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NURS 2514 > Gastrointestinal drugs > Flashcards

Gastrointestinal drugs Flashcards

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1
Q

What kind of drug is ranitidine?

A

Histamine-2 receptor antagonist

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2
Q

How does Ranitidine work?

A

Blocks H2 receptors on the parietal cells of the stomach to reduce the volume of gastric juice and decreases concentration of acid

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3
Q

Nursing assessments for H2 antagonists

A

Assess for epigastric pain, and pain or signs of GI bleeding (hematemesis, frank blood, or occult blood in stool)
Assess for signs of confusion
Administer antacids an hour apart from other medications
Monitor for signs of pneumonia

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4
Q

What kind of drug is Omeprazole?

A

Proton Pump Inhibitor

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5
Q

How does Omeprazole work?

A

Causes irreversible inhibition of H+, K+ ATPase, the enzyme that generates gastric acid
A single dose inhibits acid production by 97% in 2 hrs

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6
Q

Adverse effects of Omprazole

A

MINOR
Headache
Diarrhea
N & V
SEVERE
Pneumonia
Fractures
Rebound acid hypersecretion dyspepsia
Hypomagnesemia

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7
Q

Nursing considerations for Omeprazole

A

Administer doses before meals
Monitor serum Mg with prolonged use
Monitor for signs of pneumonia
Monitor for fractures

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8
Q

How does Sucralfate work?

A

Protects against ulcers by creating a mucosal barrier against acid and pepsin
Undergoes chemical reaction in acidic environment of stomach to form a sticky gel
Adheres to ulcer for 6 hours
Eliminated in the feces
Oral administration only

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9
Q

Adverse effects of sucralfate

A

Constipation (rare)
No systemic side effects because not absorbed

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10
Q

Nursing considerations for sucralfate

A

PO only
Should not be taken within 30 min of antacids
Can alter absorption of many other meds: should be taken 2hrs apart

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11
Q

Misoprostol description

A

Replaces endogenous prostaglandin
Suppresses secretion of gastric acid
Promotes secretion of bicarb/ mucus
Increases mucosal blood flow

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12
Q

Misoprostol indication

A

Limited to prevented NSAID induced gastroduodenal ulcers
Often seen as a combo drug w/ NSAIDs

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13
Q

Misoprostol adverse effects

A

Minimal
Diarrhea

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14
Q

Nursing considerations for misoprostol

A

Contraindicated in pregnancy - will cause spontaneous abortion

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15
Q

Antacids description

A

Alkaline compounds that neutralize stomach acids
Raise pH of stomach above 5
Reduce pepsin activity
Stimulate production of prostaglandins
Not systemically absorbed

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16
Q

Indications of antacids

A

GERD, PUD, and gastritis

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17
Q

Examples of antacids

A

Magnesium hydroxide (MOM), Aluminum hydroxide, Calcium carbonate (TUMS), sodium bicarbonate

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18
Q

Adverse effects of magnesium hydroxide

A

AKA Milk of Magnesia
Diarrhea (often administered with aluminum hydroxide to counteract this effect)
Avoid in patients with undiagnosed abd. pain
Mg can accumulate in people with renal dysfunction

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19
Q

Adverse effects of aluminum hydroxide (Almajel)

A

Constipation
High affinity for phosphate (can cause hyperphosphatemia)

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20
Q

Adverse effects of Calcium carbonate (TUMS)

A

Constipation, belching, flatulence (release CO2)
Risk for acid rebound
Calcium can accumulate in kidney failure (not recommended)

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21
Q

Adverse effects of Sodium Bicarbonate

A

Belching, flatulence (releases CO2)
In renal failure can cause systemic alkalosis
High risk of sodium loading (dangerous for HTN, HF)

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22
Q

Nursing considerations for antacids

A

Monitor GI function (constipation/ diarrhea)
Monitor electrolytes
Hypermagnesia, hyperphosphatemia, hypercalcemia
Give after meals
Unpleasant to digest therefore adherence is difficult

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23
Q

Drugs for PUD

A

Amoxicillin
Metronidazole
Clarithromycin
Tetracycline

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24
Q

Example of bulk-forming laxative

A

Psyllium

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25
Psyllium description
Similar action to finer (increased bulk to soft formed stool) Made of polysaccharides and cellulose derived from grains and plants (non digestible) Note absorbed systemically Should be administered with large glass of water to avoid obstruction/ impaction
26
Indications for psyllium
Chronic constipation, prevent straining of stool, IBS
27
What kind of laxative is lactulose?
Osmotic laxative
28
Lactulose description
Combination of galactose and fructose Poorly absorbed and not digested by enzymes in GI tract - n&v side effects Turns into lactic acid in colon which can have an osmotic action Hepatic encephalopathy - helps secretion of ammonia
29
Laxative salts - magnesium hydroxide description
Poorly absorbed salts and osmotic action draw water into intestinal lumen Lose dose therapy stool in 6-12 hrs High dose used for bowel evacuation prior to surgery or to purse poisons At risk of dehydration Mg salts are contraindicated in patients with kidney disease
30
Examples of osmotic laxatives
Lactulose Laxative salts - Magnesium hydroxide Polyethylene glycol
31
Polythelene glycol description
Non absorbable compound, retain water in intestinal lumen Causes feces to swell and soften GI side effects (N/ bloating/ cramps/ flatulence/ diarrhea) Can be used as a bowel cleanse prior to colonoscopy or other procedures at high doses
32
Example of stimulant laxative
Bisacodyl (Dulcolax)
33
Bisacodyl (Dulcolax) description
Stimulate intestinal motility and increases amount of water and electrolytes within bowel Opioid induced constipation Common drug for laxative abuse Available as rectal suppository or PO Given at night to produce stool the next day
34
Example of surfactant laxative
Docusate sodium (Colace)
35
Docusate sodium (Colace) description
Slow onset Work in the small intestine and colon Softens the stool by facilitating penetration of water Causes secretion of water and electrolytes in intestine Adverse effects: mild cramping, diarrhea
36
Nursing considerations for laxatives
Most laxatives are given until desired effect achieved and should be used short term Laxatives can be abused Water consumption is important GI assessment Most laxatives are not absorbed systemically
37
Description for using non specific antidiarrheals: opioids
Most effective antidiarrheal agents Activate opioid receptors in GI to slow intestinal motility (more time for absorption of fluid and electrolytes) May cause toxic megacolon in patients with IBD
38
Diphenoxylate (+Atropine) description
Brand name: Lomotil Opioid used only for diarrhea Atropine added to discourage abuse (unpleasant side effects) Available PO only Adv effects: dizziness, drowsiness, light-headedness, headache, n&v
39
Loperamide description
Brand name Imodium Suppresses bowel motility and bowel secretions Used to reduce volume of discharge from ileostomies Large doses do not produce morphine like effects
40
Bismuth Subsalicylate description
Brand name: Pepto Bismol Coats wall of GI tract Binds to causative bacteria or toxin which is then eliminated in stool Adv effects: increased bleeding time, constipation, dark stools, hearing loss, tinnitus, metallic taste, blue gums
41
Indications for ondansetron
Nausea associated with chemotherapy, radiation, anesthesia, viral gastritis and pregnancy
42
Ondansetron description
Trade name: Zofran Works in CTZ Acts on serotonin blocking receptors = less available serotonin Often used with dexamethasone to increase effect PO/ IV/ IM admin
43
Adverse effects of ondansetron
Headache, constipation, diarrhea, dizziness Urinary retention, muscle pain QT prolongation
44
Nursing considerations for ondansetron
Monitor EKG in patients at risk Monitor for effectiveness
45
Indications for dexamethasone
Nausea associated with chemotherapy
46
Dexamethasone description
MOA unknown Can be used with other other antiemetics (ondansetron) Used briefly for symptom management of nausea
47
What kind of drug is ondansetron?
Antiemetic serotonin antagonist
48
What kind of drug is dexamethasone?
Antiemetic glucocorticoid
49
What kind of drug is metoclopramide?
Dopamine antagonist
50
Metoclopramide description
Trade name: Maxeran Prokinetic drug Blocks dopamine and serotonin receptors in CTZ, enhances upper GI tract response to acetylcholine (increase peristalsis)
51
Indications for metoclopramide
Nausea caused by post op, cancer medications, opioids, toxins, radiation
52
Adverse effects of metoclopramide
In high doses, diarrhea and sedation With long term use: risk of tardive dyskinesia Cl: patients with GI obstruction, perforation or hemorrhage
53
Tardive dyskinesia defintion
Repetitive, involuntary movements of arms, legs, and facial muscles
54
Nursing assessments for metoclopramide
GI assessment Assess mental status (drowsiness) Look for uncontrolled movement
55
What kind of drug is Nabilone?
Cannabinoid
56
Nabilone description
MOA likely activation of receptors around vomiting centre Used to suppress chemo induced nausea and vomiting Second line drug dye to psychotomimetic effects and potential for abuse
57
Nursing considerations and side effects for Nabilone
Monitor for drowsiness SE: CNS: temporal disintegration, dissociation (avoid in pts with psychiatric disorders) CVS: tachycardia & hypotension (avoid in pts with cvd)
58
Indications for dimenhydrinate
Motion sickness, radiation, sickness, post-op, drug-induced nausea
59
Description for dimenhydrinate
Trade name Gravel Blocks H1 receptors in GI tract and muscarininc receptors in vestibular system (anticholinergic)
60
Adverse effects of dimenhydrinate
Drowsiness, hypotension, dry mouth and constipation Avoid with other CNS depressants Should not be taken with hx of glaucoma or chronic lung disease, difficulty urinating
61
Nursing considerations for dimenhydrinate
GI assessment Assess alertness (safety) Vital signs (check often with CVD) Monitor for signs of retention (bowel and bladder)
62
What kind of drug is scopolamine?
Muscarinic antagonist
63
Scopolamine description
Blocks nerve impulses between vestibular apparatus in inner ear and vomiting centre Most effective drug for preventing and treating motion sickness PO/ SC/ transdermal dosing
64
Adverse effects of scopolamine
Common: dry mouth, blurred vision, drowsiness Less common: urinary retention, constipation, disorientation
65
Nursing considerations for scopolamine
GI assessment Monitor for signs of retention (bowel & bladder) Assess alertness (safety)
66
What kind of drug is sulfazalazine?
5-aminosalicylates
67
Sulfasalazine description
Used to treat mild or moderate IBD Maintain remission after symptoms have improved Action on prostaglandin synthesis and suppression of migration of inflammatory cells into affected region
68
Nursing considerations for sulfazalazine
Monitor CBC periodically - can cause hematological disorders
69
Adverse effects of sulfasalazine
Nausea, fever, rash, arthralgia
70
What kind of drug is budesonide?
Glucocorticoids
71
Budesonide description
Anti-inflammatory action Use is to induce remission, not for long term maintenance IV/ PO
72
Nursing considerations for budesonide
Prolonged use of glucocorticoids can cause severe adverse effects, adrenal suppression, osteoporosis, increased risk for infection, Cushing's syndrome
73
Indications for budesonide
Mild to moderate ulcer colitis - works within the ileum and ascending colon
74
What kind of drug is cyclosporine?
Immunosuppressant
75
Cyclosporine description
Long term therapy Calcineurin inhibitor - very strong immunosuppressant Faster acting and stronger than other immunosuppressants Continuous IV infusion, can be administered PO in low doses to maintain remission Increased lymphoma risk, further increased when used with other immunosuppressants
76
Nursing considerations for cyclosporine
Potentially toxic compound can cause renal impairment, neurotoxicity Generalized suppression of the immune system increases risk of infection
77
Indications for cyclosporine
Severe disease that has not responded to other therapies, both UC and Crohn's
78
What kind of drug is Infliximab?
Immunomodulator
79
Infliximab description
Monoclonal antibodies Designed to neutralize TNF, a key immunoinflammatory modulator Infections: TB and other opportunistic infections are most common Infusion reactions: fever, chills, pruritus, urticaria, cardiopulmonary reactions (chest pain, hypertension, hypotension) Increased risk of lymphoma 6 wk regimen followed by maintenance infusions Q8Wks
80
Indications for Infliximab
Moderate to severe UC and Crohn's

NURS 2514 (14 decks)

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