NURS-442: Application of Pharm Principles (Module 6)

Why are GI medications commonly administered prophylactically to critically ill or hospitalized patients?

To prevent stress ulcers and reduce gastrointestinal side effects associated with other medications

What are three common categories or types of GI medications used in acute care?

Sucralfate (Carafate), proton pump inhibitors (PPIs), and histamine-2 receptor antagonists (H2RAs)

What are two examples of proton pump inhibitors (PPIs)?

Pantoprazole and omeprazole

What are two examples of histamine-2 receptor antagonists (H2RAs)?

Famotidine and cimetidine

Which H2 receptor antagonist is specifically highlighted regarding pregnancy safety?

Cimetidine

What is the pharmacologic classification of promethazine (Phenergan)?

Histamine-1 (H1) receptor antagonist

Why are the oral and rectal routes preferred for promethazine administration?

IV administration carries a risk of severe tissue damage and chemical irritation

What is the typical adult dose of promethazine?

12.5–25 mg every 4–6 hours as needed

What is the recommended pediatric dose of promethazine for children older than 2 years?

0.25–0.5 mg/kg/dose every 4–6 hours as needed

What are the major adverse effects of promethazine?

Anticholinergic effects, extrapyramidal symptoms (EPS), CNS depression, neuroleptic malignant syndrome, orthostatic hypotension, respiratory depression, and tissue necrosis

What boxed warning and pediatric contraindication are associated with promethazine?

Risk of respiratory depression; contraindicated in children younger than 2 years

What IV access is preferred when administering promethazine intravenously?

A large peripheral vein or central line, if available

How should promethazine be diluted and infused intravenously?

Dilute in 50–100 mL of normal saline and infuse over 20–40 minutes (2.5–5 mL/min)

What should nurses monitor when administering promethazine?

Vital signs, mental status, CNS effects, and the IV site

What is the pharmacologic classification and mechanism of action of metoclopramide (Reglan)?

Dopamine antagonist, gastrointestinal agent, and serotonin 5-HT4 receptor agonist

What boxed warning is associated with metoclopramide?

Risk of tardive dyskinesia

What are the primary indications for metoclopramide?

Chemotherapy-induced nausea and vomiting, hiccups, migraines, and gastroparesis

What is the typical dose range for metoclopramide?

5–20 mg

What are the major adverse effects of metoclopramide?

CNS depression, extrapyramidal symptoms (EPS), and hyperprolactinemia

How should IV metoclopramide doses below 10 mg be administered?

Undiluted by IV push over 1–2 minutes

How should IV metoclopramide doses above 10 mg be administered?

Dilute in 50 mL of normal saline and infuse over 15 minutes

What eight pharmacologic considerations should be reviewed for ondansetron (Zofran)?

Pharmacologic category, mechanism of action, indications, typical dosage and formulations, pediatric considerations, adverse effects, IV administration, and monitoring

What is the pharmacologic classification and mechanism of action of sodium polystyrene sulfonate (Kayexalate)?

Potassium binder that exchanges sodium for potassium in the intestine to promote potassium elimination

What condition is sodium polystyrene sulfonate used to treat?

Hyperkalemia

Why is sodium polystyrene sulfonate unsuitable for emergency treatment of life-threatening hyperkalemia?

Its delayed action makes it too slow for immediate potassium reduction; it lowers potassium by approximately 0.5–1.0 mEq/L per hour

What is the typical adult oral dose and maximum daily dose of sodium polystyrene sulfonate?

15 g, 1–4 times daily, with a maximum daily dose of 60 g

What routes can be used to administer sodium polystyrene sulfonate?

Oral, nasogastric (NG) tube, or rectal

How long should other oral medications be separated from sodium polystyrene sulfonate?

At least 3 hours, or 6 hours in patients with gastroparesis

What are the major adverse effects of sodium polystyrene sulfonate?

Constipation, hypokalemia, sodium/fluid overload, and intestinal necrosis

What substance should be avoided when administering sodium polystyrene sulfonate?

Sorbitol

In which gastrointestinal condition is sodium polystyrene sulfonate contraindicated?

Bowel obstruction

What laboratory values and clinical parameters should nurses monitor during sodium polystyrene sulfonate therapy?

Potassium, magnesium, calcium, fluid status, and bowel function

What symptoms should be reported immediately during sodium polystyrene sulfonate therapy?

Abdominal pain, rectal bleeding, or new constipation

What are three common types of enteral feeding tubes?

Percutaneous endoscopic gastrostomy (PEG) tubes, gastrostomy (G) tubes, and nasogastric (NG) tubes

What must nurses verify before administering medications through an enteral tube?

Correct tube placement

What position should patients maintain following enteral medication administration?

Fowler's position for at least 1 hour after medication administration

What supplies are needed to prepare medications for enteral administration?

Pill crusher, medicine cup, water, and piston syringe

How much water should be used to flush an enteral tube before medication administration?

30–60 mL

How much water should be used to dissolve crushed medications before enteral administration?

15–30 mL

How much water should be used to flush an enteral tube between medications?

15–30 mL

How much water should be used for the final flush after enteral medication administration?

30–60 mL

What should nurses consider regarding enteral feedings before and after medication administration?

Medications should not be mixed with feeding infusions, and feedings may need to be temporarily stopped before and after medication administration

What factors determine the amount of water used for enteral medication flushing?

The patient's individual needs and the type of enteral tube being used

What nutrients are included in enteral nutrition formulas?

Calories, protein, electrolytes, vitamins, minerals, trace elements, and fluids

What are four common types of adult enteral nutrition formulations?

Standard, concentrated, renal, and predigested formulas

When are concentrated enteral nutrition formulas particularly useful?

When a patient requires fluid or volume restriction

What factors influence the selection of enteral nutrition formulas for infants and children?

The patient's age and individual nutritional needs

What are the two primary methods of administering enteral nutrition?

Continuous feeding and bolus feeding

What are the primary complications nurses should monitor for during enteral feedings?

Aspiration, fluid and electrolyte imbalances, feeding intolerance, and gastrointestinal dysfunction