what is the MOA for acid controllers?

work by neutralizing stomach acid
stimulate secretion of mucous
simethicone may be added to antacid to reduce gas
pain(simethicone is an antigas medication that helps with
flatus and bloating)
increase the tone of the lower esophageal sphincter, less
lightly to reflex

what are some indications for acid controllers?

PUD Gasritis Gastric hyperacidity
GERD

what are the contraindications of acid controllers?

allergies renal pt (likely for electrolyte
imbalances) GI obstruction (don't want to over stimulate the
bowel ie Mg) pt will treat themselves OTC for years, if sx
persist for more than a few months they need to see a physician to
rule out cancer

what are adverse effects of acid controllers?

Mg causes diarrhea Aluminum causes constipation
Ca++ causes constipations/kidney stones Rebound
hyperacidity

What are some nursing implications for acid controllers?

give antacids with at least 8 oz to enhance; if constipation
occurs switch to a different one should give 1-2h before
reg meds to avoid interactions taper off to avoid rebound
acidity

What is the action of H2 antagonists?

reduces acid secretion blocks receptors in the stomach
from receiving the signal to produce acid increases pH of
stomach

Indications for H2 antagonists?

GERD PID Erosive esophagitis

What are contraindications of H2 antagonists?

allergies renal dysfunction kidney
dysfunction

what are some adverse effects of H2 antagonists?

confusion hypotension diarrhea

What are some specific H2 antagonists?

cimetidine (Tagamet) Famotidine (Pepcid)
Ranitidine (Zantac) Nizatidine (Axid)

Nursing implications/teachings for H2 antagonists?

must review hepatic labs, ALP, AST, BUN smoking
decreases effect should not be taken within one hour of
antacids avoid caffeine, alcohol, ASA, NSAIDS= GI
irritantants

What are the actions of proton pump inhibitors?

bind hydrogen-potassium-ATPase pump (proton pump)
prevents H+ movement out of parietal cells into stomach,
decreasing acid

nursing implications for/teaching for PPIs

pregnant women and nursing women should not take PPI linked to
birth defects should be taken before meal can be
given through g tube

Indications for PPIs

prophylactic

What are some specific PPI medications?

Lansoprazole (Prevacid) (can be given in
meals) Omeprazole (Prilosec) Rebeprazole
(Aciphex) Pantoprazole (Protonix) Esomeprazole
(nexium)

What are the 4 main antidiarrheal drugs?

absorbents anticholinergics opiates
probiotics

how do adsorbents work and want is a
specific med example?

bind bacteria binds to whatever the cause is, coats GI
tract and helps expel it from the body bismuth
subsalicylate (Pepto-Bismol)

how to anticholinergic antidirrheals work and what is a specific med example?

decrease peristalsis dry out GI tract med:
belladonna alkaloids (Donnatal)

Intestinal flora modifiers action and meds

restores normal flora Lactobacillus acidophilus
(Lactinex)

What are opiates' actions as an antidiarrheal and what is a
specific med example?

reduce bowel motility Med: loperamide (Imodium)

contraindications of antidiarrheals?

known allergy pepto bismol (contains ASA do not want
to give to a child with fever or flu like sx)

what are some common causes of diarrhea?

cancer tumors hyperthyroidism IDS
different drugs bacteria viruses
protozoa diet or nutritional factors common with
AIDs pts common with diabetic pts

What is a nursing implications/teaching for antidiarrheals?

Pepto bismol can cause month and stool to become black pt
should be informed and told not to be alarmed if happens

What are the actions of Laxatives?

fecal consistency increase fecal movement
facilitate defecation

Bulk forming laxatives

absorbs water psyllium (Metamucil) can cause
worsening constipation if you take Metamucil and do not take enough
water

Emollients

stool softeners and lubricants promotes water and fat
in stool meds: docusate sodium (Colace), mineral oil

Stimulant

increases peristalsis Senna, biscodyl

Nausea

unpleasant feeling that often precedes vomiting

forcible emptying of gastric and occasionally intestinal
contents

emesis (vomiting)

antiemetic drugs

used to relieve n/v

how do anticholinergic antiemetic medications work?

block ACh in vestibular uncle and reticular formation
nausea inducing signal vant ve sign to CTZ meds:
scopolamine (transderm-scop)----->(motion sickness)

What are indications for antiemetics?

motion sickness, n/v, pre operative prophylaxis

what are contraindications for antiemetics?

known allergies

What are adverse effects of antiemetics?

dizziness drowsiness tardive dyskinesia (CNS
adverse reaction: smacking lips)

Antiemetics: interactions

anticholergic: have interactions with antihistamines and
antidepressant; have drying effect antidopaminergics: can
cause CNS depression

Antiemetics:

Herbal: Ginger

good n/v good for morning sickness motion
sickness chemotherapy patients

antiemetics:

Serotonin blockers

block serotonin receptors in GI tract, CTZ, VC tx of
choice meds: ondansetron (Zoran)

antiemetics:

tetrahydrocannabinoid (THC)

inhibitory effects on reticular formation, thalamus and
cerebral cortex meds: dronabinol (marino) pill for
THC: vernally for AIDs and cancer patients

Antihistamine antiemetics: actions and specific medications

block Ach by binding to H1 receptors
Meds: meclizine (antivert) &
diphenhydramine (Benadryl)

Antidopaminergics Antiemetics: actions and specific
medications

blocks dopamine in CTZ Meds: prochlorperazine
(Compazine) and promethazine (Phenergan) increases or
stimulates peristalsis of the GI tract helps to empty out what ever
is upsetting the stomach

Prokinetics antiemetics: actions and specific medications

stimulate peristalsis and empties the stomach meds:
metoclopramide (Reglan)

what are nursing implications for enteral nutrition?

complete nutritional assessment
consider RD consult
assess baseline laboratory studies, such as total protein,
albumin, BUN, RBC, WBC, cholesterol
assess for allergies to components of enteral nutritional
supplements (whey, egg whites)
assess for lactose intolerance(signs: cramping, diarrhea,
abd bloating,flatulence) if administering
enteral nutrition by tube feeding follow policy for ensuring proper
tube placement and for checking residual volume before administering
a feeding follow procedures for flushing tubing to prevent
clogging the feeding tube with formula carefully monitor
how the patient is tolerating enteral feedings keep in mind
that most enteral feedings are started slowly, and the rate is
increased gradually

Enteral Nutrition

solutions elemental polymeric
modular CHO fat protein
altered amino acids impaired glucose

Total parental Nutrition (TPN):

actions:

/

provide basic building block for anabolism
peripheral:less than 2 wks central: >7-10 days : if
pt needs long term therapy concentrated 35% dextrose

TPN: indications

indications: intolerance of large fluid loads, metabolic
reasons

TPN: contraindications

allergies

TPN: adverse effects

infection from central line, hyperglycemia, phlebitis, air
embolism

TPN: Nursing implications/teaching

assess TPN q h IV site, patient's condition, rate
1.2 micron filter check temperature q 4hrs
FSBS at least QID rebound hypoglycemia