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NR565 Exam Final Study Guide, Study Guides, Projects, Research of Nursing

Cambridge Technical InstituteNursing

NR565 Exam Final Study Guide NR565 Exam Final Study Guide

Typology: Study Guides, Projects, Research

2021/2022

Available from 08/15/2023

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The malfunctioning kidney can’t excrete magnesium= hypermagnesemia
NR565 Exam Final Study Guide
Week 7 & 8
➢Antacids: weak bases that react with hydrochloric acid to form salt & water.
-Neutralize Gastric Acidity (causes ^pH of the stomach and duodenal bulb)
-Inhibit proteolytic activity of pepsin
-Increase lower esophageal sphincter tone
-ALL antacids are contraindicated in the presence of severe abdominal pain of unknown cause,
especially if accompanied by fever
-HIGH SODIUM content: pts w/ HTN. CHF need to use low sodium preparation
-Concurrent administration with enteric-coated drugs, destroys the coating= alters absorption,
^ the risk for adverse effects
-Administrations should be separated by at least 2 hours to decrease interactions
1. Calcium based antacids: TUMS, Caltrate, Calcarb
•Require Vitamin D for absorption from the GI tract
•Prescribed to treat calcium deficient states, i.e. chronic renal failure, post-
menopause, and osteoporosis
•Contraindicated in the presence of hypercalcemia and renal calculi
•Can cause constipation- increase bulk, fluids and mobility, stool softener
•Administered 30min- 1hr on empty stomach or 3hr after meals
•Should not be administered with food containing large amounts of oxalic acid
(spinach, rhubarb), or phytic acid (bran, cereals), they decrease the absorption of
calcium
•Taking w/ foods containing phosphorus (milk, dairy) can lead to milk-alkali
syndrome (N/V, confusion, headache).
•Taking with acidic fruit juice improve absorption
2. Aluminum based: AlternaGEL, Amphojel, Mylanta
•Inhibit smooth muscle contraction and slow gastric emptying
•Aluminum concentrated in the CNS
•Prolonged use in patients with renal failure may result in dialysis osteomalacia
•Elevated aluminum tissues levels contribute to the development of
dialysis encephalopathy
•Used to treat hyperphosphatemia in pts w/ renal failure & phosphate renal
stone prevention
•Can cause constipation- increase bulk, fluids and mobility, stool softener
3. Magnesium based: Milk of mag, Maalox, Mylanta
•Can be used to treat magnesium deficiencies from malnutrition, alcoholism, or
mag- depleting drugs
•Contraindicated in patients with renal failure & used with caution in pts with
renal insufficiency
•Can cause diarrhea- increase fiber intake
Aluminum is not easily
removed by dialysis b/c
it is bound to albumin
& transferrin = do not
cross dialysis
membrane
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The malfunctioning kidney can’t excrete magnesium= hypermagnesemia

NR565 Exam Final Study Guide

Week 7 & 8

➢ Antacids: weak bases that react with hydrochloric acid to form salt & water.

-Neutralize Gastric Acidity (causes ^pH of the stomach and duodenal bulb) -Inhibit proteolytic activity of pepsin

  • Increase lower esophageal sphincter tone -ALL antacids are contraindicated in the presence of severe abdominal pain of unknown cause, especially if accompanied by fever
  • HIGH SODIUM content: pts w/ HTN. CHF need to use low sodium preparation -Concurrent administration with enteric-coated drugs, destroys the coating= alters absorption, ^ the risk for adverse effects -Administrations should be separated by at least 2 hours to decrease interactions
  1. Calcium based antacids : TUMS, Caltrate, Calcarb
  • Require Vitamin D for absorption from the GI tract
  • Prescribed to treat calcium deficient states, i.e. chronic renal failure, post- menopause, and osteoporosis
  • Contraindicated in the presence of hypercalcemia and renal calculi
  • Can cause constipation- increase bulk, fluids and mobility, stool softener
  • Administered 30min- 1hr on empty stomach or 3hr after meals
  • Should not be administered with food containing large amounts of oxalic acid (spinach, rhubarb), or phytic acid (bran, cereals), they decrease the absorption of calcium
  • Taking w/ foods containing phosphorus (milk, dairy) can lead to milk-alkali syndrome (N/V, confusion, headache).
  • Taking with acidic fruit juice improve absorption
  1. Aluminum based: AlternaGEL, Amphojel, Mylanta
  • Inhibit smooth muscle contraction and slow gastric emptying
  • Aluminum concentrated in the CNS
  • Prolonged use in patients with renal failure may result in dialysis osteomalacia
  • Elevated aluminum tissues levels contribute to the development of dialysis encephalopathy
  • Used to treat hyperphosphatemia in pts w/ renal failure & phosphate renal stone prevention
  • Can cause constipation- increase bulk, fluids and mobility, stool softener
  1. Magnesium based: Milk of mag, Maalox, Mylanta
  • Can be used to treat magnesium deficiencies from malnutrition, alcoholism, or mag- depleting drugs
  • Contraindicated in patients with renal failure & used with caution in pts with renal insufficiency
  • Can cause diarrhea- increase fiber intake Aluminum is not easily removed by dialysis b/c it is bound to albumin & transferrin = do not cross dialysis membrane

- Loperamide (Imodium): Acute diarrhea, travelers’ diarrhea, chronic diarrhea associated w/inflammatory bowel disease

➢ Cytoprotective Agents:

❖ Pt should report onset of black tarry stools or severe abdominal pain, which

may indicate treatment failure and GI bleeding

- Sucralafate (Carafate): MOA- Aluminum salt that binds to necrotic ulcer tissue where it acts as a barrier to acid, pepsin, and bile salts. Action is largely topical. - Separate administration of interacting drugs by 2 hours - Take on an empty stomach - Causes constipation- increased fluids, dietary bulk and exercise - Do not use with digoxin or warfarin= decreases effectiveness - Indication for active duodenal ulcer x8wks and maintenance after healing x2wks - Misoprostol (Cytotec): MOA- Inhibition of acid secretion in response to stimuli such as meals, histamine, and coffee by binding to prostaglandin E receptors, mucosal protective qualities. - Pregnancy X: Can produce uterine contractions endangering pregnancy causing spontaneous abortion, premature birth, or birth defects. Women of childbearing age should have a negative pregnancy test before prescribed and start misoprostol on day 2 or 3 of menstrual period. If pregnancy is suspected, drug should be stopped immediately. - Take with food - Can cause diarrhea, if persists x1WK notify provider - Indicated for prophylaxis and treatment of duodenal ulcers associated with NSAID use Renal impairment doubles half life

  • Adverse reactions: drowsiness, dystonia, akathisia, tardive dyskinesia, ability to mask post-surgical and neurological conditions, potential for agranulocytosis and blood dyscrasias 4-10 wks after initiation, can cause urine to turn pink to reddish brown (does not indicate hematuria)
  • Promethazine can cause bone marrow suppression
  • Sedating and extrapyramidal effects
  • Contraindicated in Parkinson’s disease, narrow-angled glaucoma, bone marrow depression, severe cardiovascular and liver disease (serious adverse reactions)
  • BLACK BOX WARNING: Promethazine contraindicated in children less than 2 years old due to potentially fatal respiratory depression
  • Caution: use w/ respiratory impairment caused by acute pulmonary infection or chronic respiratory disorders such as severe asthma & emphysema = Silent PNA can develop. These drugs suppress the cough reflex, aspiration of vomitus is a risk and used cautiously where aspiration is a risk, suggest very short antiemetic use.
  • Avoid use in children younger than 5 years old

❖ Cabbabinoid: dronabinol (Marinol)

  • MOA: Work in the CNS like cannabis to prevent n/v associated w. cancer chemotherapy & as an appetite stimulant, especially in HIV pts
  • Adverse reactions: euphoria (shouldn’t drive), depression, dizziness, paranoid thoughts, somnolence, and abnormal thoughts
  • Caution: use with patients who have hx of seizure disorder b.c it may lower the seizure threshold, pts w/ cardiac disorders should be monitored for hypotension, possible hypertension, syncope, palpitations or tachycardia.
  • High potential for abuse

❖ 5-HT3 receptor agonists: palonosetron (Aloxi), dolasetron mesylate

(Anzemet), granisetron (Kytril, Sancuso) and ondansetron (Zofran)

  • MOA: Block serotonin both peripherally and on vagus nerve terminals & the chemoreceptor trigger zone (CTZ) to decrease emesis
  • First-line treatment in n/v due to drugs or gastroenteritis
  • Adverse reactions: constipation, headache, fatigue, dizziness, diarrhea. Less common but concerning rare cases of tachycardia, bradycardia, hypotension, and QT prolongation
  • Potential to mask progressive ileus

❖ Anticholinergic: Scopolamine (Transderm Scop)

  • MOA: Belladonna alkaloid anticholinergic acts as a competitive inhibitor of muscarinic in the parasympathetic nervous system, also blocks cholinergic transmission from the reticular center to the vomiting center in the brain
  • First line treatment for motion sickness prevention, those cruising in large or small ships
  • Applied in the hairless area behind the ear 4 hours prior to needed effect and can be left in place up to 3 days. Wash hands after handling patch to avoid getting medication in the eyes (can cause blurry vision & pupil dilation)
  • Adverse reactions: dry mouth, drowsiness, blurred vision, dilated pupils

BLACK

BOX

  • Decrease secretion of saliva and decrease gastric motility
  • Caution: pts with open-angle glaucoma or gastrointestinal or bladder neck obstruction, use cautiously in the elderly due to CNS effects
  • Contraindicated: pts w/ narrow angle glaucoma

❖ NKI receptor agonist: Aprepitant (Emend)

❖ MOA: crosses the blood brain barrier and occupies the NK1 receptors to

prevent n/v in pts receiving chemotherapy

❖ Approves for post-op n/v and chemo

❖ Adverse reactions: fatigue, dizziness, hiccups, possible elevated ALT/AST, BUN

❖ A LOT of drug-drug interactions: dexamethasone (decrease dex dose by 50%

is coadministering), warfarin (lowers plasma concentration, monitor INR levels), Oral contraceptives (use alternative or back up contraceptive method) , Diltiazem (increases levels, monitor)

❖ Misc: trimethobenzamide (Tigan)

❖ MOA: Inhibits emetic stimulation of the chemoreceptor trigger zone (CTZ)

Do not inhibit acetylcholine, so they reduce gastric acid secretion by only 35%-50%

➢ Histamine-2 receptor antagonists:

-Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid), Ranitidine (Zantac)

MOA: Inhibit acid secretion by gastric parietal through a reversible blockade of histamine at histamine 2 receptors, potent inhibitors of all phases of gastric acid secretion, including muscarinic agonists and gastrin

  • Used to reduce gastric acid in NPO pts for prophylaxis and management of duodenal and gastric ulcers and GERD (not first-line treatment of GERD), if no esophageal erosive disease is present H2RA’s can be used for maintenance therapy for relief of GERD symptoms
  • Also used for heart burn, acid indigestion and “sour stomach”
  • Should be taken w/ meals or immediately after & at bedtime, daily doses are best @ bedtime, take 1 hour away from other drugs, & two hours away from sucralfate
  • OTC preparations should not be taken for more than 2 wks w.o consulting healthcare provider
  • Famotidine is labeled safe for infants & neonates
  • Common side effects: drowsiness, dizziness, constipation (increase fiber and fluid intake), or diarrhea & nausea
  • Caution: Renal impairment (dosage adjustments), Elderly (due to decrease in renal function), Cimetidine can cause gynecomastia & impotence, and CNS reversible reactions (mental confusion, agitation, psychosis, depression, and disorientation), Hemotalogical adverse reactions include agranulocytosis, granulocytopenia, thrombocytopenia, and aplastic anemia.
  • Contraindicated: Nizatidine and Ranitidine DO NOT rx for patients w. hx of liver disease (causes hepatocellular injury, hepatitis)
  • Report black tarry stools- may indicate GI bleeding. Sore throat, diarrhea, rash, confusion, or hallucinations should be reported promptly (might need dosage Pt.’s w/ renal impairment = more subject to CNS effects

➢ Prokinetics: metoclopramide (Reglan)

MOA: Stimulates motility in the upper GI tract, increases tone and amplitude of gastric contractions, relaxes the pyloric sphincter and duodenal bulb, and increases peristalsis of the duodenum and jejunum, resulting in accelerated gastric emptying and increased speed of gastric transit without stimulating gastric, biliary, or pancreatic secretions.

  • Improves gastroesophageal reflux disease symptoms by increasing lower esophageal tone
  • Also is a dopamine receptor agonist in the CNS, including the chemotherapy trigger zone leading to prevention of emesis
  • Used to treat reduced gastric motility - gastroparesis associated with DM, GERD, and emesis associated with chemo
  • Take 30min before meals and at bedtime
  • Creatinine clearance less than 40mL/min dose should be cut in half - BLACK BOX WARNING : risk for developing tardive dyskinesia and parkinsonian- like symptoms, the risk increases the longer its in use, treatment should not exceed 12 weeks and be discontinued immediately if signs of movement disorder, Report involuntary movement of the eyes, face, or limds immediately
  • Contrindicated : in the presence of disorders in which stimulation of GI motility is dangerous (GI hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation), dopamine- associated activity affects the CNS & can cause depression (mild- severe w. suicidal ideation), pt.s w. pheochromocytoma b/c the drug can cause hypertensive crisis
  • Safe to administer to pt .s with hx of impaired hepatic function as long as renal function is normal

➢ Proton pump inhibitors (PPI’s):

-Esomeprazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec),

Pantoprazole (Protonix), Rabeprazole (Aciphex), Dexlansoprazole (Dexilant,

Kapidex)

MOA: Inhibition of basal and stimulated acid secretion (regardless of stimulus) by suppressing gastric acid secretion via reduction of H+ secretion and inhibition of the H +/K+/ATPase enzyme system at the secretory surface of the parietal cell itself to block the final step of H+ secretion.

  • PPI’s are ironically acid labile & so most are formulates as EC tablets or granules Reduce gastric acid by 90%! Causes achlorhydria -a state where hydrochloric acid in digestive organs is absent

BLACK

BOX

WARNING

Stepped-approach algorithm for peptic ulcer disease.

➢ Laxatives

- All share contraindication of use in the presence of nausea, vomiting, or undiagnosed abdominal pain, or if bowel obstruction is suspected or diagnosed - All share precautions for dependency, chronic use of laxatives may result in electrolyte imbalances, steatorrhea, osteocalcin, and vitamin and mineral deficiencies - Tartrazine sensitivity- may cause allergic reactions including asthma, seen in pts who also have aspirin sensitivity. - Common adverse reactions: excessive bowel activity, cramping, flatulence, and bloating -Rapid-acting laxitives are best taken in the morning; slower-acting ones at bedtime, taking on an empty stomach with a full glass of water for more rapid results, pts should retain suppositories for 15-30 min before expelling “Laxative abuse syndrome” most common in women w/ depression, personality disorders, or anorexia nervosa.

  • Caution: very young, older adults and those with dysphasia are at high risk for lipid aspiration pneumonia, avoid use during pregnancy due to decrease in absorption in fat-soluble vitamins = hypothrombinemia in newborn

❖ Surfactants: docusate sodium, docusate calcium, docusate potassium

  • MOA: reduce surface tension of the oil- water interface on the stool and facilitate admixture of fat and water into the stool, producing an emollient action, referred to as ‘stool softeners’
  • Most beneficial when feces are hard or dry
  • Can be administered safely to ALL ages and during pregnancy- no precautions or contraindications

❖ Hyperosmolar laxatives ‘misc’: Glycerin, Lactulose

  • MOA: hyperosmotic compound that draws water from extravascular spaces into the lumen of the intestine, resulting in more liquid stool
  • Glycerin is used to treat fecal impactions caused by neurogenic bowel, in which the bowel is filled with feces but cannot be evacuated
  • Lactulose is used to treat chronic constipation in the elderly and is the only laxative used to treat hepatic encephalopathy
  • Caution: in pt.’s w/ high volume depletion, dehydration, lactulose can cause hyperglycemia- caution with DM

❖ Chloride Channel Activators: Lubiprostone (Amitiza)

  • MOA: is a bicyclic fatty acid derived from prostaglandin E1 that acts by specifically activating CIC-2-chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote spontaneous bowel movements. - Indicated for chronic constipation caused by opioids and irritable bowel disease in women aged 18 years or older or chronic idiopathic constipation.
  • Adverse effect: nausea (may be relived w. food), diarrhea, dyspnea can occur in patients taking 24mcg BID

❖ Opioid- Receptor Antagonists: Methylnaltrexone

  • MOA: Antagonist to the mu-receptor in the GI track and treats the constipation patients experience when taking opioids without affecting the analgesic effect of opioids
  • Caution: can cause opioid withdrawal, monitor closely
  • Adverse reactions: abdominal pain, nausea, diarrhea, hyperhidrosis It lowers the pH of the colon, which inhibits the diffusion of ammonia across colonic membranes