Acid-Controlling, Antidiarrheal, and Antiemetic Drugs

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Questions and Answers

Which of the following is NOT a typical secretion of the stomach?

  • Hydrochloric acid
  • Bicarbonate
  • Amylase (correct)
  • Intrinsic factor

Parietal cells in the gastric gland are primarily responsible for producing which substance?

  • Pepsinogen
  • Hydrochloric acid (correct)
  • Mucus
  • Gastrin

Which of the following factors can stimulate the secretion of hydrochloric acid (HCl) by parietal cells?

  • Large fatty meals
  • Emotional stress
  • Caffeine
  • All of the above (correct)

What is the primary function of mucus secreted by the gastric mucosa?

<p>To protect the gastric lining from hydrochloric acid and digestive enzymes (D)</p> Signup and view all the answers

Which of the following conditions is NOT directly related to acid production in the stomach?

<p>Irritable Bowel Syndrome (IBS) (A)</p> Signup and view all the answers

What is the primary mechanism of action of antacids?

<p>Neutralizing stomach acid (B)</p> Signup and view all the answers

Which of the following best describes how antacids promote gastric mucosal defense?

<p>By stimulating secretion of mucus, bicarbonate, and prostaglandins (D)</p> Signup and view all the answers

Which of the following is a potential adverse effect associated with aluminum-containing antacids?

<p>Constipation (A)</p> Signup and view all the answers

Why are magnesium-containing antacids often combined with aluminum-containing antacids?

<p>To counteract the constipating effects of aluminum (C)</p> Signup and view all the answers

A patient with a history of renal failure is prescribed an antacid. Which type of antacid should be avoided?

<p>Magnesium-based antacids (C)</p> Signup and view all the answers

What is a potential consequence of long-term use of calcium-based antacids?

<p>Kidney stones (D)</p> Signup and view all the answers

Which of the following is a characteristic of sodium bicarbonate antacids?

<p>Quick onset, short duration (B)</p> Signup and view all the answers

Why should caution be used when administering sodium bicarbonate antacids to patients with heart failure?

<p>It can exacerbate fluid retention due to sodium content (B)</p> Signup and view all the answers

How should enteric-coated medications be taken in relation to antacids?

<p>Antacids may cause premature dissolving of enteric-coated medications (D)</p> Signup and view all the answers

What is a primary mechanism of action of H2 receptor antagonists?

<p>Blocking hydrogen ion secretion by blocking histamine (H2) receptors (A)</p> Signup and view all the answers

Which suffix is commonly found in the generic names of H2 receptor antagonists?

<p>-tidine (B)</p> Signup and view all the answers

Which of the following statements regarding H2 receptor antagonists is correct?

<p>Are available OTC in lower dosage forms (C)</p> Signup and view all the answers

In which clinical situation would H2 receptor antagonists be most appropriate?

<p>Maintenance therapy for GERD (C)</p> Signup and view all the answers

Which of the following adverse effects is more commonly associated with cimetidine compared to other H2 receptor antagonists?

<p>Erectile dysfunction and gynecomastia (B)</p> Signup and view all the answers

How does cimetidine interact with the cytochrome P450 enzyme system?

<p>It inhibits the enzymes, potentially increasing the blood concentration of drugs metabolized by this pathway (D)</p> Signup and view all the answers

Which of the following instructions should the nurse include when teaching a patient about taking H2 receptor antagonists?

<p>Take the medication with meals (B)</p> Signup and view all the answers

Smoking decreases the effectiveness of which of the following medications?

<p>H2 receptor antagonists (D)</p> Signup and view all the answers

What laboratory values should a nurse assess in patients with impaired renal or liver function before administering H2 receptor antagonists?

<p>Liver function tests and creatinine (C)</p> Signup and view all the answers

What is the mechanism of action of proton pump inhibitors (PPIs)?

<p>Irreversibly inhibiting the hydrogen-potassium ATPase pump (D)</p> Signup and view all the answers

Which suffix is characteristic of proton pump inhibitors (PPIs)?

<p>-prazole (B)</p> Signup and view all the answers

For which condition are proton pump inhibitors (PPIs) typically considered a first-line therapy?

<p>Symptomatic GERD not responding to other medical treatment (A)</p> Signup and view all the answers

Which of the following is a potential long-term adverse effect of proton pump inhibitors (PPIs)?

<p>Osteoporosis (C)</p> Signup and view all the answers

How do proton pump inhibitors (PPIs) affect the absorption of ketoconazole, ampicillin, and iron salts?

<p>They may interfere with absorption (A)</p> Signup and view all the answers

When should omeprazole (Losec) be administered in relation to meals?

<p>Before meals (B)</p> Signup and view all the answers

What is a key instruction that the nurse should provide to a patient taking pantoprazole capsules via a gastric tube?

<p>The content may be mixed with apple juice (A)</p> Signup and view all the answers

What is the primary mechanism of action of sucralfate in treating ulcers?

<p>Forming a protective barrier over the ulcer (C)</p> Signup and view all the answers

What is an important consideration when administering sucralfate with other medications?

<p>Administer other drugs at least 2 hours before sucralfate (B)</p> Signup and view all the answers

Why is misoprostol contraindicated in pregnant women?

<p>It can induce uterine contractions (B)</p> Signup and view all the answers

What is the mechanism of action of simethicone?

<p>Causing mucus-coated gas bubbles to break into smaller ones (D)</p> Signup and view all the answers

Patients with a history of what condition should be most cautious when using bismuth subsalicylate?

<p>Ulcers (C)</p> Signup and view all the answers

What is the primary mechanism of action of anticholinergic antidiarrheal medications?

<p>Decreasing intestinal muscle tone and peristalsis (D)</p> Signup and view all the answers

Which potential side effect should patients be aware of when taking anticholinergic antidiarrheal medications?

<p>Urinary retention (B)</p> Signup and view all the answers

What is the primary effect of opiate antidiarrheal medications on bowel function?

<p>Decreasing bowel motility (D)</p> Signup and view all the answers

Which potential side effect is most important to monitor in patients taking opiate antidiarrheal medications in conjunction with other CNS-depressant medications?

<p>Respiratory depression (B)</p> Signup and view all the answers

What is the general mechanism of action of adsorbent antidiarrheals?

<p>Coating the walls of the GI tract and binding to causative agents (A)</p> Signup and view all the answers

What is the intended action of probiotic antidiarrheal medications?

<p>To restore the balance of normal intestinal flora (D)</p> Signup and view all the answers

Which instruction is most important for the nurse to give patients taking any form of antidiarrheal medications?

<p>Notify their physician immediately if symptoms persist (B)</p> Signup and view all the answers

What is the most appropriate initial nursing action before administering a laxative to a patient?

<p>Assess for recent changes in bowel patterns and abdominal pain (A)</p> Signup and view all the answers

Why might a healthcare provider advise a patient like Jerry, who has been self-treating heartburn with antacids, to discontinue their use prior to further evaluation?

<p>Long-term antacid use can mask symptoms and delay the diagnosis of more serious underlying conditions, like GERD or gastritis. (B)</p> Signup and view all the answers

In the case of a patient with GERD and gastritis secondary to stress-induced hyperacidity, what is the primary rationale for using PPIs like omeprazole?

<p>To decrease acid production, allowing the esophageal and gastric mucosa to heal. (C)</p> Signup and view all the answers

What key information should be included when educating a patient, such as Jerry, who is starting PPI therapy for GERD?

<p>The full effect of PPIs may take several days to achieve, and consistent daily use is necessary. (D)</p> Signup and view all the answers

Which question would be most important for the nurse to ask Petra, an elderly patient reporting chronic constipation and stimulant laxative use, to assess potential contributing factors?

<p>&quot;Can you describe your typical daily fluid intake and dietary fiber consumption?&quot; (A)</p> Signup and view all the answers

What is a potential long-term consequence associated with chronic use of stimulant laxatives, such as those being used by Petra?

<p>Dependence on laxatives and reduced bowel motility (A)</p> Signup and view all the answers

Which nonpharmacological intervention would be most appropriate for Petra to prevent constipation?

<p>Regular physical activity and increased dietary fiber intake (C)</p> Signup and view all the answers

Considering Petra's age and history of chronic stimulant laxative use, which over-the-counter (OTC) option would be the most appropriate first-line choice to help prevent constipation?

<p>An osmotic laxative like polyethylene glycol (PEG) (A)</p> Signup and view all the answers

What is the primary mechanism of action of ondansetron (Zofran) in managing chemotherapy-induced nausea and vomiting for patients like Mr. Lee Edwards?

<p>Blocking serotonin (5-HT3) receptors in the CTZ and vagal nerve terminals (B)</p> Signup and view all the answers

Which important teaching point should the nurse emphasize to Mr. Lee Edwards regarding his oral ondansetron prescription?

<p>Ondansetron is most effective when taken 30-60 minutes prior to chemotherapy. (B)</p> Signup and view all the answers

If Mr. Lee reports that ondansetron is not effectively controlling his chemotherapy-induced nausea and vomiting, and expresses concern about a friend's suggestion to use marijuana, what would be the most appropriate initial response?

<p>&quot;Let's explore other antiemetic options first, and I will discuss the potential risks and benefits of medical cannabis with your oncologist, as well as its legal implications.&quot; (D)</p> Signup and view all the answers

Flashcards

Hydrochloric acid (HCl)

Produced by parietal gland; aids digestion & barrier to infection.

Bicarbonate in stomach

Buffers stomach acid, preventing hyperacidity.

Pepsinogen precursor

Needed for dietary protein breakdown in the stomach.

Intrinsic factor

Necessary for absorbing vitamin B12 and iron.

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Mucous in stomach

Coats & protects the gastric lining from acid & digestive enzymes.

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Prostaglandins (PG's)

Part of inflammatory response; responds to injury/inflammation. Involved with mucous production.

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Parietal cells

Cells producing HCl, maintains pH of 1-4, stimulated by food, caffeine, chocolate, & alcohol.

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Most common acid-related disease

Hyperacidity or Dyspepsia

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PUD: peptic ulcer disease

Gastric & Duodenal ulcers caused by malfunction of pepsin cells

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GERD: acid reflux disease

Caused by build up of acid production or a lazy pyloric sphincter

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Helicobacter pylori (H. pylori)

Bacterial ulcers, which eats away at the stomach lining

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Antacids

Stomach acid buffer

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H2 antagonists

Blocks hydrogen ion secretions by blocking histamine (H2) receptors

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Proton pump inhibitors PPIs

Binding to and inhibits the enzyme resulting in the blockage of all secretion from parietal cells

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Antacids Indications

acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and reflux.

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Antacids: Aluminum Salts

Binds to phosphate and may lead to hypercalcemia and hypophosphatemia, constipating effects

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Antacids: Magnesium Salts

Adverse effect diarrhea; usually used with other agents to counteract this effect

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Antacids: Calcium Salts

May cause constipation & kidney stones, can result in rebound hyperacidity

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Antacids: Sodium Bicarbonate

Buffers the acidic properties of HCl

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H2 receptor antagonists

Blocks hydrogen ion secretion and reduces gastric acid

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H2 Receptor Antagonists Action

Makes the cells less responsive to histamine decreasing acid production

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Parietal cell stimulation

Parietal cells release positive hydrogen ions (protons) during HCI production

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PPIs

Binds directly to the hydrogen-potassium-ATPase pump mechanism and irreversibly inhibits the action of this enzyme = results in a total blockage of hydrogen ion secretion from the parietal cells.

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Lansoprazole (Prevacid)

Used to treat acute or chronic acid reflux.

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Sucralfate

Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas

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Simethicone

Used to reduce the discomfort of gastric or intestinal gas (flatulence) and aid in its release via the mouth or rectum.

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Diarrhea

Abnormal passage of stools with increased frequency, fluidity, and weight or with increased stool water excretion.

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Adsorbents

Binds to the causative bacteria or toxin, whichis then eliminated through the stool

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Anticholinergics

Decrease intestinal muscle tone and peristalsis of GI tract. Slows the movement of fecal matter through the large bowel and increased time for water reabsorption

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Opiates

Decrease bowel motility and reduce pain by relief of rectal spasms

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Probiotics

Restore the balance of the normal flora supplying bacteria to Gl tract

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Bulk forming

Acute or chronic constipation and Irritable bowel syndrome

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Emollient

Stool softners

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Hyperosmotic

Increase fecal water content

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Stimulant

Increases peristalsis via intestinal nerve stimulation

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Nausea

Unpleasant feeling that often precedes vomiting

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Emesis (vomitting)

Forcible emptying of gastric, and occasionally, intestinal contents

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Antiemetic agents

Used to relieve nausea and vomiting. All antiemetic agents work at some site of the vomiting pathway

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Vomiting center (VC)

n the brain-initiates nausea and vomiting

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Why stop antacids before tests?

Stopping antacids is advised before tests for conditions like GERD and gastritis to avoid masking symptoms and ensure accurate diagnosis.

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Rationale for PPI use in GERD

PPIs reduce stomach acid production, relieving GERD symptoms and preventing damage to the esophagus.

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Risks of long-term laxative use

Stimulant laxatives can cause dependence and weaken the bowel's natural ability to function, leading to chronic constipation.

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Nonpharmacological constipation prevention

Drink lots of water, eat fiber-rich foods, exercise regularly and establish a regular bowel routine.

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Ondansetron mechanism of action

Ondansetron blocks serotonin, a chemical that can trigger nausea and vomiting, especially during chemotherapy.

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Patient teaching for ondansetron

Adverse effects, dosing, timing re: chemotherapy, and alternative therapies to discuss with his oncologist.

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Study Notes

Case Study Chapter 39: Acid Controlling Drugs

  • Mr. Jerry Yip, a 50-year-old attorney, self-treated heartburn for years with large amounts of antacids.
  • His healthcare provider instructed him to stop taking antacids and referred him to a gastroenterologist after discovery of GERD (gastroesophageal reflux disease) and gastritis secondary to stress-induced hyperacidity via endoscopy.
  • The healthcare provider prescribed omeprazole (Prilosec, Losec) 20 mg once daily.

Case Study Chapter 40: Antidiarrheal Drugs and Laxatives

  • Petra, a 72-year-old retired nurse who exercises regularly, reports constipation with only one bowel movement every 3 days for the past 3 months, instead of daily.
  • Petra has been taking a stimulant laxative up to twice a day and feels weak and has tummy cramping.

Case Study Chapter 41: Antiemetic and Antinausea Drugs

  • Mr. Lee Edwards, a 66-year-old carpenter with a recent lung cancer diagnosis, starts chemotherapy after recovering from a right lung lobectomy.
  • His premedication includes various drugs, including oral ondansetron (Zofran) for home use.
  • Key considerations include the mechanism of action of ondansetron (Zofran) for chemotherapy-induced nausea and vomiting, patient teaching points, and what to explain if ondansetron is ineffective and marijuana is suggested.

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