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Pharmacology-digestion
pharmacology
11
Nursing
Undergraduate 3
07/24/2013

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Cards

Term

 

 

Meds Affecting Digestion and Nutrition

(General Key Points)

Definition

 

 

·   GI tract is the route of administration and the target of action

·   GI effects are common (abdominal pain, constipation, nausea)

·   When peptic ulcers are caused by H. pylori, non-antibiotics promote healing but only antibiotics will cure the disease.

·   Drug therapy for peptic ulcers is directed at controlling symptoms, facilitating healing, lowering risk for complications, and preventing relapse

Prevention of emesis is more effective than treating it.

Term

 

 

Histamine2 (H2) Receptor

Agonists

Definition

 

 

Expected Action:

Proto: ranitidine (Zantec) — Others: cimetidine (Tagamet), nizatidine (Axid), famotidine (Pepcid)

·  Selectively block H2 receptors in parietal cells to suppress gastric acid secretion

Therapeutic Uses:

·  OTC for heartburn, sour stomach, and indigestion

·  Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)

·  In conjunction with antibiotics to treat ulcers caused by H. pylori.

Adverse Effects:

·  dec. libido / impotence

·  CNS effects (lethargy, depression, confusion) - inc. frequent in elderly ĉ renal or liver dysfunction.

Contraindications/Precautions:

♀ (B)

[image]    

[image]   inc. risk of bacterial colonization of stomach and respiratory tract

Interactions:

·   

·  Warfarin, phenytoin – metabolizing enzymes inhibited by cimetidine - inc. levels

·  Concurrent use of antacids dec. absorption H2-receptor antagonists

Education:

·  Stop drinking, stop smoking, eat smaller, more frequent meals

·  Ranitidine can be taken without regard to food

Term

 

 

Proton Pump Inhibitor

Definition

 

 

Expected Action:

Proto: omeprazole (Prilosec) — Others: pantoprazole (Protonix), lansoprazole (Prevacid), esomeprazole (Nexium)

·  dec. gastric acid secretion by irreversible inhibition of enzyme that produces it.

·  Reduce basal and stimulated acid production

Therapeutic Uses:

·   

·  Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)

Adverse Effects:

·  Insignificant ĉ short-term treatment

Contraindications/Precautions:

♀ (C)

·   

[image]   inc risk pneumonia d/t  inc. pH promoting bacterial colonization

Interactions:

·   

·  Delayed absorption of Ampicillin, digoxin, iron, ketoconazole if concurrent

Education:

·   

·  IV pantoprazole may cause thrombophlebitis, headache, or diarrhea.

Term

 

 

Sucralfate

Definition

 

 

Expected Action:

Proto: Sucralfate (Carafate)

·  Acidic conditions Δ sucralfate to viscous gel that adheres to and protects ulcers.

Therapeutic Uses:

·  Acute duodenal ulcers

·  Investigational use for gastric ulcers and GERD

Adverse Effects:

·  No systemic effects

·  Avoid constipation by > 1500 cc fluids and inc. fiber

Contraindications/Precautions:

♀ (B)

[image]    

Interactions:

·  Antacids interfere with absorption of sucralfate.

·  ò absorption of phenytoin, digoxin, warfarin, ciprofloxacin

Education:

·  Take on empty stomach, 4x per day

               

 

Term

 

 

Antacids

Definition

 

 

Expected Action:

Proto:Al(OH)3 gel (Amphojel), Others: AlCO3, Mg(OH)2 (Milk of Magnesia), NaHCO3

·  Neutralize gastric acid and inactivate pepsin

·  Mucosal protection through stimulation of prostaglandin production

Therapeutic Uses:

·  Peptic ulcer disease and GERD

Adverse Effects:

·  Al/Ca compounds -constipation, Mg compounds - diarrhea

·  Na+-containing - fluid retention

·  Al(OH)3-hypophosphatemia

·  Mg2+ compounds - toxicity with renal impairment.

Contraindications/Precautions:

♀ (C)

[image]   GI perforation or obstruction

Interactions:

·   

·  Aluminum-compounds bind to warfarin, tetracycline and dec. their absorption

Education:

·  Chew tablets thoroughly then take with 8 oz water or milk

·  Frequency of administration makes compliance difficult

Term

 

 

Prostaglandin E Analog

Definition

 

 

Expected Action:

Proto: misoprostol (Cytotec)

·  dec. acid secretion / inc. secretion of HCO3- and mucus / dec. submucosal vasodilation.

Therapeutic Uses:

·  Long-term NSAID therapy

·  Induce labor by causing cervical ripening.

Adverse Effects:

·  Diarrhea and abdominal pain

·  Dysmenorrhea and spotting

Contraindications/Precautions:

♀ (X)

[image]   Potential to become pregnant

Term

 

 

Antiemetics

(Types)

Definition

 

 

·   Serotonin antagonists......................................................... ondansetron (Zofran)

·   Dopamine antagonists.......................................... prochlorperazine (Compazine)

·   Glucocorticoids......................................................... dexamethasone (Decadron)

·   Cannabinoids...................................................................... dronabinol (Marinol)

·   Anticholinergics.................................................. scopolamine (Transderm Scop)

·   Antihistamine......................................................... dimenhydrinate (Dramamine)

Others

·   Granisetron (Kytril)

·   Promethazine (Phenergan)

·   Metoclopramide (Reglan)

·   Hydroxyzine (Vistaril)

Aprepitant (Emend)

Term

 

 

Antiemetics

(Action, Use, Effects, Interactions)

Definition

 

 

Agent:

Action

Use

Ondansetron

 SERR in CTZ & vagal nerve

Chemo, radiation, postop

Prochlorperazine

DOPR in CTZ

Chemo, opioids, postop

Dexamethasone

Unknown

Combo for chemotherapy

Dronabinol

Unknown

Chemotherapy (CINV)

Scopolamine

 impulses: inner ear - VC

Motion sickness

Dimenhydrinate

HISR MUSR inner ear - VC

Motion sickness

Agent

Adverse Effect

Ondansetron

Headache, diarrhea, dizziness

Prochlorperazine

EPS (Tx ĉ Benadryl or Ativan), hypotension, sedation, and anticholinergic effects.

Dronabinol

Dissociation, dysphoria, hypotension, tachycardia

AntiCh, AntiHis

Sedation, anticholinergic effects

Interactions

·  CTZ = chemoreceptor trigger zone

·  CNS depressants / Antihypertensives / Anticholinergics - Additive Effects

[image]   Antagonists ĉ urinary retention, asthma, and narrow-angle glaucoma

·  Combo therapy allows lower doses of each \ dec. side effects

Term

 

 

Laxatives

Definition

 

 

Agent:

Action

Use

Bulk-forming

{psyllium}

Soften mass, inc bulk – same as dietary fiber.

dec. diarrhea, control stool, promote defecation

Surfactant

{docusate}

inc. H2O content

Opioids, pain, straining, dec. risk impaction, promote defecation

Stimulant

{bisacodyl}

inc. peristalsis, H2O absorption (dec. colon, inc. intestine)

Colonoscopy prep, short-term Tx d/t  inc. opioid use

Osmotic

{Mg(OH) 3}

inc. intestine H2O = inc mass = stretching =inc. peristalsis

Chemotherapy (CINV)

Agent

Adverse Effect

All

GI irritation

All

Rectal burning=proctitis (D regular use of bisacodyl suppository)

Mg2+ salts

Accumulate toxic levels of magnesium ([image] in renal dysfunction)

Na+ salts

Accumulation: [image] in heart disease and hypertension

Interactions

·  Milk & antacids destroy enteric coating

[image]   Fecal impaction / bowel obstruction / ulcerative colitis / diverticulitis

·  Promote inc. fiber foods and > 1.5 L S daily

Term

 

 

Antidiarrheals

Definition

 

 

Expected Action:

Proto: diphenoxylate (Lomotil)

Others: loperamide (Imodium), difenoxin (Motofen)

·  Activate opioid receptors in GI to dec. motility and inc. absorption of water & Na+

Adverse Effects:

·  At recommended doses, diphenoxylate has no CNS effects

·  inc. diphenoxylate doses= typical opioid responses

Contraindications/Precautions:

♀ (?)

·   

·  inc. risk of megacolon with inflammatory bowel disorders = serious complications including perforated bowel.

Interactions:

·  CNS depressants inc. depressive effect

Education:

·  Encourage use of electrolyte replacement drinks

·  Avoid plain water (no electrolytes) and caffeine (inc. motility)

·  Manage dehydration (weight, VS, I&O) – 0.45% NS may be prescribed

Term

 

 

Prokinetic Agents

Definition

 

 

Expected Action:

Proto: metoclopramide (Reglan)

·   dopamine and serotonin receptors in CTZ \dec emesis

·  Augments action of acetylcholine to ñ upper GI motility

Therapeutic Uses:

·  Postop and chemo-induced nausea and vomiting

·  GERD

·  Diabetic gastroparesis

Adverse Effects:

·  EPS: Restlessness, spasms of face & neck. Minimize EPS with benzodiazepine like lorazepam (Ativan).

·  Diarrhea

·  Sedation

Contraindications/Precautions:

♀ (?)

[image]   Seizure disorder (ñ seizure risk)

[image]   GI perforation or bleeding, bowel obstruction, and hemorrhage

[image]   Kids and older adults due to inc. risk of EPS

Interactions:

·  Concurrent EtOH or CNS depressant: inc. seizure / sedation risks

·  Opioids and anticholinergics dec. effects of metoclopramide.

Education:

·  Dose ≥ 10 mg dilute in 50 mL D5W or Ringer’s; Infuse over 15m

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