magnesium to counteract constipation
¢Often recommended for patients with renal disease (more easily excreted) |
|
|
Term
| Examples of aluminum Salts |
|
Definition
Aluminum carbonate: Basaljel
Hydroxide salt: AlternaGEL
Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel |
|
|
Term
| Antacids: Magnesium Salts |
|
Definition
¢Commonly cause diarrhea; usually used with other drugs to counteract this effect
¢Dangerous when used with renal failure—the failing kidney cannot excrete extra magnesium, resulting in accumulation |
|
|
Term
|
Definition
¢Forms: many, but carbonate is most common
¢May cause constipation, kidney stones
¢Also not recommended for patients with renal disease—may accumulate to toxic levels
¢Long duration of acid action may cause increased gastric acid secretion (hyperacidity rebound)
¢Often advertised as an extra source of dietary calcium |
|
|
Term
|
Definition
—Tums (calcium carbonate) |
|
|
Term
| example of magnesium salts |
|
Definition
Hydroxide salt: magnesium hydroxide (MOM)
Carbonate salt: Gaviscon (also a combination product)
Combination products such as Maalox, Mylanta (aluminum and magnesium) |
|
|
Term
| Antacids -- Sodium Bicarbonate |
|
Definition
¢Highly soluble
¢Buffers the acidic properties of HCl
¢Quick onset, but short duration
¢May cause metabolic alkalosis
¢Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency |
|
|
Term
|
Definition
¢used to relieve the painful symptoms associated with gas
¢Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products |
|
|
Term
Histamine Type 2 (H2)
Antagonists |
|
Definition
Reduce acid secretion
All available OTC in lower dosage forms
Most popular drugs for treatment of acid-related disorders
cimetidine(Tagamet) nizatidine(Axid) famotidine(Pepcid) ranitidine (Zantac)
ALL END IN -TIDINE |
|
|
Term
All Histamine Type 2 antagonists (H2)
ends in.... |
|
Definition
|
|
Term
| H2 Antagonists: Drug Effect |
|
Definition
¢Suppressed acid secretion in the stomach
¢Can also be give for allergic reactions although uncommon |
|
|
Term
H2 Antagonists: Indications
why do we give it |
|
Definition
¢GERD
¢PUD
¢Erosive esophagitis
¢Adjunct therapy in control of upper GI bleeding
¢Pathologic gastric hypersecretory conditions |
|
|
Term
H2 Antagonists: Adverse Effects |
|
Definition
¢Overall, very few adverse effects
¢Cimetidine may induce impotence and gynecomastia
¢May cause:
Headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects |
|
|
Term
|
Definition
Does not play well with other meds
can increase drug levels
does not like MAOIs at all |
|
|
Term
H2 Antagonists:
Drug Interactions |
|
Definition
¢cimetidine
Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels
All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption
¢SMOKING has been shown to decrease the effectiveness of H2 blockers |
|
|
Term
H2 Antagonists:
Nursing Implications |
|
Definition
¢Assess for allergies and impaired renal or liver function
¢Use with caution in patients who are confused, disoriented, or elderly
¢Take 1 hour before or after antacids
¢For intravenous doses, follow administration guidelines |
|
|
Term
|
Definition
•The parietal cells release positive hydrogen ions (protons) during HClproduction
•This process is called the “proton pump”
•H2 blockers and antihistamines do not stop the action of this pump
JUST KNOW THAT IT SUPPRESSES ACID |
|
|
Term
PRoton Pump Inhibitors
Drug effects |
|
Definition
¢Total inhibition of gastric acid secretion
lansoprazole (Prevacid)
omeprazole (Prilosec)*
rabeprazole (Aciphex)
pantoprazole (Protonix) (IV form available)
esomeprazole (Nexium |
|
|
Term
| All proton pump inhibitors are.... |
|
Definition
|
|
Term
Proton Pump Inhibitors:
Adverse Effects |
|
Definition
¢Safe for short-term therapy
¢Some approved for long-term therapy
¢Adverse effects uncommon
¢Long term use can cause a decrease in B12 absorption |
|
|
Term
Proton Pump Inhibitors:
Nursing Implications |
|
Definition
¢Assess for allergies and history of liver disease
¢Pantoprazole is the only proton pump inhibitor available for parenteral administration, and can be used for patients who are unable to take oral medications
¢May increase serum levels of diazepam, phenytoin, and cause increased chance for bleeding with warfarin |
|
|
Term
Proton Pump Inhibitors:
Nursing Implications (cont’d) |
|
Definition
¢The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 g or the tube may become clogged
¢Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules
¢Proton pump inhibitors often work best when taken 30 to 60 minutes before meals |
|
|
Term
|
Definition
¢Cytoprotective drug
¢Used for stress ulcers, PUD
¢Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas
¢Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)
¢Little absorption from the gut
¢May cause constipation, nausea, and dry mouth
¢May impair absorption of other drugs—give other drugs at least 2 hours before sucralfate
¢Do not administer with other medications
¢Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels
|
|
|
Term
|
Definition
¢Synthetic prostaglandin analog
¢Prostaglandins have cytoprotective activity
Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate
Promote local cell regeneration
Help to maintain mucosal blood flow
¢Used for prevention of NSAID-induced gastric ulcers
¢Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea
|
|
|
Term
|
Definition
¢Antiflatulent drug
¢Used to reduce the discomforts of gastric or intestinal gas (flatulence)
¢Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones
¢Result is decreased gas pain and increased expulsion via mouth or rectum |
|
|
Term
Over-the-counter
antiflatulents |
|
Definition
Activated charcoal
Simethicone
¢Alters elasticity of mucus-coated bubbles, causing them to break
¢Used often, but there are limited data to support effectiveness |
|
|
Term
| Antacids: Adverse Effects |
|
Definition
Minimal, and depend on the compound used
¢Aluminum and calcium
Constipation
¢Magnesium
Diarrhea
¢Calcium carbonate
Produces gas and belching; often combined with simethicone |
|
|
Term
| Antacids: Drug Interactions |
|
Definition
¢Adsorption of other drugs to antacids
Reduces the ability of the other drug to be absorbed into the body
¢Chelation
Chemical binding, or inactivation, of another drug
Produces insoluble complexes
Result: reduced drug absorption
¢Increased stomach pH
Increased absorption of basic drugs
Decreased absorption of acidic drugs
¢Increased urinary pH
Increased excretion of acidic drugs
Decreased excretion of basic drugs
|
|
|
Term
| Antacids: Nursing Implications |
|
Definition
¢Assess for allergies and preexisting conditions that may restrict the use of antacids, such as:
Fluid imbalances
Pregnancy
Renal Disease
GI obstruction
Heart Failure (HF)
¢Patients with HF or hypertension should not use antacids with high sodium content |
|
|
Term
| Antacids: Nursing Implications |
|
Definition
¢Use with caution with other medications due to the many drug interactions
¢Most medications should be given 1 to 2 hours after giving an antacid
¢Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset |
|
|
Term
| Antacids: Nursing Implications (cont’d) |
|
Definition
¢Be sure that chewable tablets are chewed thoroughly, and liquid forms are shaken well before giving
¢Administer with at least 8 ounces of water to enhance absorption (except for the “rapid dissolve” forms)
¢Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as cancer or bleeding ulcers
¢If symptoms remain ongoing, patient should seek medical evaluation
|
|
|
Term
Antidiarrheals:
Mechanism of Action
adsorbents
Adsorbents
Adsorbents
Adsorbents |
|
Definition
¢Coat the walls of the GI tract
¢Bind to the causative bacteria or toxin, which is then eliminated through the stool
¢Examples: bismuth subsalicylate (Pepto-Bismol), activated charcoal, aluminum hydroxide, others |
|
|
Term
Antidiarrheals:
Mechanism of Action
antimotility drugs: anticholinergics |
|
Definition
¢Decrease intestinal muscle tone and peristalsis of GI tract
¢Result: slowing the movement of fecal matter through the GI tract
¢Examples: belladonna alkaloids, (atropine, hyoscyamine) |
|
|
Term
Antidiarrheals:
Mechanism of Action
Antimotility drugs: opiates |
|
Definition
¢Decrease bowel motility and relieve rectal spasms
¢Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed
¢Reduce pain by relief of rectal spasms
Examples: paregoric, opium tincture, codeine, loperamide (OTC), diphenoxylate |
|
|
Term
Antidiarrheals:
Mechanism of Action
Intestinal Flora modifiers |
|
Definition
¢Probiotics or bacterial replacement drugs
¢Bacterial cultures of Lactobacillus organisms
work by:
Supplying missing bacteria to the GI tract
Suppressing the growth of diarrhea-causing bacteria
¢Example: L. acidophilus (Lactinex) |
|
|
Term
Antidiarrheals:
Combination Products |
|
Definition
Diphenoxylate with atropine (Lomotil)
¢Diphenoxylate is combined with subtherapeutic amounts of atropine
¢This discourages recreational opiate drug use
¢Large dosages will result in extreme anticholinergic effects (dry mouth, abdominal pain, tachycardia, blurred vision) |
|
|
Term
Antidiarrheals:
Adverse Effects
Adsorbents |
|
Definition
¢Increased bleeding time
¢Constipation, dark stools
¢Confusion, twitching
¢Hearing loss, tinnitus, metallic taste, blue gums |
|
|
Term
Antidiarrheals:
Adverse Effects
Anticholinergics |
|
Definition
¢Urinary retention, hesitancy, impotence
¢Headache, dizziness, confusion, anxiety, drowsiness
¢Dry skin, rash, flushing
¢Blurred vision,
¢Hypotension, bradycardia, |
|
|
Term
Antidiarrheals:
Adverse Effects
Opiates |
|
Definition
¢Drowsiness, sedation, dizziness, lethargy
¢Nausea, vomiting, anorexia, constipation
¢Respiratory depression
¢Hypotension
¢Urinary retention
¢Flushing |
|
|
Term
| Antidiarrheals: Interactions |
|
Definition
¢Adsorbents decrease the absorption of many drugs, including digoxin, clindamycin, quinidine, hypoglycemic drugs, others
¢Adsorbents cause increased bleeding time and bruising when given with anticoagulants
¢Antacids can decrease effects of anticholinergicantidiarrheal drugs
¢Many other interactions |
|
|
Term
Antidiarrheals:
Nursing Implications |
|
Definition
¢Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies
¢DO NOT give bismuth subsalicylate to children or teenagers with chickenpox because of the risk of Reye’s syndrome
¢Use adsorbents carefully in elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion
¢Do not administer anticholinergics to patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon |
|
|
Term
Antidiarrheals:
Nursing Implications |
|
Definition
¢Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes
¢Assess fluid volume status, I&O, and mucous membranes before, during, and after initiation of treatment
¢Teach patients to notify their physician immediately if symptoms persist
¢Monitor for therapeutic effect
|
|
|
Term
|
Definition
•Abnormally infrequent and difficult passage of feces through the lower GI tract
•Symptom, not a disease
•Disorder of movement through the colon and/or rectum
•Can be caused by a variety of diseases
or drugs |
|
|
Term
|
Definition
¢Bulk forming
¢Emollient
¢Hyperosmotic
¢Saline
¢Stimulant
¢Peripherally acting opioid antagonists |
|
|
Term
Laxatives: Mechanism of Action
Bulk forming
Bulk forming |
|
Definition
¢High fiber
¢Absorb water to increase bulk
¢Distend bowel to initiate reflex bowel activity
¢Examples:
psyllium (Metamucil)
methylcellulose (Citrucel) |
|
|
Term
Laxatives: Mechanism of Action
Emollient |
|
Definition
¢Stool softeners and lubricants
¢Promote more water and fat in the stools
¢Lubricate the fecal material and intestinal walls
¢Examples:
Stool softeners: docusate salts (Colace, Surfak)
Lubricants: mineral oil |
|
|
Term
Laxatives:
Mechanism of Action
hyperosmotic |
|
Definition
¢Increase fecal water content
¢Result: bowel distention, increased peristalsis, and evacuation
¢Examples:
polyethylene glycol (GoLYTELY)
sorbitol, glycerin
lactulose (also used to reduce elevated serum ammonia levels) |
|
|
Term
Laxatives:
Mechanism of Action
Saline |
|
Definition
¢Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines
¢Result: bowel distention, increased peristalsis, and evacuation |
|
|
Term
Laxatives:
Mechanism of Action
Saline Laxative examples |
|
Definition
¢Magnesium hydroxide (Milk of Magnesia)
¢Magnesium citrate (Citroma) |
|
|
Term
Laxatives:
Mechanism of Action
Stimulant |
|
Definition
¢Increases peristalsis via intestinal nerve stimulation
¢Examples:
senna (Senekot)
bisacodyl (Dulcolax) |
|
|
Term
| Peripherally Acting Opioid Antagonists |
|
Definition
¢Treatment of constipation related to opioid use and bowel resection therapy
¢Block entrance of opioid into bowel
¢Strict regulations for use
¢Allow bowel to function normally with continued opioid use
methylnaltrexone (Relistor)
alvimopan (Entereg) |
|
|
Term
| Bulk forming laxitives : USE |
|
Definition
Acute and chronic
constipation
Irritable bowel syndrome
Diverticulosis |
|
|
Term
|
Definition
Acute and chronic
constipation
Softening of fecal impaction; facilitation of BMs in anorectal conditions |
|
|
Term
|
Definition
Chronic constipation
Diagnostic and surgical preps |
|
|
Term
|
Definition
Constipation
Diagnostic and surgical preps |
|
|
Term
|
Definition
Acute constipation
Diagnostic and surgical preps |
|
|
Term
Laxatives
Bulk forming Adverse Effects |
|
Definition
Impaction
Fluid overload
Electrolyte imbalances
Esophageal blockage |
|
|
Term
Laxatives
Hyperosmotic
Adverse Effects |
|
Definition
Abdominal bloating
Electrolyte imbalances
Rectal irritation |
|
|
Term
Laxatives
saline
adverse Effects
|
|
Definition
Magnesium toxicity (with renal insufficiency)
Cramping
Electrolyte imbalances
Diarreha
Increased thirst |
|
|
Term
laxatives
Emollient
adverse Effects
|
|
Definition
Skin rashes
Decreased absorption
of vitamins
Electrolyte imbalances
Lipid pneumonia |
|
|
Term
laxatives
Stimulant
adverse effects |
|
Definition
Nutrient malabsorption
Skin rashes
Rectal irritation
Electrolyte imbalance
Gastric irritation
Rectal irritation |
|
|
Term
| All laxatives can cause __________ |
|
Definition
|
|
Term
Laxatives: Nursing Implications
|
|
Definition
¢Obtain a thorough history of presenting symptoms, elimination patterns, and allergies
¢Assess fluid and electrolytes before initiating therapy
¢Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain
¢A healthy, high-fiber diet and increased
fluid intake should be encouraged as an alternative to laxative use
¢Long-term use of laxatives often results in decreased bowel tone and may lead to dependency
¢All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated
|
|
|
Term
| Laxatives: Nursing Implications |
|
Definition
¢Patients should take all laxative tablets with
6 to 8 ounces of water
¢Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 ounces) of water
¢Monitor for therapeutic effect
¢Give bisacodyl with water because of interactions with milk, antacids, and juices
¢Inform patients to contact their physician if they experience severe abdominal pain, muscle weakness, cramps, and/or dizziness, which may indicate possible fluid or electrolyte loss
|
|
|
Term
Antiemetic and Antinausea Drugset
Mechanism of Action and
Other Indications
Anticholinergic drugs (ACh blockers)
Drugs |
|
Definition
¢Bind to and block acetylcholine (ACh) receptors in the inner ear labyrinth
¢Block transmission of nauseating stimuli to CTZ
¢Also block transmission of nauseating stimuli from the reticular formation to the VC
¢Scopolamine
Also used for motion sickness |
|
|
Term
Antiemetic and Antinausea Drugset
Mechanism of Action and
Other Indications
Antihistamine drugs (H1 receptor blockers) |
|
Definition
¢Inhibit ACh by binding to H1 receptors
¢Prevent cholinergic stimulation in vestibular and reticular areas, thus preventing nausea and vomiting
¢Also used for motion sickness, nonproductive cough, allergy symptoms, sedation
dimenhydrinate (Dramamine)
diphenhydramine (Benadryl)
meclizine (Antivert) |
|
|
Term
Antiemetic and Antinausea Drugset
Mechanism of Action and
Other Indications
Antidopaminergic drug |
|
Definition
¢Block dopamine receptors on the CTZ
prochlorperazine (Compazine)
promethazine (Phenergan)
droperidol (Inapsine): Use is controversial because of associated cardiac dysrhythmia
¢Also used for psychotic disorders, intractable hiccups
¢Others |
|
|
Term
Antiemetic and Antinausea Drugset
Mechanism of Action and
Other Indications
Prokinetic Drugs |
|
Definition
¢Block dopamine in the CTZ
¢Cause CTZ to be desensitized to impulses it receives from the GI tract
¢Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents
¢metoclopramide (Reglan),
¢Long-term use may cause irreversible tardivedyskinesia
¢Also used for GERD, delayed gastric emptying |
|
|
Term
Antiemetic and Antinausea Drugset
Mechanism of Action and
Other Indications
Serotonin Blockers |
|
Definition
¢Block serotonin receptors in the GI tract, CTZ, and VC
dolasetron (Anzemet)
granisetron (Kytril)
ondansetron (Zofran)
palonosetron (Aloxi)
¢Used for nausea and vomiting in patients receiving chemotherapy and for postoperative nausea and vomiting |
|
|
Term
Antiemetic and Antinausea Drugset
Mechanism of Action and
Other Indications
Tetrahydrocannabinoids |
|
Definition
¢Major psychoactive substance in marijuana
¢Inhibitory effects on reticular formation, thalamus, cerebral cortex
¢Alter mood and body’s perception of its surroundings
¢dronabinol (Marinol)
¢Used for nausea and vomiting associated with chemotherapy, and anorexia associated with weight loss in AIDS patients |
|
|
Term
Antiemetics
adverse effects |
|
Definition
¢Vary according to drug used
¢Stem from their nonselective blockade of various receptors |
|
|
Term
|
Definition
¢Used for nausea and vomiting including that caused by chemotherapy, morning sickness, and motion sickness
¢Adverse effects
Anorexia, nausea and vomiting, skin reactions
¢Drug interactions
May increase absorption of oral medications
Increase bleeding risk with anticoagulants |
|
|
Term
| Nursing Implications for Antiemetics |
|
Definition
¢Assess complete nausea and vomiting history, including precipitating factors
¢Assess current medications
¢Assess for contraindications and potential drug interactions
¢For chemotherapy, antiemetics are often given 1 to 3 hours before a chemotherapy drug
¢Many of these drugs cause severe drowsiness; warn patients about driving or performing any hazardous tasks
¢Taking antiemetics with alcohol may cause severe CNS depression
¢Teach patients to change position slowly to avoid hypotensive effects
¢Monitor for therapeutic effects
¢Monitor for adverse effects
|
|
|
