Exam 4: GI

which two zones dictate vomiting

chemoreceptor trigger zone and vomiting center

what is combination therapy

using antimimetic drugs that target both zones

what else can the chemoreceptor trigger zone stimulate

increase in intercrainial pressure

inner ear

pain

GI disorders

vomiting

diarrhea

constipation

all drugs used to treat GI disorders

antiemetics

antidiarrheals

stool softeners

laxatives

what should be tried first to help with vomiting before using drugs

nonpharmacologic measures

nonpharmacologic measures for vomiting

pedialyte

gatorade

teas

what is the BRAT diet

banana

rica

applesauce

toast

why is the BRAT diet no longer used

it does not include fluid/electrolyte replacement

what is increased BUN a sign of

dehydration

drugs that make up antimetics

nonprescription/OTC

anticholinergic prescriptive antihistamine antiemetics

action of OTC antiemetics

inhibit vestibular stimulation in the middle ear

drugs that are OTC antiemetics

Dymenhydrinate (Dramamine)

Meclizine Hcl (Dramamine less drowsy)

bisthmuth subsalicylate (Pepto, Kaopectate)

which drug is similar to bisthmuth subsalicylate

aspirin

what should be considered before giving an OTC antiemetic

aspirin allergy

not for morning sickness

drug group that is anticholinergic prescriptive antihistamine antiemetics

H1 receptor agonists

drugs that are H1 receptor agonists

Diphenhydramine (Benadryl)

Promethazine (Phenergan)

Hydroxazine (Vistaril)

which H1 receptor agonists is common in hospital settings

Promethazine (Phenergan)

which H1 receptor agonist is the weakest

Hydroxazine (Vistaril)

action of anticholinergic prescriptive antihistamine antiemetics

act on vomiting center

decrease stimulation of CTZ and vestibular pathways

what condition is Diphenhydramine (Benadryl) specifically used for

severe nausea/vomiting during pregnancy

side effects of anticholinergic prescriptive antihistamine antiemetics

impaired decision making

confusion

hyperactivity

how long are scopalamine patches used for

3 days

uses for scopalamine patches

relieving nausea/motion sickness

end of life

scopalamine patches cause anticholinergic effects, what should nurses watch out for

increased thirst/dry secretions

why should you wash your hands between scopalamine patch application

if you touch your eye, the medication residue can enlarge the pupil

list of centrally acting antiemetics

Phenothiazines

Nonphenothiazines

Serotonin receptor blockers

substance P/neurokinin 1 receptor antagonists

dopamine antagonists

which centrally acting antiemetics is most commonly used

Phenothiazine

drugs that are Phenothiazines

Prochlorperazine (Compazine)

Chlorpromazine

Perphenazine

action of Phenothiazines

depresses the CNS to decrease n/v

routes of Phenothiazine

oral

rectal

IM

IV

conditions you would not give Phenothiazines

coma, CNS depression, brain damage

severe hypo/hypertension

severe liver dysfunction

drawback with Phenothiazine

wreaks havoc on liver and kidneys

what conditions should Phenothiazines be used cautiously

renal dysfunction

moderates liver impairment

active peptic ulcer

pregnancy and lactation

main side effects of Phenothiazine

drowsiness

dizziness

weakness

dry mouth

drug interactions with Phenothiazine

CNS depressants

alcohol

what should the nurse obtain before giving Phenothiazine

good medication hx

drug group that is a Nonphenothiazine

Prokinetic

how long should Nonphenothiazines be taken

short term

name of Nonphenothiazine drug

Metoclopramide (Reglan)

action of Nonphenothiazines

speeds the movement of food through the stomach and intestines

which two drugs classes are used for n/v during pregnancy

Nonphenothiazine and Diphenhydramine (Benadryl)

main symptoms with Nonphenothiazine

EPS symptoms of Tardive dyskinesia

psychosocial disturbances

which group of people are most at risk for Tardive dyskinesia

children

other use for Prochlorperazine (Compazine)

anti anxiety med

meds that are nonphenothiazines

dolasetron (Anzamet)

ondansetron (Zofran)

how to distinguish nonphenothiazines from other drugs

ends in -setron

other names for nonphenothiazines

5-HT3 receptor agonists

serotonin antagonists

action of nonphenothiazines

block receptors in CNS and GI tract

pros of taking nonphenothiazines

stops emesis

cons of taking nonphenothiazines

anticholinergic effects can result in confusion

onset of taking IV zofran

immediate onset

which drugs are paired with other antiemetics

Zofran and substance P Neurokinin 1 receptor antagonists

meds that are substance P/Neurokinin 1 receptor antagonists

Aprepitant (Emend)

Rolapitant (Varubi)

action of substance P Neurokinin 1 receptor antagonists

act directly on CNS to block receptors of N/V

what conditions should substance P Neurokinin 1 receptor antagonists cautiously be used

pregnancy and lactation

stand out adverse effect of substance P Neurokinin 1 receptor antagonists

dehydration

drug interactions with substance P Neurokinin 1 receptor antagonists

Pimozide

Warfarin

hormonal contraceptives

what labs to get if someone is on warfarin and needs an antiemtic

get INR levels

impact of substance P Neurokinin 1 receptor antagonists on warfarin and birthcontrol

makes them less effective

meds that are dopamine antagonists

Butyrophenones (droperidol, haloperidol, haldol)

Benzos (ativan)

action of dopamine antagonists

act on CTZ

block dopamine receptors

recommendation with prescribing dopamine antagonists

start low and slow since RR depression and sedation is common

nursing considerations with dopamine antagonists

alterations in heart rythm

Torsades de pointe

what is Torsades de pointe

significant heart alterations that can lead to Vfib

glucocorticoids meds as antiemetics

Dexamethasone

Methylpresdnisolone

specific use for glucocorticoids

n/v after chemotherapy

what type of patient are we concerned about with glucocorticoids

diabetics

what should be ordered alongside taking glucocorticoids

get blood sugars 4x a day

Misc. agents uses as antiemetics

Medical cannabis: Dronabinol (Marinol)

Trimethobenzamide (Tigan)

what class does Trimethobenzamide (Tigan) belong to

antihistamines

routes Trimethobenzamide (Tigan) can be taken as

oral or IM

general assessment for antiemetics

cause of emesis

general planning/goal for antiemetics

no emesis

interventions for antiemetics

non-pharm and pharm methods

meds that are adsorbents

activated charcoal

action of adsorbents

binds drug/chemical to activated charcoal to absorb it

who should be called with ingestion or admin of adsorbent

Poison control

concern with taking adsorbents

it interferes with other meds and disrupts therapeutic effects

forms of adsorbents

mixed with liquid

tablet

causes of diarrhea

spoiled food

spicy food

fecal impaction

IBD

chron’s disease

tumors

nonpharm measures to help with diarrhea

pedialyte

gatorade

which labs are altered with dehydration

K+

Mg

Na

BUN

why must stool be clear before giving meds with travelers diarrhea

meds would trap pathogen if stool is still brown (system is not cleared)

cause of travelers diarrhea

E coli

treatment for travelers diarrhea

Fluoroquinolone antibiotics

which med should be avoided with travelers diarrhea

Loperamide (Immodium)

why should tx for travelers diarrhea be limited to 2 days

can cause severe constipation

action of opiates and opiate related agents as antidiarrheals

decrease GI motility

drug that is a opiates and opiate related agents

Loperamide

action of loperamide

stops irritation and spasms

reduces water in intestines

why are low amount of Loperamide prescribed

high amounts can cross the blood brain barrier

OTC antidiarrheal meds

Kaopectate

Pepto Bismol

Rx antidiarrheal med

Lotomil (diphenoxylate + atropine)

effects of atropine as an antidiarrheal

helps decrease spasms and drys things up

action of antidiarrheals

coat wall of GI tract and absorbs bacteria or toxins

nursing consideration with antidiarrheals

aspirin allergy

side effects of OTC antidiarrheals

dizziness

drowsiness

headache

weakness

side effects of RX antidiarrheals (Lomotil)

anticholinergic effects

flatulence

abdominal pain

arthalgia

myalgia

nursing diagnosis for antidiarrheals

presence of diarrhea