GI/GU Medications NUR 328 UAB 2.0

a nurse is caring for a female client who has crohn's disease. complete the following sentence by using the lists of options.

the priority finding the nurse should report is yellow sclera because it indicates hepatoxicity.

a nurse is caring for a client who experiences motion sickness. select the 2 instructions the nurse should provide to the client about their newly prescribed medication.

• avoid activities that require alertness

• increase fluid and fiber intake

a nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. which of the following statements should the nurse plan to include

avoid driving or activities requiring alertness

a nurse is caring for a client who has peptic ulcer disease. the nurse should monitor the client's phosphorus levels when administering which of the following medications

aluminum hydroxide

a nurse is teaching a client who has a new prescription for methotrexate. the nurse should instruct the client to monitor for manifestations of which of the following conditions

hepatotoxicity

a nurse is caring for a client who has a prescription for alosetron. the nurse should recognize that alosetron therapy is effective when the client reports which of the following

one formed stool per day

a nurse is providing teaching to a client who has a new prescription for loperamide. which of the following instructions should the nurse include

avoid activities that require alertness

a nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. the nurse should inform the client that docusate sodium has which of the following therapeutic effects

prevents straining

a nurse is reviewing the medical record of a client who has a new prescription for famotidine. the nurse should recognize that which of the following medications interacts with famotidine

ketoconazole

a nurse is caring for an older adult client who has kidney disease and a new prescription for cimetidine. the nurse should instruct the client to report which of the following manifestations

lethargy

which of the following medications have protocols that require clients to meet specific risk-management criteria and sign a treatment agreement before the nurse can administer the medication

alosetron

a nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions

a positive pregnancy test

a nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. the nurse should instruct the client to take the medications at least 2 hr apart for which of the following reasons

sucralfate interferes with the absorption of phenytoin

a nurse is caring for a client who has a new prescription for alosetron to treat irritable bowel syndrome. the nurse should instruct the client to report which of the following adverse effects of the medication

abdominal pain

a nurse is planning care for a client who is receiving chemotherapy and has a new prescription for ondansetron. which of the following actions should the nurse plan to take (select all that apply)

• infuse the medication 30 min prior to chemotherapy

• infuse the medication slowly over 15 min

• repeat the dose 4 hr after chemotherapy

a nurse is administering sulfasalazine to a client. which of the following data should the nurse collect to help identify an adverse drug reaction (select all that apply)

• skin integrity

• temperature

• CBC

a nurse should recognize that diphenoxylate/atropine should be used with caution for a client who has which of the following conditions

inflammatory bowel disease

a nurse is caring for a client who has a new prescription for famotidine to treat GERD. the nurse should instruct the client to wait at least 1 hr between taking famotidine and which of the following over-the-counter medications

antacids

a nurse is caring for a client who was assigned male at birth, who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. which of the following information should the nurse provide the client with about alosetron

the medication is prescribed to clients who were assigned female at birth, who have IBS-D lasting more than 6 months

a nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. which of the following instructions should the nurse include? (select all that apply)

• take the medication with at least 8 oz of fluid

• increase fluid and fiber intake

a nurse is caring for a client who is taking lubiprostone. the nurse should tell the client that lubiprostone can cause which of the following adverse drug reactions

nausea

a nurse is teaching a client who has a new prescription for sulfasalazine. which of the following statements should the nurse make

use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn

a nurse is providing teaching to a client who has a new prescription for omeprazole to treat a duodenal ulcer. which of the following instructions should the nurse include

swallow the capsules whole

a nurse is assessing a client who has administered ondansetron IV 1 hr ago. which of the following findings should the nurse recognize as an adverse effect of this medication

dizziness

Antibiotics for PUD/GERD

• Amoxicillin, Bismuth, Clarithromycin, Metronidazole, Tetracycline, Tinidazole

• Action of ABX is to eradicate H. Pylori

• This will always be a combo of multiple meds for at least 10-14 days

• Consider medication resistance, GI upset/side effects, and compliance

• Confirmation through urea breath test, stool antigen test, or some sort of upper-endoscopy based testing

Histamine 2 Receptor Agonists Prototype

Cimetidine

Cimetidine MOA

blocks secretion of gastric acid

Cimetidine Therapeutic Uses

prevent/treat gastric and duodenal ulcers, GERD, hypersecretory conditions, and heartburn in conjunction with ABXs for H. pylori and urticaria

Cimetidine AE

• Gynecomastia

• CNS effects (crosses BBB, more likely in geriatric)

• constipation, diarrhea, nausea, decreased libido, impotence

Cimetidine CI/C

• geriatric clients increased CNS effects

• clients at high risk for pneumonia (COPD)

• reduction in dose for kidney patients

• pregnancy

Cimetidine DI

can inhibit enzymatic metabolism of drugs -> increasing levels of meds like

• warfarin

• phenytoin

• theophylline

• lidocaine

  • meds with a narrow margin for safety

Cimetidine NI

• checking drug levels and PT/INR

• usually given at bedtime

• monitor for bleeding

• check med list, S/Es, pneumonia—teaching about compliance and diet

• Take w/ antacids to help alleviate pn for ~1 wk (but 1-2 hrs apart to not affect absorption)

Cimetidine Healing

• 6-8 wks w/ gastric or duodenal

• 12 wks for esophagitis

Proton Pump Inhibitors Prototype

Omeprazole

THINK “Pretzel”

Omeprazole MOA

• block basal and stimulated acid production

• reduces acid by inhibiting the enzyme that produces gastric acid

• irreversible inhibition

Omeprazole Therapeutic Uses

short-term therapy (4-8 weeks) of gastric ulcers, erosive esophagitis, and GERD, prevention of stress ulcers

Omeprazole AE

• pneumonia

• osteoporosis/fractures

• rebound hypersecretion

• hypomagnesemia

  • Sz, muscle cramps, hyperreflexia

• C. Diff

• GI side effects

Omeprazole CI/C

• pregnancy (indications of congenital birth defects)

• high risk for pneumonia (think COPD, immunosuppressed)

Omeprazole DI

• digoxin

• phenytoin

• clopidogrel

• -azoles

• benzodiazepines

• antivirals

Omeprazole NI

• watching for signs of thrombotic events for pts taking clopidogrel

• should be administered before food

• monitoring for diarrhea or loose stools

• s/s of pneumonia and hypomagnesemia

Omeprazole Healing

• 2 wks for gastric or duodenal ulcers

• 1-2 wks for GERD

• 8 wks for esophagitis

Mucosal Protectants Prototype

Sucralfate

Sucralfate MOA

turns into physical protective barrier for ulcer for up to 6 hours, does not affect acid

Sucralfate Therapeutic Uses

duodenal ulcers/maintenance, neutralize gastric acid

Sucralfate AE

• Constipation - increase fiber!

• dry mouth

Sucralfate CI/C

pregnancy/ lactation

Sucralfate DI

• phenytoin

• digoxin

• warfarin

• ciprofloxacin

• antacids

Sucralfate NI

• take this medication 1-2 hours before a meal to maximize effectiveness

• keep proper intervals between other meds and this one, usually 2 hours

Sucralfate Healing

Usually takes 4-8 wks to help heal, unless confirmed earlier through endoscopy, healing rates similar to h2RAs

Prostaglandin E Analog Prototype

Misoprostol

THINK “Miso Soup”

Misoprostol MOA

• decreases acid secretion

• increases the secretion of bicarb and mucus

• promotes vasodilation

Misoprostol Therapeutic Uses

• used w/ long-term NSAID use to prevent ulcers

• off-label: to induce labor or medical termination of pregnancy

Misoprostol AE

• diarrhea

• dysmenorrhea (painful menstrual cramps)

Misoprostol CI/C

pregnancy (Cat X), lactation

Misoprostol DI

some diarrhea w/ antacids

Misoprostol NI

asking women about menstrual cycles/ contraceptives

Antacids Prototype

Aluminum hydroxide

Aluminum Hydroxide MOA

neutralize stomach acid

Aluminum Hydroxide Therapeutic Uses

GERD, prevention of stress ulcers and PUD

Aluminum Hydroxide AE

• constipation

• fluid retention

  • if sodium containing

• electrolyte imbalances

• alkalosis

• magnesium toxicity

Aluminum Hydroxide CI/C

• patients with HF or hypertension (Na+)

• do not use with abdominal pain or GI perforation/obstructions

• careful in renal/hepatic pts

Aluminum Hydroxide DI

• delay absorption of meds

• the aluminum compounds bind to drugs like warfarin, digoxin and tetracycline, interfering with absorption and reducing their effects

Aluminum Hydroxide NI

• do not take these meds within 1-2 hours of other medications -> interfere w/ absorption

• assess for s/e and therapeutic action

Digestive Enzymes Prototype

Pancrelipase

Pancrelipase MOA

replaces pancreatic enzymes to aid indigestion/absorption of fats, proteins, and carbs

Pancrelipase Therapeutic Uses

replacement treatment in those w/ deficiency exocrine pancreatic enzymes

Pancrelipase AE

• GI irritant

• headache

• cough

Pancrelipase CI/C

• pork allergy

• pregnancy/lactation

• gout/hyperuricemia

Pancrelipase DI

decreases absorption of folic acid/ iron

Pancrelipase NI

this medication is taken w/ every meal and every snack!

Substance P/Neurokinin 1 Receptor Antagonist Prototype

Aprepitant

Aprepitant MOA

acts directly on CNS to block n/v receptors with little to no effect on serotonin, dopamine, or corticosteroid receptors

Aprepitant Therapeutic Uses

• post-op n/v (PONV)

• delayed CINV (chemo-induced)

• can prolong action of other meds in combination

Aprepitant AE

• GI effects

• HA/fatigue/dizziness

• possible liver damage (transient elevation in labs)

• abnormal heart rhythm

Aprepitant CI/C

• pimozide

• breastfeeding children

• liver or kidney disease

Aprepitant DI

• warfarin

• oral contraceptives

• many interactions with drugs

• can increase glucocorticoids

Aprepitant NI

• Needs another method of birth control for 28 days after last dose

Serotonin Antagonist Prototype

Ondansetron, Granisetron

THINK “Dancer”

Ondansetron MOA

block peripheral (vagus) and central (CTZ) receptor sites associated with n/v

Ondansetron Therapeutic Uses

CINV, radiation therapy, anesthesia, pregnancy, viral gastritis

Ondansetron AE

• HA

• QT Prolongation (Torsades de Pointes)

Ondansetron CI/C

• pregnancy/lactation

• check med list for other meds that prolong the QT or patient hx of QT elongation

• may need ECG prior to administration

Ondansetron DI

• apomorphine

  • can cause drop in BP → LOC

Ondansetron NI

• monitor for side effects, relief of N/V

• Can be given concurrently with corticosteroid for efficacy with CINV

Dopamine antagonist/ Phenothiazines Prototype

Prochlorperazine, Promethazine

Prochlorperazine MOA

blockade of dopamine receptors in CTZ

Prochlorperazine Therapeutic Uses

CINV, PONV, migraines

Prochlorperazine AE

• extrapyramidal side effects (EPs)

• orthostatic hypotension

• sedation

• anticholinergic

• CNS depression

Prochlorperazine CI/C

• geriatrics

• children under 18yrs old

  • extrapyramidal symptoms

• asthma

• urinary retention/obstruction

• narrow angle glaucoma

Prochlorperazine DI

• CNS depressants

• use of HTN meds

• anticholinergics

Prochlorperazine NI

watch for side effects and interactions with other medications

Anticholinergics Prototype

Scopolamine

THINK “SCOPE”

Scopolamine MOA

muscarinic antagonist that interrupts nerve pathway from inner ear to vomiting center

Scopolamine Therapeutic Uses

• motion sickness, pre-op nausea

  • given before symptoms start

Scopolamine AE

• dry mouth

• blurred vision/drowsiness

• less effects when transdermal

Scopolamine CI/C

Geriatric pts

Scopolamine DI

NONE!

Scopolamine NI

• monitor for side effects, especially with geriatric patients

  • risk for falls

Antihistamines Prototype

Dimenhydrinate, Meclizine

Dimenhydrinate MOA

blocks histaminergic and muscarinic cholinergic receptors in nerve pathway in inner ear to vomiting center