Week 5 Concepts: Nutrition Acid-Controlling Drugs Prepare: Acid-Controlling Drugs Stomach Areas Identify the areas of the stomach.
Gastric Glands Match the gastric gland cell with its function. Produce and secrete hydrochloric acid
Parietal cells
Secrete pepsinogen which is a precursor to pepsin
Chief cells
Provide a protective coating for the stomach
Mucosa cells
Parietal Cells Which receptors in the stomach are responsible for stimulating the secretion of acid from the parietal cells? Select all that apply. Histamine Adenosine triphosphate (ATP) pump Proton ion Gastrin Acetylcholine (ACh)
Self-Check: Stomach Acid Gastric Hyperacidity Gastric hyperacidity is the over production of stomach acid. Stomach Acid The pH of stomach acid is 1-4.
Self-Check: Hyperacidity Gastroesophageal Reflux Disease (GERD) Gastroesophageal reflux disease is when excessive acid backs up into the esophagus. Acid-controlling Drugs Match the acid-controlling drugs with how they work.
Antacids
Reduce acid by neutralization within the stomach
Histamine (H) 2 Blockers (H2 receptor agonist)
Reduce acid by blocking signals to the parietal cells
Proton Pump Inhibitors
Reduce acid by working within the parietal cells
Self-Check: H. Pylori (Helicobacter pylori) Helicobacter pylori (H. pylori) Helicobacter pylori (H. pylori) is a Bacteria that can infect the gastric track.
Reflect: Acid-Controlling Drugs Acid-controlling Drugs The telehealth nurse is responding to question send to the Hancock Healthcare Services’ social media page. Review the questions and choose the best response. Question 1 / 6 Mandy345 asks: I have heartburn and I am in the pharmacy. Do all acid controlling drugs work the same way? Choose your best response from the choices given below. “Acid controlling drugs do not all work the same way.” “It depends on each person’s genetics.” “Yes, they do.” “I think so.” Question 2 / 6 MrTom2u wrote: I take a lot of prescribed daily medication, including digoxin. Is it safe to take any type of acid controlling drugs with my medications? Choose your best response from the choices given below. “Yes, acid controlling drugs are safe. You may also need to take an extra dose of your digoxin to stay in your therapeutic range.” “Yes, acid controlling drugs are safe and should be taken with your nightly medications.“ “Yes, acid controlling drugs are safe and can be taken with your daily medications.” “Yes, acid controlling drugs are generally safe. Check with your doctor for the best choice of acid controlling drugs for you.” Question 3 / 6 Mavis52 wrote: What lifestyle changes can I start that will prevent/reduce my heartburn (hyperacidity) symptoms? Choose the correct response from the choices given below. “Chewing gum will prevent your hyperacidity symptoms.” “Eat later in the evening so your stomach can digest your food while you sleep.” “Drinking more water will prevent your hyperacidity symptoms.” “Changing your diet and reducing stress can decease your symptoms.” Question 4 / 6 Mavis52 wrote back: My husband said that smelling his food on the grill will make my stomach secrete digestive fluid. Is this true? Choose the correct response from the choices given below. “No, food must be present in the stomach for the secretion of digestive enzymes.” “Yes. Smelling, seeing, or tasting food can cause your stomach to secrete digestive acids.” “Yes, but it only happens with smelling grilled food.” “No, only chewing and swallowing food makes you secrete stomach acids.” Question 5 / 6 Mav12 asks: Do these work the same way to reduce acid in my stomach? Acid-reducing medication
Effervescent tablet antacid Choose your best response from the choices given below. “Yes, they both neutralize the acid present in the stomach.” “Yes, they work the same in your stomach; they just have different names.” “No, the effervescent tablet antacid neutralizes the acid in the stomach and the acid-reducing medication blocks signals to cells in your stomach.” “No, the acid-reducing medication neutralizes the acid in the stomach and the effervescent tablet antacid blocks signals to cells in your stomach.” Question 6 / 6 You just received a direct message (DM) from Twitter. Mary10 wrote: @HHSH My Dad was just admitted to the intensive care unit. Why was he given an acid-controlling drug? He is intubated and not eating. Choose the best response from the choices given below. “Sorry to hear about your dad. This is old school care and is outdated and not needed.” “Sorry to hear about your dad. This is not a normal course of treatment.” “Sorry to hear about your dad. It was most likely given to prevent stress related ulcers.” “Sorry to hear about your dad. It was most likely given to shrink his stomach.” Parietal Cells The secondary response of parietal cells activates the hydrogen–potassium–adenosine triphosphatase (ATP) pump.
Antacids (magnesium carbonate, aluminum hydroxide, calcium carbonate, sodium bicarbonate) Prepare: Antacids Antacid Which salt compounds are contained in antacid? (Select all that apply.) Manganese Sodium Chloride Magnesium Aluminum Calcium Simethicone What is the purpose of simethicone? Reduce gas Dilate stomach vessels Reduce gastric motility Promote defecation Side Effect of Antacids Antacids are made of salt compounds. Magnesium antacid salt compound can cause the side effect of diarrhea.
Self-Check: Antacids Therapeutic Effects of Antacids What are the expected therapeutic effects of antacids? Select all that apply. Raise stomach pH Lower stomach pH Allow ulcers time to heal Neutralize stomach acids
Provide relief from heartburn Treat patients with heart disease
Self-Check: Drug Interactions Match the interaction with the definitions. Reduces the ability of the other drug to be absorbed into the body
Adsorption
Chemical inactivation of other drugs that produces insoluble complexes
Chelation
Increases the absorption of basic drugs and decreases the absorption of acidic drugs
Increased stomach pH
Increases the excretion of acidic drugs and decreases the excretion of basic drug
Increased urinary pH
Self-Check: Antacid Compounds Combining two salt compounds in an antacid has what beneficial effect? Increase absorption of the antacid Decrease the antacid efficacy Prevent side effects from each salt compounds. Prevent metabolic acidosis Antacid Side Effects Drag the correct side effect for each of the antacid salt compounds given below:
Salt Compound
Side effects
Magnesium-Containing Antacids Carbonate salt
Diarrhea
Aluminum-Containing Antacids Carbonate salt
Constipation
Calcium-Containing Antacids Carbonate salt
Constipation/Diarrhea
Sodium-Containing Antacids Bicarbonate salt
Flatulence, gastric distention
Reflect: Antacids Side Effects A client takes an aluminum-containing antacid, such as aluminum hydroxide, for which side effect? Diarrhea Fluid retention Constipation Gastrointestinal (GI) upset Antacid Drug Mike has chronic renal failure. Magnesium-containing antacids may not be the best based on the patient's medical condition. Antacid Table Complete the table below by dragging the appropriate choices into the blank cells.
Mechanism of Action Antacids are effective in the treatment of hyperacidity based on which mechanism of action? Decreases duodenal pH Decreases gastric pH Decreases stomach motility Neutralizes gastric acid Administration of Antacids Antacids should not be taken 1 hour before or 2 hours after any prescription medications. Antacids A client called asking about antacids. The client asked, "How fast and how long will they work?" The nurse responded, “Antacids start working within 15 minutes and last up to 4 hours. Onset and Duration of Antacids The onset and duration of action of antacids are onset 15 mins and duration 4 hours Antacid Drugs Tums and Maalox are calcium containing antacids.
H2 Receptor Antagonists Prepare: H2 Receptor Antagonists H2 Receptor Antagonists (H2RA) Which statement about H2RA is correct? They can cause cancer at high doses They are used to treat ulcers in the sigmoid colon They reduce hyperacidity in the stomach They reduce flatulence Route of Administration Which routes can cimetidine be administered? Select all that apply.
Intravenous (IV) Transdermal (Topical) By mouth (PO) Intramuscular (IM) H2 Receptor Antagonists Which of the following statements about H2 receptor antagonists (H2RA) is correct? H2RAs reduce hyperacidity by Increasing mucus production in the small intestine. H2RAs reduce hyperacidity by blocking receptors on specialized acid producing cells in the stomach. H2RAs reduce hyperacidity by appetite suppression. H2RAs reduce hyperacidity by neutralizing acid secretions.
Self-Check: H2 Receptor Antagonists (H2RA) Histamine 2 (H2) Receptor Antagonists Which type of cells do H2 receptor antagonists bind to inhibit acid production? Chromaffin cells Adipose cells Parietal cells Mast cells Histamine 2 (H2) Receptor Antagonist Administration Which statement about H2 receptor antagonists administration is true? H2 receptor antagonists can be chewed. H2 receptor antagonists must be administered with 4 glasses of mineral water. H2 receptor antagonists can be administered at night H2 receptor antagonists can be administered with prescribed oral antibiotics.
Self-Check: H2 Receptor Antagonists Histamine 2 (H2) Receptor Antagonists – Caution Patients with renal and hepatic disease should use caution when taking H2 receptor antagonists. Histamine 2 (H2) Receptor Antagonists Which statement(s) are correct concerning H2 receptor antagonists? (Select all that apply.) H2 blockers duration of action is 6-12 hours H2 causes increased mucus production H2 receptor blockers inhibit gastric secretion H2 blockers can be administered by IV H2 blockers duration is 4 hours
Reflect: H2 Receptor Antagonists Histamine 2 (H2) Receptor Antagonists: Drug Names A H2 receptor antagonist will be prescribed for a client. Which medications are H2 receptor antagonists? Select all that apply. Famotidine esomeprazole cetirizine ranitidine Histamine 2 (H2) Receptor Antagonist: Older Adult Population The H2 receptor antagonist dose in the older adult population should be decreased due to slower renal function. Famotadine The client has an order for famotadine once daily. The nurse schedules the medications for which of the following
times? With cardiac medication in the morning With afternoon antibiotics One (1) hour before or two (2) hours after medications With antacids Cimetidine Dosing Complete the cimetidine dosing information by dragging the missing values to the correct cell. Indication
Route
Dose
Frequency
Heartburn
PO
200 mg
Twice daily
Gastroesophageal Reflux Disease (GERD)
PO
1600 mg; divided
2-4 times daily
Histamine 2 (H2) Receptor Antagonist Drugs Which H2 receptor antagonist has the highest risk for drug interactions? famotidine cimetidine omeprazole nizatidine Side Effects A 75-year-old client has been admitted for a gastrointestinal bleed. The client is confused and disoriented after receiving several medications. Which medication can worsen confusion and disorientation for this client? misoprostol pantoprazole famotidine calcium carbonate Cimetidine Pharmacokinetics Complete the cimetidine pharmacokinetics table by dragging the missing values to the correct cell. Route
Onset
Peak
Half-life
Duration
PO
15-60 minutes
1-2 hours
2 hours
4-5 hours
Proton Pump Inhibitors Prepare: Proton Pump Inhibitors Proton Pump Inhibitor: Indications Which of the following are indications for a proton pump inhibitor? Select all that apply. Coughing Calcium deficiency Heartburn Gastrointestinal bleeding pH too high Proton Pump Inhibitors Proton pump inhibitors work in which cells in the body? Mast cell Gamma receptors Parietal Cells Histamine receptors
Administration Routes What are the possible administration routes for pantoprazole? Select all that apply. Intravenous (IV) Suppository Intramuscular (IM) Oral (PO)
Self-Check: Proton Pump Inhibitors Proton Pump Inhibitors (PPI) PPIs reduce acid in the stomach by blocking how hydrogen ions are released. Proton Pump Inhibitor: Drug Interactions When should the nurse instruct the client to take their proton pump inhibitor? 20-30 minutes before meals With an antacid Daily with morning medications With the evening dose of antibiotics
Self-Check: Proton Pump Inhibitors (PPI) Drugs Patient Teaching The patient was prescribed lansoprazole. Which statements indicate additional teaching is needed? Select all that apply. “I am glad I can chew this tablet.” “This capsule is large. I am going to sprinkle this lansoprazole capsule in my applesauce. Let me check the package insert and contact the pharmacy.” “To make sure I remember to take my medications in the morning, I am going to take my lansoprazole and my antibiotic at the same time.” “I will continue my full course of treatment and take all my pills as instructed.” Side Effects The client is receiving pantoprazole intravenously. The nurse monitors the client for which possible side effects? Select all that apply. Headache Fatigue Numbness Diarrhea
Self-Check: Proton Pump Inhibitor Administration Routes The healthcare provider is considering ordering pantoprazole for the client. What are the possible administration routes for pantoprazole? Select all that apply. Oral (PO) Intravenous (IV) Intramuscular (IM) Suppository
Reflect: Proton Pump Inhibitors Proton Pump Inhibitors Which statements about proton pump inhibitors are true? Select all that apply. There are a lot of adverse effects with these drugs such as vertigo They are part of the treatment plan for patients with helicobacter pylori (H. pylori) infections They should be taken 30 to 60 minutes before meals
They can be chewed and should be taken with antacids Proton Pump Inhibitor Medication The nurse is caring for a patient in the intensive care unit after a myocardial infarction. The nurse notices that the patient’s medication list includes a proton pump inhibitor, but there is no mention of any gastrointestinal (GI) disorders on his chart. Drag and drop the correct reason into the space below. Prophylactic treatment to prevent stress ulcers Proton Pump Inhibitor (PPI) Use A PPI is indicated for which of the following conditions? Select all that apply. Zollinger-Ellison Syndrome Helicobacter pylori (H. pylori) treatment Peptic Ulcer Disease Gastroparesis Omeprazole Dosing Complete the omeprazole dosing information by dragging the missing values to the correct cell. Route
Dose
Frequency
Duration
PO
200 mg
Daily
4-8 weeks
PO
60 – 120 mg
Daily
Ongoing
Pantoprazole Pharmacokinetics Complete the pantoprazole pharmacokinetics table by dragging the missing values to the correct cell.
Route
Onset
Peak
Half-life
Duration
PO
2.5 hours
2-2.5 hours
1 hour
7 days
IV
End of infusion
End of infusion
1 hour
7 days
Proton Pump Inhibitor (PPI) – Mechanism of Action What is the mechanism of action of a PPI? Inhibits mucus production in the intestine Irreversibly blocks pepsin from release of the parietal cell Irreversibly blocks the hydrogen-potassium-adenosine triphosphatase (H+/K+ ATPase) pump Prevents gastrin from activating the parietal cell Medication A 68-year-old, post-menopausal female presents to urgent care with pain in her right arm that started after a recent fall. An x-ray confirms fractures in both the radius and ulna, with indications of osteoporosis. Which medication regularly taken by the patient may have contributed to the fracture? vitamin D supplement aspirin 81 mg calcium supplement omeprazole 120 mg Client Education Which statements indicate the client requires additional education about proton pump inhibitor (PPI)? Select all that apply. I will take the PPI with meals. I will take this only when I experience heartburn. I will not take the PPI with my antibiotics.
I will not chew the pills.
Nursing Application: Acid-Controlling Drugs Prepare: Nursing Application: Acid-Controlling Drugs Medication for Hyperacidity famotidine treats symptoms of hyperacidity by preventing parietal cells’ stimulation from histamine. Medication Which medication neutralizes acid in the stomach? esomeprazole ranitidine calcium carbonate pantoprazole Hyperacidity Medication pantoprazole reduces hyperacidity by preventing the parietal cell from excreting acid (hydrogen ions).
Explore: Mary’s Case Study Mary is a 54-year-old school administrator, being seen because antacids are not relieving her heartburn and abdominal pain. Mary describes her eating habits as follows: “I am so busy and my job is overwhelming , so stressful. I try to eat healthy, but all my meals are takeout and I am sure they are not healthy. I usually take my antacids during the day and before I go to bed. I started chewing 2 tabs with every dose and now the antacid is not working anymore. I am not sure what to take.” When asked about the medications she has tried to help her heartburn, Mary lists several. She said that one of them, she does not recall which, caused diarrhea so she stopped taking it. Of all that she tried, she still takes calcium carbonate for her bones, but it is not helping her stomach issues anymore. When asked, she explains that she forgot to take her calcium carbonate with her on a recent vacation and noticed her symptoms got worse. When she got home and started taking them again, they no longer helped her stomach. Question 1 / 5 Which antacid would most likely have had caused Mary’s diarrhea? Amphojel Tums Milk of Magnesia Mylanta Question 2 / 5 Which phenomenon explains the increased stomach pain when Mary stopped taking her calcium carbonate? Metabolic alkalosis Milk alkali syndrome Rebound Acidity Hypercalcemia Question 3 / 5 Mary was tested for H. pylori infection in the office and asked what information the test will provide. What is the best response by the health care provider? With the increase in stomach pH. we are testing your proton pump count. We are testing for milk alkali syndrome. We are testing the pH. of your stomach. This test is will indicate if you have an infection in your stomach.
Question 4 / 5 Mary underwent further testing and was diagnosed with gastroesophageal reflux disease (GERD). Before prescribing pantoprazole, the health care provider screens for which contraindications for this medicine? (Select all that apply.) Osteoporosis Hepatic Diseases Constipation Tinnitus Question 5 / 5 Mary asked the health care provider what changes are needed to her diet. Indicate which food items she should eat (i.e. foods that will promote less acid reflux) and which food items should be avoided (i.e. foods that will irritate acid reflux).
Reflect: Nursing Application: Acid-Controlling Drugs Proton Pump Inhibitor (PPI) When educating an individual with a new prescription for omeprazole, what instruction is given for when to take the medication? Take omeprazole 2 hours after meals. Take omeprazole with your daily antibiotic medication. Take omeprazole with your favorite antacid. Take omeprazole 30 minutes before meals. Client Education The client is in the pharmacy clinic to pick up her PPI prescription. As the pharmacist hands her the medicine, the client makes the following statement indicating that she needs additional education about her new prescription? “I am going to take them daily as directed.” “I will take my capsule with a full glass of water.” “I should chew these like my antacid I used to take.” “I am taking these to relieve my GERD symptoms.” Proton Pump Inhibitors: Side Effects Which conditions are associated with long-term use of proton pump inhibitors? (Select all that apply.) Amenorrhea C. diff. infections Photophobia Risk of bone fractures Xerosis Client Education During the discussion with the client picking up their PPI medication, which statement should the pharmacist follow-
up? “I am going to avoid my favorite alcohol cocktail for a while.” “If I have black tarry stools I need to call the office.” “While taking these PPIs, call the doctor before starting any new medication.” “Once I start to feel better I can stop taking the medication.” Therapeutic Effect For how long will PPIs have a therapeutic effect? 24 hours Treatment Plan The client mentions that a friend uses famotidine for their acid reflux, and wants to know why she was prescribed pantoprazole? Which actions of PPI make them useful in the client's treatment plan? (Select all that apply.) Are taken weekly Neutralizes pepsin Lower Ph in the stomach Blocks up to 90% of acid secretion Relatively long duration of action Antacids Antacids do not prevent the overproduction of acid in the stomach, they neutralize acids that are present. Antacid Contraindication For each situation listed, select whether antacid therapy is or is not contraindicated.
Antiemetic and Antinausea Drugs Prepare: Antiemetic Drugs Categories Of Antiemetic Drugs There are seven categories of antiemetic drugs, which include anticholinergics, antihistamines, antidopaminergics, neurokinin receptor antagonists, prokinetics, serotonin blockers, and tetrahydrocannabinoids. Antiemetic Mechanism of Action Though the seven categories of antiemetic drugs have different mechanisms of action, the majority work by blocking one of the vomiting pathways which block the neurologic stimulus that induces vomiting. Medication to Relieve Vomiting Medications used to treat and relieve nausea and vomiting are called antiemetic drugs.
Self-Check: Medication Indication Anticholinergics are indicated for motion sickness, pre-op secretion reduction, nausea, and vomiting. Prokinetics are indicated for delayed gastric emptying, gastroesophageal reflux, nausea and vomiting. Serotonin blockers are indicated for post-operative vomiting and vomiting associated with chemotherapy.
Self-Check: How Do They Work?
Please drag and drop the correct site of action that block the neurologic stimulus that induces vomiting over the list of categories of antiemetic medications:
Self-Check: Dry Mouth Which categories of antiemetic medications may cause a dry mouth side effect? (Select all that apply.) Antidopaminergics Neurokinin Receptor Antagonists Prokinetics Tetrahydrocannabinoids Anticholinergics
Reflect: Antiemetic Drugs Antiemetics and CNS Depression Which of the following categories of antiemetic medications may cause CNS depression? (Select all that apply.) Antihistamines Anticholinergics Prokinetics Antidopaminergics Antiemetic Categories What are the seven categories of antiemetic drugs? (Select all that apply.) Anticholinergics Antihistamines Neurokinin receptor antagonists Prokinetics Antidopaminergics Serotonin blockers Tetrahydrocannabinoids Parasympatholytics Antiemetics and Motion Sickness Which antiemetic medications would be appropriate for motion sickness? (Select all that apply.) Anticholinergics
Antihistamines (H1) Serotonin blockers Tetrahydrocannabinoids Antiemetics and Gastroesophageal Reflux Which antiemetic medications would be appropriate for nausea associated with gastroesophageal reflux? Tetrahydrocannabinoids Anticholinergics Prokinetics Serotonin blockers Therapeutic Effect of Antiemetics What is the therapeutic action of antiemetic medications? Treat and relieve nausea and vomiting Support gastrointestinal health flora Treat and relieve symptoms of diarrhea Increase absorption of nutrients in the gastrointestinal system Antiemetic Mechanism of Action What is the mechanism of action in the majority of antiemetic medications? Blocking one of the vomiting pathways which block the neurologic stimulus that induces vomiting Blocking all of the vomiting pathways which block the neurologic response that suppress vomiting Blocking all of the vomiting pathways which block the neurologic stimulus that induces vomiting Unblocking vomiting pathways which are responding through a neurologic stimulus that induce vomiting Antiemetics and Chemotherapy Which antiemetic medications would be appropriate for chemotherapy nausea and vomiting? (Select all that apply.) Serotonin blockers Anticholinergics Neurokinin antagonists Tetrahydrocannabinoids How They Work Please drag and drop the correct category of antiemetic medication under the correct site of action. Each category can include more than one medication class, and each class can be used more than once.
If you can’t read Labyrinth (inner ear) ● Anticholingerics ● Antihistamines ● Antidopaminergics ● Prokinetic drugs Gastrointenstinal tract ● Prokinetic drugs ● Serotonin blockers Cerebral cortex ● THC ● Corticosteroids ● Benzodiazepines
Chemoreceptor trigger zone (CTZ) ● Antidopaminergics ● Prokinetic drugs ● Serotonin blockers Vomiting center (medulla) ● Serotonin blockers
Serotonin Blockers (ondansetron) Prepare: Serotonin Blockers (ondansetron) Classification of Serotonin Blockers To which class of medications do serotonin blockers belong? Antidiarrheal Antiemetic Anti-inflammatory Laxative Indications for Use of Serotonin Blockers Ondansetron is a serotonin blocker that works to prevent nausea and vomiting. ondansetron Use ondansetron may be given for chemotherapy, radiation and postoperative nausea and vomiting.
Self-Check: Appropriate Usage Which of the following are appropriate times to give ondansetron for nausea and vomiting? Radiation Peri-Operative Postoperative Chemotherapy
Self-Check: ondansetron Effects at the 5-HT3 Receptor Sites Ondansetron works by blocking the serotonin effects at the 5-HT3 receptor sites, which are located in vagal nerve terminals and chemoreceptor trigger zone of the central nervous system. Therapeutic Effect A therapeutic effect is clear when there is a(n) decrease in incidence and severity from nausea and vomiting after chemotherapy, radiation, and surgery. Safety: ondansetron In general ondansetron is safe unless there is a known allergy to the medication. Contraindications include oral disintegrating tablets in patients with phenylketonuria, congenital long QT syndrome, and concurrent use of apomorphine. Current Use with ondansetron Which of the following medication is safe to use with ondansetron? diphenhydramamine apomorphine carbamazepine rifampin
Reflect: Serotonin Blockers (ondansetron)
Routes of Administration Which of the following are routes of administration available for ondansetron?
Half-Life: ondansetron Please drag and drop the correct half-life for ondansetron on the chart below:
Consult Health Care Provider Before administering ondansetron, which of the following conditions require further follow-up with the health care provider? (Select all that apply.) Congenital long QT syndrome Abdominal pain Headache Allergy to ondansetron Phenylketonuria ondansetron: Adverse Effects Which of the following are possible adverse effects of ondansetron? (Select all that apply.) Sexual dysfunction Headache Abdominal pain Prolonged QT interval Serotonin syndrome Vomiting Adverse Drug Interaction Administering ondansetron to a patient taking which medications may result in an adverse drug to drug interaction? (Select all that apply.) rifampin phenytoin apomorphine diphenhydramamine medications affecting serotonergic neurotransmitters probiotics Pregnancy and Contraindication Which of the following times during pregnancy would be contraindicated to administer ondansetron for hyperemesis gravidarum? 2nd trimester Post-partum
3rd trimester 1st trimester Chemotherapy and Timing When administering ondansetron for chemotherapy-related nausea and vomiting. What is the best time for the patient to receive this medication? Before chemotherapy treatment begins Prior to going to bed After chemotherapy treatment ends With food Receptors Blocked Which receptors are blocked by ondansetron thereby reducing nausea and vomiting? Serotonin receptors Thermoreceptors Mechanoreceptors Histamine Receptors
Nursing Application: Antiemetic and Antinausea Drugs Prepare: Nursing Application: Antiemetic and Antinausea Drugs Nausea and Vomiting Medications What medications are used to treat and relieve nausea and vomiting? Antiemetic Antiviral Probiotics Antidiarrheal Antiemetic Medications Which of the following antiemetic medications may cause a patient to have CNS depressant interactions? (Select all that apply.) Antihistamines Prokinetics Anticholinergics Antidopaminergics Antiemetic Drug Which of the following is not a type of antiemetic drug? Serotonin blockers Antihistamines Parasympatholytics Anticholinergics
Self-Check: Assessment Assessment: Antiemetic Medications The nurse is caring for a patient with nausea and vomiting after an overdose of morphine. Which antiemetic medication class(es) should be avoided? (Select all that apply.) Antihistamines Anticholinergics Antidopaminergics Prokinetics Serotonin Blockers Priority Assessments
Which are the priority assessments when administering anticholinergics? (Select all that apply.) No assessment is needed CNS depression Electrolyte imbalances Dehydration
Self-Check: Interventions Medication Administration A patient is prescribed an antiemetic to be given sublingual route. The nurse knows that this medication will be administered where? Having the patient swallow with water Deep into the muscle tissue Dissolved under the tongue Rectal suppository Subjective and Objective Data Which assessment findings should the nurse monitor in a client receiving antiemetic medications? (Select all that apply.) Blood pressure Nausea and vomiting Pressure ulcers Lung sounds Bowel sounds Pulse rate Abdominal pain
Self-Check: Patient Teaching Patient Teaching Which items should be included in your patient teaching regarding antiemetic medications? (Select all that apply.) Avoid driving and other high-response activities until you learn how the medication affects your body. Take medications with food. The goal of this treatment is to prevent or decrease your nausea and vomiting. Slowly change position to help avoid a quick drop in your blood pressure known as orthostatic hypotension. Call for assistance with ambulating to avoid falling from the drowsiness and/or dizziness. Drink with a full glass of water. Do not take on an empty stomach. Antiemetic medications may cause drowsiness.
Reflect: Nursing Application: Antiemetic and Antinausea Drugs Therapeutic Action A patient was prescribed an antiemetic and asks why he needs to take another pill. What is the nurse’s best response related to the therapeutic action of antiemetic medications? “It will help to support your gastrointestinal health flora.” “It is to treat and relieve your nausea and vomiting.” “It will help regain nutrients you have lost during the vomiting episodes from the past several days.” “It is to treat and relieve your symptoms of diarrhea.” Drug Interactions Please drag the potential interaction(s) that can affect each class. Anticholinergics
Serotonin blockers and tetrahydrocannabinoids
Drying effects No significant interactions
Antidopaminergics, antihistamines, and prokinetics
CNS depression with alcohol or other CNS depressants
Neurokinin receptor antagonists
Induce warfarin and reduce oral contraceptive effectiveness
Adverse Effects Please drag in the appropriate adverse effects for each medication class. Anticholinergics
dry mouth, difficulty urinating, constipation, rash
Antihistamines
dizziness, vision changes, urinary retention
Antidopaminergics
orthostatic hypotension, tachycardia, headaches
Neurokinin Receptor Antagonists
fatigue, diarrhea, abdominal pain and discomfort
Prokinetics
supraventricular tachycardia, sedation, restlessness
Serotonin Blockers
bronchospasm, prolonged QT interval
Tetrahydrocannabinoids
anxiety, confusion, euphoria, visual changes
Medications A 25-year-old patient comes in with complaints of sickness when she is in the car. She also was very sick this past weekend when she was on a fishing boat with some friends. What medication class(es) do you anticipate will be ordered for her? (Please drag the class(es) that would be appropriate options for this patient.)
Appropriate ● Anticholingerics ● Antihistamines Inappropriate ● Antidopaminergics ● Prokinetics ● Tetrahydrocannbinoids ● Neurokinin antagonists ● Serotonin blockers Nausea and Vomiting Medications A 40-year-old cancer patient states that she has been experiencing nausea and vomiting after her first chemotherapy treatment and is wondering if there is anything that can help. What medication class(es) do you anticipate will be ordered for her? (Please drag the class(es) that would be appropriate options for this patient.)
Appropriate ● Tetrahydrocannbinoids ● Neurokinin antagonists ● Serotonin blockers Inappropriate ● Anticholingerics ● Antihistamines ● Antidopaminergics ● Prokinetics Prepping for Mouth Surgery Medications A 70-year-old patient is prepping for mouth surgery. The health care provider is explaining that they will need to dry up his secretions in his mouth to help with the procedure. What medication class(es) do you anticipate will be ordered for him? (Please drag the class(es) that would be appropriate options for this patient.)
Appropriate ● Anticholingerics Inappropriate ● Tetrahydrocannbinoids ● Neurokinin antagonists ● Serotonin blockers ● Antihistamines ● Antidopaminergics ● Prokinetics Nausea and Vomiting Medications A 60-year-old post-operative patient is experiencing nausea and vomiting. All of his vital signs are within normal limits. What medication class(es) do you anticipate will be ordered for him? (Please drag the class(es) that would be appropriate options for this patient.)
Appropriate ● Serotonin blockers Inappropriate ● Anticholingerics ● Tetrahydrocannbinoids ● Neurokinin antagonists ● Antihistamines ● Antidopaminergics ● Prokinetics Antiemetic Medication A 35-year-old patient has been experiencing gastroesophageal reflux for several months. What antiemetic medication class(es) do you anticipate will be ordered for her? (Please drag the class(es) that would be appropriate options for this patient.)
Appropriate ● Prokinetics Inappropriate ● Serotonin blockers ● Anticholingerics ● Tetrahydrocannbinoids ● Neurokinin antagonists ● Antihistamines ● Antidopaminergics
Week 5 Concepts: Elimination Antidiarrheals Prepare: Antidiarrheals Antidiarrheal Medications What is the primary goal of antidiarrheal medications? Counter or combat diarrhea Increase stool frequency
Decrease inflammation Decrease pain associated with bowel disease Acute Diarrhea It is essential to figure out the cause of the diarrhea in order to select appropriate medications. Which of the following would be regarded as acute diarrhea? (Select all that apply.) Sudden onset Lasts up to two weeks Occurring for the past 2 years. Lasts longer than 3 weeks Antidiarrheal Drug Classes Identify and select the four classes of antidiarrheal drugs. (Select all that apply.)
Self-Check: Therapeutic Use The therapeutic use of antidiarrheal medications are for control and symptom relief of acute and chronic diarrhea.
Self-Check: Antidiarrheal Usage Match the type of antidiarrheal used for the type of case:
Type of Antidiarrheal
Mild Cases
Severe Cases
Antibiotic-causing Diarrhea Cases
Adsorbents
Opiates / Anticholinergics
Probiotics
Self-Check: Antidiarrheal: Caution What type of antidiarrheal should be used with caution for children and why? Probiotics due to risk of the many side effects Probiotics due to risk of allergic response Adsorbents due to risk of Reye’s syndrome z Adsorbents due to risk of allergic response
Self-Check: Anticholinergics 3 Anticholinergics work by decelerating peristalsis by reducing contractions and smooth muscle tone of the GI tract.
Self-Check: Opiates Which medications are opiates? (select all that apply.) loperamide codeine diphenoxylate atropine
Reflect: Antidiarrheals Therapeutic Use of Antidiarrheal What is the therapeutic use of antidiarrheal medications? Symptom relief of constipation Increase movement in the bowel to promote healthy flora Decrease flora in the GI tract
Control and symptom relief of diarrhea Therapeutic Action of Anticholinergic What is the therapeutic action of anticholinergic antidiarrheal medications? Drag the correct answer in the box here. Reduce contractions and smooth muscle tone of the GI tract Action of Adsorbents The primary action of adsorbent antidiarrheal medications is to coat the walls of the GI tract and bind the bacteria or toxin to the adsorbent surface for elimination. Examples of Probiotics Identify and select the examples of probiotics from the list below. (Select all that apply.)
Therapeutic Actions of Opiate What are the therapeutic actions of Opiate antidiarrheal medications? Coat the walls of the GI tract and bind the bacteria or toxin to the adsorbent surface for elimination Increase absorption of water, electrolytes and nutrients from the GI tract Reduce the rhythmic contractions and smooth muscle tone of the GI tract to slow peristalsis Reduce bowel motility and rectal spasms Restore balance of normal bacterial flora Actions of Probiotics What are the actions of probiotics on the GI system? (Select all that apply.) Decrease dangerous bacterial overgrowth Decrease normal GI flora Decrease all bacteria Increase normal GI flora Contraindications of Antidiarrheals Which of the following are contraindications of antidiarrheal medications? (Select all that apply.) Irritable bowel syndrome (IBS) Colitis Drug overdose Intestinal obstruction Severe abdominal pain of unknown cause Parasitic infection Antidiarrheal Classes Drag the drug examples to the appropriate antidiarrheal classes listed on the left side. Adsorbents
bismuth subsalicylate / activated charcoal
Anticholinergics
atropine
Opiates
opium tincture / loperamide / codeine
Probiotics
saccharomyces boulardii / lactobacillus
Nursing Application: Antidiarrheals
Prepare: Nursing Application: Antidiarrheals Goals of Antidiarrheal Treatments What are the goals of antidiarrheal medication treatments? (Select all that apply.) Prevent malabsorption and nutritional deficits Decrease stool frequency Replenish nutrients Increase stool frequency Decrease pain associated with abdominal cramps Antidiarrheal Medications Drugs are absorbed from the intestines into the bloodstream, so antidiarrheal medications can alter this process by either increasing or decreasing the absorption of some drugs. Adsorbents can decrease the absorption of digoxin, hypoglycemic drugs and quinidine. Increased bleeding times occur with warfarin due to adsorbents binding to vitamin K. Decreased anticholinergic antidiarrheal medications effects occur when administered with antacids. Opiate antidiarrheal medications can have increased depressant effects when given with other CNS depressants like alcohol. Contraindication of Adsorbents A patient is about to receive an adsorbent antidiarrheal medication. Which of the following is a contraindication? Alcohol overdose Severe abdominal pain of unknown cause Drug overdose Irritable bowel syndrome (IBS)
Self-Check: Sedatives: Mr. Williams' Case Study Mr. Williams' Case Study: Sedatives Let’s explore sedatives through Mr. Williams’ case study. Review the slides below and answer the following questions. Question 1 / 2 The following medications have been prescribed for Mr. Williams. Which of the medications is a concern? Beta-blocker – metoprolol Opiate antidiarrheal – diphenoxylate-atropine Probiotic – lactobacillus Bronchodilator - albuterol Question 2 / 2 Why is diphenoxylate-atropine (Opiate antidiarrheal) not appropriate for Mr. Williams? (Select all that apply.) Recent drug overdose diphenoxylate-atropine is for constipation Opiates may cause dependency Opiates may cause respiratory depression
Self-Check: Antidiarrheals: Samuel's Case Study Antidiarrheals Samuel’s Case Study Let’s explore the nursing application of antidiarrheals through Samuel’s case study. Samuel is a 2-year-old boy experiencing acute diarrhea. He is admitted to the pediatric unit and prescribed medications to stop the diarrhea and rehydrate him. Review the information and answer the question that follows. Question 1 / 3 Samuel has just recovered from the influenza and the diarrhea started the next day. What should the nurse include in her assessment. (Select all that apply.) Assess for dehydration Ask the guardian about the frequency and consistency of stools
Assess bowel sounds prior to palpation Ask the patient about his pain on a scale from 0-10 Question 2 / 3 Due to the age of the patient, the interventions will be focused on educating the child's guardians, with inclusion of the child as appropriate. The medications arrive and the patient is to receive bismuth subsalicylate, an adsorbent antidiarrheal medication. What action should the nurse take prior to medication administration? Assess bowel sounds Assess intake and output numbers Assess pain Contact the physician as the medication is contraindicated Question 3 / 3 The health care provider revises the prescribed medication and Samuel receives treatment for several days. Samuel is also diagnosed with bacterial pneumonia and treated with IV antibiotics for several days. Samuel heals well and is ready to be discharged. The nurse enters the room to give discharge instructions, instructing the family to contact the health care provider if the diarrhea returns or if fever or abdominal pain occur. Samuel’s mom asks why her son was prescribed a probiotic and what it does. What is the best response? “The probiotic is to protect the lung tissue as it heals from the bacterial pneumonia.” “Probiotics are like vitamins for the intestines.” “Probiotics work like antibiotics and kill all bacteria in the intestines. This will ensure the diarrhea does not return.” “Probiotics reestablish the normal bacteria (flora) that is in the intestines. This can be helpful after taking antibiotics.”
Reflect: Nursing Application: Antidiarrheals Opiate Antidiarrheals Opiate antidiarrheal medications reduce bowel motility and rectal spasms. What should the nurse assess for in patients who are taking this medication? Respiratory rate Bowel sounds Heart rate Decreased intake Drug Interactions Anticholinergics can cause serious side effects if they are used inappropriately. Antacids decreases the therapeutic effect of anticholinergics when it is concurrently administered? Action of Probiotics Which item describes the main action of probiotics? Increase normal GI flora and increase fluids and electrolyte absorption Decrease dangerous bacterial overgrowth and increase normal GI flora Decrease normal GI flora and dangerous bacteria Decrease all bacteria and GI flora Patient Teaching What patient teaching regarding side effects/adverse reactions should the nurse provide to a patient taking probiotics? “There are no known side effects or adverse reactions.” “You should not take these as they are hazardous to you health.” “Do not take after a course of antibiotic therapy.” “Do not take these on an empty stomach or you will experience nausea.” Assessment Technique
What important assessment technique is important prior to antidiarrheal medication administration? Drag the correct answer in the box here. Auscultate the abdomen before you palpate Antidiarrheal Classes and Alterations Drugs are absorbed from the intestines into the bloodstream, so antidiarrheal medications can alter this process by either increasing or decreasing the absorption of some drugs. Please match the antidiarrheal class with the alteration below. Adsorbents
Increased bleeding times occur with warfarin due to this antidiarrheal binding to vitamin K
Anticholinergics
Decreased antidiarrheal medication effects occur when administered with antacids
Opiates
Can increase depressant effects when given with other CNS depressants
Probiotics
No known interactions
Antidiarrheals Medications Which of the following situations are appropriate or not to receive an antidiarrheal? Drag each situation to the proper column. Give an antidiarrheal
Symptom or Diagnosis
● ● ●
Do not give an antidiarrheal
Irritable bowel syndrome (IBS) Drug overdose Alcohol overdose
● ● ● ● ●
Diarrhea associated with a bacterial or parasitic infection Colitis Severe abdominal pain of unknown cause Intestinal obstruction Previous hypersensitivity
Medication Contraindication What medication is contraindicated in pediatric patients who recently recovered from chickenpox or influenza? bismuth subsalicylate (adsorbent) lactobacillus (probiotic) atropine (anticholinergic) activated charcoal (adsorbent)
Laxatives Prepare: Laxatives Medications Laxatives can be bulk-forming, emollient, hyperosmotic, saline, or stimulant. Laxatives Laxatives are available over the counter (OTC). Use of Laxatives What is the main use of laxatives? Long-term weight loss goals Appendicitis symptom relief Counteract constipation Decrease diarrhea
Self-Check: Usage of Laxatives Use of Laxatives Laxatives are medications used to treat constipation which is a symptom.
Laxative Usage What is a major concern about long-term laxative use? (Select all that apply.) Dependence Opioid addiction Congestive Heart Failure Bowel damage Common Uses for Laxatives Which of the following are common uses for laxatives? (Select all that apply.) Increase ammonia absorption Treat constipation in pregnant women Bowel movement facilitations for inactive colon Preparation for diagnostic procedures of the colon
Self-Check: Laxative Effects Identify and select the proper laxative class based on its description.
Self-Check: Laxatives Contraindications Laxatives should be avoided in those with a drug allergy, appendicitis symptoms, intestinal obstruction, and undiagnosed abdominal pain.
Reflect: Laxatives Laxatives: Drug Interactions Laxatives may interact with several drugs since laxatives act on the intestines. The intestines are where many drugs are absorbed and then distributed through the bloodstream. Match the correct type of laxative with the correct interaction: Decrease absorption of antibiotics, digoxin, nitrofurantoin, salicylates, tetracyclines, oral anticoagulants
Stimulant
Decrease absorption of antibiotics, digoxin, salicylates, tetracyclines, warfarin
Bulk-forming
Decrease the absorption of fat-soluble vitamins
Mineral oil
Increase CNS depression when given with barbiturates, anesthetics, opioids and antipsychotics
Hyperosmotic
Effect of laxative is decreased by oral antibiotics
Lactulose
Action of Bulk-forming Laxatives What is the main action of bulk-forming laxatives? Lower the surface tension of GI fluids so that more water and fat are absorbed into the stool and the intestines. Stimulate the nerves of the intestines resulting in increased peristalsis and increased fluid in the colon. Absorb water into the intestine, which increases size, distends the bowel, and promotes bowel movement. Increase osmotic pressure in the small intestine; this action produces a watery stool. Increase fecal water content which results in distention, increased peristalsis, and easier evacuation. Laxative Groups Identify what are the laxative groups from the medication groups listed on the left side column. Drag the correct
laxative groups to the right side column.
Action of Stimulant Laxatives The main action of stimulant laxatives is to stimulate the nerves of the intestines resulting in increased peristalsis and increased fluid in the colon. Action of Hyperosmotic Laxatives What is the main action of hyperosmotic laxatives? Increase fecal water content which results in distention, increased peristalsis, and easier evacuation. Increase osmotic pressure in the small intestine; this action produces a watery stool. Stimulate the nerves of the intestines resulting in increased peristalsis and increased fluid in the colon. Absorb water into the intestine, which increases size, distends the bowel, and promotes a bowel movement. Lower the surface tension of GI fluids so that more water and fat are absorbed into the stool and the intestines. Constipation Medications 3 The main use of laxatives is to counteract constipation. They are often misused and are available over the counter (OTC). Long-term inappropriate use leads to dependence and bowel damage. Action of Saline Laxatives The main action of saline laxatives is to increase osmotic pressure in the small intestine; this action produces a watery stool. Actions of Laxatives Match the type of laxative with the main action.
Nursing Application: Laxatives Prepare: Nursing Application: Laxatives Laxative Medication Laxative medication class works with what symptom? Flatulence Palpitations Diarrhea Constipation Categories of Laxatives Which of the following are the categories of laxatives? (Select all that apply.) Bulk-forming Stimulant Hyperosmotic Anticholinergics Saline Emollient Probiotics Adsorbents Laxative Side Effect What GI system issue is of concern with long-term laxative use? Indigestion Nausea Vomiting Bowel damage
Explore: Laxatives: Norma's Case Study Laxatives Norma’s Case Study Let’s explore the nursing application of laxatives through Norma’s case study. Norma is a 70-year-old patient who was admitted with constipation. She just came up to the floor and I haven’t had a chance to assess her yet. Review the information and answer the question that follows. Question 1 / 5 Nurse knocks and enters the room and washes her hands and said. “Hi Norma, I will be your nurse today. I am going to start by asking you some questions.” What assessment questions the nurse will be sure to ask Norma during her assessment related to her constipation. Any bleeding when you have a bowel movement? Has it become difficult to breath with exercise? How much water do you drink per day? How many cigarettes do you smoke per day?
How much fiber is in your diet? Are you experiencing any pain, nausea or vomiting? How have your bowel habits changed over the past several weeks? How often do you exercise? Do you use laxatives often? Question 2 / 5 Nurse is talking with Norma. “Norma, you have been ordered a saline enema.” What is a accurate statement by the nurse? “Please lay on you right side.” “Please sit on the toilet.” “Please lay on your back.” “Please lay on your left side.” Question 3 / 5 What nursing actions are important when administering the enema? (Select all that apply.) Stop the enema if the patient experiences severe abdominal pain Insert the catheter with the nozzle pointing toward the umbilicus Lubricate the tip of the apparatus Release the fluid gradually Insert the catheter with the nozzle pointing toward the back Quickly release the fluid Question 4 / 5 The nurse returns to evaluate the effectiveness of the enema. Which of the following findings indicate that the enema was effective? (Select all that apply.) Constipation is resolved Hyperactive bowel sounds Normal bowel sounds Mild abdominal pain No abdominal pain Question 5 / 5 Norma is happy with these results. “Thank you for helping me. I feel much better. Next time I will ensure to use a laxative at home sooner, so I do not need to come to the hospital.” Which of the following are correct responses by the nurse? (Select all that apply.) “Yes, great idea! Laxatives do not have side effects.” “Yes, great idea!” “No, it won’t help.” “Ensure to increase activity, fluids and eat fiber in your diet.” “You want to use caution with using laxatives as they can cause bowel damage.”
Reflect: Nursing Application: Laxatives Assessment Technique You are training a new nurse on the unit and are observing her assessment of a client admitted with influenza and constipation. Which of the following assessment techniques by the new nurse requires correction? Inspecting the abdomen before auscultating Auscultating with the bell of the stethoscope Palpating the abdomen prior to auscultation of the abdomen Palpating abdomen after listening for bowel sounds Laxative Medication
Which of the following patients are candidates for a laxative medication? (Select all that apply.) A 68-year-old man prepping for a colonoscopy A 44-year-old with unknown abdominal pain A 65-year-old male with an inactive colon A 22-year-old pregnant woman with constipation Actions of Laxatives Match the type of laxative with the main action.
Laxative Abuse Why are adolescents at risk for laxative abuse? Drag the best answer here. Eating disorders Assessment Questions What type questions should be included in your assessment prior to administering laxative medications? (Select all that apply.) How many cigarettes do you smoke per day? How many glasses of water do you drink per day? What is your typical diet? How often do you use laxatives? How many days per week do you exercise? Drug Interaction Your patient is on antibiotics and warfarin. What type of laxatives may cause drug interactions in this patient? (Select all that apply.) Bulk-forming ibuprofen Saline Stimulant Client Teaching Teaching for clients needing frequent laxative medications should include which of the following? (Select all that apply.) Increase fiber in your diet Increase fluids Decrease exercise Increase activity Types of Laxatives What type of laxative may cause drug interactions in a client receiving anesthesia? Bulk-forming Emollient Hyperosmotic Adsorbent
Diuretics
Prepare: Diuretics Nephron The nephron is the functional unit of the kidneys. Identify the different parts of the nephron.
Self-Check: Diuretic Classes: Mechanism of Action Identify where the medication works on the nephron.
Self-Check: Diuretic Classes and Drugs Diuretic Classes What should be monitored for each diuretic class of medication? Drag what to assess on the right side column that matches with the correct diuretic class on the left side column. Carbonic Anhydrase Inhibitors (CAIs)
Monitor labs for Metabolic acidosis
Loop Diuretics
Monitor for ringing in the ears or hearing loss
Thiazides and Thiazide-like Diuretics
Monitor blood glucose
Potassium-Sparing Diuretics
Monitor electrolytes potassium K+
Drug Names Match the drug name with the correct information regarding them.
hydrochlorothiazide - this thiazide diuretic may increase potassium levels. Commonly used as first line treatment for hypertension, and idiopathic hypercalciuria. spironolactone - this potassium-sparing diuretic is indicated for ascites, especially due to liver failure. Avoid use in hyperkalemia. mannitol - this osmotic diuretic is commonly used to reduce intracranial pressure and cerebral edema in head trauma. It also prevents kidney damage in acute renal failure. furosemide - this is a common non-potassium-sparing diuretic indicated for rapid diuresis in heart failure. It has an adverse effect of ototoxicity at high doses. Monitor for hypokalemia.
Reflect: Diuretics Loop Diuretics 3 Loop diuretics and thiazide diuretics can be administered together. Within the nephron, these drugs work on the different locations to increase urine production. Diuretics Classes Which class of diuretics, used to treat glaucoma, works by acting on the proximal tubule? Drag the correct answer in the box here. Carbonic anhydrase inhibitors Diuretic Drug Name Which of the following diuretic is used to treat glaucoma? furosemide mannitol acetazolamide bumetanide Thiazide Diuretics What area of the nephron does thiazide diuretics target? Ascending loop of Henle Distal convoluted tubule Ascending loop of Henle AND Distal convoluted tubule Proximal convoluted tubule Diuretic Class: Mechanism of Action Match the Mechanism of Action with the correct diuretic class. Carbonic Anhydrase Inhibitors (CAIs)
Inhibition of bicarbonate reabsorption
Loop Diuretics
Inhibition of sodium, potassium and chloride reabsorption
Osmotic Diuretics
Inhibition of water and sodium and chloride, Rapid onset
Potassium-Sparing Diuretics
Inhibition of sodium and reabsorption of potassium
Thiazides and Thiazide-like Diuretics
Inhibition of sodium and chloride
Loop Diuretics (furosemide) Prepare: Loop Diuretics (furosemide)
Loop Diuretics Loop diuretics have a rapidzzz onset. Loop Diuretics Loop diuretics target the ascendingzzz loop of henle. Loop Diuretics 2 Loop diuretics decreases blood pressure by reducingzzz cardiac preload and vasodilationzzz of blood vessels.
Self-Check: furosemide Tom’s Case Study Tom is a 67-year-old male with congestive heart failure. He is in the emergency department because of breathing difficulty. The healthcare provider prescribed a dose of furosemide. The client’s additional medications for drugs that could adversely affect the furosemide were reviewed. Review the information and answer the question that follows. Question 1 / 4 How fast do you expect furosemide 40 mg IV to work? 1-2 hours 50 min 5 minutes Unknown Question 2 / 4 The Nurse Practitioner is monitoring the effectiveness of the diuretic Tom was given. Which outcomes are expected after administration of a diuretic? Decrease in weight Increase in urine output Decrease in blood pressure Question 3 / 4 How long is the half-life of furosemide? 6-8 hours 2-3 minutes 2-3 hours 30-60 minutes Question 4 / 4 Which assessment finding indicates the diuretic was effective? The client’s blood pressure increased. The client states, “My nausea is relieved.” The client states, “I am able to breathe easier.” The client has active bowel sounds in all four quadrants. Assessment Findings When assessing the nasal mucus membranes of an individual being treated with a diuretic, the examiner notes they are moist and pink. Based on these cues, which hypothesis best describes these findings? This a normal assessment, however this finding indicates the patient's kidneys do not work well. This is an abnormal assessment finding that indicates the patient may have clotting issues. This is an abnormal assessment finding and indicates the patient may be in fluid overload. This is a normal assessment finding and indicates the patient may be hydrated.
Reflect: Loop Diuretics (furosemide)
furosemide Furosemide works on the ascending loop of henle by preventing the reabsorption of sodium and potassium. Patient Teaching Your patient is taking a loop and thiazide like diuretic. The patient asks if is safe to take two water pills. What is the best response? No, let me review healthcare provider prescription. Yes, these act on 2 different areas of the nephrons. No, but for your condition this will work best. Yes, they both act on the same area of the kidneys. Loop Diuretics Effects Loop diuretics are effective with inhibiting sodium reabsorption within the nephron because it inhibits the sodium-potassiumchloride pump in the loop of henle. Administration Routes What are the available routes to administer furosemide? (Select all that apply.) Intramuscular (IM) Oral (PO) Intravenous (IV) Suppository Loop Diuretics Which medications are from the loop diuretics class? (Select all that apply.) furosemide torsemide spironolactone hydrochlorothiazide Loop Diuretic For which electrolyte imbalance will the nurse monitor the patient taking a loop diuretic? Drag the correct answer in the box here. Hypokalemia furosemide Oral How long will oral form of furosemide be effective? 2 hours 4 hours 6-8 hours 6-8 minutes Heart Failure The nurse is caring for a 78-year-old patient diagnosed with heart failure. The client takes baby aspirin, simvastatin, and albuterol. The healthcare provider increased the client's dose of furosemide to 40 mg a day. The client started complaining of dizziness, headaches, blurred vision, and dry mouth. The healthcare care provider obtained a Basic metabolic panel test during the client's clinic visit. What is the cause of the client's condition? Dehydration Hypokalemia Metabolic acidosis Side effect of loop diuretics Side effects of albuterol
Osmotic Diuretics (mannitol)
Prepare: Osmotic Diuretics (mannitol) mannitol Mannitol has a rapid onset of action. Glomerular Filtrate Which statements about glomerular filtrate are correct? (Select all that apply.) Made in the Bowman's capsule Includes potassium Does not contain glucose Is the final urine waste product in the bladder Contains a lot of water and selective molecules and electrolytes for reabsorption Movement Osmosis is the movement of water through a semipermeable membrane from an area of low concentration to an area of higher concentration.
Self-Check: mannitol: Adverse Reaction The patient has just received a third dose of mannitol and has been producing a substantial amount of urine output. For which adverse reaction to mannitol is the patient at risk? Hypercalcemia Hypernatremia Hyperkalemia Hyponatremia
Self-Check: mannitol Administration of mannitol Which statements are true about the administration of mannitol?
mannitol Mannitol increaseszzz glomerular filtration by vasodilationzzz. mannitol: Monitoring A patient with a closed head injury has an order for intravenous (IV) mannitol 20% concentration. What should the nurse monitor during the infusion? (Select all that apply.) The family doesn’t touch excite the patient Ability to cough and deep breath Urine output Intracranial pressure mannitol: Mechanism of Action Which of the following are correct statements about mannitol's, an osmotic diuretic, mechanism of action? (Select all that apply.) Activates the transport pump of sodium and water
Pulls water and solutes into the filtrate Keeps protein in the filtrate Decreases the osmotic pressure of the filtrate Increases the osmotic pressure of filtrate
Reflect: Osmotic Diuretics (mannitol) mannitol Therapy The patient is receiving mannitol therapy after his heart catherization. He is complaining of headache and chills. His vital signs are within normal limits. What should the nurse’s next step be? Stop the therapy because Mike is uncomfortable Stop the therapy because Mike is starting to have renal impairment Continue the therapy and add a new filter Continue the therapy and monitor the patient Assessment Finding What assessment finding requires immediate intervention if found while a patient is receiving mannitol? Lungs with increased fluid - crackles throughout lung fields Patient complains of dry mouth and thirst A decrease in intracranial pressure (ICP) BP 110/72 Mannitol administration should be discontinued if which adverse effects occur? (Select all that apply.) Renal failure Cardiac impairment Increased urine output Reduced intraocular pressure Administering mannitol Which electrolytes should you monitor when administering mannitol? (Select all that apply.) Potassium Magnesium Chloride Sodium Mannitol Effects Mannitol can be administered to achieve which outcomes? (Select all that apply.) Reduce intraocular pressure Reduce intracranial pressure Protect kidneys from toxic agents Reduce lower extremity edema mannitol by IV The nurse is in the room preparing a mannitol infusion by attaching a filter to the IV tubing. What is the purpose of the filter? To stop blood from entering the IV bag To keep the IV line open To prevent air in the IV line To block crystallized minerals from entering the IV line mannitol: Contraindications What are the contraindications for the use of mannitol? (Select all that apply.) Coughing Severe renal disease
Allergy to the medication Severe hypovolemia mannitol Use A patient is receiving mannitol for increased intracranial pressure (ICP). Which statements are correct about this medication? Select all that apply. Mannitol will remove water from the brain and place it in the blood to be removed from the body. Mannitol will cause water and electrolyte reabsorption in the renal tubules. When a patient receives mannitol the nurse must monitor the patient for both fluid volume overload and depletion. Mannitol is not for patients who are experiencing anuria.
Nursing Application: Diuretics Prepare: Nursing Application: Diuretics Loop Diuretics The nurse monitors patients receiving treatment with loop diuretics for which complications? (Select all that apply.) Hypotension Fluid Overload Hypochloremia Hypokalemia Hyponatremia Diuretic Drugs Of the currently available diuretic drugs, which of the following cannot be taken if the client has a sulfa allergy? Loop diuretic Potassium sparing diuretics Carbonic anhydrase inhibitors Osmotic diuretics Carbonic Acid Anhydrase Inhibitors Carbonic acid anhydrase inhibitors work on which part of the nephron? Loop of henle Epithelial cells Proximal tubule Basolateral membranes
Self-Check: Diuretics: Maria's Case Study Diuretic Drugs Apply your critical thinking skills and what you have learned about diuretic drugs in the case study below. Maria’s Case Study The nurse is caring for a 72-year-old Maria who has been hospitalized for left ventricular heart failure. Maria is currently taking losartan 50mg. The healthcare provider added furosemide 40 mg IV q12h. Review the information and answer the question that follows. Question 1 / 5 Which lab values should be reviewed prior to administering furosemide? (Select all that apply.) Chloride Creatinine Potassium BUN INR Magnesium Sodium
Question 2 / 5 The patient’s lab results (BMP values) are provided in the table above. Why is the low potassium a concern prior to administering furosemide? furosemide will keep potassium at the same level. furosemide increases potassium and will affect the liver and lungs. furosemide will increase potassium and can cause cardiac arrhythmia. furosemide will prevent Potassium K+ is from being reabsorbed and could lower the electrolyte. Question 3 / 5 The patient’s vital signs are provided in the table above. Why is the current blood pressure a concern prior to administering furosemide? By removing water, furosemide can lower the blood pressure. furosemide may depress the respiratory center in the brain. The medication will temporarily raise the blood pressure. Individual’s treated with this drug may experience high temperatures. Question 4 / 5 The patient’s vital signs are provided in the table above. How can the blood pressure and fluid status of the patient be assessed in more detail? Range of motion Orthostatic BP Peak flow Swallow study Question 5 / 5 Which assessments provide baseline cues about the fluid status of an elderly patient prior to administering a diuretic medication? (Select all that apply.) Weight Tongue color Capillary refill Breath sounds Skin turgor
Reflect: Nursing Application: Diuretics Client Education Tom is starting furosemide at home. Medication instructions were explained to him and his family. Which statement indicates understanding of how the medication works. “Since I take all my other meds at night, I am going to take this medication in the evening.” “I take all my meds in the evening. However, I am going to take this medication in the morning.” “I will take this medication with milk.” “I am going to take this medication with a full glass of water.” Medication Class torsemide belongs to the loop diuretics class. Diuretic Drug DM is a 62-year-old African-American man who has hypertension and now presents with signs of ankle edema, increased blood pressure, and abnormal lung sounds. Which diuretic does the nurse anticipate administering to quickly and safely remove fluid? Drag the correct answer to the box here. furosemide furosemide What type of medication is furosemide? Drag the correct answer here. Loop Diuretic
acetazolamide Friedrich, who has glaucoma, asks the nurse why he was recently prescribed acetazolamide. Which is the best response by the nurse? ”Acetazolamide is a type of diuretic that decreases the pressure in your eye caused by glaucoma.” “I am not sure. Do you also have heart failure?” “The medicine helps clear the blockage that causes your glaucoma.” “Sometimes that medication is used to prevent altitude sickness. Are you traveling soon?” Nursing Interventions The nurse is developing a plan of care for a client with fluid volume overload related to heart failure exacerbation. The healthcare provider has prescribed an IV loop diuretic. What nursing interventions should be included in the client’s plan of care? (Select all that apply.) Strict measuring of the client's daily intake and output. Encourage the client to drink 2 L of fluids per day. Assess strength every shift. Educate the client about consuming a low potassium diet. Perform and assess daily weights. Note fluid changes. furosemide The nurse is educating a client about furosemide. In which situation would the nurse instruct the client to stop taking the furosemide and contact their healthcare provider? If the client developed a tremor in their hand If the client was beginning a new exercise program If the client had a fever over 101.1F If the client was unable to urinate Drug Group Furosemide may increase the ototoxic potential of aminoglycoside antibiotics drug group?