Presentation is loading. Please wait.

Presentation is loading. Please wait.

Pharmacology I: NURS 1950 1.  Objective 1: list the components of gastric juice that contribute to the pain associated with peptic ulcers  Objective.

Similar presentations


Presentation on theme: "Pharmacology I: NURS 1950 1.  Objective 1: list the components of gastric juice that contribute to the pain associated with peptic ulcers  Objective."— Presentation transcript:

1 Pharmacology I: NURS

2  Objective 1: list the components of gastric juice that contribute to the pain associated with peptic ulcers  Objective 2: describe the physiology of gastric secretions 2

3  Objective 3: list drugs considered to be ulcerogenic 3

4  Objective 4: explain the actions of the antiulcer drugs ◦ Decrease acidity ◦ Block histamine receptors ◦ Gastrointestinal prostaglandins 4

5 ◦ Gastric acid pump inhibitors ◦ Coating agents ◦ Prokinetic agents ◦ Antispasmodic agents 5

6  Objective 5: describe the pain reducing effects of antacids 6

7  Raise the pH of gastric contents ◦ Higher pH, less acidity  Decreased pain 7

8  Objective 6: identify the features of an ideal antacid ◦ Cheap ◦ Effective ◦ No constipation or diarrhea ◦ No systemic effects ◦ No rebound acidity 8

9  Objective 7: differentiate between the various antacids 9

10  Riopan, Maalox, Mylanta II, low sodium  Calcium carbonate, Aluminum hydroxide: constipation  Magnesium: diarrhea, electrolyte imbalance  Calcium carbonate & sodium bicarbonate: rebound acidity 10

11  Simethicone: defoaming agent Alginic acid: highly viscous solution—sodium alginate 11

12  Objective 8: describe the nursing implications associated with antacid therapy 12

13  What are the assessments and interventions the nurse would do for a client taking an antacid? 13

14  Objective 9: state the mechanism of action of anticholinergic and antispasmodic agents 14

15  Anticholinergics and antispasmodics the same ◦ Drugs include belladonna, probanthine, bentyl ◦ Used for spastic conditions of GI tract, peptic ulcers and irritable bowel syndrome ◦ Block parasympathetic nervous system  Activity is systemic  What would you see with anticholinergics? 15

16 ◦ Which clients should not use anticholinergics? 16

17  Objective 10: identify appropriate nursing actions relative to caring for clients receiving antispasmodic drugs 17

18  Assess: mental status, teach about orthostatic hypotension  In the elderly: increased constipation  If arrhythmia or palpitations: stop the drug, call the physician 18

19  Objective 11: describe the effects and uses of H2 receptor antagonists, and proton pump inhibitors 19

20  H2 receptor antagonists ◦ Block histamine 2 receptors ◦ Raises pH of gastric contents  Used for GERD, duodenal ulcers, Zollinger-Ellison syndrome  Used to prevent or treat stress ulcers 20

21  Drugs include ◦ Cimetidine (Tagamet) ◦ Famotidine (Pepcid) ◦ Nizatidine (Axid) ◦ Rantidine (Zantac) 21

22  Drugs can cause ◦ Dizziness, HA, diarrhea, constipation ◦ If confusion, disorientation, hallucination, see MD ◦ Can cause gynecomastia, hepatotoxicity 22

23  Proton pump inhibitors ◦ Inhibit gastric acid pump ◦ Treat: severe esophagitis, GERD, gastric and duodenal ulcers, Zollinger-Ellison syndrome ◦ Can be used with antibiotics for H pylori 23

24  SE: diarrhea, HA, muscle pain and fatigue  If rash: call MD 24

25  Drugs include ◦ Esomeprazole (Nexium) ◦ Lansoprazole (Prevacid) ◦ Omeprazole (Prilosec) ◦ Pantoprazole (Protonix) ◦ Rabeprazole (Aciphex) 25

26  Objective 12: Explain the nursing interventions associated with H2 receptor antagonists and proton pump inhibitors 26

27  Objective 13: identify causes of constipation  Objective 14: explain the uses of laxatives and cathartics  Objective 16: describe the actions of the types of laxatives  Objective 17: identify laxatives according to type 27

28  Causes of constipation ◦ What are some things or conditions that can cause constipation? 28

29  Act three ways ◦ Affect fecal consistency ◦ Increase fecal movement ◦ Remove stool from rectum 29

30  Laxatives OTC; misused ◦ Dependence ◦ Damage bowel ◦ Cause problems in bowel 30

31  Caution: surgical abdomen; appendicitis; N/V; fecal impaction; intestinal obstruction; undiagnosed abdominal pain  Contraindicated: hypersensitivity 31

32  Bulk-forming  Emollient  Hyperosmotic  Saline  Stimulant 32

33  Bulk-forming: natural fiber-like ◦ Absorb water ◦ Distends bowel ◦ Initiates reflex bowel activity  Best for long term use 33

34  Emollient laxatives ◦ Stool softener (Docusate salts)  Lowers surface tension  Allows more fat & water to be absorbed  When should these be used? 34

35 ◦ Lubricant laxative (mineral oil)  Lubricates fecal material & intestinal wall  Prevents H20 from leaking out of gut  Stool expands & softens 35

36  The emollients and lubricants do not seem to increase peristalsis ◦ Oils a problem in constantly recumbent clients 36

37  Hyperosmotic increase water content in large intestine ◦ Distends bowel ◦ Increases peristalsis ◦ Evacuates the bowel ◦ Non-absorbable ion exchange ◦ Used before diagnostic tests 37

38  Saline laxatives increase osmotic pressure in small intestine ◦ Inhibit absorption of water & elytes ◦ Increase amount of water & elytes 38

39  Results: watery stool  Increased distention of bowel  Promotes peristalsis & evacuation  Example: citrate of magnesia 39

40  Stimulant laxatives stimulate nerves ◦ Increases peristalsis ◦ Increase fluid in colon  Increases bulk  Softens stool 40

41  Few systemic effects ◦ Primary site of action the gut  Therapeutic Uses ◦ Common constipation ◦ Bowel preparation pre-op, diagnostic tests 41

42  Bulk forming: impaction above strictures, fluid overload, electrolyte imbalance, gas  Emollient: skin rash, decreased absorption vitamins, lipid pneumonia, elyte imbalance  Hyperosmotic: abdominal bloating, rectal irritation, elyte imbalance 42

43  Saline: magnesium toxicity, elyte imbalance, diarrhea, increased thirst  Stimulant: nutrient malabsorption, gastric irritation, elyte imbalance, discolored urine, rectal irritation 43

44  Bulk-forming: interfere with absorption antibiotics, digoxin, salicylates, oral anticoagulants  Mineral oil: decrease absorption fat soluble vitamins  Hyperosmotic: increased CNS depression with barbiturates, general anesthetics, opioids, antipsychotics 44

45  Oral antibiotics decrease effect of lactulose  Stimulants: decrease absorption antibiotics, digoxin, tetracycline, oral anticoagulants 45

46  Objective 15: identify features of an ideal laxative and cathartic ◦ What do you think makes an ideal laxative? 46

47  Objective 18: describe the major nursing implications associated with the administration of laxatives 47

48  Assess: drugs client takes including OTC and herbs  Assess bowel elimination pattern  Assess diet and fluid intake  Assess activity and exercise  Assess for travel, dehydration  Assess for any past GI problems 48

49  Objective 19: identify causes of diarrhea ◦ What things, conditions can cause diarrhea? 49

50  Objective 20: describe the uses of antidiarrheal agents  Objective 21: identify the antidiarrheal agents 50

51  Antidiarrheal drugs: local or systemic action ◦ Local: adsorb water to cause a formed stool ◦ Systemic: act on autonomic nervous system to decrease peristalsis 51

52  Groups based on mechanism of action ◦ Adsorbents ◦ Antimotility ◦ Bacterial replacement ◦ Antisecretory ◦ Enzymes 52

53  Treat underlying cause  Adsorbents: coat walls of GI tract; bind causative bacteria, toxin ◦ Bismuth subsalicylate (Pepto-Bismol) ◦ Attapulgite (Kaopectate) ◦ Aluminum hydroxide (AlternaGel, Maalox) ◦ Kaolin-pectin 53

54  Decrease: peristalsis, muscle tone  Use with adsorbents, opiates  Examples: ◦ Atropine ◦ Hyoscyamine ◦ Hyosine 54

55  Decrease bowel motility  Reduce pain  Increased absorption of water & elytes (absorption time) 55

56  Adsorbents: bismuth subsalicylate: form of ASA  Activated charcoal  Side Effects ◦ Adsorbents: can increase bleeding time, dark stools, tinnitus, metallic taste, blue gums ◦ Anticholinergics: urinary retention, impotence, anxiety, brady or tachy-cardia, blurred vision, photophobia 56

57  Adsorbents: decrease digoxin, clindamycin, oral hypoglycemics. Methotrexate-toxicity  Anticholinergics: decreased effect with antacids. Increased anticholinergic effect with tricyclic antidepressants, MAOIs, amantadine & antihistamines 57

58  Opiates: additive CNS depression-alcohol, narcotics, sedative-hypnotics, antipsychotics, skeletal muscle relaxants  Pepto + oral anticoagulants 58

59  Objective 22: describe the nursing implications associated with antidiarrheal agents 59

60  Assess for cause of diarrhea ◦ Medications ◦ Infections ◦ Diet ◦ Lactulose intolerance ◦ Emotional stress ◦ Hyperthyroidism ◦ Inflammation of gut ◦ Surgical bypass of gut 60

61  Objective 23: discuss the pathophysiology of nausea and vomiting ◦ Nausea: sensation of abdominal discomfort that is intermittently accompanied by the desire to vomit ◦ Vomiting: the forceful expulsion of gastric contents up the esophagus and out of the mouth 61

62 62

63  Objective 24: identify antiemetic drugs and their classification ◦ Dopamine antagonists ◦ Serotonin antagonists ◦ Anticholinergics ◦ Corticosteroids ◦ Benzodiazepines ◦ Cannaboinoids 63

64  Objective 25: identify the mechanism of action, indications for use and desired effects of antiemetic drugs 64

65  Phenothiazines, butyrophenones (Haldol) and metoclopramide (Reglan) ◦ Phenothiazines include Thorazine and Compazine  Drugs act to inhibit dopamine receptors that are part of the pathway to the vomiting center.  Also block other dopamine receptors in the brain  Can cause EPS 65

66 ◦ Phenothiazines mostly used ◦ Reglan popular 66

67  Serotonin Antagonists: chemotherapy, radiation, post op  Block serotonin receptors in the CTZ and GI tract  Drugs include ◦ Dolasetron (Anzemet); granisetron (Kytril) and ondansetron (Zofran) 67

68  Anticholinergics: counterbalance the amount of acetylcholine at the CTZ  Often for motion sickness; may see for clients on chemotherapy  Drug examples ◦ Cyclizene (Marezine), dimenhydrate (Dramamine), meclizene (Antivert), scopolamine 68

69  Corticosteroids ◦ Sometimes see Decadron ◦ Don’t know its action 69

70  Cannaboinoids ◦ Active ingredient THC from marijuana ◦ Inhibit various pathways to the CTZ ◦ Drugs include: dronabenol (Marinol)  Do cause mind altering effects  Can be abused 70

71  Benzodiazepines: various activities such as sedation, depression of vomiting center, can cause amnesia ◦ Examples: diazepam, lorazepam and midazolam 71

72  New for chemo clients ◦ Neurokinin receptor antagonist  Aprepitant (Emend) 72

73  Objective 26: explain the use of emetics 73

74  Emetics are used when the stomach needs to be emptied ◦ Use after overdose ◦ Example: syrup of Ipecac: NO LONGER used for kids  Fresh supplies are needed as the drug will expire 74

75  Objective 27: Describe the nursing process related to the administration of emetics/antiemetics ◦ What assessments would you make? ◦ What interventions would you initiate? 75

76  Objective 28: demonstrate the ability to calculate drug dosages 76


Download ppt "Pharmacology I: NURS 1950 1.  Objective 1: list the components of gastric juice that contribute to the pain associated with peptic ulcers  Objective."

Similar presentations


Ads by Google