Module 4 Key Points PDF

Module 4A AUTONOMIC NERVOUS SYSTEM AGENT Key Points 1. Autonomic Nervous System (ANS) Overview - Innervates (controls): - Smooth muscles, glands, heart, lungs, gastrointestinal tract, bladder, eyes. - It is the **involuntary nervous system**, meaning it operates without conscious control...

Module 4A AUTONOMIC NERVOUS SYSTEM AGENT Key Points 1. Autonomic Nervous System (ANS) Overview - Innervates (controls): - Smooth muscles, glands, heart, lungs, gastrointestinal tract, bladder, eyes. - It is the **involuntary nervous system**, meaning it operates without conscious control. 2. Neurons - Afferent (Sensory) Neurons: Send signals to the Central Nervous System (CNS). - Efferent (Motor) Neurons: Transmit impulses from the brain to effector organs, such as muscles and glands. - The ANS is divided into two parts: - Sympathetic Nervous System - Parasympathetic Nervous System 3. Sympathetic Nervous System -Adrenergic Receptor Organ Cells: - Alpha1, Alpha2, Beta1, Beta2 receptors. - Neurotransmitter: Norepinephrine. - Effects on Body Tissues: - Alpha1: Constriction of blood vessels, increasing blood pressure. - Beta1: Increases heart rate and contractility. - Beta2: Bronchodilation, increased blood flow to skeletal muscles, relaxation of uterine muscles. 4. Parasympathetic Nervous System - Cholinergic System: - Neurotransmitter: Acetylcholine. - Cholinergic Receptor Organ Cells: Nicotinic and Muscarinic receptors. - Effects on Body Tissues: - Parasympathetic Response: Constriction of pupils, decreased heart rate, constriction of bronchioles, increased GI motility, bladder contraction. 5. Adrenergic Agonists (Sympathomimetics) - Mechanism: Mimic the effects of sympathetic neurotransmitters (e.g., norepinephrine) by acting on adrenergic receptor sites. - Examples and Uses: - Dopamine, Epinephrine, Norepinephrine: Treat hypotension, shock, and bradycardia. - Albuterol, Metaproterenol: Bronchodilators used for asthma. - Side Effects: Restlessness, tachycardia, tremors, hypertension, urinary urgency, etc. 6. Adrenergic Blockers - Mechanism: Block the sympathetic nervous system, antagonizing the effects of epinephrine.  - Effects: Decrease heart rate, blood pressure, and respiratory rate. Causes bronchoconstriction and vasoconstriction in organs. - Uses: Hypertension, migraines, glaucoma, angina (beta blockers), etc. - Examples: Propranolol (beta blocker), Clonidine (alpha blocker), Doxazosin. - Side Effects: Bronchoconstriction, hypotension, bradycardia, hyperglycemia. 7. Cholinergic Agonists - Mechanism: Mimic the parasympathetic nervous system (rest and digest), opposite of adrenergic effects. - Effects: Decrease heart rate, lower blood pressure, constricted pupils, increased salivation, sweating, and gastrointestinal activity. - Uses: Treat urinary retention, Alzheimer’s disease, and Myasthenia gravis. - Examples: Bethanechol, Donepezil, Neostigmine. - Side Effects: SLUDGE (Salivation, Lacrimation, Urinary incontinence, Diarrhea, Gastrointestinal cramps, Emesis), bradycardia, hypotension. 8. Anticholinergics - Mechanism: Block acetylcholine, opposite of cholinergic effects, reduce parasympathetic activity. - Effects: Bronchodilation, reduced GI and GU tract activity, pupil dilation, and dry mouth. - Uses: IBS, pre-operative settings, bladder spasms, eye exams, heart stimulation. - Examples: Atropine, Scopolamine, Benztropine. - Side Effects: "Hot as a hare," "Mad as a hatter," "Red as a beet," "Dry as a bone," and "Blind as a bat." Key Takeaways: - The sympathetic system (adrenergic) prepares the body for **fight or flight** (increased heart rate, bronchodilation, vasoconstriction), while the parasympathetic system (cholinergic) promotes **rest and digest** functions (decreased heart rate, increased digestion, pupil constriction). - Drugs that affect the ANS can **stimulate** or **block** these systems to treat conditions like hypertension, asthma, heart failure, and urinary retention. This provides a high-level overview of the autonomic nervous system and the medications that influence it. Module 4B MEDICATIONS AFFECTING THE RESPIRATORY SYSTEM Key Points ### Key Points from the Presentation on **Airflow Disorders & Respiratory Medications** --- ### **1. Medications for Airflow Disorders** - **Beta2 Adrenergic Agonists** (e.g., Albuterol, Formoterol, Salmeterol): - **Albuterol** is **short-acting** (rescue inhaler) for **acute asthma attacks**. - **Formoterol & Salmeterol** are **long-acting** (maintenance therapy), not for acute attacks. - **Inhaled Anticholinergics** (e.g., Ipratropium): - Used to **relieve bronchospasms**, especially in COPD or asthma. - **Theophylline**: - A **methylxanthine** for **long-term asthma management**; **therapeutic range**: 5-15 mcg/mL. - **Adverse effects**: Nausea, diarrhea, restlessness, dysrhythmias, seizures. - **Zafirlukast**: - A **leukotriene receptor antagonist** for **long-term asthma control**. --- ### **2. Case Study 1: Asthma Management** - **Patient**: Mr. Smith (24, allergic to pollen/dust), presenting with **wheezing**, **tachycardia**, and **hypoxia**. - **Current Medications**: Beclomethasone (corticosteroid) & Ipratropium (anticholinergic). - **Beclomethasone**: Used for **long-term asthma control** (corticosteroid). - **Ipratropium**: **Inhaled anticholinergic** for bronchodilation. - **Treatment Ordered**: - **Albuterol + Ipratropium Nebulizer** (stat treatment) for acute asthma relief. - **Albuterol**: **Beta2-agonist** for quick relief, bronchodilates. - **Ipratropium**: **Anticholinergic** for bronchodilation. - **Teaching Points for Mr. Smith**: - **Albuterol**: Rescue inhaler for acute attacks. - **Ipratropium**: Used for long-term control; take as prescribed. --- ### **3. Inhaler Technique** - Mr. Smith's **incorrect inhaler technique**: - **Mistake**: He shakes the inhaler vigorously, holds it at an angle, and squeezes it during a **quick, deep breath**. - **Proper Technique**: - Shake inhaler. - Exhale fully before inhaling. - Inhale **slowly** and deeply while pressing the inhaler. - **Hold breath for 10 seconds** to allow the medication to settle in the lungs. - **Key Teaching**: - **Use a spacer** if needed for better delivery of the medication. - **Wait 1 minute** between puffs for beta-agonists. --- ### **4. Theophylline** - **Used for**: Long-term control of asthma and COPD. - **Therapeutic Range**: 5-15 mcg/mL. - **Signs of Toxicity**: Nausea, diarrhea, restlessness (mild); dysrhythmias, seizures (severe). - **Avoid caffeine**: Increases CNS and cardiac effects and can increase theophylline levels. --- ### **5. Medications for Upper Respiratory Disorders** - **Antitussives**: - **Codeine (Opioid)**: For **dry, non-productive cough**; monitor for **sedation** and **opioid dependency**. - **Dextromethorphan (Non-opioid)**: For **dry cough**; **fewer CNS effects** than codeine. - **Decongestants** (e.g., **Phenylephrine**, **Pseudoephedrine**): - **Alpha-1 agonists** causing vasoconstriction to reduce congestion. - **Nasal sprays**: Avoid use for more than **3-5 days** to prevent **rebound congestion**. - **Expectorants** (e.g., **Guaifenesin**): - Used for **productive coughs** to **thin mucus**; increase fluid intake. - **Antihistamines**: - **Diphenhydramine (1st gen)**: Causes **sedation** and **anticholinergic effects**. - **Loratadine (2nd gen)**: Minimal sedative and anticholinergic effects. - **Key Point**: **Can cause false negative** results on allergy tests. - **Nasal Glucocorticoids** (e.g., **Fluticasone**, **Budesonide**): - **First-line for allergic rhinitis**; **take daily**. --- ### **6. Case Study 2: Dry Cough (Mrs. McCoy)** - **Treatment**: - **Codeine** for dry cough, but **monitor for sedation** and **opioid dependency**. - If patient is **elderly**, **Dextromethorphan** may be preferred for fewer side effects. - **Productive Cough**: - **Guaifenesin** is appropriate for productive coughs. - **Pediatric Considerations**: Always check **pediatric dosing** before giving any medication to children. --- ### **7. Case Study 3: Nasal Congestion (Cassie)** - **Treatment**: **Decongestants** (e.g., **Phenylephrine**, **Pseudoephedrine**) to relieve nasal congestion.  - **Important Teaching**: **Monitor for increased blood pressure**, avoid prolonged use of nasal sprays to prevent rebound congestion. --- ### **8. Case Study 4: Allergic Rhinitis (Lily & Kate)** - **Lily's Treatment**: **Loratadine** (2nd gen antihistamine) for seasonal allergies. - **Kate's Allergies**: If symptoms persist despite **Loratadine**, an **allergy skin test** may be needed. Avoid taking **antihistamines** before the test as they can affect the results. --- ### **9. Case Study 5: Seasonal Allergic Rhinitis (Joy)** - **Treatment**: **Fluticasone** or other **nasal glucocorticoids** for **allergic rhinitis**. - **Adverse Effects**: Watch for **nosebleeds**, **throat irritation**, and **hoarseness**. --- ### **10. Practice Questions** #### **Practice Question 1**: - **First Medication for Severe Asthma Attack**: - **Answer**: A. **Albuterol Nebulizer** – fast-acting bronchodilator. #### **Practice Question 2**: - **Montelukast Teaching**: - **Answer**: A. **Take daily, even when feeling well.** - **C.** **This is a maintenance medication for asthma.** - **D.** **Report signs of mood changes or suicidal thoughts.** #### **Practice Question 3**: - **Medication for Sneezing & Itchy Eyes**: - **Answer**: B. **Diphenhydramine** (1st gen antihistamine). #### **Practice Question 4**: - **Teaching for Guaifenesin**: - **Answer**: A. **Increase fluid intake.** - **C.** **Report cough lasting longer than 1 week.** #### **Practice Question 5**: - **Theophylline Toxicity**: - **Answer**: B. **Nausea and diarrhea** (early signs of toxicity). - **D.** **Heart racing** (sign of toxicity). --- ### **Takeaway Points** - **Beta-2 Adrenergic Agonists**: - **Short-acting** (Albuterol) for acute episodes. - **Long-acting** (Formoterol, Salmeterol) for maintenance therapy. - **Glucocorticoids**: Used for **long-term management** of asthma and allergic rhinitis. - **Do not use for acute attacks**. - **Theophylline**: Monitor levels and avoid **caffeine**. - **Anticholinergics** (Ipratropium): Caution with **BPH** and **glaucoma**. - **Expectorants and Decongestants**: Educate patients about proper use to avoid side effects like **rebound congestion**. --- ### **Final Teaching Notes** - **Inhalers**: Teach patients proper technique to ensure maximum effectiveness. - **Medication Timing**: Beta2 agonists before glucocorticoids. - **Side Effects**: Always educate patients on monitoring for common side effects like sedation with antihistamines, and **tachycardia** with decongestants. --- This summary highlights the major teaching points and case study scenarios related to respiratory medications and asthma management. Module 4C MEDICATIONS AFFECTING THE ENDOCRINE SYSTEM Key Points 1. Addison’s Disease - **What is it?** - **Addison's Disease** is **primary adrenal insufficiency**, where the adrenal glands produce insufficient amounts of **cortisol** and **aldosterone**, leading to hormonal imbalances. - **Signs & Symptoms:** - **Fatigue** and weakness - **Weight loss** - **Low blood pressure** (hypotension) - **Hyperpigmentation** (dark skin, especially on pressure points like elbows, knees, and palms) - **Salt cravings** - **Nausea, vomiting, and abdominal pain**  - **Hypoglycemia** (low blood sugar) - **Treatment (Medications):** - **Corticosteroids** such as **Hydrocortisone**, **Prednisone**, and **Dexamethasone** to replace cortisol. - **Fludrocortisone** (mineralocorticoid) for aldosterone replacement. --- ### **2. Hyperthyroidism / Graves' Disease** - **What is it?** - **Hyperthyroidism** occurs when the thyroid gland produces excessive thyroid hormones, causing an **overactive metabolism**. **Graves' Disease** is an autoimmune disorder that is a common cause of hyperthyroidism. - **Signs & Symptoms:** - **Weight loss** despite increased appetite - **Tachycardia** (rapid heart rate) - **Heat intolerance** and sweating - **Tremors** - **Nervousness, irritability, and anxiety** - **Goiter** (enlarged thyroid) - **Exophthalmos** (bulging eyes in Graves' disease) - **Treatment (Medications):** - **Methimazole** and **Propylthiouracil (PTU)**: Antithyroid drugs that **block the synthesis of thyroid hormones**. - **Beta-blockers** (e.g., **Propranolol**) to manage symptoms like tachycardia. - **Radioactive iodine** therapy to destroy overactive thyroid tissue. - **Surgical thyroidectomy** in severe cases. --- ### **3. Hypothyroidism** - **What is it?** - **Hypothyroidism** is a condition where the thyroid gland **does not produce enough thyroid hormone**, leading to **slowed metabolism**. - **Signs & Symptoms:** - **Fatigue** - **Weight gain** - **Cold intolerance**  - **Constipation** - **Dry skin, hair loss** - **Depression** - **Bradycardia** (slow heart rate) - **Goiter** (enlarged thyroid) - **Treatment (Medications):** - **Levothyroxine** (synthetic T4 hormone) is the primary treatment for hypothyroidism. - **Monitoring**: Blood levels (TSH, T4) should be monitored, especially when starting or adjusting dosage. **Important Points about Levothyroxine:** - Take on an **empty stomach**, **30-60 minutes before breakfast**. - It may take **6-8 weeks** to observe the effects of medication. - **Never switch brands** without consulting a doctor. - Overmedication can lead to symptoms of **hyperthyroidism** (e.g., anxiety, palpitations). --- ### **4. Diabetes Mellitus Type 1 & 2** #### **Type 1 Diabetes (T1DM)** - **What is it?** - An **autoimmune condition** where the pancreas **produces no insulin** due to destruction of beta cells. - **Signs & Symptoms:** - **Polyuria** (frequent urination) - **Polydipsia** (excessive thirst) - **Polyphagia** (increased hunger) - **Weight loss** despite eating normally or more - **Fatigue** - **Blurred vision** - **Elevated blood glucose** (hyperglycemia) - **Treatment (Medications):** - **Insulin therapy** is the cornerstone of treatment. Types of insulin include: - **Rapid-acting** (e.g., **Insulin Lispro** - Onset: 15-30 minutes, Peak: 0.5-3 hours) - **Short-acting** (e.g., **Regular insulin** - Onset: 30 min-1 hr, Peak: 1-5 hrs) - **Intermediate-acting** (e.g., **NPH insulin** - Onset: 1-2 hrs, Peak: 4-14 hrs) - **Long-acting** (e.g., **Insulin Glargine** - Onset: 1-4 hrs, Peak: None) - **Continuous insulin pumps** for some patients. #### **Type 2 Diabetes (T2DM)** - **What is it?** - A metabolic disorder where the body becomes resistant to insulin or does not produce enough. - **Signs & Symptoms:** - **Polyuria**, **Polydipsia**, **Polyphagia** - **Fatigue** - **Blurred vision** - **Slow healing of wounds** - **Frequent infections** - **Elevated blood glucose** (hyperglycemia) - **Treatment (Medications):** - **Sulfonylureas** (e.g., **Glipizide**, **Glyburide**): Increase insulin release from the pancreas. - **Biguanides** (e.g., **Metformin**): Decreases glucose production in the liver, enhances glucose uptake. - **GLP-1 agonists** (e.g., **Liraglutide**), **SGLT2 inhibitors** (e.g., **Canagliflozin**) to improve blood glucose control. - **Insulin** may be required in later stages. **Important Notes:** - **Sulfonylureas** can cause **hypoglycemia**, **weight gain**, and should be **avoided with alcohol** due to a **disulfiram-like reaction**. - **Metformin**: Take with meals to reduce **GI distress**. Monitor for **lactic acidosis** in patients with kidney issues. --- ### **5. Cushing's Disease** - **What is it?** - **Cushing's Disease** is a condition caused by an overproduction of cortisol, often due to a **pituitary tumor** (excess ACTH production). - **Signs & Symptoms:** - **Moon face** (round, puffy face) - **Buffalo hump** (fat accumulation on the upper back) - **Weight gain**, especially in the abdomen - **Hypertension** - **Osteoporosis** - **Easy bruising** - **Muscle weakness** - **Treatment (Medications):** - **Surgical removal** of pituitary tumor or adrenal glands if applicable. - **Corticosteroid inhibitors** (e.g., **Ketoconazole**) to reduce cortisol production. - **Radiation therapy** for inoperable tumors. --- ### **Medications for Diabetes Management** #### **Sulfonylureas** - **Action**: Stimulate **insulin release** from the pancreas. - **Example**: **Glipizide**, **Glyburide**. - **Side Effects**: **Hypoglycemia**, **weight gain**. #### **Biguanides** - **Action**: **Reduces glucose production** in the liver, increases glucose uptake, decreases glucose absorption in the intestines. - **Example**: **Metformin**. - **Side Effects**: **GI distress**, **lactic acidosis** (rare, serious), **B12 deficiency**. #### **Glucagon** - **Action**: **Raises blood glucose** by stimulating the breakdown of glycogen into glucose in the liver. - **Use**: Emergency treatment for **severe hypoglycemia**. - **Side Effects**: **GI distress**. --- ### **Important Points for Diabetes Medications** - **Hypoglycemia Treatment**: Always have a source of glucose (e.g., **glucose tablets**) or a **glucagon kit** available. - **Metformin**: Take **30 minutes before breakfast** to reduce GI side effects. - **Sulfonylureas**: **Avoid alcohol** to prevent a **disulfiram-like reaction** (flushing, nausea, vomiting). --- ### **Summary: Key Medications and Actions** 1. **Levothyroxine** for **Hypothyroidism** – Take on **empty stomach**, monitor for overmedication symptoms (tachycardia, anxiety). 2. **Methimazole & PTU** for **Hyperthyroidism / Graves' Disease** – Block thyroid hormone synthesis, monitor for **agranulocytosis** and **liver injury**. 3. **Hydrocortisone, Prednisone** for **Addison’s Disease** – Replace cortisol, **taper doses** during stress to avoid adrenal crisis. 4. **Sulfonylureas** for **Type 2 Diabetes** – Increase insulin secretion but risk **hypoglycemia**. 5. **Metformin** for **Type 2 Diabetes** – Reduces glucose production in liver, can cause **GI distress**, and **lactic acidosis**. 6. **Insulin** for **Diabetes** – Various forms (Rapid, Short, Intermediate, Long) with different onset/peaks. 7. ** Glucagon** – For **severe hypoglycemia**. --- This concise overview covers the essential information on both the disorders and medications involved. Module 4D GI AND NUTRITION Key Points 1. Medications for Peptic Ulcer Disease (PUD)** #### **Treatment for Peptic Ulcer Disease (PUD)** - **Medications**: - **Histamine Receptor Antagonists (-tidines)** - **Proton Pump Inhibitors (-prazoles)** - **Antacids** - **Sucralfate** - **Antibiotics** (for H. pylori infections) - **Avoid**: - **NSAIDs** - **Steroids** - **Lifestyle Modifications**: - Avoid **smoking**, **alcohol**, and **spicy/acidic foods**. - **GI Bleeding**: Signs include **coffee-ground emesis** and **black, tarry stools**. #### **Histamine Receptor Antagonists (H2 Blockers)** - **Medications**: End in **-tidine** (e.g., **Famotidine**, **Ranitidine**). - **Adverse Effects**: Constipation, diarrhea, nausea. - **Indications**: Treat ulcers, GERD, heartburn, acid indigestion. - **Mechanism of Action (MOA)**: Block H2 receptors, reducing gastric acid secretion and hydrogen ion concentration. - **Patient Education**: Avoid smoking, alcohol, and limit NSAIDs. Notify provider if GI bleeding occurs. #### **Proton Pump Inhibitors (PPIs)** - **Medications**: End in **-prazole** (e.g., **Omeprazole**, **Pantoprazole**). - **Adverse Effects**: Pneumonia, osteoporosis (fractures), rebound acid secretion, **C. difficile** infection, **hypomagnesemia**. - **Indications**: Short-term and long-term treatment of PUD and GERD. - **MOA**: Inhibit the enzyme responsible for gastric acid production. - **Patient Education**: Take before meals in the morning, **notify provider of GI bleed**, do not crush sustained-release forms. #### **Sucralfate (Mucosal Protectant)** - **Adverse Effects**: Constipation. - **Indications**: Treats acute duodenal ulcers, maintenance therapy. - **MOA**: Forms a protective barrier over ulcers. - **Patient Education**: Take 30 minutes before or after antacids, and **do not crush or chew** tablets. #### **Antacids** - **Medications**: Include **Aluminum Hydroxide**, **Magnesium Hydroxide**, **Calcium Carbonate**, **Sodium Bicarbonate**. - **Adverse Effects**: - **Aluminum**: Constipation - **Magnesium**: Diarrhea - **Calcium**: Constipation - **Sodium**: Fluid retention - **Indications**: PUD, GERD, prevention of stress ulcers. - **MOA**: Neutralize gastric acid. - **Patient Education**: Take 1 hour before or after other medications. --- ### **2. Medications for GI Disorders** #### **Antiemetics** - **Dopamine Antagonists (e.g., Promethazine)** - **Adverse Effects**: Extrapyramidal symptoms, sedation, hypotension, anticholinergic effects. - **Indications**: Prevent nausea and vomiting (N/V) from chemotherapy, toxins, or post-surgery. - **MOA**: Blocks dopamine receptors in the CTZ (chemoreceptor trigger zone). - **Serotonin Antagonists (e.g., Ondansetron)** - **Adverse Effects**: Headache, diarrhea, dizziness, prolonged QT interval. - **Indications**: Prevents N/V due to chemotherapy, radiation, or surgery. - **MOA**: Blocks serotonin receptors in the CTZ. - **Cannabinoids (e.g., Dronabinol)** - **Adverse Effects**: Sedation, tachycardia, dissociation. - **Indications**: Used for chemo-induced nausea and vomiting (CINV) and appetite stimulation. - **MOA**: Appetite stimulation and emesis prevention. --- #### **Laxatives** - **Bulk-Forming Laxatives (e.g., Psyllium)** - **Adverse Effects**: Obstruction. - **Indications**: Temporary constipation relief and IBS. - **MOA**: Increases stool bulk and softens stool. - **Osmotic Laxatives (e.g., Magnesium Hydroxide)** - **Adverse Effects**: Toxic magnesium levels, dehydration. - **Indications**: Constipation, bowel prep before surgery. - **MOA**: Draws water into the intestine to increase stool mass. - **Surfactant Laxatives (e.g., Docusate Sodium)** - **Adverse Effects**: Sodium absorption and fluid retention. - **Indications**: Constipation and fecal impaction. - **MOA**: Lowers stool surface tension to allow water to penetrate. - **Stimulant Laxatives (e.g., Bisacodyl)** - **Adverse Effects**: Rectal irritation (if suppository), GI irritation. - **Indications**: Preoperative bowel prep, short-term constipation relief. - **MOA**: Stimulates peristalsis and increases water in the intestine. --- #### **Antidiarrheals** - **Diphenoxylate + Atropine** - **Indications**: Decreases stool frequency and fluid content in diarrhea. - **MOA**: Activates opioid receptors in the GI tract to reduce motility and increase fluid absorption. - **Patient Teaching**: Max dose is 8 tabs/day; drink fluids with electrolytes. --- ### **3. Vitamins, Minerals, & Supplements** #### **Ferrous Sulfate (Iron Supplement)** - **Adverse Effects**: GI distress, teeth staining. - **Indications**: Iron-deficiency anemia, prevention in at-risk populations (e.g., pregnant women). - **MOA**: Provides iron for RBC development and oxygen transport. - **Patient Education**: Can take with food but may decrease absorption; may cause **dark stools**. #### **Folic Acid (Vitamin B9)** - **Indications**: Prevents neural tube defects in pregnancy, treatment of other folate-deficiency conditions. - **MOA**: Essential for DNA production and RBC, WBC, and platelet production. - **Patient Education**: Monitor for effectiveness with improved RBC count and increased energy. --- ### **Deep Dive: Important Medication Details** 1. **Antacids and Precautions**: - Use **caution in clients with kidney impairment** (e.g., **Magnesium Hydroxide**). - **Sucralfate** coats and protects ulcers from further injury. - Patients with **PUD** should avoid **NSAIDs** due to irritation of the stomach lining. 2. **GI Bleed Symptoms**: - **Notify the provider** if symptoms like **coffee-ground emesis** or **black, tarry stools** occur. 3. **Laxative Usage**: - Avoid laxatives in patients with **fecal impaction**, **bowel obstruction**, or **acute surgical abdomen** to prevent perforation. 4. **GI Disorders - Antiemetics**: - **Ondansetron (Serotonin Antagonist)**: Administer before chemotherapy to prevent **CINV**. - **Metoclopramide** (Prokinetic): Avoid alcohol and monitor for **sedation** and **extrapyramidal symptoms**. --- ### **Questions for Review** **Peptic Ulcer Disease** - **Question #1**: What does **famotidine** do for a gastric ulcer? - **Answer**: **c.** It suppresses gastric acid secretion helping the ulcer to heal. - **Question #2**: What should the nurse teach about **sucralfate**? - **Answer**: - **a.** Take four times a day, one hour before meals and at bedtime. - **b.** Avoid antacids within 30 minutes of sucralfate. - **d.** Report GI bleeding to the provider. **GI Disorders** - **Question #3**: What lifestyle modifications should the nurse teach a patient with constipation? - **Answer**: - **a.** Increase intake of fresh fruits and vegetables. - **c.** Exercise regularly. - **d.** Increase fluid intake to 2-3 L/day. - **Question #4**: What is an appropriate teaching point for a client on **diphenoxylate with atropine**? - **Answer**: **b.** As my stools decrease, I will discontinue this medication. --- This summary encapsulates essential information for treating **Peptic Ulcer Disease**, addressing **GI disorders**, and understanding **Vitamins, Minerals, and Supplements**.