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NUR112 exam 4
resp, GI and endocrine systems
| Question | Answer |
|---|---|
| Proton pump inhibitor common SE/ASE | SE:GI symptoms, belching, gas, abd pain, malaise long term use: stomach infection due to blocking stomach acid, anemia from ↓ protein absorption ADE: allergy, edema, joint pain, blurred vision, depression |
| pantoprazole | proton pump inhibitor preg category C |
| esomeprazole | proton pump inhibitor |
| rabeprazole | proton pump inhibitor additional ADE: dizziness, photosensitivity pregnancy category C |
| lansoprazole | proton pump inhibitor dizziness |
| omeprazole | proton pump inhibitor dizziness category C |
| H2 Blockers common SE/ASE | confusion, dizziness, drowsiness, HA, altered taste, GI symptoms, impotence, ↓ sperm count, anemia, neutropenia, thrombocytopenia ASE: arrhythmia, ↓WBC, ↓production of RBC (aplastic anemia) |
| cimetidine | H2 Blocker Drug induced hepatitis |
| ranitidine | H2 Blocker black tongue and dark stools |
| famotidine | H2 Blocker |
| nizatidine | H2 Blocker drug induced hepatitis |
| proton pump inhibitors consideration for older adults | ↑ risk for hip fx due to decreased calcium absorption, ↓ B12 absorption |
| antacid common SE/ASE | calcium or aluminum: constipation magnesium: diarrhea ↑ risk of HF with sodium containing antacids Do not take if having abd pain |
| mag hydroxide/aluminum hydroxide/simethicone | Category C aluminum ↑ risk for Alzheimers |
| calcium carbonate | constipation Category C |
| bismuth subsalicylate | Pepto-bismal cytoprotective: coats stomach and intestine inhibits H. pylori contains aspirin ↑ risk of bleeding with coumadin grey/black stools and tongue, stool impaction category C |
| sulcrafate | cytoprotective to open sore area, makes a thick coating, stops the effect of pepsin SE: constipation, GI symptoms, gas category B |
| metoclopramide | promotility drug SE: fatigue, restlessness, CNS symptoms, supraventricular tachycardia, ↑or↓ BP, gynecomastia ASE: neuroleptic malignant syndrome, tardive dyskinesia |
| antibiotics for H. pylori | clarithromycin metronidazole tetracycline amoxicillin |
| insulin | beta cells |
| glucagon | alpha cells |
| clear and colorless insulin | rapid-acting short-acting glargine (Lantus) long detemir (levemir) |
| cloudy insulin | intermediate acting NPH |
| insulin considerations in older adults | ↑ hypoglycemia due to beta-adrenergic blocking drugs, warfarin |
| Incretin analog MOA | similar to glucagon-like peptide 1 (GLP-1) pancreas releases more insulin makes pt feel full, slows gastric emptying weight loss |
| exenatide | Incretin analog SE: GI symptoms ASE: hypoglycemia do not use in children, pregnant or breast feeding women |
| liraglutide | Incretin analog SE: GI symptoms ASE: hypoglycemia do not use in children, pregnant or breast feeding women |
| DDP-IV inhibitor MOA | slows inactivation of incretin hormone improves beta cell function |
| sitagliptin | DDP-IV inhibitor SE: runny nose, sore throat, URI ASE: anaphylaxis, angioedema, Stevens-Johnson syndrome Not for use in children, pregnant or breast feeding women |
| thiazolidinediones MOA | makes insulin receptors more sensitive |
| pioglitazone | thiazolidinedione SE: URI, HA, muscle aches, edema, anemia ASE: liver problems, CI in liver disease |
| rosiglitazone | thiazolidinedione SE: URI, HA, muscle aches, edema, anemia ASE: liver problems, ↑ HF due to edema, CI in liver disease |
| alpha-glycosidase MOA | slows digestion of starches and complex carbs by inhibiting the enzyme that breaks them down |
| carabose | alpha-glycosidase inhibitors ASE: liver problems, difficulty digesting fatty meals, CI in liver disease Do not use in children |
| miglitol | alpha-glycosidase inhibitors ASE:liver problems, difficulty digesting fatty meals, CI in liver disease Not for use in children |
| thiazolidinedione MOA | works with insulin to reduce BG, makes receptors more sensitive Not for children |
| sulfonylureas MOA | triggers beta cells to release small amount of preformed insulin similar to sulfonamide |
| sulfonylureas SE/ASE | photosensitivity, blurred vision, edema, anemia ASE: hypoglycemia |
| glimepridine | sulfonylureas |
| glipizide | sulfonylureas |
| glyburide | sulfonylureas |
| biguanide MOA | causes release of glucose from glycogen, increases sensitivity of receptors, reduces absorption of glucose, does not act directly on beta cells, does not cause hypoglycemia |
| metformin | biguanide bloating, gas, abd pain, HA ASE: lactic acidosis, slow irregular HR if pt is to have surgery or contrast dye xay, do not give metformin for 48 hours afterwards |
| meglitinde MOA | acts directly on beta cells, causes brief, burst-like release of insulin |
| meglitinide SE/ASE | dizziness, back pain, URI, flu-like achiness ASE: hypoglycemia |
| nateglinide | meglitinide |
| repaglinide | meglitinide |
| amylin analog MOA | delays gastric emptying, triggerrs satiety in brain, suppresses glucagon release |
| amylin analog drug | pramlintide SE: GI symptoms, hypoglycemia not for use in children, pregnant or breast feeding women |
| nursing considerations for insulins | PINCH drug! test BG before giving, make sure pt can eat within 15-30 minutes, do not interchange insulins, check vial for color and clarity, do not shake vial, 28-30 guage needles, check and recheck!, do not use 2 inch radius around umbilicus, 90 degree angle, check pt hourly for hypoglycemia |
| nursing considerations for oral antidiabetic drugs | ask about allergies to sulfa if giving a sulfonylurea, give with first bite of meal if giving alpha-glucosidase drugs, check for hypoglycemia if pt is also taking aspirin, NSAIDs, warfarin, beta-adrenergic blockers, fluoroquinolone, antibiotis, probenecid, or azole andtifungal drugs, check hourly for S&S of hypoglycemia, |
| insulin | hormone of plenty |
| glucagon | hormone of starvation |
| S&S of diabetes | excessive hunger, thirst, polydipsia, polyuria, weight loss, fatigue |
| S&S of hypoglycemia | confusion, cool and clammy skin, tremors, HA, hunger, sweating |
| nursing considerations for drugs that increase incretins and amylin | teach s&s of hypoglycemia, take before meals, drug losses effectiveness if it is frozen or warm, ETOH will increase hypoglycemia, notify provider or go to ER if allergic reaction occurs |
| peak expiratory rate flow (PERF) | established by age, size and gender, emergent if PERF drops below 50% |
| wheeze | squeaky or snorelike sound |
| beta-adrenergic agonist MOA bronchodilator | bind to receptors and cause an increase in cAMP, SABAs = rescue drugs LABAs = prevention |
| cholinergic antagonist MOA bronchodilator | block parasympathetic NS, this allows a person's natural epinephrine and norepinephrine to bind to smooth muscle receptors, causes bronchodilation and decreases secretions |
| albuterol | SABA |
| terbutaline | SABA |
| pirbuterol | SABA |
| arformoterol | LABA |
| salmeterol | LABA |
| ipratopium | cholinergic antagonist |
| tiotropium | cholinergic antagonist |
| aminophylline | methylxanthine |
| theophylline | methylxanthine |
| methylxanthine MOA bronchodilator | given systemically, increase cAMP, used only when other types of management are ineffective, cause cardiac and CNS overstimulation |
| common SE/ASE of bronchodilators | heavy use allows drug to enter mucous membrane and act systemically - ↑BP, nervousness, insomnia; dry mouth and throat, bad taste, ASE: allergic reaction within a few minutes of using inhaler, angina, MI, |
| anticholinergic agents SE/ASE | urinary retention, blurred vision, eye pain, nausea, HA |
| methylxanthine SE/ASE | dysrhythmias, |
| nursing considerations for bronchodilator | ask pt to demonstrate or describe technique, auscultate lungs before and after to determine effectiveness, assess temp and mental status if giving methylxanthines |
| anti-inflammatory drugs for Resp problems MOA | corticosteroids- decrease production of chemicals that trigger inflammation |
| anti-inflammatory drugs for Resp problems MOA | mast cell stabilizers - prevent the release of histamines |
| anti-inflammatory drugs for Resp problems MOA | leukotriene inhibitors - prevents leukotriene production in WBCs, block leukotriene receptors on inflammatory cells |
| beclomethasone | corticosteriod |
| budesonide | corticosteriod |
| flunisolide | corticosteriod |
| fluticasone | corticosteriod |
| triamcinolone | corticosteriod |
| cromolyn sodium | mast cell stabilizer |
| nedocromil sodium | mast cell stabilizer |
| montelukast | leukotriene inhibitor |
| zafirlukast | leukotriene inhibitor |
| zileuton | leukotriene inhibitor |
| inhaled anti-inflammatory drug common SE/ASE | bad taste and dry mouth, ↑ risk for oral infection, HA, abd pain ASE: when heavily used can cause adrenal gland suppression, liver impairment, allergic reaction |
| nursing considerations anti-inflammatory drug | inspect pt mouth and throat for infection, wait at least 5 minutes after bronchodilator to give this med, prime canister, assess for s&s of decreased liver function, these drugs are for prevention not for rescue, rinse mouth, |
| mucolytic MOA | breaks connections that hold protein and mucus molecules |
| mucolytics | guaifenesin, acetylcysteine |
| acetylcysteine | delivered with a nebulizer, has very unpleasant odor, may cause broncospasms, aspiration pneumonia due to not being able to cough up secretions |
| antidote for acetaminophen overdose | acetylcysteine |
| phenothiazine MOA | block dopamine receptors in chemotrigger zone of the brain |
| anticholinergic MOA | inhibit intestinal cramping and inhibit vestibular input into CNS |
| antihistamines | block histamine at H1 receptor sites, inhibit intestinal cramping and inhibit vestibular input into CNS, depress inner ear excitability |
| 5HT3 receptor antagonists | bind to and block serotonin receptors in the intestinal tract and chemotrigger zone of the brain - used in chemotherapy |
| dopamine antagonists | block dopamine from binding to receptors in the chemotrigger zone and intestinal tract, food moves more quickly |
| promethazine (phenergan) | phenothiazine; confusion, disorientation, dizziness, dry mouth, nausea, vomiting, rash, sedation, neuroleptic malignant, syndrome, tardive dyskinesia, neutopenia, sever tissue necrosis with IV push, respiratory depression |
| prochlorperazine (compazine) | phenothiazine; blurred vision, constipation, dizziness, dry eyes, dry mouth, involuntary muscle spasms, bitterness, mouth puckering, neuroleptic malignant syndrome, neutopenia, severe tissue necrosis with IV push |
| scopolamine | anticholinergic; blurred vision , constipation, dilated pupils, dizziness, drowsiness, dry mouth, rash, urinary retention, respiratory depression |
| meclizine | antihistamine; drowsiness |
| granisetron | 5HT3 receptor antagonist |
| ondansetron (zofran) | 5HT3 receptor antagonist; abd pain, constipation, fatigue, HA |
| metoclopramide | dopamine antagonist; drowsiness, fatigue, increased depression, restlessness, tardive dyskinesia |
| trimethobenzamide | dopamine antagonist; blurred vision, diarrhea, drowsiness, cramps, headache, hypotension, rectal irritation with supp, coma and seizures, |
| cyclizine | antihistamine; drowsiness, dry mouth, hypotension, respiratory depression |
| nursing consideration: antiemetics | check body temp, BP, HR and rhythm, resp rate, loc, auscultate for active bowel sounds, assess for abd distention, hx of depression, weigh daily, report resp depression immediately, metoclopramide may cause mild to severe depression, children may have muscle spasms of jaw, neck and back and balance issues, elderly are more likely to develop CNS effects |
| S&S of neuroleptic malignant syndrome | high fever, resp distress, tachycardia, seizures, diaphoresis, BP changes, pallor, fatigue, severe muscle stiffness and loss of bladder control |
| S&S of constipation | fewer than 3 BMs in a week, sudden decrease in BMs, hard stools, bowels feel full even after BM, bloated sensation |
| bulk-forming drugs | adds bulk which increases mass that stimulates peristalsis |
| methycellulose | bulk-forming drugs |
| psyllium | bulk-forming drugs; bronchospasm, GI cramps, intestinal or esophageal obstruction, nausea, vomiting |
| emollient with stimulant | allow the stool to mix with fatty substances |
| docusate sodium and casanthranol | emollient with stimulant; diarrhea, rash, stomach cramps, throat irritation |
| stimulants | increase peristalsis |
| bisacodyl | stimulant; abd cramps, diarrhea, hypokalemia, muscle weakness, nausea, rectal burning, hypokalemia |
| osmotic laxative | cause retention of fluid in the bowel, increasing water content of stool |
| lactulose | osmotic laxative; abd distention, belching, diarrhea, gas, GI cramps, hypoglycemia in diabetics, hyperglycemia |
| lubiprostone | osmotic laxative; abd pain and distention, diarrhea, dizziness, dry mouth, gas, HA, nausea, peripheral edema, reflux |
| magnesium hydroxide | osmotic laxative; diarrhea, flushing, sweating |
| polyethylene glycol | osmotic laxative; abd bloating, cramping, gas, nausea |
| sodium phosphate | osmotic laxative; abd bloating, abd pain, dizziness, electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypokalemia,sodium retention, GI cramping, HA, nausea, vomiting |
| castor oil | lubricant; belching, cramping, diarrhea, nausea |
| glycerin supp | lubricant; abd cramps, hyperemia or rectal mucosa, rectal discomfort |
| docusate | emollient; mild GI cramps, throat irritation, rash |
| antimotility drugs MOA | slow the movement of stool through the bowel allowing more time for water and essential salts to be absorbed |
| difenoxin with atropine | antimotility drug; blurred vision, constipation, confusion, dizziness, drowsiness, dry eyes, dry mouth, flushing, GI distress, HA, insomnia, nausea, nervousness, tachycardia, urinary retention, vomiting |
| diphenoxylate with atropine | antimotility drug; blurred vision, constipation, confusion, dizziness, drowsiness, dry eyes, dry mouth, flushing, GI distress, HA, insomnia, nausea, nervousness, tachycardia, urinary retention, vomiting, flushing |
| loperamide | antimotility drug; abd pain, allergic reaction, constipation, distention, dizziness, drowsiness, dry mouth, nausea, vomiting |
| paregoric | antimotility drug; abd pain, constipation, loss of appetite, nausea, vomiting |
| adsorbent/adsorbent drugs MOA | remove substances that cause diarrhea from the body |
| attapulgite | adsorbent/adsorbent drugs; constipation, bloating, feeling of fullness |
| calcium polycarbophil | adsorbent/adsorbent drugs; abd fullness, gas, laxative dependence with long term use |
| antisecretory drugs | decrease secretion of intestinal fluids and slow bacterial activity |
| bismuth subsalicylate | antisecretory drugs; constipation, gray-black stools, impaction in infants and debilitated pts, tinnitus, |
| nursing considerations: antidiarrheal drugs | obtain baseline weight and vitals, auscultate for active bowel sounds, ask about allergies or unusual reactions to aspirin, reassess q 4-8 hours, check resp status due to possible resp depression, watch for toxic megacolon, document consistency, ordor and appearance of stools, may cause dizziness- don't drive, notify provider if diarrhea doesn't go away in days or if they develop a fever, abd pain, or distention, no ETOH, bismuth sbsalicylate and calcium polycarbophil are not for small children |
| thyroid hormones | thyroxine (T4), triiodothyronine (T3) |
| lithium | reduces thyroid function |
| levothyroxine | thyroid hormone replacement drug |
| liothyronine sodium | thyroid hormone replacement drug |
| thyroid hormone replacement drug SE/ASE | side effects are from overdose and symptoms will be those of hyperthyroidism, ASE: over work of heart leading to angina, MI, HF, increased activity of CNS can cause seizures, enhance anticoagulants, especially warfarin, |
| s&s of hyperthyroidism | being too warm, sweating, difficulty sleeping, weight loss, increases number of BMs per day |
| S&S of hypothyroidism | constipation, excess facial and body hair, edema of face and shins, feels cold, fatigue, low body temp, decreased libido, bradycardia, bradypnea, thick tongue, weight gain |
| nursing considerations: thyroid hormone replacement | assess BP, HR and resp rate, reassess, ask about CP, check for increased bleeding if pt is on warfarin, teach pt to check their pulse- increase of 20 bpm for a week or dysrhythmia - contact provider, do not take with fiber supplement, |
| Grave's disease | most common cause of hyperthyroidism, body makes antibodies to TSH and binds with receptors on thyroid cells, acts as agonist and turn on the thyroid cells causing them to divide and form a goiter |
| thyroid suppressing drugs MOA | enter thyroid gland, combine with enzyme that connects idoine and tyrosine to make T3 and T4 |
| thyroid suppressing drug SE/ASE | rash, loss of taste sensation, HA, muscle and joint pain, itchiness, drowsiness, n/v, lymph node enlargement and edema ASE: bone marrow suppression, hepatotoxic, kidney damage |
| nursing considerations: thyroid suppressing drug | check liver functions, check dose and medication carefully, check pt that also takes warfarin for increased bleeding, check daily for jaundice, check WBC, category D, |
| methimazole | thyroid suppressing drug |
| propylthiouracil | thyroid suppressing drug |
| estrogen | main female sex hormone, excreted by ovaries and adrenal gland |
| FSH | cause the ovaries to secrete estrogen and allows one ovum to mature each month, GnRH triggers the pituitary gland to release LH |
| corpus luteum | releases progesterone |
| hypothalamus | secretes GnRH--triggers anterior pituitary to release FSH and LH-- LH triggers ovulation and activation of corpus lutem |
| menopause | high levels of FSH act on blood vessels making them dilate = hotflash |
| HRT MOA | inhibits the feedback system and lowers levels of FSH |
| S&S of reduced estrogen levels | atrophy of vaginal tissue, dry skin, increased rate of osteoporosis, painful intercourse, |
| S&S of high FSH levels | decreased mental concentration, hot flashes, night sweats, sleep problems |
| HRT SE/ASE | breast tenderness, breakthrough bleeding, fluid retention, weight gain, acne, hypertension due to fluid retention ASE: MI risk is higher, increase blood clotting, excessively think uterine lining causing excessive bleeding, increase growth of cancers that are hormone sensitive, liver impairment, gallbladder disease, pancreatitis |
| nursing considerations: HRT | encourage yearly screenings, quit smoking, check for jaundice every day, go to ER for CP, swelling in one leg, or symptoms of a stroke |
Created by:
nursingTSJC2013
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