GI Disorder

Question 1

Constipation more frequent in

Answer 1

Older adults

Question 2

Diagnosis requires at least two of the following symptoms.

for const

Answer 2

Two or fewer bowel movements per week
Lumpy or hard stools at least 25% of time
Straining to pass stools at least 25% of time
Feeling of incomplete evacuation at least 25% of time

Question 3

Const causes

Answer 3

lack of fluid intake
Lack of dietary fiber
Immobility

Question 4

Tx of Const nutriotinoal

Answer 4

Prune/prune juice
Increase fluid
Increase activity
Increase fibre

Question 5

Increased fiber includes

Answer 5

Whole wheat, bran, oats, fruits and vegetables.

Will increase gas production initially but the effect decreases with time.

Question 6

Pharmacotherapy w/ laxatives

Answer 6

Laxatives are drugs that promote evacuation of bowel

Question 7

Classes of laxatives

Answer 7

Bulk-forming (ie psyillium)

Stool softeners (ie docusate)

Stimulants

Osmotics

Question 8

Builk forming laxatives

Answer 8

Bulk-forming (ie psyillium)
Fibre that absorbs water, forming bulkier stool that passes more easily
Must be taken with lots of water

Question 9

Stool softeners

Answer 9

Docusate

Surfactant that lowers surface tension of stool allowing more water to enter stool
Often given when constipation poses a risk

Question 10

Stimulants laxatives

Answer 10

Irritate bowel, promoting peristalsis What do you think this can cause?

Question 11

Osmotic laxatives

Answer 11

Draw water into GI tract
Can cause dehydration

Question 12

Psyllium Mucilloid

Answer 12

Bulk forming lax
Metamucil, Psyllium

Occasional constipation
Reduction of blood cholesterol with longer use

Mechanism of action
Absorbs water in bowel forming a bulky stool
Bulky stool stimulates defecation reflex

AE
- safest laxitive if taken as directed with water

Mild. cramping or D
If not taken with adequate water, can cause obstruction of the esophagus or intestines

Question 13

When giving laxatives ensure

Answer 13

Closeby commode or
Clear path to BR

Question 14

How often must pts have BM in hospital

Answer 14

Pt must have BM EVERY 3 days

Question 15

Diarrhea is

Answer 15

Increased fluidity of feces when colon does not reabsorb enough water

Often secondary to another condition

i.e.
GI infection
Drugs (antibiotics, NSAIDs, orlistat, digoxin)
Inflammation of bowel
Foods
Diseases of SI and pancreas, leading to malabsorption of food

Question 16

Prolonged diarrhea

Answer 16

Indication for pharmacotherapy
Symptom of underlying disease

Prolonged diarrhea can cause:
1 Fluid deficit
2 acid–base imbalances
3 electrolyte abnormalities

Question 17

Tx focus when dealing with diarrhea

Answer 17

to eliminate primary cause of diarrhea and to manage symptoms through pharmacotherapy
If infection is primary cause, then antibiotics will be most effective treatment.

Question 18

Oral solutions would you reccomend for diarrhea

Answer 18

Gatorade, pediolyte

Question 19

Diet for diarrhea

Answer 19

Decrease fiber
Decrease milk products
Avoid fatty foods
Avoid coffee & tea

Question 20

Pharmacotherapy of diarrhea

Answer 20

Opioids (Most common)
- Codeine
Loperamide
Non opioid
- Pepto-Bismol
Psyllium - absorbs water to form bulk

Question 21

Atropine

Answer 21

Used for: Mod-severe diarrhe
MoA: Binds to mu opioid receptors in GI tract reducing peristalsis
- Atropine blocks ACh receptors to reduce peristalsis
Combined, this combo provides time for water to be abosrombed from LI

Question 22

Loperamide (Immodium)

Answer 22

Loperamide is an anti-diarrheal agent that provides symptomatic relief

also increases rectal tone,reducing daily fecal volume, and increasing the viscosity and bulk density of feces .It also increases the tone of the anal sphincter, thereby reducing incontinence and urgency.

Onset: 1 hour, can last for 3 days

Does not mediate significant analgesic activity at therapeutic

Question 23

Assessment before Immodium

Answer 23

Obtain a complete health history including allergies and drug history
Obtain vital signs, ECG and electrolytes why?
Obtain and evaluate stool culture why?
Assess for presence of dehydration why?

Question 24

Interventions for pts recieving antidiarrheal therapy

Answer 24

Monitor for anticholinergic effects including dry mouth
Initiate safety measures to reduce risk of falls

Question 25

Vomiting controlled by

Answer 25

Controlled by the vomiting center of the brain that receives signals from digestive tract, inner ear, chemoreceptor trigger zone, cortex

Question 26

Complications from chronic vomitingq

Answer 26

Dehydration Electrolytes WT loss Metabolic alk

Question 27

When foods and fluids cannot be tolerated, start with

Answer 27

Warm fluids, gatorade, bland fluid

Question 28

Complentary alternative therapy for NV

Answer 28

Acupuncture Herbs like ginger and peppermint Breathing exercises

Question 29

Pharm therapty of NV KNOW THIS

Answer 29

Anticholinergics Antihistamines

Question 30

Scopolamine Class Use AE

Answer 30

Anticholinergics Often given as a patch or SQ Nausea due to Motion sickness or Post OP AE-Dry mouth, Sleepines, Urinary retention, Agitation, Dilated pupils

Question 31

Antihistimanines (Gravol)

Answer 31

Nausea due to motion sickness Cause significant drowsiness AE- Drowsiness. Dizziness, Blurred vision,Dry mouth, nose, and throat, Constipation

Question 32

Serotonin Receptor antiagonists

Answer 32

Ondansetron - zofran Chemotherapy-induced nausea and vomiting AE- Blurred vision, bradycardia, anxiety, agitation, shivering

Question 33

Phenothiazines

Answer 33

H2 receptor antagonists; ie prochlorperazine) Antineoplastic therapy - NV

Question 34

Cannabinoids (Marinol-dronabinol)

Answer 34

Used to treat NV caused by Antineoplastic (Chemo) therapy Stimulate appetite (CAN be a benefit) AE- seizures, tachycardia, mood changes

Question 35

Corticosteroids used for

Answer 35

Tx of NV in Antineoplastic therapy (Cancer tx) Post-surgical nausea and vomiting

Question 36

Haldol

Answer 36

classified as an antipsychotic but also helps control nausea and vomiting by blocking dopamine receptors in the brain. 1st Line therapy for preventing post op vomiting Can be given PO AE: Anxiety, tiredness, neuroleptic malignant sundrome (Life threatening)

Question 37

Metoclopramide (Maxeran)

Answer 37

Tx of severe NV Blocks D2 receptors in brain, preventing signaling to the vomiting centre AE: Drowsiness, Extrapyramidal effects (Smack lips, lick lips, twisting neck etc/)

Question 38

In both Crohn’s and ulcerative colitis, malnutrition can result. Why do you think this is?

Answer 38

Crohns - Affects the small intestine

Question 39

First response to IBD exacerbation

Answer 39

NPO

Question 40

Pharmacotherapy of IBD (1 of 2)

Answer 40

5 ASA Corticosteriods Immunosuppressants

Question 41

IBS Tx

Question 42

Pancreatis

Answer 42

Digestive enzymes remain in the pancreas rather than being released into duodenum Acute pancreatitis More common in middle-aged adults Associated with gallstones in females, alcoholism in males Chronic pancreatitis Associated with alcoholism

Question 43

Causes of pancreatitis

Answer 43

Alcoholism Infections Genetic (cystic fibrosis)

Question 44

Pancrelipase

Answer 44

Use: Replacement therapy for patients with insufficient pancreatic exocrine secretions Panceatisi MoA- Facilitates digestion lipids into glycerol and fatty acids starches into dextrin and sugars proteins into peptides

Question 45

Protevyion from acid secretion in stomach

Answer 45

Goblet cells produce mucous which protects the lining of the stomach Pancreas secretes bicarbonate ions into duodenum to neutralize acid to protect mucosa

Question 46

Most peptic ulcer dx caused by

Answer 46

H pylori

Question 47

Duodenum ulcers relieved by

Answer 47

Food

Question 48

Gastric ulcers

Answer 48

More common in those over 60, not relieved by food

Question 49

GERD

Answer 49

Chronic condition

Question 50

Nutritional therapy for GERD

Answer 50

Consume small meals and consume liquids bw meals Limit foods or substances increasing gastric acid (Coffee and alcohol) (Choclate fried food) Avoid lying down after eating or eating right before bed. Meals should be consumed at least 3 hours before bed. Avoid wearing tight garments or bending over. Avoid cigarette smoking which relaxes the sphincter. Avoid using NSAIDS. Which can damage esophageal mucosa.

Question 51

Ranitidine (Zantac)

Answer 51

Uses: Duodenal ulcers, gastric ulcers Hypersecretory conditions (ie ZES) Heartburn, GERD Used off-label to counter medications that promote development of peptic ulcers MoA: Blocks H2 receptors on the parietal cells in the stomach to decrease acid production Administered once daily

Question 52

AE of Ranitidine

Answer 52

Adverse effects Uncommon and transient Serious adverse effects, reduction in; 1 Platlets 2 RBC 3 WBC

Question 53

Proton Pump Inhibitors

Answer 53

PPIs block the enzyme (H+/K+ pump )on parietal cells, reducing acid secretion in the therapy of PUD and GERD Should be taken about 30 minutes before meals

Question 54

Omeprazole

Answer 54

PPI Uses: By prescription, approved for short-term, 4- to 8-week therapy of active peptic ulcers OTC, indicated for relief of heartburn MoA: Reduces acid secretion in stomach by irreversibly binding to the H+/K+ pump AE: Headache, nausea, diarrhea, rash, abdominal pain SHOWN to cause cancer long term (In animals)

Question 55

Main downside of taking antacids

Answer 55

Can reduce absorptionof OTHER Drugsthat require acidic environment Neutralize the stomach acid

Question 56

Adverse effects of hydroxide

Answer 56

Constipation At high doses, aluminum products bind with phosphate in GI tract, and long-term use can result in phosphate depletion