Summary
Summary NSG 251 Exam 3 Drugs Study Guide
- Course
- NSG 251
- Institution
- Marian University
Exam 3 Drugs - Drug review info for antiacids, anemia, anti-diarrheal, constipation, antiemetics. *Essential Study Material!!
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DRUG NAMEMedication(s): sulfamethoxazole-trimethoprim
Mechanism:
One
Two
Three
Uses:
One
Two
Three
Interactions/Contraindications:
One
Two
Three
Adverse Effects:
One
Two
Three
Nursing Process:
One
Two
Three
,ANTIACIDS: Gastro / Acid-Controlling
Mechanism:
Base (alkaline) mediated inhibition of the protein-digesting ability of pepsin
Increase in protective lining of the stomach
Increase tone of the lower esophageal (cardiac) sphincter which minimizes acid reflux
o At low doses: Stimulate mucus production
o At low doses: Stimulate prostaglandins
o At low doses: stimulate bicarbonate
Uses:
Symptomatic relief of stomach pain and reflux “heartburn”
Interactions/contraindications:
Allergy
Renal failure: DO NOT USE ANY MAGNESIUM BASED PRODUCT
Caution: Electrolyte disturbances: hypercalcemia
Caution: bowel obstruction: magnesium
Interactions: common mechanisms
o Adsorption and chelation: other drugs are bound to or chemically inactivated reducing or preventing their
therapeutic effects
o Increased stomach pH: increases absorption of basic drugs (benzodiazepines, sympathomimetics, valproic acid)
and decreases absorption of acid drugs (allopurinol, thyroid hormones, digoxin, antihistamines, corticosteroids,
digoxin, aspirin, isoniazid)
o DO NOT GIVE WITH quinolone antibiotics: blocks antimicrobial effect
Adverse effects:
Magnesium: diarrhea
Aluminum and calcium: constipation
Calcium: kidney stones
Systemic alkalosis with OVER USE of any antacid, especially sodium bicarbonate (baking soda)
Calcium can cause acid rebound
Chronic high dose calcium antacids can cause milk-alkali syndrome
Hypercalcemia, headache, nausea, and alkalosis
Aluminum antacids can lead to hypercalcemia and hypophosphatemia
Calcium antacids can cause gas and belching
Nursing Process:
Conduct appropriate history and physical exam with focus of GI tract disorders, bowel pattern, GI related pain
Review current medications and review any available labs
Assess for HTN, heart failure, presence of edema: antacids are high in sodium
Long-term self-medication with antacids may be masking manifestation of a serious underlying condition (such as a
bleeding ulcer, or cancer): encourage occasional use only, if continued use is necessary, advise patient to see their HCP
after 2 weeks of use
Separate antacids by 2 hours from other meds
Pregnancy category A
Many antacids are high in sodium: read labels if the patient is on a sodium restriction
Calcium based antacids may also be used a source of calcium (as for osteoporosis treatment, prevention)
Liquid antacids must be shaken prior to dosing
Assess/report: prolonged constipation/diarrhea, increasing abdominal pain/distension, hematemesis or black tarry
stools
,HISTAMINE 2 RECEPTOR ANTAGONIST (H2 BLOCKERS) – Gastro / Acid-Controlling
Medication(s): cimetidine
Mechanism:
Competitively block the H2 receptor on parietal cells making them less responsive to the effects of histamine,
acetylcholine, and gastrin resulting in reduced hydrogen ions and thereby increasing the pH of the stomach and relief of
symptoms
Uses:
Reduce but do not stop acid secretion in the treatment of GERD, PUD, esophagitis
Control of upper GI bleeding
Prophylaxis of stress ulcers
Interactions/contraindications:
Allergy
Caution: liver/kidney: may need dose adjustment
Interactions: cimetidine has A TON of interactions with other medications: always look at the patient’s medication
profile prior to administration
o Recommendation to switch to famotidine (Pepcid) which has very few drug interactions
Adverse effects:
Good safety profile
Confusion and disorientation may occur in the older adult
Cimetidine may cause impotence and gynecomastia
Hypotension with IV administration, especially if infused too quickly
Headache
Diarrhea
thrombocytopenia
Nursing Process:
Conduct an appropriate history and physical exam with focus of GI tract disorders, bowel pattern, GI related pain
Assess/report: bruising, fatigue, diarrhea, black tarry stools, sore throat, or rash to the HCP
Monitor for mental status changes
Monitor renal and liver labs
Take cimetidine with food
Smoking decreases effectiveness of H2 blockers: encourage patient to reduce use or quit
H2 blockers should be taken 1 to 2 hours BEFORE an antacid
Cimetidine may also be used, with other drugs, to treat allergic reactions
, PROTON PUMP INHIBITORS (PPIs) – Gastro / Acid-Controlling
Medication(s): omeprazole (several in class end in “prazole”)
Mechanism:
Bind directly to the proton pump causing a total blockage of all hydrogen ion secretion from parietal cells
This stops 90% of acid secretion for 24 hours: this is achlorhydric (without acid)
o Can lead to bacterial overgrowth
o Can lead to intestinal metaplasia (a nonadaptive cellular/tissue change)
o Can lead to hip fractures
Does not affect food absorption
Uses:
First line therapy for esophagitis, GERD (poorly responsive to other treatments such as H2 blockers), short term
treatment of active gastric/duodenal ulcers, NSAID induced ulcers, and stress ulcer prophylaxis. Long term maintenance
of healing of erosive esophagitis, and pathologic hypersecretory states
Interactions/contraindications:
Allergy
Interaction: increase serum levels of diazepam and phenytoin
Interaction: increase risk of bleeding with warfarin
Interferes with absorption of digoxin, ampicillin, and iron
Slowed absorption when given with sucralfate
Food slows absorption
Adverse effects:
Over prescribing of PPIs may be linked to GI tract infections due to loss of normal acid mediated microbial protection:
FDA: BOX WARNING: Clostridioides (formerly Clostridium) difficile
Osteoporosis from inhibition of stomach acid necessary for calcium absorption, also PPIs may speed up bone
demineralization: FDA: BOX WARNING: wrist, hip, and spine fractures, pneumonia, and magnesium depletion
Possible link between PPIs and dementia
Nursing Process:
Complete appropriate history and physical exam, focusing on GI:
Ability to swallow (some capsules are LARGE)
Some capsules can be opened and given with small amount of applesauce: check prior to
administration
Joints ROM, muscle strength, history of fractures without trauma
All PPIs can be used with antibiotics to treat H. pylori infection
Can be given orally or capsules opened/diluted in water and given per NG or PEG
NOTE: pantoprazole granules must be given through a NG tube larger than 16 French – clogging will occur with
smaller tubes
Some PPIs come in IV formulation
Give on an empty stomach 30-60 minutes before meals to enhance absorption
For patients with GERD: teach to avoid black pepper, caffeine, alcohol, harsh spices, and extremes in food temperature
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