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Pharm II - Week 5
Thyroid & GI Drugs
| Question | Answer |
|---|---|
| True or false: constipation is defined by the frequency of stools | False. Defined by consistency |
| Explain the function of thyroid hormone | Stimulates use of energy (elevates basal metabolism, increases O2 use), stimulates heart, promotes growth (brain, skeletal muscle) |
| Triiodothyronine and thyroxin are also known as | T3, T4 respectively |
| _____ and ______ regulate the thyroid | Hypothalamus and anterior pituitary |
| Thyroid hormone is given when there is _____ or as a ______ after a thyroidectomy | Underproduction; supplement |
| Need for treatment and outcomes of thyroid therapy are measured by... | TSH level, serum T3, T4 |
| True or false: TSH level is sensitive to detecting hyperthyroidism | False. HYPOthyroidism |
| What serum hormone is sensitive for detecting hyperthyroidism? | T3 |
| True or false: as people age, their thyroids become less active | True |
| List the s/sx of hypothyroidism | Lethargy, confusion, poor concentration, skin cold/dry, brittle hair, flat affect, fatigue |
| What is the difference between secondary and primary hypothyroidism? | Secondary is where thyroid isn't being stimulated by pituitary to produce hormones. Primary is where thyroid can't produce amount of hormones pituitary calls for. |
| Hypothyroidism is considered a _____ condition | Teratogenic |
| True or false: pregnancy seems to trigger both hypothyroidism and hyperthyroidism | True |
| First line treatment for hypothyroidism is... | T4 (levothyroxine, Synthroid). Converts to T3. |
| For T4 list the following: TI, route, % of protein binding, half life, AE | Narrow TI, PO, highly protein bound, long half life. AE: too much includes tachycardia, angina, insomnia, nervousness, heat intolerance |
| Synthroid should always be taken ______ | on an empty stomach |
| Which drugs can interact with levothyroxine and decrease thyroid levels? | Ca, Fe, Questran |
| Questran should be taken _____ hours before/after thyroid hormone is administered | 4 |
| What drugs can interact with levothyroxine to increase thyroid levels? | Dilantin, Zoloft, penobarbital |
| Levothyroxine enhances _____, can _____ insulin needs, and shouldn't be used to treat ___ | Coumadin; increase; obesity |
| When purchasing levothyroxine, what should the consumer keep in mind? | Generic-to-generic drugs can have very different bioavailability due to differences in inactive ingredients |
| What are some s/sx of Hyperthyroidism? | Hair loss, exopthalamus, rapid pulse, palpitations, anxiety, insomnia, restlessness, irritability, diarrhea, increased sweating, temperature intolerance, weight loss, osteoporosis |
| People with hyperthyroidism are more prone to... | Heart attacks, CVA |
| Hyperthyroid treatment can include | Surgery, radiation, PTU |
| PTU (propylthiouracil): route, rate of absorption, half life and protein binding | Given PO, rapidly absorbed, SHORT half-life, moderately protein-bound. |
| PTU: mechanism of action and AE | Prevents synthesis of thyroid hormone, conversion of T4 -> T3. Doesn't destroy preexisting thyroid hormone. AE: agranolocytosis |
| List GI drug categories and subclassess | Antiulcer drugs: antibiotics, antacids, antisecretory agents, muscosal protectants. Laxatives |
| Ulcers are found mostly in ____ and _____ | Lesser curvature of stomach and duodenum |
| Ulcers affect ___ of adults at some time | 10% |
| Ulcers are mostly caused by _____ when defenses are lowered | Helicobacter pylori |
| Ulcers can alway be exacerbated by ____, ____, and _____ | NSAIDs, glucocorticoids, nicotine (impairs healing due to vasoconstriction) |
| S/sx of ulcers include ___ and _____ | Stomach pain and green, tarry stools |
| True or false: inhaled glucocorticoids can cause ulcers | False. Only PO with repetitive use |
| Which antibiotic is best for ulcer Tx? | Amoxicillin |
| Common antibiotic regimen for ulcers involves... | Use of 3 antibiotics at same time along with either a histamine2 receptor agaonist or proton pump inhibitor |
| Downsides of treating ulcers with antibiotics include... | Nausea and diarrhea. Expensive. Hard to adhere to. Can led to C. difficile or other secondary infection r/t intestinal flora disruption |
| Histamine2 receptor antagonists Tx ulcers how? | 1) suppresses secretion of gastric acid, 2) reduces acidity of acid by blocking histamine2 receptors on gastric parietal cells |
| List two histamine2 receptor antagonist drugs | cimeditine (Tagamet), ranitidine (Zantac) |
| True or false: the following are appropriate routes for cimeditine/ranitidine (PO, IM, IV) | True. Rarely given IM. |
| Tagamet/Zantac has a ___ half-life | Short |
| True or false: cimeditine should be taken on an empty stomach for better absorption | False. Should be taken with food for slower absorption. |
| Other indications for Tagamet/Zantac include ___ and prevention of ____ | GERD, aspiration pneumonitis |
| ____ is an example of a proton pump inhibitor | omeprazole/Prilosec |
| Proton pump inhibitors are _____ in suppressing production of ___. Their effects are ___ than H2 receptor blockers | most effective; gastric acid; better |
| True or false: omeprazole is a prodrug | True |
| Prilosec has ____-coated granules inside capsule | Enteric |
| Omeprazole inhibits ___ of stomach acid in __ hours and effect persists | 97%; 2 hours |
| Persistent use of omeprazole may change ___ ____ | Bone density |
| Prilosec has been used in peds to Tx ___. Why is this a bad idea? | Colic. Bad idea because baby colic is not a GI disturbance |
| Constipation can be caused by: | Diet deficit in fluid and fiber; opioid use |
| True or false: laxatives are the most overused OTC drug category | True |
| Laxatives are contraindicated with the following: (list 6) | Nausea, vomiting, abdominal pain, acute surgical abdomen, bowel obstruction, pregnancy |
| A pt. comes in with severe, unexplained N/V. She admits she has taken a laxative earlier in the day. What should the RN be concerned about? | Severe bowel impairment. Depending on cause of N&V, could lose bowel or, if pregnant, cause miscarriage |
| Medical criteria for constipation states a pt. must have __ of the symptoms below for over __ months | 2, 3 |
| Symptoms of constipation include: | Less than 3 bowel movements/week, straining, hard stools*, sensation of an obstruction/incomplete defecation, manual maneuvering required to defecate |
| List three types of laxatives | 1) surfactant laxative, 2) bulk-forming laxative, 3) stimulant laxatives |
| Describe a prototype drug for each laxative type | Surfactant laxative (docusate/Colace), bulk-forming (psyllium/Metamucil), stimulant (bisacodyl/Ducolax) |
| ____ takes several days to work; best to start with the opioids. This drug allows water to enter the stool | docusate/Colace |
| Doucsate should be given with ____ | Water |
| True or false: with Colace, N/V and cramping are common side effects | False. Rare side effects |
| ___ is often given as suppository but can be PO pill as well | bisacodyl/Ducolax |
| Psyllium is intended for ___ use. It isn't digested by the body | Very occasional |
| How does Metamucil work? | Swells and bulks up content by letting H2O into intestine, which is stretched, stimulating peristalsis |
| Bisacodyl/Ducolax takes how long to work PO? How long as suppositories? | PO: 6-12 hours to work. Suppository: 15-60 min. |
| A major side effect of bisacodyl/Ducolax is ___ | Cramping |
| Metamucil is essentially ___ | Fiber |
| ____ is an example of prokinetic agents | Cisapride/Propulsid |
| How do prokinetic agents work? | Increase motility in upper GI. Stimulates serotonin receptors to increase ACh release into enteric NS |
| Cisapride is a ____ receptor agonist and a _____ | Serotonin 5-HT4; parasympathomimetic |
| True or false: Propulsid has limited use in US due to severe AE | True. Severe effects often cardiac |
| Laxative abuse will cause the following (list 4) | 1) dehydration, 2) electrolyte imbalance, 3) weight loss, 4) bowel irritation |
| When providing pt. education, you should get pt. to focus on bowel ___ not ___ | Consistency; frequency |
| Withdrawal of laxative can mean the next stool won't occur into __ | Days after |
| Laxative abuse is most commonly seen in... | The young (eating disorders) and elderly (due to chronic constipation) |
| True or false: using laxatives to lose weight results in significant weight loss | False. very modest actual sustained weight loss |
| Laxative abuse can result in what consequences for young pts.? | Frequent pain associated with self-administration, social isolation, impaired sleep, harmful long-term consequences on bowel function |
| Laxative abuse in elderly are often caused by... | Pelvic floor dysfunction, medication effects, numerous age-specific conditions |
| If a pt. has abused laxatives, to give them Tx generally a nurse would provide a ____. | Stool softener |
| The emetic response is a ___ | Reflex |
| Where is the vomiting center? | Nucleus of neurons in medulla |
| Emetic response can occur in three ways | 1) stimulation of vomiting center, 2) direct stimuli from cerebral cortex, 3) indirect-acting stimulant |
| Direct stimuli from cerebral cortex that often result in N/V include: | Fear, upsetting sights, smells, pain, signals from vestibular apparatus of inner ear |
| Indirect-acting stimulants active ____ ____ _____ | Chemoreceptor trigger-zone |
| CTZ activation leads _____ from _______ along ____ pathways | signals; stomach/intestine; vagal |
| Direct action of certain compounds can be carried to CTZ in blood (list three) | Ipecac, anti-cancer drugs, opioids |
| What is antiperistalsis? | Reverse peristalsis where things move from intestine back into stomach |
| List four categories of anti-emetic drugs | Serotonin receptor antagonists; glucocorticoids; dopamine antagonists; herbals (mint/marijuana) |
| Ondanestron/Zofran is a _____. It's the best drug for ___ d/t anti-cancer and anesthesia | Serotonin receptor antagonist; nausea |
| What is ondanestron's mechanism of action? | Blocks 5-HT3 receptors located in CTZ and afferent vagal neurons in upper GI tract |
| Ondanestron/Zofran's route is... and AE include... | PO/IV; headache, diarrhea, dizziness |
| Glucocorticoids used as anti-emetics include ____ and ____ | Dezamethasonze and Decadron |
| Mechanism of action for dezmethasone/Decadron, route, ADE | MOA: unknown, IV route, adverse effects few if used short term |
| Glucocorticoids often given for.... | Pain, opioids, nausea |
| True or false: prednisone works as well as Decadron | False. Doesn't work quite as well |
| Examples of dopamine antagonists include ____ and _____ | prochlorperazine/Compazine and haloperidol/Haldol |
| What is the mechanism of action of prochlorperazine/haloperidol? | Blocks dopamine2 receptors in CTZ |
| ADE of Compazine/Haldol include | Anticholinergic, extrapyramidal effects, sedation |
| Prochlorperazine/haloperidol are pregnancy category ___ drugs | C |
| ____ works well as an anti-emetic in cancer pts. | Marijuana |
Created by:
choel
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