12 Objective 8: describe the nursing implications associated with antacid therapy
13 What are the assessments and interventions the nurse would do for a client taking an antacid?
14 Objective 9: state the mechanism of action of anticholinergic and antispasmodic agents
15 What would you see with anticholinergics? Anticholinergics and antispasmodics the sameDrugs include belladonna, probanthine, bentylUsed for spastic conditions of GI tract, peptic ulcers and irritable bowel syndromeBlock parasympathetic nervous systemActivity is systemicWhat would you see with anticholinergics?
17 Objective 10: identify appropriate nursing actions relative to caring for clients receiving antispasmodic drugs
18 Assess: mental status, teach about orthostatic hypotension In the elderly: increased constipationIf arrhythmia or palpitations: stop the drug, call the physician
19 Objective 11: describe the effects and uses of H2 receptor antagonists, and proton pump inhibitors
20 Used for GERD, duodenal ulcers, Zollinger-Ellison syndrome H2 receptor antagonistsBlock histamine 2 receptorsRaises pH of gastric contentsUsed for GERD, duodenal ulcers, Zollinger-Ellison syndromeUsed to prevent or treat stress ulcers
21 Drugs include Cimetidine (Tagamet) Famotidine (Pepcid) Nizatidine (Axid)Rantidine (Zantac)
22 Drugs can cause Dizziness, HA, diarrhea, constipation If confusion, disorientation, hallucination, see MDCan cause gynecomastia, hepatotoxicity
23 Proton pump inhibitors Inhibit gastric acid pumpTreat: severe esophagitis, GERD, gastric and duodenal ulcers, Zollinger-Ellison syndromeCan be used with antibiotics for H pylori
24 SE: diarrhea, HA, muscle pain and fatigue If rash: call MD
26 Objective 12: Explain the nursing interventions associated with H2 receptor antagonists and proton pump inhibitors
27 Objective 13: identify causes of constipation Objective 14: explain the uses of laxatives and catharticsObjective 16: describe the actions of the types of laxativesObjective 17: identify laxatives according to type
28 Causes of constipation What are some things or conditions that can cause constipation?
29 laxatives Act three ways Affect fecal consistency Increase fecal movementRemove stool from rectum
30 Laxatives OTC; misused DependenceDamage bowelCause problems in bowel
32 Groups of Laxatives Bulk-forming Emollient Hyperosmotic Saline Stimulant
33 Mechanism of action Best for long term use Bulk-forming: natural fiber-likeAbsorb waterDistends bowelInitiates reflex bowel activityBest for long term use
34 Lowers surface tension Allows more fat & water to be absorbed Emollient laxativesStool softener (Docusate salts)Lowers surface tensionAllows more fat & water to be absorbedWhen should these be used?
35 Lubricates fecal material & intestinal wall Lubricant laxative (mineral oil)Lubricates fecal material & intestinal wallPrevents H20 from leaking out of gutStool expands & softens
36 The emollients and lubricants do not seem to increase peristalsis Oils a problem in constantly recumbent clients
37 Hyperosmotic increase water content in large intestine Distends bowelIncreases peristalsisEvacuates the bowelNon-absorbable ion exchangeUsed before diagnostic tests
38 Saline laxatives increase osmotic pressure in small intestine Inhibit absorption of water & elytesIncrease amount of water & elytes
39 Results: watery stoolIncreased distention of bowelPromotes peristalsis & evacuationExample: citrate of magnesia
46 Objective 15: identify features of an ideal laxative and cathartic What do you think makes an ideal laxative?
47 Objective 18: describe the major nursing implications associated with the administration of laxatives
48 Assess: drugs client takes including OTC and herbs Assess bowel elimination patternAssess diet and fluid intakeAssess activity and exerciseAssess for travel, dehydrationAssess for any past GI problems
49 Objective 19: identify causes of diarrhea What things, conditions can cause diarrhea?
50 Objective 20: describe the uses of antidiarrheal agents Objective 21: identify the antidiarrheal agents
51 Antidiarrheal drugs: local or systemic action Local: adsorb water to cause a formed stoolSystemic: act on autonomic nervous system to decrease peristalsis
52 Antidiarrheals Groups based on mechanism of action Adsorbents AntimotilityBacterial replacementAntisecretoryEnzymes
53 Mechanism of action Treat underlying cause Adsorbents: coat walls of GI tract; bind causative bacteria, toxinBismuth subsalicylate (Pepto-Bismol)Attapulgite (Kaopectate)Aluminum hydroxide (AlternaGel, Maalox)Kaolin-pectin
54 Anticholenergics Decrease: peristalsis, muscle tone Use with adsorbents, opiatesExamples:AtropineHyoscyamineHyosine
55 Opiates Decrease bowel motility Reduce pain Increased absorption of water & elytes (absorption time)
56 Drug Effects Adsorbents: bismuth subsalicylate: form of ASA Activated charcoalSide EffectsAdsorbents: can increase bleeding time, dark stools, tinnitus, metallic taste, blue gumsAnticholinergics: urinary retention, impotence, anxiety, brady or tachy-cardia, blurred vision, photophobia
59 Objective 22: describe the nursing implications associated with antidiarrheal agents
60 Assess for cause of diarrhea MedicationsInfectionsDietLactulose intoleranceEmotional stressHyperthyroidismInflammation of gutSurgical bypass of gut
61 Objective 23: discuss the pathophysiology of nausea and vomiting Nausea: sensation of abdominal discomfort that is intermittently accompanied by the desire to vomitVomiting: the forceful expulsion of gastric contents up the esophagus and out of the mouth
63 Objective 24: identify antiemetic drugs and their classification Dopamine antagonistsSerotonin antagonistsAnticholinergicsCorticosteroidsBenzodiazepinesCannaboinoids
64 Objective 25: identify the mechanism of action, indications for use and desired effects of antiemetic drugs
65 Dopamine antagonistsPhenothiazines, butyrophenones (Haldol) and metoclopramide (Reglan)Phenothiazines include Thorazine and CompazineDrugs act to inhibit dopamine receptors that are part of the pathway to the vomiting center.Also block other dopamine receptors in the brainCan cause EPS
67 Serotonin Antagonists: chemotherapy, radiation, post op Block serotonin receptors in the CTZ and GI tractDrugs includeDolasetron (Anzemet); granisetron (Kytril) and ondansetron (Zofran)
68 Often for motion sickness; may see for clients on chemotherapy Anticholinergics: counterbalance the amount of acetylcholine at the CTZOften for motion sickness; may see for clients on chemotherapyDrug examplesCyclizene (Marezine), dimenhydrate (Dramamine), meclizene (Antivert), scopolamine
69 CorticosteroidsSometimes see DecadronDon’t know its action
70 Do cause mind altering effects Can be abused CannaboinoidsActive ingredient THC from marijuanaInhibit various pathways to the CTZDrugs include: dronabenol (Marinol)Do cause mind altering effectsCan be abused
71 Benzodiazepines: various activities such as sedation, depression of vomiting center, can cause amnesiaExamples: diazepam, lorazepam and midazolam
72 New for chemo clients Neurokinin receptor antagonist Aprepitant (Emend)
74 Fresh supplies are needed as the drug will expire Emetics are used when the stomach needs to be emptiedUse after overdoseExample: syrup of Ipecac: NO LONGER used for kidsFresh supplies are needed as the drug will expire
75 Objective 27: Describe the nursing process related to the administration of emetics/antiemetics What assessments would you make?What interventions would you initiate?
76 Objective 28: demonstrate the ability to calculate drug dosages