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Flashcards in Exam 7 Deck (37)
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1

What does GERD stand for?

Gastroesophageal Reflux Disease

Acid is splashing up into the esophagus... leading to irritation.

2

Symptoms of GERD:

Heart burn
Nausea
Chest pain
Belching

Narrowing it down to GERD by their description of pain (burning).

3

What does PUD mean?

Peptic Ulcer Disease

Major adverse effect of aspirin. Aspirin inhibits the mucous production in the stomach as well as

4

This drug, in the anti-heartburn/antacid/phosphate binder class, has a 20 minute onset time and a 2-3 hour time of duration:

This slide also states action, adverse effects, indications, and precautions...

aluminum hydroxide (Alternagel)

Action:
Binds phosphates in the GI tract.
Neutralizes gastric acid and inactivates pepsin (enzyme that breaks down proteins into smaller peptides).

Adverse effects:
- Constipation
- Reduction in phosphate (hypophosphatemia)

Indications:
- Lowering of phosphate levels in patients w/renal failure.
- Adjunctive therapy: peptic, duodenal, and gastric ulcers
- Hyperacidity, indigestion, reflex esophagitis.

Precautions:
Contraindicated in "Severe abdominal pain of unknown cause".
Use cautiously in: Hypercalcemia, hypophosphotemia, OB.

5

An electrolyte disturbance in which there is an abnormally low level of this in the blood, the condition has many causes, but is most commonly seen when malnourished patients (especially chronic alcoholics) are given large amounts of carbohydrates:

Hypophosphatemia.

This creates a high phosphorus demand by cells, removing phosphate from the blood...

Many alcoholics have GI upsets so they take antacids (aluminum hydroxide/Alternagel) which exacerbate their already low phosphate levels (alcohol impairs phosphate absorption) which may lead to hypophosphatemia.

6

A drug or other substance that serves a supplemental purpose in therapy:

An adjunct.

Adjunctive therapy:
therapy that is given in addition to the primary, main, or initial therapy to maximize its effectiveness.

7

This drug is in the anti ulcer / histamine H2 antagonist class. It is used in the management of GERD and PUD:

This slide also states action, adverse effects, indications, and precautions...

ranitidine (Zantac)

Action:
Blocking H2 receptors... preventing histamine from stimulating release of stomach acid, raising the pH in the stomach.

Used for:
PUD
GERD

Adverse effects: rare
- Neutropenia
- Thrombocytopenia

(The more common drug from this class being used in the local hospitals in northern colorado is called famitodine or Pepsid)

Best taken in evening due to increase in acid production between 10pm - 2am

8

This drug is an anti-ulcer / proton pump inhibitor (PPI):

Most effective and expensive on the market for reducing stomach acid...

This slide also states action, adverse effects, indications, and precautions...

omeprazole (Prilosec)

Action:
- Inhibiting the proton pump, which inhibits the hydrogen ions from being pumped in/out that is needed to make stomach acid. So, prevents stomach acid from being formed.

Adverse effects:
- diarrhrea
- headache
- abdominal pain
- malabsorption esp Ca and other minerals... long-term use can lead to osteoperosis!

Onset:
30 minutes - 3.5 hours

Duration:
up to 72 hours! So, once a day dosing.

Interactions:
Interferes with hepatic enzymes.

Route:
NO IV in USA but other PPI's avail for IV

Given 1-2 / day... usually in morning.

9

Ant-acid teaching:

- Long term use may mask serious conditions (ulcer, cancer, etc) Seek physician if not improved in a week.

- Take after meals or at bedtime

- H2's and PPI's work similarly so don't take together.

10

This is a symptom, not a disease, and is characterized as less than 2 BM's a week:

Constipation

Lifestyle Causes:
Sedentary

not drinking enough water

not enough fiber

Opioids and anticholinergic drugs slow peristalsis

Iron supplements tend to bind

Cause from Disease:
Depression

Diverticulitis

Tumor causing blockage

11

Nursing interventions of constipation:

Assessment:
Pain
Distention
Confused patient may show agitation

Diagnosis:
>2BM/week
Hard stools @ least 25% of the time
Straining to pass stool " " " "

What's the cause? Need to find out so we can prevent it from happening again.

12

What are the 2 categories of pharmacotherapy used for constipation?

1. Laxatives
2. Cathartics - pre procedural prep

13

What are the 5 types of laxatives?

1. Bulk forming: Metamucil 12-24 hr
Teaching: drink w/a lot of water

2. Stimulant / irritant: Dulcolax
Commonly used in hospital (15 min suppository)
PO 8-12 hrs

3. Fecal Softeners: Colace
Used more often as prophylactic. This helps water get absorbed into the stool.

4. Hyperosmolar: Milk of Magnesia 30 min-4 hr
Lots of particles that pull fluid into the GI tract... help stool soften.
RISK: electrolyte imbalance (drinking magnesium)

5. Lubricants: Mineral oil; PO 6-8 hr/ 15 min rectal
Not used very often. Oil coats feces preventing water from being absorbed... but also blocks fat soluble vitamins from being absorbed.
Teaching: Administer away from meals.

14

What is the primary neurotransmitter for the parasympathetic nervous system?

Acetylcholine

15

This drug can help prevent GI spasms and a reduction in oral secretions. This helps prepare for a scope (endoscomy):

Atropine (not given very often)

Can help with helping absorb water.
(Can cause constipation)

Can assist medication's absorption due to the GI tract slowing down.

Adverse:
Blurred vision, tachycardia, drowsiness, etc.

16

This drug is from the anti-diarrheal/opioid class:

diphenoxylate with atropine (Lomotil)

*Controlled substance

Action:
Slows peristalsis (from opioid - but only in GI, would have to abuse to get "high" effect but the atropine is there to prevent abuse - gives unpleasant reaction: tachycardia/dry mouth/blurred vision

Adverse effects: above
constipation

Onset:
1 hr

Short-term fix, not on long time

Imodium is used more often than Lomotil FYI

17

This drug is from the anti-emetic/ Serotonin receptor antagonist class:

ondanseteron (Zofran)

Action:
Blocks serotonin receptors in the chemoreceptor trigger zone. Our body has a vomiting center where gets info from many receptors in from various areas (GI, ear, etc) that tells vomiting center need to throw up... this drug goes to that chemo trigger zone in vomiting center doesn't get the signal to throw up

Adverse effects:
Constipation/diarrhea
Dizziness
Headache

Monitor:
Dehydration

Route:
Many (most likely IV in hospital, IM or buccal at home)

When?
Nausea due to medications, chemotherapy

18

Reiterated what the drugs are doing on the GI tract...

Slowed GI = more drug level due to more time to absorb...

Also, change of pH... if drug absorbed better in acidic environment then may be affected if pH of stomach increases (ant-acids).

19

What do we call the inflammation of the nasal mucosa from exposure to allergens?

Allergic Rhinitis

"Hay fever"

Red swollen eyes, sneezing, itching, coughing, scratchy throat, congestion, postnasal drip.

From?
Plants, spores, pollutants, dust

20

What is the first line drug class used to treat rhinitis?

Anti-histamines

They are selective H-1 receptor blockers.

Can cross BBB and lead to dry membranes

Most effective when taken prophylactically (limited ability to reverse symptoms already present)

Also used as adjunct to treat severe allergic reactions

21

What happens when H-1 receptors are blocked?

Vasoconstriction (at least no dilation)

Blockage of increased capillary permeability

No CNS affects like itching

Bronchodilation (at least no constriction)

22

Explain the 2 different generations of anti-histamines:

First generation:
"older drugs" that cause drowsiness because BBB...
* Diphenhydramine (Benadryl)

Second generation:
Less sedation because they do not cross BBB
* Fexofenadine (Allegra)

23

These inhaled drugs work directly on the nasal mucosa:

Inhaled Corticosteroids

No serious adverse effects

First line drug for allergic rhinitis

24

This inhaled drug causes vasoconstriction and suppresses inflammation:

Fluticasone (Flonase)

- Works by decreasing the synthesis and release of inflammatory mediators (histamine, leukotrienes)

This causes a:
Reduction in bronchial hyperreactivity
Decrease in airway mucus
Decrease in infiltration/activity of inflammatory cells
Decrease in edema of the airway mucosa

25

These work to reduce congestion caused by the inflammatory process:

Decongestants

AKA "sympathomimetics" or adrenergic agonists

Used for allergic rhinitis or the common cold

Most limiting adverse effect of intranasal meds is rebound congestion. Occurs with long-term use. It's a worsening of congestion once drug wares off. PO form does not cause rebound.

26

This decongestant is a Swedish slang word:

Sudafed

Pseudoephedrine (Sudafed)

Action:
Activates alpha 1 adrenergic receptors - Causing a vasoconstriction in the nasal mucosa; and a shrinking of mucosal swelling

Activates beta 2 adrenergic receptors (lungs) - leading to bronchodilation.

Adverse effects:
- CNS stimulation (insomnia, restlessness, anxiety)
- High doses = seizures, psychosis
- Dysrhythmias
- HTN
- Palpitations
- Tachycardia
- Dry mouth
- No rebound congestion (given PO not intranasal)

27

These are used commonly to suppress a cough:

Antitussives

Dextromethorphan (Delsym, Robitussin)

Action:
Works directly on the cough center in the medulla to elevate the cough-threshold.

Adverse effects with higher doses:
- Sedation
- dizziness

28

This increases bronchial secretions thereby reducing the thickness or viscosity of secretions:

Expectorants

Allows mucus to be removed more easily by coughing.

guafenesin (Mucinex)

29

These are used to break up thick bronchial mucus:

Mucolytics

Used in patients with:
- Cystic fibrosis and/or
- Chronic bronchitis

30

What do we call a chronic inflammatory disorder of the airway?

Asthma

50% caused by allergens
50% unknown

Allergen induced:
- Include mediators of the immune system/ inflammatory response are released by the MAST cells.

- The airway becomes swollen and edematous; more mucus

- Spasms of the bronchial passages; smooth muscle hyperactive to triggers... cold air/smoke = spasm