[11] FINALS | GIT

Question 1

ANTIEMETICS

NON-PRESCRIPTION ANTIEMETICS
Antihistamine
* Dimenhydrinate (Dramamine, Dimetabs)
* Cyclizine HCl (Marezine)
* Diphenhydramine hydrochloride (Benadryl)

Bismuth Subsalicylate
* Bismuth subsalicylate (Pepto-Bismol)

Phosphorated Carbohydrate Solution
* Phosphorated carbohydrate solution (Emetrol)

Question 2

ANTIEMETICS

PRESCRIPTION ANTIEMETICS
Antihistamines
* Hydroxyzine (Vistaril, Atarax, Iterax)
* Promethazine (Phenargan)

Anticholinergics
* Hyoscine (Buscopan) – antispasmodic
* Scopolamine (Transderm-Scop)
* S/E: drowsiness, blurred vision (pupillary dilation), tachycardia, constipation, dry mouth

Question 3

ANTIEMETICS

PRESCRIPTION ANTIEMETICS: Dopamine Agonists

Phenothiazine Antiemetics
* Drug Interaction: alcohol, narcotics, sedatives, general anesthesia
* S/E: moderate sedation, hypotension, EPS, CNS effects, mild anticholinergic signs
* Ex.: Chlorpromazine (Thorazine) and Prochlorperazine Meleate (Compazine)

Butyrophenones
* Treat post-op N&V and emesis associated with calcium chemotherapy, toxins, and radiation therapy
* S/E: EPS, hypotension
* Ex.: Haloperidol (Haldol), Droperidol (Reglan, Plasil)

Metoclopramide (Reglan, Plasil)
* Blocks dopamine and serotonin receptors in the CTZ
* S/E: sedation and diarrhea

Question 4

ANTIEMETICS

BENZODIAZEPINES
* Ex. Diazepam (Valium) and Lorazepam (Ativan) - DOC

SEROTONIN (5-HT3) RECEPTOR AGONISTS
* Used for calcium chemotherapy-induced emesis
* MOA: blocks serotonin receptors in the CTZ and specialized cells in the GIT
* S/E: headache, dizziness, diarrhea, fatigue
* Ex. Ondansetron (Zofran), Dolasetron (Anzemet)

GLUCOCORTICOIDS (Corticosteroids)
* Dexamethasone (Decadron)
* Methylprednisolone (Solu-Medrol)

Question 5

ANTIEMETICS

CANNABINOIDS
* Active ingredient in Marijuana
* Dronabinol (Marinol) and Nabilone (Cesamet)
* S/E: mood changes, euphoria, drowsiness, dizziness, headaches, depersonalization, nightmares, confusion, incoordination, memory lapse, dry mouth, orthostatic hypotension or HPN, tachycardia

MISCELLANEOUS ANTIEMETICS
* Suppresses the impulses to the chemoreceptor trigger zone, tjus inhibiting the activity of the vomiting center
* Diphenidol (Vontrol) and Trimethobenzamide (Tigan)
* S/E: dry mouth, blurred vision, constipation, increased heart rate
* A/R: dizziness, anxiety, skin rash, diarrhea

Question 6

ANTIEMETICS

NURSING RESPONSIBILITIES
* Observe the characteristic of vomitus
* Obtain hx of present illness
* Check VS
* Encourage to maintain oral hygiene
* Instruct not to consume alcohol
* Don’t give antiemetics to pregnant women in their 1st
* trimester
* Instruct the patient not to drive.
* Encourage the use of nonpharmacological methods.

Question 7

EMETICS

NURSING RESPONSIBILITIES
* Determine the toxic substances ingested.
* Caustic substances: ammonia, chlorine bleach, toilet cleaners
* Petroleum distillates: gasoline, kerosene, paint thinners
* Check VS and report abN findings.
* Call the poison control center.
* Offer sufficient fluids should be given.
* Don’t offer Ipecac or fluid to a semi-conscious or unconscious patient.
* Keep away from children.

Question 8

ANTIDIARRHEALS

OPIATES
* Action: decrease intestinal motility, decreasing peristalsis
* S/E: constipation
* Ex.: tincture of opium (Paregoric, Codeine)

OPIATE-RELATED AGENTS
* Action: decrease intestinal peristalsis and can be used as combination with opiates; decreased abdominal cramping
* Ex.: Diphenoxilate (Lomotil), Difenoxin (Motofen), Loperamide (Imodium)
* S/E: drowsiness, dizziness, constipation, dry mouth, weakness, rashes, flushing, blurred vision, mydriasis urine retention
* A/R: paralytic ileus, severe allergic reaction

Question 9

ANTIDIARRHEALS

ADSORBENTS
Action: Coats the wall of the GI tract and adsorbs the bacteria or toxins that cause the diarrhea
Ex. Kaolin and Pectin (Kaopectate) and Bismuth Salts (Pepto-Bismol)
S/E: Constipation
A/R: Fecal impaction or ulceration in infants and elderly

Question 10

ANTIDIARRHEALS

SOMATOSTATIN ANALOG
Inhibit the gastric acid, pepsinogen, gastrin, cholecystokinin, and serotonin secretions and intestinal fluid
It decreases smooth muscle contractility
Ex. Octreotide Acetate (Sandostatin)

MISCELLANEOUS
Used to control diarrhea
Ex. Furazolidone (Furoxone), Lactobacillus, and Parepectolin (CSS V)

Question 11

ANTIDIARRHEALS

NURSING RESPONSIBILITIES
* Assess for hx of infection and other causes of diarrhea.
* Check VS.
* Assess freq and char of stools, S/S of DHN
* Check clients BS.
* Instruct patient to avoid taking sedatives, tranquilizers, and other narcotics because CNS depression may result.
* Encourage to increase OFI
* Monitor electrolytes

Question 12

LAXATIVES

Action: promote evacuation of the bowel, promote softening of the stools

TYPES:
Osmotic/Saline
Stimulants
Bulk-forming
Emollients (Stool Softener)

Question 13

LAXATIVES

OSMOTIC LAXATIVES
Action: pull water into the colon and incrase water in the feces to increase bulk which stimulates peristalsis
Include salts and saline products (Na, K, and Mg), lactulose, and glycerine

Lactulose
Draws water into the intestines to form a soft stool; dereases serum ammonia

Glyerine
Increases water in the feces in the large intestine
S/E: flatulence, diarrhea, abdominal cramps, nausea, and vomiting
C/I: renal insufficiency, DM

Question 14

LAXATIVES

STIMULANT (CONTACT LAXATIVES)
Acts directly on the intestine, causing an irritation to the sensory nerve endings that promotes peristalsis and evacuation
S/E: nausea, abdominal cramps, weakness, and reddish-brown urine (phenolphthalein, senna, or cascara)
Prolonged use of Senna (Senokot) - damages nerve; loss of intestinal muscular tone

Ex.
Castor Oil - stimulates urine contaction; for bowel preparation
Bisacodyl (Dulcolax) - barium enema
Senna (Senokot)
Phenolphthalein (Ex-Lax, Doxidan)

Question 15

LAXATIVES

BULK-FORMING LAXATIVES
Action: natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing fecal bulk and peristalsis
This group of laxative not absorbed by the body, no systemic S/E and does not cause laxative dependence
Ex. Psyllium (Metamucil) and Methylcellulose (Citrucel)
S/E: nausea, vomiting, flatus, diarrhea, abdominal cramps

Question 16

LAXATIVES

EMOLLIENTS (STOOL SOFTENER)
Action: lubricate the intestinal wall and soften the stool, allowing a smooth passage of fecal contents, thus decreasing straining during defacation
S/E: nausea, vomiting, diarrhea, abdominal cramping

Ex.
Softenener - Docusate Ca (Surfak)
Docusate Na (Colace)
Lubricants: Mineral Oil

Question 17

LAXATIVES

NURSING RESPONSIBILITIES
Assess for renal insufficiency
Monitor I and O
Instruct to increase OFI
Eat food rich in fiber
Avoid overuse of laxatives because F and E imbalances and dependency
Encourage exercise
Bulk-forming laxatives to be mixed with 8-10 ounces of water, stir and drink immediately
Mineral oil should be taken with juice
Take it before meals or at bedtime so vitamin absorption will not be blocked; 30 minutes after other meds
Store suppositories at < 30 deg. C

Question 18

ANTIULCER DRUGS

PEPTIC ULCER DISEASE
Esophageal Ulcer - reflux of acidic gastric contents into the esophagus
Gastric Ulcer - occurs because of the breakdown of the GMB
Duodenal Ulcer - hypersecretion of acid from the stomach that passes to the duodenum

Question 19

ANTIULCER DRUGS

TRANQUILIZERS
Action: to reduce vagal stimulation and decrease anxiety
Ex.: Librax - combinaiton of the anxiolytics chlordiazepoxide (Librium) and the anticholinergic Clidinium bromide (Quarzan)

Question 20

ANTIULCER DRUGS

ANTICHOLINERGICS
Actions:
Decrease Ach by blocking the cholinergic receptors
Relieve pain by decreasing gastric motility and secretion
Delay gastric emptying

Ex.: Propantheline bromine (Pro-banthine)

Question 21

ANTIULCER DRUGS

ANTACIDS
Actions: Neutralize HCl and reduce pepsin activity

With Systemic Effect
Sodium Bicarbonate: Bromo-Seltzer and Alka-Seltzer
Calcium Carbonate (Tums)

Non-Systemic Effect
Aluminum
Aluminum, Aluminum Hydroxide
Aluminum Carbonate (S/E: constipation, hypophosphatemia)

Magnesium
Magnesium Carbonate, Magnesium Phosphate
S/E: diarrhea, hypermagnesemia

Question 22

ANTIULCER DRUGS

HISTAMINE 2 BLOCKER
Action: block the H2 receptors of the parietal cells in the stomach thus reducing gastric and concentration

Question 23

ANTIULCER DRUGS

HISTAMINE 2 BLOCKER
Cimetidine (Tagamet)
1975; first H2 blocker
Increases the effects of theophylline, beta-blockers, anticoagulants, anticonvulsants
Duration: 4-5 hours

Ranitidine (Zantac)
1983
Peak concentraction: 1-3 hours
Gastic and duodenal ulcer used prophylactically, relieves symptoms of reflux esophagitis, prevent stress ulver and aspiration pneumonitis
Duration: up to 12 hours

Question 24

ANTIULCER DRUGS

HISTAMINE 2 BLOCKER
Famotidine (Pepcid)
1986
Short term use for duodenal ulcer and Zollinger-Ellison syndrome
50-80% more potent thatn Cimetidine and 5-8 x tan Ranitidine

Nizatidine (Axid)
1988
Latest H2 blocker
Relieves nocturnal gastric acid secretions for 12 hours
Administer at bedtime to prevent recurrence of duodenal ulcer

Question 25

# ANTIULCER DRUGS PROTON PUMP INHIBITORS Action: supresses gastric acid secretion by inhibiting the hydrogen/K ATPase enzyme system located in the gastric parietal cells Inhibits gastric acid secretion up to 90% Agents that block the final step of acid production S/E: headache, dizziness, diarrhea, abdominal pain, rash

Question 26

# ANTIULCER DRUGS PROTON PUMP INHIBITORS Omeprazole (Prilosec) First DOA: 72 hours Lansoprazole (Prevacid) 1993 Ulcer relief usually occurs within 1 week DOA: 24 hours Rabeprazole (Aciphex) More effective in treating duodenal ulcers rather than gastric Most effective in GERD and hypersecretory disease (Zollinger-Ellison Syndrome) Pantoprazole (Protonix) Treat short-term erosive GERD IV is effective in treating Zollinger-Ellison Syndrome Esomeprazole (Nexium) Newest PPI Highest success rate in healing erosive GERD

Question 27

# ANTIULCER DRUGS PEPSIN INHIBITOR Action: covers the ulcer and protects it form acid and pepsin; adhering to the ulcer surface It does not neutralize acid or decrease acid secretions Ex. Sucralfate (Carafate) S/E: constipation, dry mouth, dizziness Given before meal

Question 28

# ANTIULCER DRUGS PROSTAGLANDIN ANALOGUE ANTIULCER DRUG Action: suppress gastric acid secretion and increase cytoprotective mucus in the GI tract Ex. Misoprostol (Cytotec) C/I: pregnant and women of child-bearing age S/E: diarrhea, abdominal pain, flatulence, nausea, vomiting, constipated and menstrual spotting

Question 29

# ANTIULCER DRUGS NURSING RESPONSIBILITIES: Antacid Avoid administering antacid with other drugs, 1-2 hours after other meds Encourage to take 2 oz of water to ensure that the drug reaches the stomach Administer on empty stomach or 1-3 hours after meal and at bedtime Avoid taking antacids with milk or food high in vitamin D

Question 30

# ANTIULCER DRUGS NURSING RESPONSIBILITIES: H2 BLOCKER Administer drugs before meals Avoid smoking Instruct the client not to drive or engage in dangerous activities Drug-induced impotence and gynecomastia are reversible

Question 31

NURSING RESPONSIBILITIES: Pepsin Inhibitor Administer on empty stomach Administer antacid 30 minutes before or after sucralfate Increase OFI, dietary bulk Exercise No smoking