Nursing Process, Pharmacological Principles & Antidiarrheals Flashcards
(230 cards)
1
Q
Nursing Process
A
A research-based organizational framework for professional nursing practice
Flexible, adaptable, and considered the major systematic framework for professional nursing practice
Ensures the delivery of thorough, individualized, and quality nursing care to patients
Requires critical thinking (clinical reasoning and clinical judgement)
Ongoing and constantly evolving process
2
Q
5 Steps of the Nursing Process
Which includes goals and outcome criteria?
Which includes PT education?
A
ADPIE
P- Planning includes GOALS and Outcome criteria
Implementation- PT education
3
Q
Assessment
List what you want to assess.
A
Data collection, review, and analysis
Medication profile:
Any and all drug use
Home or folk remedies;
natural heath products or homeopathic treatments
Alcohol, tobacco, caffeine intake
Current or past illicit drug use
Prescriptions and over-the-counter medications
Past or present health history and associated drug regimen
Family history; growth and developmental stage
Issues related to age and medication regimen
4
Q
Define NANDA-I?
Purpose?
A
North American Nursing Diagnosis Association International (NANDA-I)
Purpose of NANDA-I is to increase the visibility of nursing’s contribution to the care of patients and to further develop, refine, and classify the information and phenomena related to nurses and professional nursing practice.
5
Q
International Classification for Nursing Practice (ICNP)
A
Project of the International Council of Nurses
The ICNP is a framework that can be cross-mapped with other health care classification systems, creating multidisciplinary health vocabularies within information systems.
Cross-mapped with other health care classification systems such as NANDA
The Canadian Nurses Association (CNA) has endorsed the ICNP as the standard for collecting nursing data.
Disparity in opinion as to which approach is best
6
Q
Nursing Diagnoses
Define and list the 3 step process.
A
Nursing diagnoses are used to communicate and share information about the patient and the patient’s experience.
Three-step process:
PART I: Human response to illness, injury, or significant change
PART II: Factors related to the response (“related to”)
PART III: Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”)
7
Q
Common nursing diagnoses related to drug therapy develop from data associated with:
A
Deficient knowledge
Risk of injury
Nonadherence
Various disturbances, deficits, excesses, or impairments in bodily function
8
Q
Planning
A
Identification of goals and outcome criteria
9
Q
Define Goals and Outcome criteria?
A
Goals:
Objective, measurable, and realistic, with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria
Outcome criteria
Concrete descriptions of patient goals
10
Q
Implementation
A
Implementation is guided by the preceding phases of the nursing process.
Initiation and completion of specific nursing actions as defined by nursing diagnoses, goals, and outcome criteria
Independent, collaborative, dependent
Statements of interventions include frequency, specific instructions, and any other pertinent information.
11
Q
List the 10 rights of medication
A
MEDICATION/ DRUG
PT
DOSE
TIME
ROUTE
DOCUMENTATION
REASON
REFUSE
EVALUATION/ ASSESSMENT
PT EDUCATION
12
Q
Time-Critical Scheduled Medications
A
Facility-defined medications:
Administer at exact time when necessary (e.g., rapid-acting insulin), otherwise within 30 minutes before or after scheduled time.
Early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm
13
Q
Non–Time Critical Scheduled Medications
A
Daily, weekly, monthly medications: Administer within 2 hours before or after scheduled time.
Medications prescribed more frequently than daily but no greater than q4h: Administer within 1 hour before or after scheduled time.
Early or delayed administration within a specified range of either 1 or 2 hours should not cause harm
14
Q
Medication Errors
A
Defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient, or consumer”
INCIDENT REPORT
15
Q
Evaluation
A
Systematic, ongoing, and dynamic part of the nursing process
Determining the status of the goals and outcomes of care
Monitoring the patient’s response to drug therapy
Therapeutic, expected, and toxic responses
Clear, concise documentation
16
Q
THE PATIENT REPORTED THAT HIS MEDICATION AT 2100 WAS MISSED
WHAT WOULD YOU DO?
A
Check MAR
17
Q
PT taking antiepileptic medications and has NPO orders. What would you do?
A
Call the Doctor to clarify instructions
18
Q
PT is requesting pain medications. What would you do first?
A
First assess pt’s pain and pain level
19
Q
Drug
A
Any chemical that affects the physiological processes of a living organism
20
Q
Pharmacology
A
Broadest term for the study or science of drugs
21
Q
Chemical name
A
Describes the drug’s chemical composition and molecular structure
22
Q
Generic name
A
(nonproprietary, official name)
Name given to a drug approved by Health Canada
23
Q
Trade name
A
(proprietary name)
The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer).
24
Q
Drug classification
3 ways to classify drugs?
A
Drugs are grouped together based on:
their similar properties
their structure
their therapeutic use
25
Example of names
Chemical: propionic acid
Generic: ibuprofen
Trade: Advil
26
Pharmacological Principles
Pharmaceutics
Pharmacokinetics
Pharmacodynamics
Pharmacogenomics (pharmacogenetics)
Pharmacotherapeutics
Pharmacognosy
Pharmacoeconomics
Toxicology
27
Pharmaceutics
The study of how various drug forms influence the way in which the drug affects the body
Optimal design
how the drug influence the body
28
Dissolution-dissolving of solid dosage forms and their absorption
Enteric coating
Thin filmed drugs (quick dissolve in buccal tissue)
Combining drugs
Time-release technology
29
Enteric coated
coats the drug- so that it dissolves in the intestines to protect stomach acid
30
Fastest form of oral drugs
liquid
31
slowest form of oral drugs
enteric
32
Enteric coated
DO NOT CRUSH/ will dissolve in stomach and disrupt the acid (so call pharmacy to send a liquid form of the drug)
33
Pharmacokinetics DEFINE
The study of what the body does to the drug
From the time drug is put into the body until the parent drug and metabolites have left the body
34
4 steps Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Remember: “A D M E” sounds like “add me”
35
Pharmacokinetics: Absorption
Includes (3)?
Bioavailability, first-pass effect, routes
36
Bioavailability
The extent of drug absorption
extent a drug becomes completely available to its destination/ enter circulation
37
First-pass effect
Reduces bioavailability to <100% (inactive metabolites)
Occurs in liver
38
Types of routes
Enteral route- GI tract
Sublingual and buccal routes
Parenteral route
Topical route
Transdermal route
Inhalation route
39
Types of parenteral routes (7)
intradermally,
subcutaneously,
intravenously,
intramuscularly,
intrathecally (spinal cord)
intra-articularly( joint),
intra-arterially
40
Define enteral route
4 routes
The drug is absorbed into the systemic circulation through the mucosa of the stomach, small intestine, or large intestine
Oral
Sublingual
Buccal
Rectal (can also be topical)
41
What 4 ROUTES bypass the first pass effect at the liver?
Sublingual and buccal
Parenteral
Topical route (except rectum)
42
Parenteral route (7)
Intravenous (fastest delivery into the blood circulation)
Intramuscular
Subcutaneous
Intradermal- mantu test
Intra-arterial
Intrathecal- spinal cord
Intra-articular- joint
43
Which type of topical route has a first effect?
Rectum because it is part of the GI tract
44
Types of topical route?
Skin (including transdermal patches)
Eyes
Ears
Nose
Lungs (inhalation)
Rectum- HAS FIRST PASS EFFECT (part of GI tract)
Vagina
45
Pharmacokinetics: Distribution
Transport of a drug by the bloodstream to the drug’s site of action
46
4 places of extensive blood supply:
Heart
Liver
Kidneys
Brain
47
MAIN SITE OF METABOLISM
Liver
48
Distribution:
Albumin?
The most common blood protein and carries the majority of protein-bound drug molecules.
49
If a given drug binds to albumin, it is?
Inactive
50
Active
drug that is not bound
51
The unbound portion of a drug is called?
and considered?
Active
is considered a "free" drug
52
Low albumin levels can contribute to?
drug toxicity because less drug will be inactive
inactive drugs: drug binds to albumin
53
What causes drug-drug interaction?
Competition between drugs for binding sites, with albumin
54
A possible solution for drugs competing for binding sites and causing drug-to-drug interactions?
Is to change administration times between these drugs.
55
Pharmacokinetics:
Metabolism is also referred to as?
Also referred to as biotransformation
Biochemical alteration of a drug
56
Metabolism is a biochemical alteration of a drug into (4)
An inactive metabolite,
A more soluble compound,
A more potent metabolite (as in the conversion of an inactive prodrug to its active form),
Or a less active metabolite
57
What is the most responsible for metabolism?
Other organs? 5
The liver
Others: skeletal muscle, kidneys, lungs, plasma, intestinal mucosa
58
Cytochrome P-450 enzymes
(Or simply P-450 enzymes), also known as microsomal enzymes
59
Lipophilic
(“fat loving”)
enzymes work mostly on these
60
Hydrophilic
(water-loving)
easier to metabolize
61
Substrates
targeted drugs for specific enzymes
62
Enzyme inhibitors
decrease or delay metabolism
63
Enzyme inducers
stimulate metabolism
64
Liver/ kidney disease can lead to
toxicity
65
Pharmacokinetics:
Excretion
Elimination of drugs from the body
Liver and bowel also play a role
Renal excretion – affected by kidney disease
Biliary excretion – affected by liver disease/ bowel disease
66
Primary organ of excretion?
Primary organ responsible is kidney
67
What other 2 organs play a role in excretion
Liver and bowel also play a role
68
What does kidney disease affect?
renal excretion
69
what does liver and bowel disease affect
biliary excretion
70
Pharmacokinetics
Half-life
Time required for half (50%) of a given drug to be removed from the body during elimination phase
The length of time required for the concentration of a particular substance (typically a drug) to decrease to half of its starting dose in the body.
71
Pharmacokinetics:
Steady state
define
how many half lives
Amount of drug removed via elimination = (equals) amount absorbed with each dose
Takes about 4-5 half lives of drug administration
Steady state means consistent blood levels and correlates with maximum therapeutic benefits
72
Onset of action
when it starts to have an effect
73
Peak effect
maximal therapeutic effect
74
Duration of action
how long it is effective
75
The length of time until the onset and peak of action and the duration of action play an important part in determining the
peak level and trough level of a drug
76
What happens if the peak blood is too high?
drug toxicity
77
Peak level
highest blood level of a drug
highest concentration of a drug in the blood
highest level of drug in the blood
78
Trough level
lowest blood level of a drug
the lowest concentration of a drug in the blood
79
Toxicity occurs if the
Peak blood level of the drug is too high
80
What is used to monitor peak/trough, adequate therapeutic effects, minimize drug toxicity
Therapeutic drug monitoring
81
Onset
When the drug elicits response
82
Peak
Max response
83
Duration
How long it is effective
84
Pharmacodynamics
(2)
The study of what the drug does to the body
The mechanism of drug actions in living tissues (how does it work)
85
Therapeutic effect
A positive effect on faulty physiology.
The goal of drug therapy.
86
Mechanism of action
Modified cell or tissue function
87
3 types of mechanism of action
Receptor interactions
Enzyme interactions
Nonselective interactions
88
Receptor interactions
drug and receptor binding
89
Enzyme interaction
drug and enzyme binding
90
Nonselective interactions
disrupt cell processes in various ways
disrupt cell membranes; some antibiotics
91
Organ used by the first pass effect
Liver
92
Difference between PO and IV dose as influenced by 1st pass effect?
PO dose will be always higher than IV dose due to the 1st pass effect
93
Agonist receptors
forms a bond with specific receptors
binds to a receptor and gets a response
94
Antagonists
block the receptor
Does NOT get a response > to block the effects
95
Pharmacotherapeutics
The clinical use of drugs to prevent and treat diseases
96
The desired therapeutic outcomes is:
Outcome goals need to be ____.
patient-specific, established in collaboration with the patient.
Outcome goals need to be realistic.
97
Contraindications-
anything that makes a drug dangerous for a pt
98
Types of drug therapy
(7)
acute, maintenance, supplemental, palliative, supportive, prophylactic, empirical
99
acute
acute illness
100
maintenance
chronic disease maintenance therapy- oral contraceptives
101
supplemental/ replacement
insulin, iron
102
palliative
comfort measures
103
supportive
maintain integrity of body functions (fluid/electrolytes, blood products)
104
phropylactic
VACCINE
antibiotics
105
emperical
antibiotics before seeing a culture test
106
Slowest pain relief
PO
107
Pharmacotherapeutics
Monitoring: What to look for?
Therapeutic action- beneficial effects
adverse effect- predictable undesirable;e effect
Therapeutic index
drug concentration/ drug levels (blood or urine specimens
Patient condition- weight, concurrent illness
108
Therapeutic index
determines?
define?
Ratio of toxic level to therapeutic level
toxic level : therapeutic level
(determines safety of a drug);
narrow/large or low/high; “therapeutic window”
109
tolerance
decreasing response to repeated drug doses
effects of opioid
110
dependence
physiological or psychological need for a drug
111
physical dependence
physiological need for a drug to avoid physical withdrawal symptoms
112
Psychological dependence (addiction):
an obsessive desire for a drug
113
Pharmacotherapeutics:
Drug interactions
with other drugs or food
increased or decreased effect of one drug on another
114
additive effects
total effect of both drugs; T3/ Percocet
115
synergistic effects
greater effect if both; one enhances the other
116
antagonist effects
less effect if both
1 + 1= less than 2
can reduce absorption/ effect of another drug
117
Incompatibility
cannot be given together
chemical deterioration of one or both
118
adverse drug event
broad term for an undesirable occurrence involving medications
119
medication error
compromise 10 rights
120
adverse drug withdrawal event
during withdrawal
121
Idiosyncratic reaction
unexpected occurrence in patient
122
Medication processes where errors can occur:
Prescribing
Dispensing
Administering
Monitoring
123
Teratogenic
Teratogenic – fetal defects
124
Mutagenic
Mutagenic – permanent change in genes (radiation)
125
Carcinogenic
Carcinogenic – cancer causing (excessive hormone therapies)
126
Pharmacognosy
The process of identifying medicinal plants and their ingredients, pharmacological effects, and therapeutic efficacy
127
4 main sources of pharmacognosy drugs?
plants, animals, minerals, and laboratory synthesis
128
Pharmacoeconomics
(2)
Study of the economic factors influencing the cost of drug therapy
Cost–benefit analysis
129
TOXICOLOGY
Science of poisons and unwanted responses to both drugs and chemicals
130
Clinical toxicology deals specifically
Clinical toxicology deals specifically with the care of poisoned patients.
131
Pharmacogenetics
The study of the genetic basis for variations in the body’s response to drugs, with a focus on variation related to a single gene
See ethnocultural implications - e.g. G6PD deficiency (drug induced hemolysis)
132
What does pharmacogenomics survey?
surveys the entire genome for determinants of drug response
133
Define diarrhea
How many per day?
Abnormal passage of stools with increased frequency, fluidity, and weight or with increased stool water excretion
Consists of three or more loose or liquid stools per day
134
Acute diarrhea
Onset
Duration
_________ (can cause?)
resolves without?
Sudden onset in a previously healthy person
Lasts from 3 days to 2 weeks
Self-limiting
Resolves without sequelae (aftereffect)
135
Chronic diarrhea
Duration
Associated with?
Symptoms (6)
Lasts for more than 3 to 4 weeks
Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness
136
Causes of acute diarrhea (5)
bacteria, virus, drug-induced, nutritional factors, protozoa
137
Causes of chronic diarrhea (6)
tumours, diabetes, Addison's disease, hyperthyroidism, IBS, AIDS
138
Goals of diarrhea treatment (4)
stopping the stool frequency
alleviates abdominal cramps
Replenish fluids and electrolytes
prevent weight loss and nutritional deficits from malabsorption
139
3 KINDS OF ANTIDIARRHEALS
adsorbents
anti motility drugs
Probiotics
140
2 types of anti motility drugs
opiates
anticholinergics
141
Probiotics are also known as (2 different names)?
intestinal flora modifiers
bacterial replacement drugs
142
Mechanism of actions of Adsorbents
Coat the walls of the gastrointestinal tract
Bind to the causative bacteria or toxin, which is then eliminated through the stool
143
Absorbent drugs
1 important to know
Bismuth Subsalicylate
(Pepto-Bismol)
Other: activated charcoal, and antilipemic drugs, colestipol and cholestyramine
144
Adsorbents are used for _______ cases
mild
145
Antichollinergis and Opiates are used for?
more severe cases
146
Probiotic is used for?
antibiotic-induced diarrhea
147
C- diff is not treated with?
antidiarrheals/ laxative
148
Bismuth Subsalicylate's chemical structure
a form of acetylsalicylic acid (aspirin)
its a salicylate
149
Bismuth Subsalicylate
Caution in?
children and adolescents especially those recovering from chicken pox/ influenza due to the risk of Reye's syndrome
150
6 Adsorbents: Bismuth Subsalicylate's adverse effects
Increased bleeding time- has salicylate
Constipation, dark stools
Confusion
Tinnitus
Metallic taste
Blue gums or black tongue
151
How do absorbents DECREASE effectiveness of many drugs?
by decreasing the absorption of certain drugs
examples: digoxin, quinidine, sulphate, antihyperglycemic drugs
152
Bismuth Subsalicylate when taken with WARFARIN, ASPIRIN, OR OTHER NSAIDS can cause?
IN OA?
increased bleeding times and bruising
can cause confusion to OA
153
Adsorbents decrease the ________ of many drugs, including digoxin, quinidine sulphate, and hypoglycemic drugs.
Adsorbents cause increased bleeding time and bruising when given with?
Toxic effects of_______ are more likely when given with adsorbents.
absorption of many drugs
anticoagulants
methotrexate
154
Oral anticoagulant, WARFARIN, when given with adsorbents results in?
WHY?
increased bleeding time and bruising because adsorbents binds to VITAMIN K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal flora in the bowel.
155
Patients with diarrhea associated with virus/ bacterial infection treatment
Why?
do not give antidiarrheals
cause organisms to stay in the body longer and delay recovery
156
2 example of an antimotility drug
anticholinergic drugs
opiates
157
Mechanism of action of antimotility drug: ANTIcholinergics drug?
(2) effects and (2) results
slow peristalsis by reducing rhythmic contractions and smooth muscle tone of GI tract.
Result: slows the movement of fecal matter through the gastrointestinal tract
drying effect: reduces gastric secretions- constipation (slow GI tract motility)
158
anticholinergic drugs are used in combination with
absorbents and opiates
159
2 example of an anticholinergic drug
belladonna alkaloids (not used in Canada)
atropine sulfate
160
Anticholinergics Adverse effects
Anticholinergics- drying
Urinary retention,
sexual dysfunction
Headache, dizziness, confusion, anxiety, drowsiness
Dry skin, flushing
Blurred vision
Hypotension, bradycardia or tachycardia; think of it as precipitating abnormal cardiac rhythms
161
Antimotility drugs: opiates
(3) mechanism of action
decrease bowel motility
reduce pain and relieves rectal spasms
Increases transit time through the bowel, allowing more time for water and electrolytes to be absorbed
162
3 medications under opiates?
codeine phosphate
loperamide hydrochloride
diphenoxylate hydrochloride with atropine sulphate
163
Opiates Adverse effects
Drowsiness, dizziness, lethargy
Nausea, vomiting, constipation
Respiratory depression
Hypotension
Urinary retention
Flushing
164
Opiates interactions
have additive CNS depressant if given with CNS depressant, alcohol, opioids, sedative, muscle relaxant
165
Probiotic mechanism of action 2
obtained from bacterial culture
replenish bacteria that help restore the balance of normal flora
and suppress the growth of diarrhea-causing bacteria (by creating an unfavourable environment for the overgrowth of harmful organisms)
166
Probiotics
2 names
2 effects
Also known as intestinal flora modifiers and bacterial replacement drugs
Bacterial cultures of Lactobacillus organisms work by
Supplying missing bacteria to the gastrointestinal tract
Suppressing the growth of diarrhea-causing bacteria
167
1 example of probiotic
Lactobacillus acidophilus
168
Antidiarrheals Nursing Implications
Obtain (5)
Obtain a thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergies.
169
DO NOT GIVE_______ to children or teenagers with chicken pox or influenza because of the risk of Reye’s syndrome. (has salicylate)
Bismuth subsalicylate
170
Use adsorbents carefully in (4)
older adult patients and those with decreased bleeding time
clotting disorders
recent bowel surgery
or confusion.
171
Do not administer anticholinergics to patients with a history of (5)
narrow-angle glaucoma,
gastrointestinal obstruction,
myasthenia gravis,
paralytic ileus,
or toxic megacolon.
172
Teach patients to take medications exactly as _____ and to be aware of their ____intake and ______ changes.
Assess _______, _______ and ______, and ______ _______ before, during, and after initiation of treatment.
Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes.
Assess fluid volume status, input and output, and mucous membranes before, during, and after initiation of treatment.
173
Opiates: diphenoxylate hcl with atropine sulfate
acts on?
action 2
can cause?
Lomotil- little to no analgesic
opiate agonist
acts on the smooth muscle of the intestinal tract
inhibit GI motility and excessive propulsion
can cause dependency & combine with atropine to discourage recreational use (causes dry mouth, tachycardia, and anticholinergic effects)
174
Opiates: Loperamide hcl
binds to opiate receptors in the intestinal wall
inhibit the release of ach and prostaglandin (REDUCES PERISTALSIS AND INCREASE INTESTINAL TRANSIT TIME)
increase the tone of anal sphincter which decreases incontinence and urgency
inhibit peristalsis in the intestinal wall
175
antidiarrheals adverse effects
specific to each drug family
most are minor and non life threatening
176
antidiarrheals contraindication
allergy, diarrhea cause by bacteria or parasites, major acute GI obstruction such as intestinal obstruction/ colitis
177
antichollinergic effects are decreased when given with>
antacids
178
Constipation (4)
Abnormally infrequent and difficult passage of feces through the lower gastrointestinal tract
A symptom, not a disease
Disorder of movement through the colon or rectum
Can be caused by a variety of diseases or drugs
179
2 ways to treat constipation
sugical
non surgical
180
non-surgical ways to treat constipation
Dietary (e.g., fibre supplementation)
Behavioural (e.g., increased physical activity)
Pharmacological- laxatives
181
5 types of laxatives
Bulk forming
Emollient (stool softeners, lubricant laxatives)
Hyperosmotic
Saline
Stimulant
182
laxatives
treats constipation by increasing fecal movement, affect fecal consistency, facilitate defecation
among misused OTC, laxative dependence, damage to bowel
183
ingestion and defacation span
24 to 36 hrs
184
Bulk-forming laxative: mechanism of action
High fibre
Absorb water to increase bulk
Distend bowel to initiate reflex bowel activity (promotes BM)
185
1 example of Bulk-forming Laxative
psyllium (Metamucil®)
186
Emollient laxative: mechanism of action
Stool softeners and lubricants
Promote more water and fat in the stools
Lubricate the fecal material and intestinal walls
187
Emollient laxative 2 examples and actions
Stool softeners: docusate salts (Colace®)
[lower surface tension of GI fluids so that more water and fat are absorbed into the stool and intestines]
Lubricants: mineral oil
[lubricate fecal material and intestinal wall, preventing absorption of water from intestines- contents become soft- promotes bowel distention and defecation]
188
Hyperosmotic laxative: mechanism of action
Increase fecal water content
Results in bowel distention, increased peristalsis, and evacuation
189
3 examples of Hyperosmotic laxative
PEG
GLYCERIN
LACTULOSE
P G L
190
Lactulose can also be used for?
also used to reduce elevated serum ammonia levels
191
PEG is used for?
used for diagnostic procedures
192
Saline laxative: mechanism of action
Increases osmotic pressure within the intestinal tract, causing more water to enter the intestines
Results in bowel distention, promotes peristalsis, and evacuation
193
2 examples of saline laxative
Magnesium hydroxide (Milk of Magnesia®)
Magnesium citrate
S M (Saline Mg)
194
Stimulant laxative: mechanism of action
stimulate nerves that innervate intestines
Increase peristalsis via intestinal nerve stimulation
195
stimulant laxative 2 examples
senna (Senokot®)
bisacodyl (Dulcolax®)
196
Peripherally Acting Opioid Antagonists
Treatment of constipation related to opioid use and bowel resection therapy
Block entrance of opioid into bowel
Yet to be approved by Health Canada; accessible through the Special Access Programme in some jurisdictions
Allow bowel to function normally with continued opioid use
197
Bulk forming laxative: INDICATION (4)
Acute and chronic constipation, IBS, diverticulosis
198
Emollient laxative: INDICATION (4)
Acute and chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions
199
Hyperosmotic laxative: INDICATION (3)
Chronic constipation,
diagnostic and surgical procedures
200
Saline laxative: INDICATION
Constipation, diagnostic and surgical procedures
201
Stimulant laxative: INDICATION (3)
Acute constipation, diagnostic and surgical procedures
202
BULK FORMING adverse effects
Impaction
Fluid overload
Electrolyte imbalances
Gas formation
Esophageal blockage
Allergic reaction
203
Emollient adverse effect
Skin rashes
Decreased absorption of vitamins
Electrolyte imbalances
Lipid pneumonia
204
Hyperosmotic adverse effects
Abdominal bloating
Electrolyte imbalances
Rectal irritation
can cause dehydration to OA
205
Saline adverse effects
Magnesium toxicity (with renal insufficiency)
Electrolyte imbalances
Cramping,
diarrhea
Increased thirst
206
Senna (stimulant) medication timing consideration
Senna is taken an hour differently from other meds- because it lessens absorption
207
Stimulant adverse effects
Nutrient malabsorption
Skin rashes
Gastric irritation
Electrolyte imbalances
Discoloured urine
Rectal irritation
208
What adverse effects do all laxative share in common is?
All laxatives can cause electrolyte imbalances!
209
Laxatives: Obtain a thorough history of (3)?
presenting symptoms, elimination patterns, and allergies.
210
Laxatives: assess _____ and _____ before initating therapy
Inform patients not to take a _______ or ______ if they are experiencing nausea, vomiting, or abdominal pain.
Assess fluid and electrolytes before initiating therapy.
Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, or abdominal pain
211
A healthy, high-fibre diet and increased fluid intake should be encouraged as an _______ to laxative use.
Long-term use of laxatives often results in decreased________ and may lead to _________.
All laxative tablets should be swallowed whole, not _____ or _____, especially if enteric-coated.
A healthy, high-fibre diet and increased fluid intake should be encouraged as an alternative to laxative use.
Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated.
212
Patients should take all laxative TABLETS with ___ to ____ ML of water
Take BULK FORMING laxatives with at least _____mL (___ oz) of water.
180 to 240 mL of water
At least 240 mL (8 oz) of water
213
Give ______ with water on an empty stomach because of interactions with milk, antacids, and juices.
Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible ____ or _____ loss.
Monitor for _____ effect.
bisacodyl
fluid/ electrolyte loss
therapuetic
214
IBS
characterized by?
How do patients cope 2
Chronic intestinal discomfort characterized by cramps, diarrhea, or constipation
Patients usually cope with the symptoms by avoiding irritating foods or by taking over-the-counter laxatives and antidiarrheal drugs.
215
Caution laxative use in pt with..
surgical abd
appendicitis
abd pain
N and V
fecal impaction
intestinal obstuction
weight loss aid
eating disorder
216
Bulk-forming interactions (psyllium)
decrease absorption of abx, digoxin, warfarin, salicylate, tetracycline
217
Mineral oil (emollient) interactions
decraese absorption of fat solluble vitamins (A, D, E, K)
218
Hyperosmotic (PEG, Glycerin, Lactulose) interactions
increase CNS depression if given opioids, barbiturates, anesthetic, antipsychotic
219
Stimulant (senna, bisacodyl) interactions
decrease absorption of abx, digoxin, nitro, salicylate, anticoagulant
220
Bulk forming
Psyllium
used _____
action
needs to be taken with _____
contraindicated:
used long term (OTC)
increases water absorption, increasing the total volume of intestinal contents
produces normal stools
needs to be taken with lots of water
contraincated: intestinal obstruction, fecal impaction, abd pain, N&V
221
Emollient
Docusate sodium (colace)- softeners
Mineral oil- lubricant
fecal softeners/ lubricate stools
softeners- lower surface tension of fluids- allow water and fat to be absorbed into the stool and intestines (do not cause defecation- helps with ease of passage)
lubricants- prevent water loss from intestines/ stools
- soften and expand stool
Oral/ enema lubricants not recommended due to aspiration
contraindicated- intestinal obstruction, abd pain, N&V
222
Hyperosmotic laxatives action
PEG
Glycerin
Lactulose
increase the water content of feces- distention, peristalsis, evacuation
223
gylcerin
Gylcerin- promote BM- increase osmotic pressure in the intestines- draw fluid into colon (used in children- mild effect)
224
lactulose
metabolized in?
the ______ environment that draws water into the colon
reduces?
contraindicated in pt with ______ diet
metabolized in the large intestine
the hyperosmotic environment that draws water into the colon
reduces blood ammonia
contraindicated in pt with galactose diet
225
PEG
used for diagnostic tests
potent- total cleansing
contraindicated- GI obstruction, gastric retention, bowel perforation, toxic colitis
226
Saline laxative
Magnesium hydroxide action and produces?
increase osmotic pressure and draw water into the colon producing watery stool
227
Magnesium hydroxide
used in ______ procedure
caution in pt with
unpleasant OTC
used in an endoscopic procedure
caution in pt with kidney insufficiency- causes increased MG
contraindicated- kidney disease, obstruction
228
stimulant
Senna
Bisacodyl
induce _____ in entire _______
can cause ______
Induce peristalsis
entire GI tract
can cause dependence
229
Bisacodyl
_______ used
bowel prep for ______ exam
OTC
commonly used
bowel prep for endoscopic exam
230
Senna
______ used
____ constipation/ bowel prep for surgery/ exam
may cause abd pain
produce bowel evacuation _ to ___ hrs
OTC
commonly used
acute constipation/ bowel prep for surgery/ exam
may cause abd pain
produce bowel evacuation 6 to 12 hrs
