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Pharmacology Exam 2 > Drugs Affecting GI Secretions > Flashcards

Drugs Affecting GI Secretions Flashcards

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1
Q

What are the underlying causes of GI Disorders?

A

Dietary Excess
Stress
Hiatal Hernia ( upper part of the stomach bulges through the diaphragm into the chest cavity)
Esophagea Reflux
Adverse Drug Effects
Underlying Diseases/Disorders
Peptic Ulcer Disease

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2
Q

What does drugs acting on GI Secretions do?

A

Decrease GI secretory activity

Block the action of GI secretions

Form protective coverings on the GI lining to prevent erosion from GI secretions

Replace missing GI enzymes that the GI tract or ancillary glands and organs can no longer produce

Every drug works differently!

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3
Q

What is Peptic ulcer Disease?

A

Erosions in the lining of the stomach or adjacent areas of the GI tract.

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4
Q

What are the symptoms of Peptic Ulcer Disease?

A

Gnawing, burning pain, often occurring after meals - worse when laying down

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5
Q

What are the cause of Peptic Ulcer Disease?

A
  • NSAID use for example ibuprofen. This is because NSAIDS reduce prostaglandin secretion and prostaglandin protect the gastric mucosae. Without this protection the stomach cannot protect the mucosa from gastric acid.
  • Bacterial infection by Helicobacter pylori bacteria
  • Stress: physical and psychological
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6
Q

What are important things to remember when giving drugs that affect GI secretions in children?

A

Children may use antacids, H2 Antagonist’s & PPI’s (protein pump inhibitors)

Concerns for this age group would be electrolyte imbalances and interference with nutrition (from side effects).

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7
Q

What are important things to remember when giving drugs that affect GI secretions in adults?

A

Some concerns would be:
* Overuse (OTC)
* GI discomfort continuing (Continued OTC use without following up with provider to assess for underlying causes)
* Electrolyte disturbance
* Interference with other drugs

There are many issues that may arise from long-term use - over a year can result to C-diff & bone loss.

The drugs have not been cleared safe for pregnancy/lactation and may enter into breastmilk

  • Misoprostol - will result in miscarriage (cat.x) - Abortifacient
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8
Q

What are important things to remember when giving drugs that affect GI secretions in older adults?

A

There may be long term effects when these drug are prescribed frequently

We should prescribe these with caution for patients with renal/hepatic impairments - slower metabolism and excretion.

Many OTC drugs contain the same agents and may also interfere with RX medication (ensure accidental OD does not occur)

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9
Q

What are the suffix(ex) and potential outlier for Histamine-2 (H2) Antagonists?

A

“tidine”

Cimetidine
Famotidine (most common)
Nizatidine

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10
Q

What are Histamine-2 (H2) Antagonists prescribed for?

A

Treatment of ulcers

Prevention of ulcers related to:
* Stress
* Long-term NSAID use

Treatment of GERD

Treatment of pathological hypersecretory conditions such as
Zollinger–Ellison syndrome (stomach is producing excess amounts of secretions)

Relief of symptoms of heartburn, acid indigestion, and sour
stomach (OTC preparations)

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11
Q

How does Cimetidine work?

A

Cimetidine is a Histamine-2 (H2) Antagonist which selectively block H2 receptor sites which reduces gastric acid secretion and pepsin production leading to decreasing levels of these.

It also and blocks release of hydrochloric acid

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12
Q

Which patients should we be cautious of prescribing Famotidine to?

A

Famotidine is a Histamine-2 (H2) Antagonist.
We should be cautious when giving this to patients with cardiac/renal/hepatic dysfunction.

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13
Q

What adverse effects are associated with Nizatidine use?

A

Nizatidine is a Histamine-2 (H2) Antagonist and can cause adverse reactions related to:

GI effect : diarrhea or constipation

CNS effect: headache, dizziness, sometimes hallucinations, somnolence/confusion.

Cardiac arrythmias and hypotension because there are H2 receptors on the heart.

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14
Q

What drug interactions do we need to be aware of when giving a patient Histamine-2 (H2) Antagonists?

A

There are too many to mention but for all of them there is an increased risk of slower metabolism of the other medication (not the H2 antagonists) which may lead to toxicity.

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15
Q

What are important things to assess for before giving a patient Cimetidine?

A

Cimetidine is a H2 antagonist.
History:
Check for pregnancy/lactation
Impaired renal/hepatic function

Physical:
Neurological status incl. orientation & affect for adverse CNS reactions
Cardiopulmonary status incl. pulse and BP
Abdominal assessment

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16
Q

What nursing conclusions can be made prior to giving a patient Cimetidine?

A

Impaired comfort - r/t CNS and GI effect
Altered Sensory Perception (kinesthetic/auditory) r/t CNS effect
Injury risk - r/t CNS effect
Altered tissue perfusion risk - risk for hypotension r/t cardiac arrythmias.
Knowledge deficit.

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17
Q

What implementations should be done when giving a patient Nizatidine?

A

Nizatidine is a H2 Antagonist.

Oral drug should be admin. ac or with meals or at bedtime - because that is when the patient is most likely to have symptoms.

Monitor patient closely with IV admin. because this is when the patient is most at risk for cardiac arrythmias.

Monitor for potential drug-drug interactions

Comfort & Safety: easy access to bathroom in case of diarrhea & assistance with ambulation due to CNS effect.

Teaching patient not to do dangerous activities until the know response to the drug (driving, heavy machinery)

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18
Q

What are the suffix(ex) and potential outlier for Antacids?

A

Carbonates : Sodium Bicarbonate & Calcium carbonate

Salts: Magnesium Salts & Aluminum Salts

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19
Q

What are Antacids used for?

A

Used when a patient have to much acid which may cause stomach upset or conditions that cause excess acid such as peptic ulcers, gastritis or hiatal hernias - a hernia that is pressing up on the stomach.

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20
Q

How does Antacids work?

A

They are a group of is an inorganic chemicals that work by neutralizing stomach acid by a direct chemical reaction.

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21
Q

What conditions should we be cautious of before giving a patient Antacids?

A

Any condition that can be exacerbated by electrolyte imbalance.

GI obstruction - would increase adverse effects.

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22
Q

What are some adverse reactions that may happen when a patient are taking Antacids?

A

Adverse reactions are related to the acid/base imbalance issues.
We may see adverse reactions such as rebound acidity - which happens when stomach becomes alkaline from taking antacid so it produces more acid.

Alkalosis - from neutralizing effect.
Constipation or Diarrhea

Calcium Bicarbonate in particular may cause Hypercalcemia and Hypophosphatemia - because calcium and phosphate have an inverse relationship.

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23
Q

What are some drug-drug interactions that we should keep an eye out for when a patient is taking Antacids?

A

It may have an effect on the absorption of many other drugs.

Should be taken 1 hr before or 2 hrs after other drugs because antacids effect absorption of other drugs due to altered chemical composition of the stomach.

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24
Q

What assessments should we do before giving a patient Aluminum salts?

A

Aluminum salts are antacids and we should be assessing for Pregnancy/lactation.
Renal dysfunction - due to possible electrolyte imbalance of the drugs which may effect the kidneys.
Do a baseline physical abdominal assessment.

Labs:
Renal function
Electrolytes

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25
What nursing conclusions' can we expect with patients taking Antacids?
Altered GI motility related to adverse effects. Electrolyte imbalance risks Knowledge deficit
26
What implementations should be expect to make when and after giving a patient Sodium Bicarbonate?
Sodium bicarbonate is an antacid and we should expects implementations such as: Giving other oral meds. 1 hr. prior or 2 hrs. after admin of antacid. Chew tablets properly and drink water after. Monitoring serum electrolytes Asses for signs/symptoms of electrolyte imbalance and acid/base imbalance Monitor for diarrhea/constipation- implement bowel program if needed Monitor nutrition w/severe diarrhea or constipation result in poor food intake. Educate for risk of acid rebound.
27
What are the suffix(ex) and potential outlier for Proton Pump Inhibitors (PPI's)?
"Prazole" Omeprazole (OTC) Esomeprazole (OTC) Lansoprazole (OTC) Pantoprazole Rabeprazole
28
What is Rabeprazole prescribed for?
Rabeprazole is a PPI and is given for treatment/prevention of ulcers Treatment of GERD Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome
29
How does Pantoprazole work?
Pantoprazole is a PPI and these drugs suppress the secretion of hydrochloric acid into the lumen of the stomach by acting at specific secretory surface receptors to prevent the final step of acid production which decreases overall level of stomach acid.
30
What are some adverse effects to look out for when giving a patient Omeprazole?
Omeprazole is a PPI and we should be aware of potential side effects such as CNS effect: dizziness & headache GI effect: Diarrhea, abdominal pain and nausea.
31
With PPIs, what drug-drug interactions should we teach a patient about and monitor for?
Benzodiazepines & phenytoin (medication for seizures) due to risk of increased toxicity. Antiretroviral medications due to altered levels of these - might end up not being effective or toxic effect. Anticoagulants can increase toxicity of some of these and decrease effect of others.
32
What assessments should we do prior to giving a patient Lansoprazole?
Lansoprazole is a PPI and we should assess for Pregnancy/lactation Physical: neurological exam & abdominal assessment.
33
What conclusions could we make when a patient will be taking PPI's?
The may have altered GI motility r/t GI effect Imbalanced nutrition risk - can alter absorption of nutrients. Altered sensory perception (Kinesthetic and auditory) - Related to CNS effect Injury risk Knowledge deficit
34
What implementations should we perform/teach patients when they are taking Esomeprazole?
Esomeprazole is a PPI. Patients should not open, chew or crush capsules - should be swallowed whole to ensure therapeutic effectiveness. Monitor for diarrhea - bowel program if needed Monitor nutritional status - If GI effect is a problem. small frequent meals. Safety/comfort measures -CNS effect Follow up after 8 weeks if no improvement. Could be underlying conditions. Patient education
35
What is the drug that we need to remember for the drug category GI Protectants?
Sucralfate
36
Why would we give Sucralfate to a patient?
To promote ulcer healing
37
How does Sucralfate work?
Coats the injured area of the stomach which prevents further injury from the acids, pepsins and bile salts. It also promotes ulcer healing.
38
What patient condition would contraindicate giving a patient Sucralfate?
If the patient has renal failure because Sucralfate contains aluminum and therefore there is a risk of buildup of aluminum which may lead to aluminum toxicity.
39
What is an adverse reaction to Sucralfate?
Adverse effect are rare. Constipation most likely. Sucralfate is a GI protectant.
40
What are some drug-drug interactions that we and the patient should be aware of when administering Sucralfate?
Aluminum salts due to increased risk of aluminum toxicity. Medications administered at the same time because sucralfate is binding agent and could potential bind to the other drugs and prevent absorption.
41
What assessments should we be doing before giving a patient an GI protectant?
Check for allergy, pregnancy/lactation & renal failure r/t to the risk of aluminum toxicity. Do a physical abdominal assessment due to the risk of constipation. | The GI protectant that we need to know is Sucralfate
42
What are some nursing diagnosis that we would make when a patient is given Sucralfate?
*Altered GI motility (constipation) r/t medication effect *Imbalance nutrition risk r/t GI effect of constipation *Knowledge deficit Sucralfate is a GI Protectant
43
What implementations should we make when giving a patient Sucralfate?
Give drug on empty stomach 1 hr. before or 2 hrs. after meals & at bedtime. It needs to be given on empty stomach to adhere to the ulcer sites. Monitor for GI pain If antacids/antibiotics are ordered give these between sucralfate doses and not within 30 min. Comfort/safety : Bowel program if needed, increase fiber & fluid to prevent constipation. Patient teaching.
44
Which drug should we remember for the drug class Prostaglandins?
Misoprostol
45
How does Misoprostol work?
Protects stomach by inhibiting gastric acid secretion and increasing bicarbonate and mucous production in the stomach.
46
Why would we give Misoprostol to a patient?
To prevent NSAID induced gastric ulcers Typically given to patients in high risk of developing an ulcer. such as patients that have a history of ulcer formation and debilitated patients. Misoprostol is a Prostaglandin.
47
When should we not give Misoprostol to a patient?
Allergy and Pregnancy (cat. X) - however these drugs can sometimes help a baby be born if mom is in labor and having trouble delivering. Misoprostol is a prostaglandin
48
What are some adverse reactions that we should be prepared to see when a patient is taking Misoprostol?
GI Effect: Nausea, diarrhea, abdominal pain. GU Effect due to prostaglandin effect on the uterus : Miscarriages, excessive bleeding, menstrual irregularities. Misoprostol is a prostaglandin
49
What should we assess for before prescribing Prostaglandin agents to a patient?
Pregnancy/Lactation Physical abdomen assessment.
50
What nursing conclusion can we expect when giving a patient Misoprostol?
Altered GI motility r/t medication effect. Impaired comfort r/t GI & GU effect Imbalanced nutritional risk r/t GI effect Knowledge deficit Misoprostol is a prostaglandin
51
What implementation should we and the patient make when administering Misoprostol?
*Serum pregnancy test within 2 weeks before beginning treatment. *Begin therapy on 2nd or 3rd day of the menstrual period *Patient education regarding the associated risks of pregnancy: miscarriage and excessive bleeding - written and oral teaching. *Explain the risk of menstrual disorders, pain, excessive bleeding *Barrier contraceptives, if applicable *Monitor nutritional status *Safety/comfort measures - easy access to bathroom facilities, small &frequent meals. Patient teaching
52
If the patient is prescribed NSAIDs as a treatment, should they take Misoprostol at the same time as they're taking the NSAIDs?
Yes. The reason the patient would have been prescribed misoprostol is most likely due to the risk of NSAID-induced ulcers. Therefore, the patient should be taking misoprostol for the entire duration while they're taking NSAIDs.
53
What two drugs should we remember for the drug category Digestive Enzymes?
Saliva Substitute Pancrelipase (Pancreatic Enzymes)
54
Why would we give a patient Pancrelipase?
Cystic fibrosis Pancreatic insufficiency Malabsorption syndrome
55
Why would you give a patient Saliva Substitutes?
Dry mouth which may be associated with stroke, radiation therapy or chemotherapy. Saliva Substitute are Digestive Enzymes
56
How does Saliva Substitutes work?
They contain electrolytes and carboxymethylcellulose to act as a thickening agent - makes it easier to swallow and also start the digestive process. Saliva Substitute are Digestive Enzymes
57
How does Pancrelipase (pancreatic enzyme) work?
By replacing enzymes that our pancreas makes that help the digestion and absorption of fats, proteins, and carbohydrates.
58
What specific type of allergy would be and absolute contraindication to Pancrelipase and why?
Allergy to pork - all pancreatic enzymes made from pancreas of a pig.
59
What should we be cautious of when prescribing saliva substitutes to a patient?
Coronary Heart Failure Hypertension Renal failure - Due to abnormal absorption of electrolytes esp. sodium would complicate/worsen these conditions. Saliva Substitute is a Digestive Enzyme
60
What are some adverse effects that we should be monitoring for when we are administering Saliva Substitute to a patient?
Increased levels of magnesium, sodium or potassium which could cause electrolyte imbalances. Saliva Substitute is an Digestive Enzyme
61
What are some adverse effects that we should be monitoring for when we are administering Pancreatic enzymes/ Pancrelipase to a patient?
GI irritation such as Nausea, Abdominal cramps and diarrhea due to direct GI irritation from the drug. Pancrelipase is an Digestive Enzyme
62
what should we assess for prior to giving a patient Digestive Enzymes?
Assess for allergies, contraindications and cautions We should do a physical baseline assessment of the abdomen and elimination patterns. Check mucosal membrane. Check cardiovascular system - due to potential electrolyte imbalances caused by saliva substitutes.
63
What nursing diagnosis would we expect to make when administering Digestive Enzymes?
Administration : Swish saliva substitute around the mouth as needed – DO NOT SWALLOW Administer pancreatic enzymes with meals and snacks Pancreatic enzymes should not be crushed or chewed - can open capsule and sprinkle over food such as applesauce to be swallowed whole. *Safety and Comfort : monitor swallowing especially with dry mouth. Monitor nutritional status. *Monitor for electrolyte imbalances with saliva substitutes due to underlying conditions that could be exacerbated by electrolyte imbalances. *Patient teaching
64
How does Misoprostol work?
Protects stomach by inhibiting gastric acid secretion. Increasing bicarbonate and mucous production in the stomach.
65
Explain why NSAIDs are most common cause of Peptic Ulcer disease.
NSAIDs reduce prostaglandin secretions and prostaglandins protect the lining of the gastric mucosae. Without the prostaglandin protection, the stomach cannot protect itself form the gastric acids.
66
What is the worry when it comes to long terms use of the GI secretion agents? what may happen?
long-term use - over a year can result to C-diff, electrolyte imbalances & bone loss
67
Which drug will result in an abortion in pregnant women, but may also be used during difficulties in delivering the baby during labor?
Misoprostol.
68
What is Zollinger–Ellison syndrome, and which drug(s) may we use to treat this disease?
A disease where the stomach is producing excess amounts of secretions. We may use H2 Antagonists such as Cimetidine to treat this and also Proton Pump Inhibitors such as Lansoprazole.
69
Which drug category reduces the amount of HCL secretion into the stomach?
Histamine 2 Antagonists : Cimetidine, Famotidine and Nizatidine and PPI's Omeprazole, Lansoprazole.
70
Are there H2 receptors on the heart?
Yes. This is why we have to be cautious with patients who have heart conditions when prescribing Histamine - 2 receptors as it may lead or exacerbate cardiac arrythmias and hypotension.
71
With what type of administration are we more likely to see the adverse effect of cardiac arrythmias in patients who are taking Nizatidine?
Nizatidine is a H2 antagonist and we are most likely to see cardiac arrythmias when these drugs are administered via IV. Patients should therefore be monitored closely when given medications this way.
72
Which drug category end in "tidine"
H2 antagonists
73
Which drug category neutralizes stomach acid by a direct chemical reaction? Names some drug classes in this category.
Antacids Sodium bicarbonate & Magnesium salts
74
Explain rebound acidity
When the stomach becomes alkaline from taking antacid so it produces more acid, or may occur when your stomach produces extra acid after you've stopped taking an acid-suppressing medication like a PPI or H2 blocker. This may lead to an dependency on the drugs.
75
What inverse relationship causes a drop in phosphate (hypophosphatemia)?
A spike in Calcium - Hypercalcemia. If there is an increase in calcium there will be a drop in phosphate. This may happen with use of the antacid Calcium Carbonate.
76
In relation to other drugs, when should Magnesium Salts be taken?
Magnesium Salts are Antacids and these should be taken 1 hr before or 2 hrs after other drugs because antacids may affect the absorption of the other drugs due to the altered chemical composition these drugs have of the stomach.
77
Which drug blocks the secretion of HCL and which drug stops the production of HCL?
H2 antagonists ex. Cemetidine blocks the secretion of HCL by working on H2 receptor sites and partially blocks the production of Pepsin. Proton Pump Inhibitors such as Omeprazole by action on specific secretory surface receptors to precent the final step of HCL production.
78
What drug class should Benzodiazepines & Phenytoin not be combined with, and why?
PPI's such as Omeprazole due to risk of increased toxicity.
79
Which drugs should not be given with anticogulants?
PPI's due to some PPI's increasing the effect of the coagulants and some PPIs decreasing the effect of the anticoagulants.
80
Explain the action of Sucralfate
Forms an ulcer adherent at ulcer sites and protects the site from further damage from acid, pepsin, and bile salts.
81
Which drug contains aluminum and may lead to build up of aluminum in patients with renal failure?
Sucralfate. Sucralfate should also not be taken in conjunction with Aluminum salts due to this risk.
82
When should Sucralfate be taken, and why is the timing important?
Sucralfate needs to be taken on an empty stomach to allow for the drug to adhere to the ulcer site. The drug should eb taken 1 hr. before or 2 hrs. after a meal and at bedtime.
83
Which drug increases bicarb and mucous production in the stomach?
Misoprostol.
84
Which GI drug may have an effect on women's periods and have effects such as spotting between periods, irregular menses and painful menses?
Misoprostol.
85
Which drug replaces the enzymes that our pancreas makes that aids in digestion and absorption of fats, proteins, and carbohydrates?
Pancrelipase which is an Digestive Enzyme
86
Which drug would you possibly give to a patient that is suffering from dry mouth following a stroke?
Salvia Substitutes which is an Digestive Enzyme
87
Which drug would you not give a patient if they have an allergy to pork OR if the patient doesn't eat pork due to cultural or spiritual reasons?
Pancrelipase and all pancreatic enzymes are made from the pancreas of pigs.
88
The nurse is caring for a client requiring digestive enzyme replacement therapy. What is the appropriate nursing diagnosis for this client?
Imbalanced nutrition, because lack of digestive enzymes may result in malnutrition.
89
what drug would we give to treat Cystic Fibrosis?
Pancrelipase
90
Which drug increases Magnesium, Sodium and Potassium levels and may cause electrolyte disturbances?
Saliva Substitutes
91
Which drug is the only GI secretion drug that may cause hallucinations, somnolence and confusion?
H2 antagonists
92
Which drug class should NOT be crushed or chewed?
PPIs
93
Which drugs has the greatest risk of rebound acidity?
Antacids due to the neutralizing effect of the stomach.
94
Which drug should NOT be swallowed but should be spat out after swishing around in the mouth?
Saliva Substitutes.
95
Which drug is used to treat Malabsorption Syndrome?
Pancrelipase
96
Which drug category requires a 8 week follow up if symptoms haven't imporved?
PPI's
97
Which drug category may cause cardiac arrythmias and hypotension?
H2 antagonists
98
Calcium Bicarbonate may lead to Hyper_________
calcemia
99
Which drug category should be chewed followed by drinking water?
Antacids
100
Which drug category may have an effect on tissue perfusion and why?
H2 antagonists may have an adverse effect on tissue perfusion due to the possible side effect of Hypotension
101
Which drug is a binding agent?
Sucralfate.
102
Which drug has few other adverse effects other than consitpation?
Sucralfate.

Pharmacology Exam 2 (20 decks)

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