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Pharm- Exam 2
GI Systems Ch. 40, 41, 42
| Question | Answer |
|---|---|
| What does the esophageal sphincter do? | -Prevents content from moving up the esophagus |
| Where is the pyloric sphincter? | -between stomach/intestines |
| What are Chief cells? | -Pepsinogen (protein) |
| What are Intrinsic Factors for? | -Necessary for absorption of Vit B12 |
| What is the pH range of gastric juices? | 1.5-3.5 |
| What is the nL blood pH? | 7.35-7.45 |
| Where is the gastric mucosa, and what does it do? | Gastric mucosa on top of stomach to protect it |
| What do the common bile duct secrete? | Bicarbs |
| What is a peptic ulcer | Erosion of Mucosa Layers (inflammation) |
| Where are peptic ulcers found? | -lesion located either in the stomach-(gastric) or small intestine (duodenal)-most common |
| Where is the most common peptic ulcer found? | Duodenum |
| What is absorbed in the small intestines? | Food |
| What is absorbed in the large intestines? | Water |
| What does vomited blood look like? | Coffee grounds |
| What does blood in the stool look like? | Usually appears black and tarry |
| If stool is purple, it means.. | blood in stool |
| If stool is green, it means.. | iron in stool |
| Coming from the small intestine, you will not see red blood. If you see red blood in the stool, it is coming from the... | large intestines, usually near the rectum |
| What are peptic ulcers caused by? (5) 1/2 | -Helicobacter pylori(H pylori-50% of PUDS) -Family History -Blood Group O -Smoking -Caffeine Intake |
| What are peptic ulcers caused by? (4) 2/2 | -Steroids, NSAIDS, ASA -Stress -Gastric Acid -Pepsin |
| What is the main treatment for PUD due to H. Pylori? | Antibiotics |
| How long are antibiotics taken for PUD due to H. Pylori? | 2-3 antibiotics for 14 days |
| What do the rest of the drugs given for PUD do? | Rest of drugs we give for PUD are to let the stomach environment be conducive for the antibiotics to work |
| What, in combination with antibiotics, are the best combination therapy for PUD with the best outcomes? | PPIs (Proton Pump Inhibitors) |
| What is GERD? | Esophageal Sphincter weakens |
| What happens in GERD? | Acid rises into the esophagus |
| GERD is caused by? (5) | -Obesity -Smoking -High Fatty Foods -Eating and Drinking before bedtime -Age > 40yrs |
| What are H2 Blockers? | -1st gen anti/acid/ulcer med |
| Prior to admin of H2B, you should do what? | Assess pt for drugs hard on stomach |
| What are H1 and H2? | Histamine Receptors |
| What do H1 do? | produce inflammation reactions |
| What do H2 do? | H2 Blockers land on the parietal cells and block stimulants from landing on the parietal cells and stimulating acid (why stress causes ulcers |
| How do H2 blockers work? | H2 Blockers land on the parietal cells and block stimulants from landing on the parietal cells and stimulating acid (why stress causes ulcers) |
| What are H2B used for? | -Used for gastric/peptic ulcers -GERD -Zollinger-Ellison Syndrome |
| What is Zollinger-Ellison Syndrome? | tumor in the pancreas or small intestine that produces high levels of gastrin in the blood stream-stimulates gastric acid production by the parietal cells |
| What do H2 Receptor Antagonist Drugs end with? | "TIDINE" |
| What are some H2 Receptor Antagonist drugs? | -Ranitidine (Zantac) -Cimetidine-Tagamet -Famotidine-Pepcid -Nizatidine-Axid |
| What is the prototype drug for H2 Receptor Antagonists? | Ranitidine (Zantac) |
| What are the S/E of H2 Receptor Antagonist drugs? (TIDINE DRUGS) | -Decreases Bone Marrow production (low wbc/rbc/platelet count) -High doses-impotence (men) |
| What are the rare S/E of H2 Receptor Antagonist drugs? (TIDINE DRUGS): -Tagment-Cimetidine | Does cross the blood brain barrier and can cause confusion, lethargy, depression |
| What are the rare S/E of H2 Receptor Antagonist drugs? (TIDINE DRUGS) -Ranitidine/Zantac | -may increase liver enzymes and Cr (ALT, AST, ALK Phos, Bilirubin) mostly with the elderly |
| What are the rare S/E of H2 Receptor Antagonist drugs? (TIDINE DRUGS) -decreased acidity | Decrease acidity of the stomach secretions can lead to pneumonia-is your client at risk for aspiration or pneumonia(COPD, Sleep apnea-acidity kills germs, w/o: more germs growing) |
| (TIDINE) Interactions | -Can potentiate Coumadin/warfarin, phenytoin/Dilantin, Theophyllin, Lidocaine |
| If a Pt is taking blood thinners w/a TIDINE (H2 antagonist, what should be monitored? | -Monitor Pt/INR levels, watch for signs of bleeding, Monitor Dilantin and Theophyllin levels |
| H2B (TIDINE): when should antacids be taken? | -If using an antacids, take antacids 2-3 hours apart from H2 Blockers |
| What is a popular H2B (TIDINE) drug and why? | -Zantac can be given with or without food-that is why it is so popular, you do not have to remember to take the drug at an off time |
| What are some nursing implications with H2B? (6) | -6 sm meals -Rest/stress reduction -No smoking(delays healing)-Avoid ASA, NSAIDS, Steroids -If alcohol worsens symptoms-avoid -Monitor for signs of bleeding-coffee ground emesis, black tarry stools, cola colored urine, bright red blood, tired, dyspnea |
| How are H2Bs effective? | -No more stomach pain -No bleeding -No super infections from antibiotics |
| What generation are PPIs? | 2nd |
| What do PPIs meds end in? | AZOLE |
| What is the PPI prototype drug? | Omeprazole (Prilosec) |
| What are other PPI drugs? (4) | -Esomeprazole-Nexium -Lansoprazole-Prevacid -Pantoprazole-Protonix -Rabeprazole-AcipHex |
| What does Prilosec do? | -Binds to H+K+-ATPase, the enzyme that that acts as a pump to release acid onto the surface of the GI mucosa |
| When is the best time to give Prilosec(Omeprazole)? | Best to give prior to eating |
| What else can Omeprazole be given with? | Antacids |
| What are some major "DO NOT" instructions for Omeprazole (prilosec) | -DO NOT CRUSH, DIVIDE OR CHEW |
| What is a long term use complication of Prilosec (omeprazole)? | Long term use has been associated with cancer in lab animals |
| What is the maximum time to give or be on Prilosec (omeprazole) | 2 months |
| For PUD, PPIs with antibiotics have good outcomes with what? | -with “curing the ulcer”, Zollinger-Ellison Syndrome |
| PPI S/E information | Rare and insignificant w/short term use |
| PPI S/E | -Headache,(N/V/D) |
| Patients on PPIs are at risk for what? | Pneumonia |
| What are some long term use risks for PPIs | -increase risk for gastric cancer and osteoporosis |
| What is a drug interaction for PPI | -Digoxin level may be increased |
| How do you administer PPIs? | -Do not crush sustained release capsules-may sprinkle over food |
| When is PPI administered? | -Daily, prior to eating |
| What should a pt taking PPIs avoid? | -Avoid irritants to stomach-alcohol, NSAIDS, ASA |
| Treatment for active ulcers are how long? | 4-6 weeks |
| How do you know if the PPI is effective? (3) | -No bleeding -No pain -No Pneumonia |
| What about Foods Needing High Acid Environment | -Some foods digest better in a high acid environment and need to be taken prior to PPI’s and H2’s |
| What two supplements work better in a high acid environment? | -Iron and Calcium |
| Can iron and calcium be given together? | -Iron and Calcium do not go together. |
| Why can calcium and iron not be given together? | Calcium prevents Iron uptake (Cows and Irons never go together, why would I Iron a cow?) |
| What is the Mucosal Protectant Drug prototype? | -Carafate/sucralfate |
| What do Mucosal protectant drugs do? | -Thick liquid that adheres to the ulcer and protects the stomach from further injury |
| How long do Mucosal Protectant drugs work? | -Can adhere for up to 6 hours |
| When should Carafate/sucralfate be given? | -Give it prior to meals for protection-empty stomach, QID |
| What is the main S/E of Carafate/sucralfate? | -Constipation |
| How do we counteract the S/E of Carafate/sucralfate? | Increase fiber/fluids, no systemic effects |
| What are some interactions of Carafate/sucralfate? | -May interfere with absorption of Dilantin, Digoxin, Warfarin and Cipro, 2 hours intervals between these meds and Carafate |
| What interferes with the absorption of Carafate? | Antacids |
| How can Carafate/sucralfate be administered? | -Do not chew, may dissolve in water or can break tablet |
| What is the prototype drug for antacids? | -Aluminum hydroxide (AlternaGel, Mylanta, Maalox, and many others). |
| Aluminum with magnesium increases effectiveness, resulting in what? | -No Constipation |
| Calcium based antacids can cause what? | -Constipation |
| Why do we need to be careful with giving aluminum based antacids? | -Can cause phosphate depletion-worsen with alcoholics/malnutrition |
| When should Aluminum hydroxide be administered? | eNeed to give two hours prior to oral medication-antacids will decrease absorbance /4 hrs after |
| How should liquid formulas of Aluminum Hydroxide be mixed? | -Shake liquid formulas well |
| How often can Aluminum Hydroxide be taken? | -Can be taken 7 times a day and |
| When should Aluminum Hydroxide be administered with regards to meals? | -1 hr prior and 3 hours after meals |
| Aluminum Hydroxide, besides 7x/d, pre/post meals, when else should it be given? | -At bedtime-esp for healing an ulcer |
| When should medications be taken with regards to taking an antacid? | -Take all medications 1 hour prior or 1 hour after taking an antacid |
| What is a common issues w/antacids? | Compliance |
| Why is compliance an issue w/antacids? | -Non compliance is a problem with antacids-especially after the pain is gone and the ulcer is finishing healing |
| What is the prototype drug for Prostaglandin E Analog? | -Cytotec/misoprostol |
| How does Cytotec work? | Acts in the GI tract to decrease acid secretion, increased the secretion of bicarbonate and protects the mucus, vasodilation and maintains blood flow |
| What is given with Cytotec to prevent gastric ulcers? | NSAIDS |
| How does Cytotec induce labor? | Causes cervical ripening |
| What else is Cytotec used for? | Often used to induce abortions |
| What is 2 main S/E of Cytotec? (2) | -Diarrhea -abd. pain |
| What Pregnancy risk category is Cytotec? | X |
| When should Cytotec be administered? (2) | Take with meals and at bedtime |
| How can we tell that Cytotec is effective? | -Absence of GERD -GI Bleeding -Abd pain -No reoccurrence of an ulcer |
| What is chyme? | -Partially digested food |
| Where is found in the gallbladder? | Bile |
| What does the pancreas secrete? | -Digestive enzymes |
| What is Bicarbonate and where is is from? | -Acid equalizer -pancreas |
| Where in the Small Intestine does most of the absorption happens? | -Jejunum |
| What is absorbed in the Jejunum? | -Absorption of Nutrients |
| What is absorbed in the Large Intestines? | -Water/Fluides |
| Where are most of the bacteria in the intestines? | -Large Intestines |
| Synthesizing of B Vitamins and Vitamin K (blood clotting) occurs where? | -Large Intestines |
| Constipation is stimulated by what? | -Parasympathetic Nervous System Stimulation |
| The parasympathetic nervous system stimulation increases what? | Peristalsis |
| What happens when stools are in the colon longer? | -Longer Stool is in the colon, more water is absorbed, harder the stool |
| What are the causes of constipation? (6) | -Lack of Fluid -Lack of Exercise -Lack of Food -Lack of Fiber -Drugs-opioids, Anticholinergics, antihistamines, iron, calcium -Diseases-hypothyroidism, Diabetes, Irritable Bowel Syndrome |
| What is the prototype drug for Metamucil? | -Psyllium Mucilloid (Metamucil) |
| Psyllium Mucilloid is a bulk type laxative, meaning that it is what type of fiber? | Insoluble fiber |
| How does Pysllium increase peristalsis? | -Psyllium swells, enlarges fecal mass, stimulates the defecation reflex- |
| It is important to drink fluids w/Psyllium, if not, what can happen? | -Can cause a bowel obstruction if not taken with enough water |
| What happens if Psyllium is taken with Digoxin, Warfarin, Antibiotics, ASA, and Nitrofurantoin | -Can decrease absorption and effects of drugs (faster bowel goes through = less absorption |
| Laxatives are stool softeners, what do stool softeners do? | -Prevents constipation-more water and fat to be absorbed into the stools (Vagus N. brain to rectum-ParaSym-Stim. By bowel movement) |
| What do stimulant laxatives do? | -Irritate the bowel mucosa |
| Stimulant laxatives should be taken with at least how much water? | 1-2 glasses |
| What are saline cathartics(strong removal of wastes) | -Osmotic laxatives-pull water into the bowels from the body |
| What do herbal agent(Senna) do? | -Herbs that irritates the bowel and increases peristalsis |
| What do mineral oils do? | -Lubricates the stool-interferes with fat absorption |
| Why do laxatives have to be given prior to xray scopes to examine the bowels? | -The bowels have to be stool free so the bowel lining can be examined. |
| SS enemas sometimes are ordered until clear-along with a strong laxative. The enemas pull fluid from the body. What can be a problem? | -Dehydration can be a real problem |
| What labs should be checked prior to giving the bowel preps? (4) | -BUN, CR, GRF, K |
| What is the number one cause of renal failure? | Dehydration |
| What can Fleets enemas be? (3) | -The Fleets can be straight water, sodium water or Phospho-Soda, |
| What is Phospho-soda and what is it used for? | -the Phospho-Soda is much more of a stimulant and is used for bowel prep |
| What is diarrhea? | -Body’s way of getting rid of toxins, pathogens, and parasites |
| Diarrhea can lead to what? | -dehydration and electrolyte imbalance |
| What diseases could be the cause of diarrhea? (3) | -Ulcerative Colitis, Crohn’s Disease, Irritable Bowel Syndrome |
| What is used to treat diarrhea? | Antibiotics |
| What is the best treatment for diarrhea? | Find cause |
| What is Lomotil? | Antidaiarrheal opioids |
| What is the prototype drug for Lomotil? | -Diphenoxylate with Atropine |
| What does Lomotil do? | -All opioids slow peristalsis, |
| How quickly does Lomotil work? | 45-60mins |
| Why is atropine added to lomotil? | *Atropine added to discourage people from taking the drug (drowsiness, dry mouth, tachycardia) |
| Does lomotil have an analgesic effect and what is the potential for abuse? | -Has NO ANALGESIC properties and extremely low potential for abuse |
| What can lomotil cause? | Can cause respiratory depression |
| If a pt overdoes on lomotil, what can be given to correct it? | -Narcan may have to be used for overdoses |
| How is an enteral feeding given? | -Given orally or through a feeding tube |
| How is parental feeding given? | -Given through an IV |
| What is TPN? | -Total Parenteral Nutrition |
| How often should tube feeding bags be changed? | Change bag q24h, no matter what |
| What can be used for a bowel prep surgery? Select all that apply A. Tap water enema/SS Enema B. Ducolax-stimulant laxative C. Glycerin suppository D. Sodium Phosphate/Fleet Phospho-Soda enema E. Docusate/Colace-stool | A, B, D |
| The nurse concludes that docusate sodium/Colace is appropriate for use in which of the following clients? Select all; A. A client who needs a bowel prep B. A postop client taking opioids analgesics for pan C. A client who had a myocardial infarction 24 ho | -Post Op client -Myocardial Infarction -Painful Hemorrhoids |
| What are S/E of IBD? (3) | Abdominal pain, cramping, and diarrhea |
| Which sex does IBD affect more? | Affects M/F equally |
| What is a risk factor for IBD? | Family history |
| What age does IBD usually affect? | 20-40 |
| Ulcers distal to the small intestines is what? | Crohn's disease |
| Mucosal Erosions in the large intestine is what? | Ulcerative Colitis (skipping lesions) |
| What are some S/E of Ulcerative Colitis? | -Abdominal cramping with frequent bowel movements |
| If Ulcerative Colitis S/E is not treated, what can it progress to? (4) | |
| What are other S/E of Ulcerative Colitis? (3) | -Purulent puss diarrhea, sloughing, mucus filled stools |
| What age bracket(s) is usually affected by Ulcerative Colitis? | -(15-30)College age is common time to get ulcerative colitis -55-65yrs |
| Irritable Bowel Syndrome (IBS) S/E? (7) | -Lower GI tract -Abdominal pain -Bloating -Excessive gas -Colicky cramping alters diarrhea with constipation -Mucous in the stools -Stress and Dietary Factors |
| What is the treatment of choice for IBS? | -No longer drug therapy-relaxation diet changes, can treat symptoms-diarrhea or constipation |
| Irritable Bowel Syndrome (IBD) treatment prototype drug is what? | -Sulfasalazine (Azulifidine) |
| What does Sulfasalazine (Azulifidine) do? | -Inhibits inflammatory mediators such as prostaglandins and leukotriene’s-thus decreases inflammation |
| What is important to know about Sulfasalazine (Azulifidine)? | -Sulfa is a base to this medication-do not give if client is allergic to sulfa |
| How should you not administer Sulfasalazine (Azulifidine)? | Do not crush or chew |
| *How can Sulfasalazine (Azulifidine)affect bones? | -May worsen bone marrow suppression esp in conjunction with methotrexate-liver toxity |
| What is a drug-drug interactions for Sulfasalazine (Azulifidine)? (2) | -Digoxin absorption may be decreased -Can increase anticoagulant effects if taking with Warfarin |
| What may Sulfasalazine (Azulifidine) overdose cause? (5) | -Abdominal pain -Anuria (no urine output/renal failure) -Drowsiness -Gastric distress -N/V -Seizures |
| Where is the vomiting center? | Vomiting center is in the medulla of the brain |
| What is the nausea/vomiting process? | -Get signals from the digestive tract, the inner ear and the chemoreceptor trigger zone in the cerebral cortex -Vomiting center stimulates wave like contractions of the stomach propel contents upward and out of the body |
| What can vomiting lead to? | Dehydration |
| Vomiting leads to dehydration, which is loss of acid. What happens to pH? | pH increases, resulting in alkalosis |
| What is the nausea medication? | Serotonin Antagonist-Zofran (Ondansentron) |
| What is the physiological process of Zofran? | -The Zofran, land on the receptors for serotonin, and does not allow the serotonin to simulate the vomiting center |
| Nausea meds are stimulated by chemotherapy, causing what? | -Causing the nausea to get to the Vomiting Center in the Brain. This is why when giving chemotherapy-pretreatment is so important. |
| How does Compazamine (prochlorperazine) work? | -Blocks dopamine receptors in the brain, which blocks dopamine stimulation of the vomiting center |
| What is Compazamine? | An Antiemetic drug |
| What are some S/E of Compazamine?(5) | -Dry mouth -Sedation -Constipation -Urinary retention -Orthostatic hypotension |
| How does alcohol affect Compazamine? | increases sedation |
| How does antacid affect Compazamine? | inhibit the absorption |
| How does taking Compazamine w/tricyclic and andtidepressants affect a pt? | -May have increased anticholinergic and hypotensive effects |
| What are some more nausea medications? | Antihistamines/Anticholinergic-Benadryl/Schopolamine |
| What are S/E of Benadryl? (10) | -Drowsiness -Dry mouth -Blurred vision -Hypersensitivity -Sedation -Tremors -Seizures -Hallucinations -Excitation- esp in children -Hypotension |
| Nausea medication that is also Antipsychotic? | Haldol |
| Nausea medication that is a corticosteroid? | Decadron |
| How is Decadron taken? | -PO -IV |
| Do we know how Decadron works in combination with Chemo drugs? | NO |
| What are the S/E of Decadron? (11) | 1.Mood swings 2.Weight gain 3.Acne 4.Insomnia 5.NA/Fluid retention HBP 6.Impaired wound healing 7.Dec. Immune function 8.Peptic ulcers 9.Low calcium 10.Loss of m. mass 11.Osteoporosis |
| Nausea medication that is a "d. Neurokinin Receptor Antagonist ? | Emend |
| Emend is a ______ class of drug and is __________? | -New -Wonderful |
| Emend is not used as often in the Real World, because it is _________? | Expensive |
| Is Emend good for Chemo ? | YES! |
| When should you give Emend with a pt. that will also have Chemo? | 1 hour prior |
| What are the S/E of Emend? (10) | 1.Fatigue 2.Constipation 3.Diarrhea 4.Anorexia 5.Nausea 6.Hiccups 7.Dehydration 8.Peripheral Neuropathy 9.Blood dyscrasia- not enough red/white/platelets counts 10.Pneumonia |
| A Nausea medication that is Marijuana based? | Marinol |
| Marinol will increase the appetite in _______ patients? | AIDS |
| What are the S/E of Marinol? | 1.Drowsiness 2.Dizziness 3.Euphoria 4.Confusion 5.Ataxia 6.Increased sensory awareness 7.Paranoia 8.Decrease motor coord 9.Hypotension |
| Nausea medication that Induces vomiting-poisoning? | Syrup of Ipecac |
| If someone has ingested a corrosive substance such as Bleach or Paint thinner, what should they do? | Call poison control ahead to clarify before they induce vomit! |
| Obesity has a BMI greater than? | 30 |
| When talking about Obesity there are _________different mechanisms in your body to keep you from __________? | -27 -starving |
| Meridia is a prototype drug for? | Sibutramine (Meridia) |
| What is meridia for? | Anorexiant, SSRI -Weight loss drug -Encourages you to NOT eat. |
| Meridia S/E ? | 1.Headache 2.Constipation 3.Insomnia 4.Xerostomia (dry mouth) |
| If Meridia is given with decongestants like cough and allergy medications is may cause? | -Elevated BP |
| An Overdose of Meridia you may see _________ and ___________ ? | -Tachycardia -HTN |
| If you Overdose on Meridia what is the treatment of choice? | - (BB) Beta-Blockers |
| What does Xenical do? | Prevents absorption of fat when eating. |
| How is Xenical taken? | Oral tablets given when eating. |
| If a person who is taking Xenical eats fats what will their stool look like ___________and what is it called?__________ | -Oily/fatty stools -Steatorrhea |
| What does it look like when someone has Steatorrhea? | Oil floats on top of water in toilet |
| Pancreatitis | Inflammation of the Pancreas |
| What remains in the pancreas rather than being released? | -Amylase -Trypsin -Lipase |
| Stimulation of pancreas is done through what? | Eating/drinking |
| What is the common bile duct comprised of? | GB bile duct and Pancreatic bile duct |
| What is the most common cause of pancreatitis for women? | Gallstones |
| What is the most common chronic type of Pancreatitis for men? | Alcohol |
| What is the most common acute type of Pancreatitis for men? | Gallstone |
| What is a treatment for pancreatitis regarding fluids? | Strict NPO including water |
| Why is a person w/pancreatitis on strict NPO including water? | -Drinking water starts peristalsis, starts in mouth |
| What are some medications used to treat pancreatitis? | H2B or PPIs |
| Why are H2Bs or PPIs used to treat pancreatitis? | -Prevent gastric secretions from being stimulated |
| Why is Bentyl-antispasmodic used to treat pancreatitis? | -Prevent pancreas from spasm-ing |
| What is the prototype drug Pancrealipase? | pancreatic enzyme; Replacement for the pancreatic enzymes the body is not producing. |
| Where does Pancrealipase work? | |
| What are S/E of Pancrealipase? | Rare, but N/V/D |
| Where is Pancrealipase derived from? | -Derived from Pigs, if allergic to pork, may not be able to take this drug |
| Who may not be able to take Pancrealipase? | Islamic or Jewish descents |
| Pancrealipase may lead to increase in uric acid, which can lead to what? | Gout (infl. of joint-usually big toe) |
| When should Pancrealipase be given? | 1-2h before or w/meals |
| When does Tammy think Pancrealipase be taken? | At the time of meal, may be sprinkled, enteric coated (want dissolved in duodenum) |
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