Exam 3 Pharmacology Review

What are anti-ulcer medications? (5)

• antacids

• H-2 receptor antagonist

• Proton Pump Inhibitors (PPI)

• Mucosal Protectants

• Antiflatulent

What meds should you avoid for ulcers?

aspirin & NSAID’s

How do you do an abdominal assessment for bowel patterns?

Auscultate, palpate, percussion

What do you do if there is blood in vomit or stool?

REPORT IT

How would you identify a proton pump inhibitor?

if it ends in -prazole

• Pantoprazole

• Esomeprazole

• Omeprazole

• Lansoprazole

How does PPI work?

to lower stomachs acidity

What would you use PPI for?

• PUD

• GERD

What is the administration consideration for proton pump inhibitors (PPI)?

• long-term therapy can cause hypomagnesemia

• use for 3 months or less

What should the patient do if they develop hypomagenesmia?

eat magnesium rich foods

What is the teaching and education you need to give your patient about PPI?

• to call provider if symptoms do not improve, especially if bleedings occurs

• discourage alcohol use, NSAID’s or food that cause GI irritation

Give an example of a mucosal protectant

sucralfate

What is the mechanism of action for Mucosal Protectants?

covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts

What is the use of a mucosal protectant?

treatment of ulcers

What administration considerations come with mucosal protectants?

• take on an empty stomach, 2 hrs after or 1 hour before meals AND at bedtime

• constipation may occur

What is an example of an antiflatulent?

simethicone

What do antiflatulents do?

relieve gas discomfort

What are the antidiarrheal medication classes? (#3)

1. adsorbents

2. antimotility

3. probiotics

What do antidiarrheal medications do?

they treat the symptoms of diarrhea but do not eliminate the cause

What is the purpose of adsorbents?

help eliminate the toxin/bacteria from GI tract

What is the purpose of antimotilities?

slow peristalsis (movement of bowel)

What is the purpose of probiotics?

help restore good bacteria

Give an example of an adsorbent.

Bismuth subsalicylate (pepto bismol)

What is an administration consideration of pepto bismol?

can cause black tongue or black stools

Give an example of an antimotility

Hyoscyamine

Is hyoscyamine a anticholinergic?

Yes. (can’t see, pee, spit, shit)

What is docusate?

a stool softener

What is MiraLax?

an osmotic agent

Give an example of a stimulant

bisacodyl (Dulcolax)

What is the mechanism of action for stimulants?

causes intestines to contract, inducing the stool to move through the colon

What are the administration considerations for stimulants?

• you can take orally/rectally

• hold in suppository for 15-20 minutes

• patient must be in Sims position (left side right leg up)

How long does the bowel movement take to produce with a stimulant?

15 minutes

What is the mechanism of action for scopolamine?

anticholinergics prevent nausea-inducing stimuli

What does scopolamine classify as?

anti-ametic

What should the patient know when applying scopolamine?

• clean sight

• wash hands before and after application

• if discarding, fold

What herbal and vitamin supplements can you take as an antiemetic?

Ginger & Vitamin B6 & peppermint tea

What the three hormone producing glands are involved in the endocrine system? (3)

1. thyroid

2. adrenal glands

3. pancreas

What are hormones regulated by?

the negative feedback loop aka the pituitary glands

Which hormones do adrenal glands produce?

aldosterone and cortisol

what hormones does the pancreas produce?

insulin and glucagon

What hormones does the thyroid produce?

Thyroxine (T4) and triiodothyronine (T3) and calcitonin

What affect does aldosterone have on the body?

increases blood sodium levels

What affect does cortisol have on the body?

increases blood sugar levels

What affect does insulin have on the body?

reduces blood sugar

What affect does glucagon have on the body?

increases blood sugar

What affect does T3 and T4 have on the body?

stimulates basal metabolic rate

What does the adrenal cortex produce?

aldosterone and cortisol

What does the pituitary gland regulate?

cortisol

What hormone is a stress hormone?

cortisol

What class is fludrocortisone?

mineralcorticoid

What does fludrocortisone do?

it FLUDS your body with more SALT & WATER

What drug can help treat Addisons disease?

Fludrocortisone

What is Addisons disease?

• an adrenal insufficiency (doesn’t produce enough cortisol and aldosterone)

• you need to ADD steroid hormone

What are the signs and symptoms of Addison disease? (7)

• salt cravings

• irritability

• N/V (nausea/vomiting)

• sexual dysfunction in women (low libido)

• low blood pressure

• dehydration

• weight loss

What are glucocorticoids?

• they are used to decrease inflammation and suppress the body’s immune response

• -one ending (“own”)

What are the adverse effects of glucocorticoids?

• increased blood glucose

• weight

• new infections

What are some teachings of glucocorticoids?

• never stop abruptly

• may need to increase the dosage of anti-diabetic medications when started one steroids due to an increase in blood sugar (caused by steroids)

What are the short term complications of diabetes?

• hypoglycemia

• hyperglycemia

• DKA

• HHA

What are the treatments for Type 1 diabetes?

• requires insulin for life

• cannot take oral medications

What are the treatments for Type 2 diabetes?

oral medications and/or insulin

What are the signs and symptoms of hyperglycemia?

3 P’s:

• polydipsia (lots of thirst)

• polyphagia (lots of hunger)

• polyuria (lots of urine)

• Juicy fruit breathe

What is the A1C test?

• blood test to diagnose diabetes

• over 3 month test

• measure sugar when it enters your bloodstream and attaches to hemoglobin

What value is considered diabetic on the A1C test?

greater than 6.5

What value is considered pre-diabetic on the A1C test?

5.7-6.4

What value is considered normal on the A1C test?

less than 5.7

What is considered hypoglycemic?

• less than 70 on the diabetic test

• causes: excess insulin, skip meals, exercise, excess alcohol

If a patient is conscious what would they give him if he was hypoglycemic?

• 15g of carbs/8oz of milk

• reassess pt in 15 minutes

If a patient is unconscious what do you give the patient?

you would administer glucagon

Hyperglycemia diabetic ketoacidosis (DKA)

• life threatening complication of diabetes that causes an increase in blood glucose

• ketones in the blood/urine

• most common in type 1 diabetes

What is found with DKA?

• blood glucose level under 300

• ketones will be present in the urine and blood

• metabolic acidosis and hyperkalemia

hyperglycemia hyperosmolar state (HHS)

• high glucose levels/dehydration

• greater than 600

• most common in type 2 diabetes

How would you store insulin if not using?

• in a refrigerator

• if vial is open: store in room @ controlled temp

How would you mix NPH (cloudy) and regular insulin (clear)

You would put clear before cloudy.

Why is it important to know onset, peak, & duration of insulin?

the major side effect/complication of insulin is hypoglycemia which happens @ peak

insulin glargine (Lantus)

insulin detemir (Levemir)

• LONG ACTING (NEVER HOLD)

• Administer once a day

• Onset: 3-4 hours

• Peak: none

• Duration: 24 hours

insulin lispro (Humalog)

insulin aspart (Novolog)

• RAPID-ACTING

• Onset: 10-30 min

• Peak: 1-3 hours

• Duration: 3-5 hours

• administer w/meals or immediately after

Humulin R

Novocain R

• SHORT-ACTING

• Onset: 30 mins - 1 hour

• Peak: 2-4 hours

• Duration: 4-8 hours

• meals 30 mins before

Humulin N (NPH)

Novatin N

• INTERMEDIATE

• Onset: 1-2 hours

• Peak: 6-14 hours

• Duration: 16-24 hours

• administer 1-2x daily

• beta blockers may mask symptoms of hypoglycemia

What is glucagons mechanism of action?

will increase blood sugar

What nurse considerations should u seek for glucagon?

provide patient with food and safely able to swallow

What does metformin (glucophage) do?

• decrease glucose production in the liver

• increase glucose uptake by the cells

What are administration considerations for metformin?

• GI upset

• lactic acidosis (overproduction of lactic acid in the body)

What are the mechanisms of action of Glipizide, glyburide and glimepiride?

stimulate the pancreas to release more insulin

What is the peak of glipizide, glyburide and glimepiride?

1-3 hour

What are the administration considerations of glipizide, glyburide and glimepiride?

• severe hypoglycemia

• must be given 30 mins before meals

What is lipohypertrophy?

build up of scar tissue caused by not rotating injection sites

What insulin should you not mix with any other insulins?

insulin glargine (long)

What are the thyroid hormones?

T3 & T4 (metabolic hormones), TSH (produced by pituitary glands)

What is hyperthyroid?

excessive production of thyroid hormones

What causes hyperthyroidism?

• too much iodine

• Graves disease

• use medication to lower

What is hypothyroidism?

low production of thyroid hormones

What causes hypothyroidism?

• not enough iodine

• Hashimoto disease

• medication to replace the hormone w

What is a hyperthyroid medication?

ptopylthiouracil (PTU)

What is a hypothyroid medication?

• levothyroxine (Synthriod)

• must be taken 30 mins -1 hour before breakfast

• monitor weight and pulse regularly

What is Alendronate (Fosamax) used for?

osteoporosis

What are the administration considerations of Alendronate (Fosamax)?

• Give to pt in the morning

• wait at least 30 mins before first meal

• pt should sit/stand for 30 minutes after administration

What are the three common insulin injection sites?

1. abdomen

2. back of upper arm

3. lateral thigh

A client is prescribed omeprazole. The nurse determines that the client is receiving its therapeutic effect if the client makes which of the following statements?

• “I no longer am experiencing constipation.”

• “My heartburn and indigestion have improved.”

• “I'm having less episodes of diarrhea.”

• “I'm having less nausea and vomiting.”

“My heartburn and indigestion have improved”

A client has been prescribed sucralfate for the treatment of gastric ulcer. The nurse should instruct the client to take this medication at what time?

• 1 hour after meals

• At the same time with an antacid

• 1 hour before meals

• Lunch time

1 hour before meals

What is the priority nursing interventions for a client receiving an antiemetic?

• Allowing them to eat whatever sounds good

• Monitor for dehydration.

• Monitor blood pressure

• Monitor heart rate

Monitor for dehydration

An osmotic agent use for constipation causes water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass. True or false?

TRUE