What type of drug is omeprazole (Prilosec)?

Antisecretory

Elevates pH

Can you crush omeprazole (Prilosec)?

Why?

No 

it has Enteric coated granules

What is omeprazole (Prilosec) 

Metabolized by?

Peptic ulcers

GERD

Erosive esophagitis

Chronic hypersecretory conditions

There are no Contra-indications for omeprazole (Prilosec).

True or False?

Other drugs metabolized by CYP 450

Is omeprazole (Prilosec) ok to use

while brest feeding?

Breast Feeding: not recommended

Which of these are common adverse effects of omeprazole (Prilosec)?

Na, V, Ha, Diarrhea, ↑bp, blood dyscrasias

HA

Diarrhea

What are the serious adverse effects of

omeprazole (Prilosec)?

What type of drug

is ranitidine (Zantac)?

Antisecretory 

inhibits prostaglandins which make mucosa*

What is ranitidine (Zantac) used to treat?

·         GERD

·         Duodenal ulcer

·         Gastric ulcer

·         Pathologic hypersecretory conditions

·         Prevention of upper GI bleeding

Heartburn/acid indigestion (OTC strength only)

Are there any contra-indications

with ranitidine (Zantac)?

If so, what?

ranitidine (Zantac) is generally well tolerated and has no Common Adverse Effects.

True or Fales?

ranitidine (Zantac) Serious  Adverse Effects include which of thess

Neutropenia, Agranulocytosis, Thrombocytopenia,

Autoimmune hemolytic or aplastic anemia

All

Neutropenia, Agranulocytosis, Thrombocytopenia, Autoimmune hemolytic or aplastic anemia

A nurse should know what about ranitidine

(Zantac) when giving it with antacids?

Give at least 2 hours apart from antacids

True or Fales?

If a pt can not affored the Rx of ranitidine

(Zantac) it is ok to use the OTC form.

Fales

· Do not substitute OTC drugs forms for prescription forms

What should a pt avoid while on 

ranitidine (Zantac)?

·         alcohol, caffeine, spicy food, products containing aspirin or ibuprofen, and smoking

What type of drug is aluminum hydroxide with magnesium hydroxide

(Maalox, Mylanta)?

GERD

Peptic ulcers

Prevents stress ulcer bleeding

Pts with CRF

PTs with CRF can not excreat the magnesium

aluminum hydroxide with magnesium hydroxide(Maalox, Mylanta)  cuases tow sideffects.

aluminum  causes _______

magnesium causes _______

Constipation: aluminum

Diarrhea: Mag

·         Interacts with many drugs due to increased gastric pH and urine pH

·         Administer 2 hours after other drugs

If a pt is out of their Rx Zantac it is ok to use Maalox or Mylanta in it's place.

True or Fales?

Fales

Do not substitute this drug for prescription drugs to treat peptic ulcer disease

What type of drug is metoclopramide

(Reglan)?

·         Increases peristalsis & gastric emptying

Antiemetic effect

what is metoclopramide (Reglan)

used to for?

 GI stimulant: Diabetic gastric   stasis

GERD

Antiemetic: Post-surgery, Chemotherapy

When is metoclopramide (Reglan)

Contra-indicated?

Of these what are common side effects

of metoclopramide (Reglan)?  

Na/Va, diarrhea, CNS complaints, blured vission                                

What are the serious side effects of 

metoclopramide (Reglan)?

What group of pts are more likely to experience tardive dyskinesia while taking  metoclopramide (Reglan)?

A nurse should know to give metoclopramide (Reglan)

when to maximize it's effects?

If a nurse notices depression, Parkinson-like symptoms, extrapyramidal effects, tardive dyskinesia, in a pt who is taking  metoclopramide (Reglan), what should the nurse do?

Hold further drug administration, contact prescriber

What type of drug is ondansetron

(Zofran)?

Prevents N/V

·         75% protein bound

Metabolized by CYP450 system

Prevents N/V in: Chemotherapy, Radiation

Certain post-operative states

What are common side effects

of ondansetron (Zofran)?

    HA, Constipation, Malaise

arrhythmias, hypotension, extrapyramidal effects

To get the best benifet from ondansetron (Zofran)

when should it be given?

What type of drug is magnesium hydroxide

(Milk of Magnesia)?

How does magnesium hydroxide

(Milk of Magnesia) work?

Attracts & retains water in intestinal lumen

Local effect  

·         Poorly absorbed

What is magnesium hydroxide

(Milk of Magnesia) used for?

magnesium hydroxide (Milk of Magnesia) 

is Contraindicated in what types of pts?

Acute abdomen, Renal failure

A pt taking magnesium hydroxide (Milk of Magnesia)

presents with Overactive GI activity,

dose she need to notify the MD?

What Serious Adverse Effects can devolope form a pt taking 

magnesium hydroxide (Milk of Magnesia)?

When giving magnesium hydroxide (Milk of Magnesia)

a nurse knows not to give it with watter because it will cause it to bind.

True or False?

False

  Pt should drink a glass of water after administration

magnesium hydroxide (Milk of Magnesia) is

for ____ term use only.

·         Attracts and retains water in the intestinal lumen of the colon.  Lactulose is metabolized by bacteria into acids and carbon dioxide.  These products increase the oncotic pressure in the colon and draw water into the stool.

The acids formed also draw ammonia into the stool for evacuation.  This action is used to decrease blood ammonia levels in hepatic coma and hepatic encephalopathy.

Lactulose (Cephulac) can only be given by enema.

True or False?

False

Can be given by enema or orally

What is Lactulose (Cephulac) 

used for?

Hepatic encephalopathy

 Hepatic coma

Constipation

Of these which are Common Adverse Effects of

Lactulose (Cephulac). 

Diarrhea, N/V, dry moulth, cardiac arest, overactive GI activity

What serious Adverse Effects can a pt

get from Lactulose (Cephulac)?

·         Safety issue with increase GI activity and patients with decreased or impaired LOC secondary to hepatic disease.

Lactulose (Cephulac) is recommended for 

long-term use with constipation.

True or False?

Fales

Not for long-term use with constipation

Pts taking Lactulose (Cephulac) you sould tach

s/s of ________ and ________  imbalances.

If a pt is taking Lactulose (Cephulac) the nurse should Monitor _________ status of patient.

• Blocks the 5-HT receptor.  It alters visceral sensation, decreasing abdominal discomfort and pain.

Lengthens the transit time in the bowel and creases chloride and water secretion.

• Rapidly absorbed.  Absorption is increased when taken with food.

Can be taken with or without food.

ALOSETRON (Lotronex) can also be usde to treat patients who have constipation with disease.

True or False?

False.

Not used in patients who have constipation with disease?

ALOSETRON (Lotronex) is not administered to anyone with IBS-Constipation.

True or False?

ALOSETRON (Lotronex) is _______ in any pt

with a  history of chronic constipation.

ALOSETRON (Lotronex)  

Should not be given to persons with a history of:

What is ALOSETRON (Lotronex)  

Common Adverse Effect?

• Constipation can lead to obstruction, perforation, impaction and toxic mega colon.

• Can develop ischemic colitis- s/s:  rectal bleeding, bloody diarrhea, abdominal pain.

• Not established in pediatric patients.
• Older adults may be at increased risk for constipation.
• Effectiveness in men not yet known.

A pt taking ALOSETRON (Lotronex) should be 

Instructed to report what?

• any constipation, rectal bleeding, bloody diarrhea, or new or worseining abdominal pain.

Pts taking ALOSETRON (Lotronex) should be encourage to drink sufficient fluids. 

True or False?

• Action unknown
• Possible inhibition of pathways resulting in decreasing production of prostaglandin, leukotrienes.

How can Mesalamine (Asacol)  5 ASA preparation be taken?

(rout)

• Patients with ulcerative colitis and proctosigmoiditis.
• Off label use for management of Crohns.

Mesalamine (Asacol)  5 ASA preparation is 

Contraindicated in what 4 types of pts?

• hypersensitivity to salicylates.
• In clients with active peptic ulcer disease.
• Use cautiously in patients with renal and hepatic impairment.

Of these which are Common Adverse Effects of Mesalamine (Asacol)  5 ASA preparation ?

Diarrhea, abdominal pain, cramps, flatulence, nausea, and headache.

all

Diarrhea, abdominal pain, cramps, flatulence, nausea, and headache.

• Rare- blood dyscrasias
• exacerbation of colitis,
• pericarditis,
• renal impairment and/or hepatotoxicity

contains the enzymes lipase, protease, and amylase which are responsible for the final phase of digestion

• Absorption, distribution, metabolism and excretion of this drug are unknown.

• Pancrelipase (Pancrease) can be used as ________ replacement therapy for patients with deficient exocrine ______ secretions:  cystic fibrosis, chronic pancreatitis, ductal obstructions

Contraindicated in patients who are hypersensitive to pork protein or enzymes.

Not used by patients with acute pancreatitis or acute exacerbations of chronic pancreatitis

Use gloves when preparing, as the powder may cause skin irritation. 

Inhaling the powder irritates the nasal mucosa and respiratory tract.

• Large dose may cause nausea, abdominal cramps, and diarrhea.
• Hyperuricosuria (the presence of excessive amounts of uric acid in the urine. ) and 
•  hyperuricemia (is a level of uric acid in the blood that is abnormally high.) have occurred with high doses.

• Pancrelipase (Pancrease) can be taken before or with meals.

• to manage obesity
• Alli- is available over the counter.

Used in conjunction with a weight loss diet and exercise program.

• chronic malabsorption syndrome or cholestasis.
• Hypersensitivity to drug.

• Organic cause of obesity such as hypothyroidism should be ruled out.

• Oily spotting
• Flatus with discharge of stool
• Increased defecation.
• Fecal incontinence.

A pt taking Orlistat (Xenical) should limit dietary ___. 

no more than 30% of daily calories.

While taking Orlistat (Xenical) meals should not contain fat.

True or False?

False

Take with all meals containing fat

Pts taking Orlistat (Xenical) need to take

fat-soluble vitamins. how should they be taken?

What is the function of Proteins (Amino Acids)

in the body?

How manny kals are in one gram

of Proteins (Amino Acids)?

What % Solutions are  

Proteins (Amino Acids) available in?

3%- 15% solutions.

Can come with or without electrolytes

What should the Protein replacement be in 

Catabolic patients?

 (Kg/Day)

What should the Protein replacement

be in pts with CRF?

(kg/day)

What should the Protein replacement

be in pts with ARF + catabolic?

What type solutions are 

carbohydrates available in?

Why should 20-70% solutions of dexterose

not be discontinued suddenly?

a temporary excess of insulin in the body

may cause s/s of hypoglycemia

through a central venous catheter,

with the tip in the superior vena cava.

10% or 20% solutions are available

( the 20% solution is better utilized by body)

What type of administration set should a nurse use with fats?

Why?

Use separate administration set, glass containers.

If plastices are used DEHP extract lipids from the set.

Before giving fats the nurse

should inspect it for what?

Inspect fat emulsions carefully for separation. 

Do not use if yellow streaking or droplets are present.

1 ml/

or 

60ml/hr

What Electrolytes are  necessary for long-term TPN?

5

potassium, magnesium, calcium, sodium,

chloride and phosphorus.

What Vitamin is not a component of

any of the adult vitamin mixtures. 

Vitamin K 

PT May need IM injections

lipids- 

so if lipids infused no injections needed

TPN Solutions Parenteral nutrition solutions should be

infused or discarded within what time frame? 

24 hours

 from once the administration set is attached.

The nurse should piggybacking medications

directly into TPN solutions.

True or Fales?

Fales

§  Piggybacking medications directly into TPN solutions is generally not recommended because of the guidelines that a designated port be used only for nutritional support.

In what 4 situations would a nurse

give a pt TPN?

10% deficit in pre-illness weight

Inability to take oral food or fluids within 7 days after surgery

Hypercatabolic situations (major infections or burns)

Nutritional support 

Patients with functional GI tract who have

insufficient oral nutrient intake.

One Disadvantage of Enteral Nutrition is that it is hard and dangerous to administer.

True or Fales?

Fales

It is relatively easy and safe to administer

For a pt to recive Enteral Nutrition

what two reflexes need to be intact?

A disadvantage of Enteral Nutrition is that the tubes can become clogged.

True or Fales?

     Incorrect tube placement is not a Complication of Enteral Nutrition, so it does not need to be checked. 

True or False?

False.

Incorrect tube placement can occur placement

should be verified 

pulmonary  ________ and diarrhea are complications

of Enteral Nutrition.

What Complications of metabolic imbalances are seen with Enteral Nutrition?

hypo or gyper glycemia,

hyperosmolar nonketotik dehydration.

What types on pts need 

Peripheral Parenteral Nutrition (PPN)?

Pts reciving Peripheral Parenteral Nutrition (PPN)

need to have a central line.

True or False?

False.

one advantage of PPN is you do not need

a central catheter

Peripheral Parenteral Nutrition (PPN) soulutions

are Less ________ then TPN. 

PPN cannot be used in nutritionally _______  patients.

PPN does not cause phlebitis.

True or False?

False

PPN May cause phlebitis.

TPN (2/1 admix) provides dextrose,  proteins and fats.

true or false

Fales

In these solutions dextrose and proteins are mixed together.  Fats are not added to the same bag.

provides calories; restores nitrogen balance and replaces essential vitamins, electrolytes and minerals. 

nutritionally complete

What metabolic complications may

arise with TPN?

What physical risk does a pt have with a 

central line insertion?

Total Nutrient Admixture (3/1) is the same as 2/1 with addition of lipids. 

Treu or False?

What is Malnutrition?

What is Starvation

Ø  24-72 hours:  first 2-3 days the losses are mainly glycogen and water.  After glycogen stores are depleted, protein is used to produce glucose.

>72 hours:  Increased mobilization of fat as the principal source of energy, reduction in the breakdown of protein

Chronically ill patients, elderly and those with prolonged starvation may suffer from this decrease in total intake of calories while maintaining adequate protein /calorie ratiol 

This can result in wasting of body fat and skeletal muscle with a decreased immune response to antigens.

Adequate intake of calories with poor protein intake= visceral protein wasting with preservation of fat and somatic muscle.  Can be seen with liquid diets, fat dies and long term use of IV fluids containing dextrose.

Ø  Loss of muscle mass

Ø  Impaired wound healing

Ø  impaired immunologic function

Ø  Decreased appetite

Ø  Loss of calcium and phosphate from bone

Ø  Amenorrhea in women

Ø  Decreased testicular function in men

What is Anthropometric Measurements

involves measuring part or all of the body to determine composition

Ø  mild malnutrition =85-95% IBW

Ø  moderate malnutrition =75-84% IBW

Ø  severe malnutrition = less than 75% IBW

provide information concerning fluids balance and kidney function.

Nitrogen balance: 

Balance is said to occur when?

What is a anabolic state?

What is a catabolic state

What does a negative nitrogen balance indicate?

the body converts muscle protein to glucose for energy. 

What are the 5 Goals of Parenteral Nutrition

1.     Replenishment of protein stores

2.     Normalization of laboratory values

3.     Reduction in morbidy/mortality

4.     Improvement of quality of life

5.     optimization of clinical outcomes

1.      Fluid and electrolytes

2.     Glucose control

3.     S/S of infections

Parenteral Nutrition

What key things should a nurse know the Administration

(6)

1.      Electronic Pump should be used.

2.     Solutions should be removed from fridge 1 hour prior to use.

3.     Push or secondary medications should not be added.

4.     Solution and tubing changes every 24 hours.

5.     Administer glucose as ordered

6. Sterile line dressing changed every 72 hours

Parenteral Nutrition

Complications:

1.     mechanical or technical:  involving the catheters, pumps

2.     infections

3.     metabolic

4.     nutritional

When should Parenteral nutrition be discontinued?