Patho Exam 3 Drugs & Content

Sickle cell anemia patho

red blood cells are shaped like sickles, as well as become rigid and sticky, resulting in slower/blocked blood flow

Sickle cell anemia risks

genetic predisposition, African/Mediterranean/Middle eastern descent

Sickle cell crisis triggers

stress, cold climates, pain, alcohol, tobacco, dehydration, infection, hypoxemia

Sickle cell crisis prevention

folic acid supplements, hydration, exercise, smoking cessation, alcohol limiting, minimizing stress

Sickle cell complications

chronic skin ulcers, hypoxia/ischemia/infection, dehydration, CVA, anemia, acute and chronic kidney disease, heart failure, impotence, poor compliance, substance abuse

Type 1 vs. type 2 diabetes patho

type 1 - beta cells destroyed, insulin dependent

type 2 - body resistant to insulin/not produced sufficiently, insulin resistant

Metabolic syndrome

characteristic of type 2 diabetes, increased risk for heart disease, CI, MI, due to abdominal obesity/high LDL, low HDL, high triglycerides, and hypertension

HbA1c/A1c

reflects overall 2-3 months glucose levels, diabetic level is 6.5% or higher, prediabetes is 5.7-6.4%, normal is below 5.7%, GOAL for diabetics is below 7%

Fasting blood sugar level

above 126 is diabetic, 100-125 is prediabetic, below 99 is normal

Recommended blood glucose level for diabetics

80-130 before meals & bedtime (adults), 90-150 before meals & bedtime (children and adolescents)

Significance of macrovascular abnormalities of diabetes

type 2 carried significantly more risk for vascular problems than type 1

Most common cause of ESRD

uncontrolled type 2 diabetic nephropathy

3 P's of diabetes mellitus

polyuria, polydipsia, polyphagia

urination, thirst, appetite

Complications of diabetes mellitus

MI, CI, blindness, leg amputation, renal failure, hyperosmolar hyperglycemic nonketotic coma (HHNC)

Only insulin given through IV

Humulin regular insulin

Sliding scale insulin dosing

rapid-acting or short-acting insulins are adjusted based on blood glucose test results

Bolus insulin dosing

single, large dose, a dose of insulin taken to handle a rise in blood glucose from eating (given via shot or insulin pump), usually short-acting and rapid-acting insulins, insulin lispro or insulin aspart

Basal insulin dosing

long-acting insulin, given once or twice a day, a small/constant stream of insulin, helps to maintain glucose levels when not eating, insulin glargine

Basal-bolus insulin dosing

preferred method of treatment for hospitalized patients with DM, mimics a healthy pancreas

Nursing implications of insulin administration

insulin ordered and prepared dosages are second checked with another nurse (QSEN safety), use insulin syringe (calibrated in units)

Diverticular disease

small, bulging pouches that form in the lining of the digestive tract (usually colon), common in ages 40+, when the pouch becomes inflamed/infected it is called "diverticulitis", causes severe abdominal pain (lower left side), fever, nausea, change in bowel habits

Diverticulitis treatment

rest, changes in diet, antibiotic therapy, severe cases may need surgery

Crohn's disease

begins with crypt inflammation and abscesses, which progress to ulcers, the ulcers link with other ulcers which creates a cobblestone appearance to the bowel, symptoms include right lower quad pain, abdominal pain, chronic diarrhea, full feeling, fever, loss of appetite, weight loss, abnormal skin tags, anal fissures, anal fistulas, rectal bleeding

Crohn's disease treatment

antibiotics, antidiarrheal medication, anti-inflammatory medications (steroids, either rectal or orally)

Primary cause of PUD

H. pylori infection

PUD risk factors

family history, smoking, caffeine, NSAIDs, stress, H. pylori

Stress ulcer prophylaxis - therapy to prevent severe GI damage (ICU patients)

PUD patho

sores/ulcers develop in the stomach lining/small intestine duodenum because the protective mucous lining is damaged

PUD clinical manifestations

pain/burning in middle/upper stomach, pain that temporarily disappears after eating or taking an antacid, bloating, heartburn, nausea/vomiting

PUD non-pharm treatment

decrease usage of NSAID medications, quit smoking, moderate alcohol

PUD pharm treatment

proton pump inhibitors, H2 blockers, antibiotics, protective medications (Pepto-Bismol)

GERD

gastroesophageal reflux disease, backup of hydrochloric acid, causes heartburn sensation, increased coughing and trouble swallowing are manifestations, asthma can exacerbate from GERD, esophageal stricture/esophagitis (inflammation), lead to cancer of esophagus, avoid acidic, spicy foods, carbonated beverages/caffeinated, eat sitting upright, reduction of weight

H2 receptors

responsible for increasing stomach acid

H2 receptor antagonist

suppresses the volume and acidity of parietal cell secretions, used for short-term treatment of duodenal and gastric ulcers and GERD

GERD patho

stomach acid repeatedly flows back into the esophagus due to an issue with the esophageal sphincter, acid reflux irritates the lining of the esophagus

GERD clinical manifestations

burning sensation (heartburn), backwash of liquid or food, upper abdominal or chest pain, dysphagia, sensation of lump in throat, nausea

GERD non-pharm treatments

elevating HOB, weight loss, smoking cessation, avoiding caffeine/alcohol/mints, not eating 2 hours prior to bedtime

GERD pharm treatments

antacids, alginates, H2 blockers, proton pump inhibitors, baclofen

GERD causes

lack of exercise, decreased fluid intake, insufficient fiber, medication such as opioids and narcotics, antacids, and iron supplements, always change lifestyle habits prior to use medication

Constipation patho

colon absorbs too much liquid from feces, causing it to become dry/hard, when food moves too slowly through the digestive tract

Constipation clinical manifestations

fewer than 3 BMs per week, dry/hard/lumpy stools, stools are difficult/painful to pass, stomach aches, cramps, bloating, nausea

Constipation non-pharm treatment

should be used before drugs, adequate fluid intake, avoid processed foods, add fruits & vegetables, keep a food diary, exercise, add OTC supplementary fiber (Metamucil, MiraLAX)

Constipation pharm treatments

prescription laxatives, surgery (rarely)

Bulk-forming laxatives important - must be taken with a full glass of water, to prevent clumping and proper digestion, can cause an impaction

Diarrhea causes

medications, bowel infections, lactose, inflammatory bowel disease, antibiotics (colitis), goal is to assess and treat the underlying condition

Bacterial gastroenteritis

use an antibacterial drug based on culture/sensitivity testing, Rifacimin is used to treat traveler’s diarrhea in patients older than 12

Probiotics for diarrhea

lactobacillus, saccharomyces boulardii (restores the normal flora of intestines following antibiotic therapy)

Diarrhea non-pharm treatment

promoting fluid intake, electrolyte-based fluids, BRAT diet, avoid caffeine and alcohol, avoid foods and drink that produce gas (vegetables and carbonated beverages)

Diarrhea pharm treatment

antibiotics/anti-parasitics, medications that treat underlying conditions, probiotics

Nausea patho

rid self of toxin, controlled by the vomiting center of medulla in brain which receives signals from digestive tract, inner ear, etc.

Nausea non-pharm treatment

drinking clear beverages, eating bland foods, avoiding greasy foods, eating smaller/more frequently, not mixing hot and cold foods, drinking beverages slowly, avoiding activities after eating, avoiding brushing teeth after eating

Overweight BMI

25-29.9

Obese BMI

over 30

Fat soluble vitamins

ADEK

Water soluble vitamins

B and C

Lispro Humalog, Aspart Novolog

Rapid acting insulin:

Given 10-15 mins before a meal, monitor blood glucose prior to giving, peaks in 1 hour, lasts for 4-8 hours

Humulin R

Short/regular insulin:

Given 30 mins before a meal, monitor blood glucose prior to giving, peaks in 30 mins, lasts for 3-6 hours

NPH insulin

Intermediate acting:

Give 2-4 hours before a meal, monitor blood glucose levels prior to giving, peaks in 8-12 hours, lasts for 18-24 hours

Glargine-solostar, Detemir

Long acting insulin:

Give at bedtime, sets in around 1 hour, no peak because it is constant, lasts up to 24 hours

Glyuride

Antidiabetic:

increases the secretion of insulin, used to treat elevated blood glucose levels, can cause hypoglycemia (take before eating), contraindicated in pregnancy, renal/hepatic impairment, critical illness, do NOT give in NPO patients due to hypoglycemic effects

Metformin

Antidiabetic:

increases the use of glucose by muscle/fat cells which decreases liver glucose production and decreases the intestinal absorption of glucose, used for insulin resistance, lactic acidotic side effect, can also cause GI effects (take with food), monitor for fatal lactic acidosis

Acarbose

Antidiabetic: delays digestion of complex carbohydrates, used in pts with a decrease in glucose after eating, can cause hypoglycemia and hepatic disease

Rosiglitazone maleate

Antidiabetic:

stimulates insulin receptors on muscle/fat/liver cells, used for insulin resistance, can cause hepatotoxicity & weight gain, BBW for heart failure, monitor liver function and signs of heart failure

Repaglinide

Antidiabetic:

stimulates pancreatic stimulation of insulin, used for high serum glucose, works by causing hypoglycemia, hold medication if pt is not going to eat

Exenatide

Antidiabetic:

stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten, used to slow gastric emptying which reduces glucose elevations after eating and produces satiety, can cause hypoglycemia, GI distress, liver disease, BBW for thyroid cancer risk, monitor for pancreatitis, given via INJECTION (not an oral med)

Sitagliptin

Antidiabetic:

balance the release of insulin and limits the release of additional glucose from the liver, used for elevated serum glucose, may complicate renal disease, BBW for joint pain, monitor for side effects including stuffy nose/sore throat/headache, etc.

Hydoxyurea

Sickle cell anemia treatment (antineoplastics):

manages sickle cell anemia crisis, inhibits DNA synthesis, can cause fever, hemorrhage, thrombocytopenia, vitamin D deficiency, dyspnea, decreased bone marrow function, BBW myelosuppression (bone) & malignancies, monitor for pancreatitis and platelet count, wear gloves when handling the drug or container

Omeprazole

PUD treatment:

antiulcer, proton pump inhibitor, blocks the enzymes responsible for secreting HCL in the stomach, used as short-term therapy for peptic ulcers and GERD as well as stress ulcers, increases risk of osteoporosis in older adults, associated with c.diff, give before food

Famotidine (Pepcid)

GI treatment:

H2 receptor antagonist, short-term treatment of duodenal and gastric ulcers/GERD, decreases production of stomach acid, can be given with or w/o food, can cause confusion and agitation in older adults

Antacids

short-term relief of heartburn, alkaline substances that neutralize stomach acid, do NOT prevent overproduction of acids, works in 20-40 minutes, lasts about 2-3 hours, common to have mixture of aluminum and magnesium, take at least 2 hours before/after other drugs

Mylanta

Antacid:

contraindicated in renal pts, aluminum and calcium cause constipation and magnesium cause diarrhea, many acids contain Simethicone (anti-gas)

Calcium tums

Antacid:

can cause kidney stones, symptoms mimic hypercalcemia, increase fiber if experiencing induced constipation

Combination treatments to treat H pylori

antibiotics and a proton pump innhibitor, ex: Metronidazole and bismuth subsalicylate, ulcer heals faster when bacteria is eliminated, can cause bleeding problems, do not use if allergic to aspirin

Sucralfate

a mucosal protectant in treatment of active stress ulcers & long term therapy for PUD, must be given four times per day, interacts with warfarin, certain antibiotics, digoxin, and antacids

Misoprostol Cytotec

inhibits gastric acid secretion and increases mucus and bicarbonate secretion, mucosal blood flow, can cause diarrhea, contraindicated in pregnancy (BBW), may induce abortion and birth defects

Bulk-forming laxatives

(usually OTC) - psyllium (Metamucil), contains fiber, absorbs water and increases bulk and produces stool, may be taken regularly

Saline laxatives

magnesium laxatives used to evacuate the bowel quickly for endo procure, contraindicated in renal patients

Lubricant laxatives

mineral oil, side effects include decreased absorption of fat, soluble vitamins, aspiration, should not be used regularly

Stimulant laxative

induces peristalsis, most likely to cause dependance, Bisacodyl

Stool softener

surfactant laxative, used post-op to prevent constipation, Docusate (COlace) little to no laxative effect

Lubirpostone

laxative; treats chronic idiopathic constipation, give on empty stomach, BBW for children under age 6 for death due to dehydration

Lactulose

laxative; derived from natural sugar, laxative, decreases ammonia level in Hepatic Encephalopathy

Psyllium (Metamucil)

absorbs excess water while stimulates a normal BM, adds bulk to fecal mass, stimulates peristalsis and defecation, treats occasional constipation, may help lower cholesterol, can cause flatulence, bloating, cramping, contraindicated with intestinal obstruction, fecal impaction, difficulty swallowing

Promethazine

Anti-nausea:

blocks dopamine from receptor sites in brain and CTZ, used for nausea vomiting, chemo, motion sickness, BBW cannot be given subq, avoid giving IV route (can cause severe tissue injury), give IM, BBW for children less than 2 due to respiratory depression, caution in older adults due to anticholinergic side effects (can cause confusion especially)

Hydroxyzine

Anti-nausea:

antihistamine, H1 receptor blocker, blocks acetylcholine in the brain, used for nausea/vomiting, prevent motion sickness, sedative to for anxiety combined with other meds during anesthesia, contraindicated in older adults due to sedative properties and anticholinergic adverse effects, administer IM deep large muscles, CANNOT be given subq or IV (sterile abscess and damage tissue)

Ondansetron (Zofran)

Anti-nausea:

selective serotonin receptor antagonist, can cause headache, diarrhea, dizziness, constipation, elevated LFTS, ecg changes, allow to dissolve on tongue without water, do not push through the foil when taking out of package

Aprepitant (Emend)

used in combination with 5-HTZ antagonist and or glucocorticoid for patients who receive highly emetic chemotherapy, blocks NKI receptors, inhibits signals to brain causes nausea, contraindicated with food and herbs can affect absorption, grapefruit juice, give one hour prior to chemotherapy, take with a full glass of water with or w/o food

Dronabinol (Marinol)

Anti-nausea:

synthetic substance derived from marijuana, FDA approved to treat n/v from chemo and appetite stimulation, abuse potential, adverse effects enhanced in older adults, can include euphoria, tachycardia, paranoia, drowsiness

Meclizine (Antivert)

Anti-nausea:

antihistamine-H1 receptor blocker, inhibits vestibular stimulation (anticholinergic), can cause drowsiness, dizziness, confusion, blurred vision, dilated pupils, dry mouth, urinary retention

Scopolamine

Anti-nausea:

Topical patches, used for nausea/vomiting/motion sickness, anticholinergic effects (side effects)

Diphenoxylate with Atropine (Lomotil)

Anti-diarrheal:

Diphenoxylate - opioid, slows peristalsis, allowing for more water reabsorption and atropine - added to discourage patients from taking too much of the medication, anticholinergic effects (SNS symptoms) with high doses, contraindicated in children younger than 2

Loperamide (Imodium)

Anti-diarrheal:

decreases GI motility, adverse effects include abdominal pain, constipation, drowsiness, fatigue, nausea, vomiting, BBW critical dysrhythmias and cardiac arrest if taking higher than normal dose, lacks the potential for abuse

Rifaximin

Anti-diarrheal:

used to treat traveler’s diarrhea in patients older than 12 years

Phentermine

Anti-diarrheal:

Anorexiants (adrenergic), stimulates the release of norepinephrine and dopamine, inhibits the reuptake of serotonin and norepinephrine, used for appetite suppression, resulting from direct stimulation of satiety center, can cause nervousness, hyperactivity, dry mouth, constipation, and hypertension

Orlistat

Anti-diarrheal:

lipase inhibitor, binds to gastric and pancreatic lipases in the GI tract and can prevent absorption of 30% of ingested fat, decreased fat absorption leads to decreased caloric intake, resulting in weight loss and improved serum cholesterol values, adverse effects include abdominal pain, oily spotting, fecal urgency and incontinence, flatulence with discharge, fatty stools, increased defecation

Vitamin A sources

liver, milk, butter, cheese, cream, egg yolk, fortified milk, margarine, cereals

Vitamin A toxicity symptoms

headaches, diarrhea, nausea, loss of appetite, dry/itching skin, hypercalcemia

Vitamin A therapeutic uses

vision health, tissue strength, growth and immune function

Vitamin E sources

vegetable oils, margarine, salad dress, other foods made with vegetable oil, nuts, seeds, wheat germ, dark green vegetables, whole grains, fortified cereals

Vitamin E toxicity symptoms

hemorrhagic effects

Vitamin E therapeutic uses

use in premature infants to reduce the toxic effects of oxygen on lungs and retina

Vitamin K sources

spinach, brussel sprouts, broccoli, cabbage, cauliflower, swiss chard, lettuce, collard greens, carrots, green beans, asparagus, and eggs