GI System

Question 1

Antacids Adverse Effects

Answer 1

Aluminum, calcium- constipation
Calcium- kidney stones
Magnesium- Diarrhea, magnesium toxicity if kidneys impaired
Sodium- Fluid retention, alkalosis

Question 2

Histamine-2 Receptor Blockers (H2RBs) Action

Answer 2

Block H2 receptor of parietal cells —> reduce hydrogen ion secretion —> increase PH in stomach

Question 3

H2RBs Therapeutic use

Answer 3

Treatment of acid-related disorders
Adjunct therapy to control upper GI bleed
Management of urticaria (rash)

Available forms: PO, IV. Nizatidine PO only

Question 4

H2RBs Adverse Effects

Answer 4

Cimetidine: confusion, disorientation in the elderly, impotence, gynecomastia.
Famotidine: Thrombocytopenia
Ranitidine: Thrombocytopenia
Nizatidine: Cough or hoarseness, chest pain

Question 5

Proton Pump Inhibitors (PPIs) Examples

Answer 5

Omeprazole
Lansoprazole
Pantoprazole

Question 6

PPIs Adverse Effects

Answer 6

Pneumonia
Osteoporosis (long term effect)
Hypomagnesemia
Wrist, spine, hip fracture
C. Diff-associated diarrhea

Question 7

PPIs therapeutic use (temporary use)

Answer 7

Ulcers
Esophagitis
GERD
NSAID induced ulcers
Prevention of stress ulcer (can be b/c of someone w/ an NG tube)

Available forms: PO and IV

Question 8

Nursing Implications on H2RBs

Answer 8

Take H2RBs 1-2 hours before antacids (antacids decrease its absorption)
Not given alone (works as an additional medication for GI bleed)
Caution in clients with COPD, pneumonia, and kidney impairment.
Cimetidine: increases anticoagulant effects of warfarin and theophylline levels
Smoking decreases effectivemess of H2RBs

Question 9

PPIs nursing implications

Answer 9

Food can decrease absorption of PPIs (take medication an hour before or after)
Make sure Don’t bite medications
Do not open PPI capsule and sprinkle contents over food: capsule contents may be opened and mixed with apple juice but not in food.
Take omeprazole once a day before breakfast
Take before meals if prescribed more than once a day

Question 10

Nursing implications

Answer 10

Shake liquid formulations of antacids
Administer medications at least 1 hour before or after an antacid
Alternate use of aluminum or calcium and magnesium antacids to normalize bowel pattern
Consume high-fiber foods and drink adequate fluids if taking magnesium hydroxide
Avoid antacids with sodium if positive for HTN or heart failure
Avoid antacids with magnesium if positive for renal dysfunction
Chew tablets throughly and drink at least 8 oz of water or milk
Maintain adequate intake of calcium and vitamin D
Notify provider of GI bleed symptoms of if symptoms of hyper acidity are not relieved .

Question 11

Sucralfate - cytoprotective Adverse Effects

Answer 11

May cause dry mouth, nausea, constipation
May impair absorption of other drugs

Question 12

Sucralfate implications

Answer 12

Increase fiber and fluid intake
Give 30 min before or after antacids and maintain 2-hr interval when giving other drugs
Take 1-hour before meals and at bedtime

Question 13

Misoprostol- prostaglandin analogue symptoms

Answer 13

Therapeutic doses may cause abdominal cramps and diarrhea

Question 14

Simethicone therapeutic effect

Answer 14

Anti-flatulent
Reduces the discomfort when passing gas

Question 15

Antidiarrheals

Answer 15

Adsorbents- Bismuth salicylate, activated charcoal
Anticholinergic- Belladonna
Opiates- OTC loperamide, Diphenoxylate/atropine
Probiotics-Lactobacillus acidophilus

Question 16

Adsorbents Adverse Effects

Answer 16

Increased bleeding times
Confusion
Tinnitus, metallic taste

Question 17

Anticholinergics Adverse effects

Answer 17

H/A, dizziness, blurred vision
Urinary retention
Dry skin, flushing

Question 18

Opiates

Answer 18

Dizziness, drowsiness
Urinary retention, constipation

Question 19

Probiotics

Answer 19

Flatulence, bloating

Question 20

Laxatives examples

Answer 20

Bulk-forming
Emollient
Hyperosmotic
Saline
Stimulant

Question 21

Bulk-forming action and examples

Answer 21

Absorb water to increase bulk
- psyllium
-methylcellulose

Question 22

Emollient actions and examples

Answer 22

Lubricate and soften stool
-lubricant: mineral oil
-stool softener: docusate sodium

Question 23

Hyperosmotic actions and examples

Answer 23

Increase fecal water content
- polyethylene glycol (PEG)
- Sorbitol
- Lactulose

Question 24

Saline actions and examples

Answer 24

Increase osmotic pressure causing more water to enter the intestines
- magnesium hydroxide
- magnesium citrate

Question 25

Stimulant actions and examples

Answer 25

Increase peristalsis via intestinal nerve stimulation - senna - Bisacodyl

Question 26

Laxative adverse effects

Answer 26

Dehydration, electrolyte imbalance GI irritation Diarrhea, rectal burning sensation

Question 27

Nursing implications

Answer 27

Obtain history of symptoms, bowel elimination patterns, and laxative use Assess fluid and electrolyte status before initiating therapy Client teaching — increase fiber intake ( bran, fresh fruits, veggies, and fluid intake 2-3L/day) — Use laxatives occasionally if needed — Do not use laxatives if experiencing N/V and abdominal pain — Take laxatives with 6-8 oz of water Take bisacodyl at bedtime for results in 6-12 hrs ; suppositories are effective within one hour

Question 28

Antiemetics therapeutic use

Answer 28

Prevent of relieve Nausea and vomiting Action: block neurological stimulus that induces vomiting

Question 29

Antiemetics examples

Answer 29

Antidopaminergic: Prochlorperazine (PO, PR, IM, IV) Serotonin blocker: Ondansetron (PO, IM, IV) Prokinetic: Metoclopramide (PO, IM, IV) Cannabinoid: Dronabinol (PO)

Question 30

Antidopaminergic- Prochlorperazine Adverse Effects

Answer 30

Extrapyramidal symptoms (EPS) Tardive dyskinesia Sedation Hypotension Anticholinergic effects

Question 31

Serotonin blocker - Ondansetron Adverse Effects

Answer 31

Headache, dizziness Dysrhythmia Diarrhea

Question 32

Prokinetic- Metoclopramide Adverse Effects

Answer 32

EPS Tardive dyskinesia Sedation Diarrhea

Question 33

Cannabinoid- Dronabinol Adverse Effects

Answer 33

Hypotension Tachycardia Dysphoria

Question 34

Antiemetics Contraindications

Answer 34

Caution in clients with asthma, narrow angle glaucoma, and urinary retention or GI obstruction Caution in children and older adults

Question 35

Antiemetic Interactions

Answer 35

Antiemetics and opioids or alcohol —> increased CNS depression Antiemetics and antihypertensives —> increased hypotensive effects

Question 36

Nursing implications for antiemetics

Answer 36

Assess precipitating factors for N/V, medical history, and current medications Give antiemetics 30-60 min before chemotherapy Assess for Anticholinergic effects and EPS

Question 37

Client teaching for antiemetics

Answer 37

Avoid driving and performin hazardous tasks due to sedations Do not combine alcohol and antiemetics due to CNS depression Change positions slowly due to orthostatic hypotension Stop the medication and notify the provider if positive for EPS. Increase fluid intake, engage in physical activity, and suck on hard candy or chew gum to help relieve Anticholinergic effects

Question 38

What is gonna be on our test

Answer 38

Question on fimetidine When shouldn’t you give certain medications.. remember contraindications Do not give Laxatives, antidiarrheals, antacids (can stimulate the GI tract as well), and antiemetics with someone with GI obstructions Evaluate the effectiveness of a medication: need to know if the medication is working A lot of questions on antacids Different GI medications address different GI issues Know specific contraindications for each specific antacid Lactulose will give you diarrhea : remember that if you are inducing diarrhea you are concerned about electrolyte imbalance. (Electrolytes include Sodium, magnesium, potassium.) Laxatives don’t usually work right away. Baseline they take 1-3 days exception would be per rectum or saline Almost all laxatives are PO example saline is PO but bisocodyl are PR and PO there are saline that can also be used as PR as well A lot of questions on constipation use and diarrhea use Know mechanism of action for each antiemetics…. Example Metoclopramide helps empty stomach contents faster Bisocodyl and senna : if someone stops taking them the body is gonna withdraw (it stimulates GI effects) so body will depend on it gonna be worried about dependency Remember dehydration for laxatives