Cimetidine: H2-Receptor Antagonists

Cimetidine – Histamine 2 -receptor antagonists

• Blocks H2 receptors, suppressing gastric acid secretion and lowering hydrogen ion concentration in the stomach.
• Prevents/treats gastric and duodenal ulcers, GERD, treats hypersecretory conditions (Zollinger-Ellison syndrome), heartburn, and acid indigestion.
• Used with antibiotics for H. pylori ulcers.
• Can cause decreased libido, gynecomastia, and impotence (ED OD), but these adverse effects reverse when dosing stops.
• CNS effects include lethargy, hallucinations, confusion, and restlessness, which are more common in older adults with kidney or liver dysfunction.
• Report constipation, diarrhea, or nausea to the provider.
• Use with caution in pregnant or lactating women.
• Older adults are more prone to CNS effects and may need lower dosages.
• Use cautiously in patients at high risk for pneumonia or who have COPD because H2 receptor antagonists decrease gastric acidity, promoting bacterial consolidation.
• Reduce dosages in patients with moderate to severe kidney or liver impairment.
• Contraindicated in clients with known sensitivity to the medication.
• Can inhibit medication-metabolizing enzymes, increasing levels of warfarin, phenytoin, theophylline, and lidocaine.
• Monitor for bleeding in clients taking warfarin and adjust dosages accordingly, monitoring INR and PT levels.
• Antacids can decrease histamine2 receptor antagonist absorption; avoid taking them 1 hour before or after.
• Smoking decreases the effectiveness; stop or avoid smoking after the last dose of the day.

Nursing Administration for Cimetidine

• Avoid smoking, which can delay healing.
• OTC availability can discourage clients from seeking appropriate healthcare
• Encourage clients to see a provider if manifestations persist
• Treatment starts with oral doses twice a day until the ulcer heals, then a maintenance dose once a day at bedtime.
• Can be administered orally, IM, or IV (slowly to avoid bradycardia).
• Food has no effect, but giving meals directly after and at bedtime prolongs the effects.
• Do not give antacids within 1 hour.
• List other histamine2-receptor antagonists such as Famotidine and Nizatidine (PO only).
• Notify the provider for any indication of obvious or occult GI bleeding (coffee-ground emesis)
• Avoid alcohol and foods that increase GI irritation, and limit the use of aspirin or NSAIDs.
• Increase fiber and fluid intake to prevent or manage constipation
• Adhere to the full treatment regimen to prevent recurrence, as several medications may be required multiple times a day.

Omeprazole – Proton Pump Inhibitor

• Blocks basal and stimulated acid production and reduces gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid.
• Used for short-term therapy of gastric and duodenal ulcers, erosive esophagitis, and GERD; treatment should be limited to 4 to 8 weeks.
• Approved for long-term therapy of hypersecretory conditions and preventing stress ulcers for at-risk clients experiencing acute events
• Observe for adverse effects and monitor and report manifestations of respiratory infection, as it can cause pneumonia.
• Can cause osteoporosis and fractures (bone loss); use only as long as needed and taper before increasing vitamin D intake.
• Can cause rebound acid hypersecretion; take a low dose if possible and taper slowly to discontinue, and take antacids to manage discomfort, which can persist for several months after stopping.
• Can cause Hypomagnesemia after taking it for longer than 3 months.

Nursing Adminstration for Omeprazole

• For long term PPI therapy, obtain baseline magnesium level and monitor throughout therapy.
• Administer magnesium supplements and advise clients to monitor and report manifestations of hypomagnesemia (tremors, cramps, seizures).
• Report fever, diarrhea, abdominal cramping, or bloody stools immediately to the provider to check for Clostridium difficile-associated diarrhea
• Only use if the benefits outweigh the risks during pregnancy and lactation; avoid pregnancy during therapy.
• Contraindicated for clients with hypersensitivity to rilpivirine, and during lactation, and use cautiously in children and with clients who have dysphagia (difficulty swallowing) or liver disease.
• Increase the risk of pneumonia, use cautiously in clients who have COPD.

Interactions with Omeprazole

• Digoxin, methotrexate, diazepam, tacrolimus, antifungal agents, and phenytoin levels can increase when used concurrently; monitor digoxin and phenytoin levels carefully if prescribed concurrently.
• Absorption of ketoconazole, itraconazole, and atazanavir is decreased when taken concurrently; avoid concurrent use, but if necessary, administer separately by 2 to 12 hours.
• Effectiveness of clopidogrel (Plavix) can decrease with concurrent use; monitor for thrombotic events.
• Do not crush, chew, or break sustained-release tablets; do not open the capsule and sprinkle contents over food to facilitate swallowing.
• Pantoprazole can irritate the injection site, leading to thrombophlebitis, when administered intravenously; monitor the IV site and change if needed.

Other Proton Pump Inhibitors

• Pantoprazole, Lansoprazole, Dexlansoprazole, Rabeprazole, Esomeprazole
• Take once per day prior to eating in the morning and use for only 4 to 6 weeks for active ulcers.
• Notify the provider for any indication of obvious or occult bleeding (coffee-ground emesis).
• Perform weight-bearing exercises, consume calcium and vitamin D, and drink plenty of fluids. Take magnesium as needed.

Sucralfate - Mucosal Protectant

• Changes into a protective barrier in the acidic environment of the stomach and duodenum, adhering to ulcers and protecting them from acid and pepsin.
• Treats acute duodenal ulcers and maintenance therapy.
• There are no systemic effects because sucralfate is minimally absorbed and eliminated in the feces.
• Can cause constipation; increase dietary fiber and fluid intake to prevent it.
• Contraindicated in those with hypersensitivity and safe in pregnancy and lactation.
• Use cautiously in clients with chronic kidney disease or diabetes mellitus.
• Can interfere with the absorption of phenytoin, digoxin, warfarin, and ciprofloxacin; maintain a 2-hr interval between these medications and sucralfate.
• Antacids interfere with its effects; take sucralfate 30 minutes before or after antacids.

Nursing Administration for Sucralfate

• Administer orally on an empty stomach; do not administer IV, IM, or SubQ.
• Give four times a day, 1 hour before the usual mealtimes and again at bedtime.
• Do not give within 30 minutes of antacids.
• Take four times a day, 1 hr before the usual mealtimes and again at bedtime.
• Complete the course of treatment and break or dissolve in water if needed, but do not crush or chew.

Aluminum Hydroxide - Antacids

• Neutralize or reduce gastric acid acidity and can reduce pepsin activity if the pH is raised above 5.
• Stimulates the production of prostaglandins for mucosal protection.
• Treats peptic ulcer disease, prevents stress-induced ulcers, and relieves GERD manifestations.
• Can cause constipation when using aluminum and calcium compounds and diarrhea when using magnesium compounds.
• Alternate use of these compounds to offset intestinal effects and normalize bowel function, adjusting administration as needed to promote a normal bowel pattern. If a client has difficulty managing bowel function, recommend a combination product that contains aluminum hydroxide and magnesium hydroxide.
• Fluid retention can result when using antacids containing sodium, so avoid them if you have hypertension or heart failure.
• Can cause hypophosphatemia when using aluminum compounds and hypercalcemia.
• Report hypercalcemia manifestations (constipation, anorexia, nausea, vomiting, confusion) to the provider.
• Magnesium compounds can lead to toxicity and hypermagnesemia in clients who have impaired kidney function, monitor for CNS depression.

Safety Considerations fo Aluminum Hydroxide - Antacids

• Do not use Gl perforation or obstruction, and be cautious in clients with abdominal pain.
• Reduces absorption of medications, including famotidine and cimetidine; allow an hour between taking antacids and these medications.
• Aluminum compounds interfere with absorption of warfarin, digoxin, and tetracycline; do not take other medications within 1 to 2 hours of taking aluminum compounds without provider approval.
• Phosphate
• Adherence is difficult due to administration frequency; the medication can be administered seven times a day: 1hr and 3 hr after meals and again at bedtime.
• Encourage compliance by reinforcing its intended effect (relief of pain, healing of ulcer).

Nursing Administration for Aluminum Hydroxide - Antacids

• List other antacids like magnesium hydroxide and calcium carbonate
• Chew tablets thoroughly and then drink at least 8oz of water or milk, and shake liquid formulations to ensure even dispersion.
• Take all medications at least 1 hr before or after taking an antacid.

Ondansetron, Prochlorperazine, Scopolamine -Antiemetics

• Ondansetron is a serotonin antagonist, prochlorperazine is a dopamine antagonist, and scopolamine is an anticholinergic (blocks neurotransmitter acetylcholine)
• Ondansetron prevents emesis by blocking serotonin receptors (5-HT3) in the chemoreceptor trigger zone (CTZ) and antagonizing serotonin receptors on afferent vagal neurons from the upper Gl tract to the CTZ.
• Uses prevent emesis related to chemotherapy, radiation therapy, and postoperative therapy. Off-label uses include treatment of nausea and vomiting related to pregnancy and childhood viral gastritis.
• Prochlorperazine (a phenothiazine) has antiemetic effects by blocking dopamine receptors in the CTZ, preventing emesis related to chemotherapy, toxins, and postoperative recovery (PO, IM, Rectal, or IV)
• Scopolamine interferes with the transmission of nerve impulses traveling from the vestibular apparatus of the inner ear to the vomiting center (VC) in the brain; given transdermally, PO, IV, or Subcutaneously, scopolamine can prevent/treat motion sickness.

Complications and Nursing Admnistration for Antiemetics

• Ondansetron can cause headaches, diarrhea, and dizziness, which can be treated with non-opioid analgesics, and monitor stool patterns and constipation; prolonged QT interval can cause dysrhythmia monitor ECG in clients who take other meds that can prolong the QT interval and use caution in clients with electrolyte abnormalities; Steven Johnson syndrome and serotonin syndrome can also ensue.
• Extrapyramidal symptoms (EPSs), including involuntary movements and other motor disturbances, can happen with prochlorperazine; administer anticholinergic medications and stop the medication and inform the provider if EPSs occur.
• Possbile adverse effects include restlessness, anxiety, and spasms of the face and neck.
• Monitor clients receiving antihypertensive medications.
• Patient may experience Hypotension so rise slowly from lying to standing.
• Anticholinergic effects: dry mouth, urinary retention, constipation.
• Monitor sedation and caution avoiding activities that require alertness.
• To minimize anticholinergic effects, sip on fluids, use laxatives, and void on a regular basis.
• Pregnant or lactating: safety not established for all unless lactating is progestin-only
• Recognize that serotonin syndrome and Steven Johnson Syndrome can also ensue

Other Facts for Antiemetics

• Antiemetics prevent/treat nausea and vomiting from various causes, and nursing assessment can identify the underlying and related factors to verify that appropriate medication is used.
• Antiemetics administered prior to prevent CINV are more effective, and combining three is better than one.
• Administer ondansetron IV 1 hr before chemotherapy or PO 1 hr before anesthesia to prevent nausea and vomiting; administer PO three times daily for clients receiving radiation.
• To prevent motion sickness, apply a scopolamine transdermal patch behind the ear four hours before travel or take the tablet one hour before travel.
• Prochlorperazine: increase fluid intake, increase physical activity, suck on hard candy or chew gum, void every 4hr and monitor I&Os, and palpate lower abdomen every 4 - 6 hrs to check bladder fullness. List other dopamine antagonists: Metoclopramide and promethazine.
• To prevent motion sickness, apply a scopolamine transdermal patch behind the ear four hours before travel or take the tablet one hour before travel

Psyllium, Docusate sodium, Bisacodyl, Senna, Magnesium hydroxide, Lactulose - Laxatives

• Psyllium is a bulk-forming laxative (fiber supplement) that identical to action of dietary fiber; softens fecal mass and increases bulk to temporarily treat constipation, decrease diarrhea if you have diverticulosis/IBS, and control stool.
• Docusate sodium is a stool softener that lowers the surface tension of the stool to allow water penetration; it softens the stool to be passed easier and prevents constipation. Softer fecal impaction and reduces strain.
• Bisacodyl and senna are stimulant laxatives that stimulates intestional peristalsis and increase water and electrolytes in the intestines.
• Used at the short-term treatment of constipation caused by high-dose opioid use or slow intestinal transit and Bowel preparation prior to surgery or diagnostic tests (colonoscopy).

Magnesium hydroxide and lactulose – osmotic laxatives

• Osmotic laxatives draw water into the intestine to increase the mass of stool, stretching musculature, which results in peristalsis.
• Used at the low dose: to prevent painful elimination (clients who have episiotomy or hemorrhoids), and high dose: client preparation prior to surgery or diagnostic tests (a colonoscopy).
• Can cause the rapid evaluation of the bowel after ingestion of poisons or following anthelmintic therapy to rid the body of dead parasites
• Can cause GI irritation and Rectal burning sensation, leading to proctitis DO NOT use bisacodyl suppositories on a regular basis.

Safety With Laxatives

• Caution, as laxatives with magnesium salts (magnesium hydroxide) can lead to accumulation of toxic levels of magnesium and cause toxic magnesium levels. For clients experiencing impaired kidney function, read labels carefully and avoid laxatives that contain magnesium.
• Laxatives with sodium salts (sodium phosphate) place clients at risk for sodium absorption and fluid retention, which will require monitoring of the nurse.
• Bulk-forming agents can cause obstruction of the esophagus or intestines; administer with a full glass of water and avoid if you have a narrowing of the intestinal lumen.
• Diuretics can cause dehydration; Monitor I&O and assess for manifestations of dehydration (poor skin turgor) and Increase water intake to at least 8 to 20 glasses a day.

Cautions for Laxative Use

• Don't use is there is Fecal impaction (hard, dry mass of stool becomes trapped in the rectum, making it difficult or impossible to pass), bowel obstruction, and acute surgical abdomen to prevent perforation and if client experiences nausea or cramping.
• In patients with colitis, the laxative of choice should be bulk-forming.
• Milk and antacids can destroy the enteric coating of bisacodyl, and take bisacodyl at least 1 hr apart from ingesting these substances.
• Obtain a complete history of laxative use and provide teaching as appropriate and if you administer Bisacodyl, give at bedtime and suppositories are effective within an hour.

Nursing Indications for Laxatives

• Instruct clients to take bulk-forming and surfactant laxatives with 8oz of water
• Returns evacuation of bowel in preparation for surgery or diagnostic tests
• Chronic laxative use can lead to fluid and electrolyte imbalances; to promote defecation and resumption of normal bowel function, increase high-fiber foods (bran, fresh fruits, and vegetables) in the daily diet and increase amounts of fluids, as well as maintain a regular exercise regimen to improve bowel function

Diphenoxylate plus atropine - Antidiarrheals

• Activate opioid receptors in the Gl tract to decrease intestinal motility and increase the absorption of fluid and sodium in the intestine.
• Antibiotics are used for bacterial diarrhea while nonspecific antidiarrheal agents minimize diarrhea manifestations.
• Should be used at recommended doses for diarrhea, diphenoxylate does not affect the NCNS system.
• At high doses, clients can experience typical opioid effects (euphoria or CNS depression). However, the addition of atropine, which has unpleasant adverse effects (blurred vision, dry mouth, urinary retention, constipation, tachycardia), discourages ingestion of doses higher than those prescribed and to avoid in pregnancy/lactation.
• High risk of megacolon in patients with inflammatory bowel disorders.
• Severe electrolyte imbalance or dehydration is contraindicated.
• If client should have bloody stools, this intervention is contrindicated!
• Diphenoxylate plus atropine, 5 mg initially, with a MAX DOSE of 8 tablets/day is used to manage dehydration.
• Drink small amounts of clear liquids or commercial oral electrolyte drink to maintain electrolyte balance and avoid plain caffeine.

Metoclopramide – Prokinetic Agents

• Controls nausea and vomiting by blocking dopamine and serotonin receptors in the CTZ, which suppresses emesis and augments the action of acetylcholine, which causes an increase in upper Gi motility/peristalsis (stimulates gut movements)
• The use of Intravenous form is for the control of post-operative and chemotherapy due to the ease of administration.
• Oral form used for diabetics.
• Tardive dyskinesia, where you develop movements on the mouth area, is dangerous where the movement may be irreversable.
• Monitor for EPS and don't administer if has GI bleeding obstruction.
• There can be an increased risk of seizures and CNS depressants when using the intervention.
• Give medications carefully and use a barrier method.

Ferrous Sulfate, Iron Dextran - Iron Preparation

• Oral: ferrous sulfate, Parenteral: Iron dextran
• Provides iron needed for RBC development and oxygen transport to cells, and the body poorly absorbs, so relatively large amounts must be taken orally to increase Hgb and Hct levels to prevent iron deficiency anemia.
• Monitor bowel patterns and intervene as necessary
• Use parenteral if they can't use oral and preferred IV route.
• Gi Distress can occur (nausea constipation heartburn)
• CE: If you get a liquid drink it will stain teeth so dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing.
• CE: IM doses hurt the skin and inject deep using Z track.

Safety with Iron Preparations

• Watch for anaphylaxis, and have equipment ready, IV route is safer than IM and administer a test dose.
• Avoid with oral and parenteral in children.
• Antacids and tetracyclines should be avoided
• Caffeine and daily interact
• Dark green stool
• Empty stomach
• Performconcurrent for high foods
• Will see RBC count go up after 4 to 5 days
• Hemoglobin will up up 2 within a month.

B12 vitamin

• It is important for conversion of folic acid from an inactive form to its active form and prevents the use of megaloblastic anemia.

• Can get it high due to incased in RBC.

• Can cause abdominal discomfort

Key Facts for Vitamin B12

• Do not use for those with reactions or pregnant
• Moderate is good by itself while bad is needs folic acid
• Masks the action.
• Disappearace of meds happens more with the others
• Improvement of the extremity area with the absence of tingling.

Folic Acid

• Aids during pregnancy
• Treats malabsorptin
• Avoid the use.
• Increase blood.
• Improves anemia

Potassium Chloride

• Treats Hypokaleima/Potassium that is less than 3.5
• GI can have irritation:
• Never give a pill because it can give too much. Instead, give liquid.

Magnesium Sulfate

• It regulates skeletal contractions.
• Treats with less that 1.3 with levels
• Can see muscle and pain
• Hold med and reverse with gluconate.

Key Factors Androgens should take

• Monitor blood pressure
• Monitor reflexes
• Teach leafy greens.

Hormonal Contraceptives

• Prevents Conception.
• Stops ovulation.
• It is effective due to evidence of no conception.
• Combination oral contraceptives are classified as monophasic, biphasic, triphasic, or quadriphasic. With monophasic OCs, the dosage of estrogen to progestin, remains the same throughout the cycle. With the other classifications, the estrogen/progestin changes to duplicate a typical menstrual cycle.
• Thicken mucus and chance the fertilization process.

Safety with Hormonal

• MI stroke and blood clots can happen
• Do not give any heart issues.
• Watch out for breast cance with no clients
• Most combination OCs are given in a cyclic pattern, usually in a 28-day regimen. Extended-cycle OCs are taken for longer than the typical 28-day cycle and Eighty-four days is common, but some preparations are taken continuously.
• Oral.
• Report bad leg pain and headache
• Watch for 7 tabs.

Testosterone- Androgens

• Promote
• Treat Hypogonadism in males.
• Promote
• Treat.
• Watch out for liver enzyme levels.

Finasteride - 5- Alpha

• Helps men to go pee better.
• Can cause libido and other thing to stop
• Take 6 months
• The prostate gets better.

Key Things with androgens

• The heart goes down
• Lowers BP.
• Monitor prostate

KEY FACTS WITH PDES

• Sidenatil does the work
• Will help get stiff
• Heart attack.
• Do not use if take nitrate
• Check pressure.
• Does not portect from sts.

Oxytocin

• Causes
• Better contactions
• Can cause abprtion
• monitor babies HR.