lOMoAR cPSD| 47061011
NR 293 Week 5, 6, 7 Questions and Answers
100% Verified UPDATED!!!
Week 5 - Nutrition Acid-controlling
drugs:
Either prevent, neutralize, or control the secretion of acid in the stomach. These drugs also
affect how medications are absorbed. Normal pH of stomach acid is 1-4
• Parietal cells → Produces and secrete hydrochloric acid o Three types of receptors:
Gastrin, histamine, Acetylcholine (ACh) if any are stimulated → acid is produced
o Secondary response → activates hydrogen-potassium-adenosine triphosphatase
(ATP) pump
• Chief cells → Secrete pepsinogen which is a precursor to pepsin
• Mucosa cells → Provide a protective coating for the stomach
• Antacids: work by neutralizing acid in the stomach o Calcium containing antacids
(tums)
• Proton pump inhibitors (PPI) → prevent ATP from working within the parietal cell o
Ranitidine (zantac)
• Histamine 2 blockers → block histamine receptors o Pantoprazole (Protonix)
• Hyperacidity (GERD) → acid peptic disorders → H. Pylori infection (bacteria in gastric
tract)
• Smelling, seeing, or tasting food can cause the stomach to secrete acids.
o Lifestyle changes to prevent/reduce heartburn → Changing diet and reducing
stress
Antacids: OTC medication
Raises stomach pH, neutralizes stomach acids, allows ulcers time to heal, provide relief from
s/s of hyperacidity
• Antacids: Contains salt compounds → magnesium, aluminum, sodium, Calcium o
Maalox → aluminum hydroxide & magnesium carbonate o Mylanta → aluminum
hydroxide & magnesium hydroxide
o Tums
o Rolaids → Calcium carbonate
• Magnesium o SE → diarrhea o Excreted by the kidneys o Contraindications: renal
disease
o Nursing considerations: use cautiously in patient with renal disease
• Aluminum o SE → constipation o Excreted in feces o Contraindications: abdominal
pain, no bowel sounds o Nursing considerations: hypercalcemia, hypophosphatemia
• Calcium o SE → constipation/Diarrhea o Excreted in feces, urine, and sweat
o Contraindications: no bowel sounds, renal stones, hypercalcemia
, lOMoAR cPSD| 47061011
o Nursing considerations: milk-alkali syndrome, which is associated
w/hypercalcemia
• Sodium
o SE → flatulence, gastric distention o Excreted by the kidneys o
Contraindications: hypernatremia
o Nursing considerations: metabolic alkalosis if the drug is abused or used over
the long term. Patient education:
o Work within 15 minutes and last up to 4 hours o Should not be taken 1 hour
before or 2 hours after any prescription medications o You can combine two salt
compounds in an antacid to prevent SE from each salt compound.
• Drug interactions:
o Adsorption → reduces ability of the other drug to be absorbed into body o
Chelation → chemical inactivation of other drugs that produces insoluble
complexes
o Increased stomach pH → increase the absorption of basic drugs and decreases
the absorption of acidic drugs
o Increased urinary pH → increases the excretion of acidic drugs and decreases
the excretion of basic drug
Ex. Digoxin → narrow therapeutic range so the change in Absorption can
have an effect on the bioavailability of digoxin.
H2 Receptor antagonists:
• Mechanism of action: H2RAs → blocks H2 receptors of acid producing parietal cells →
reduces hydrogen ion secretion from parietal cells → increases pH of stomach
• Drug names → Suffix -tidine o Cimetidine o Famotidine!!
o Ranitidine
• Side effects → confusion, dizziness, drowsiness, constipation, gynecomastia
• Routes → IV, PO, IM
• Famotidine (Pepcid) o Fewer side effects o IV, PO dosings are the same o Peak IV
0.5-3 hours, PO 1-4 hours
o Duration 6-12 hours IV, PO, IM administration routes o Medication
schedule → 1 hour before or 2 hours after medication
o AE → mental status changes
• Patient education → can be administered at night
• Nursing consideration→ Renal and hepatic diseases should use caution when taking
H2 receptor antagonists
• Older adults → dose should be decreased d/t slower renal function
Proton pump inhibitor (PPI):
Prevent secretion of hydrogen ions out of parietal cells → reducing hyperacidity → treating
GERD and allows GI ulcers to heal
• Newest acid reducing medication on the market and most effective out of the two
above.
, lOMoAR cPSD| 47061011
Indications → heartburn & GI
bleeding o H. Pylori treatment o
Zollinger-ellison syndrome
o Peptic ulcer disease → sometimes used as a prophylactic treatment to prevent
stress ulcers
• Patient assessment → prior to administering o Assess for osteoporosis → long term
can lead to reduced calcium absorption.
Assess for h/o fractures o Assess hepatic
and renal functions of elders
o Assess diet and lifestyle history. Educate on foods and behaviors that
initiate hyperacidity
o During treatment assess elderly population for diarrhea. Possible SE o
High dose or long term use can be associated with C. Diff
Symptoms may present as diarrhea, fever, abdominal pain and nausea
Omeprazole (Prilosec)!!!
o PO → 20 mg → daily → 4-8 weeks o PO → 60-120 mg →
daily → ongoing o Therapeutic effect→ 24 hours o take
20-30 mins before meals
o Metabolized in the liver and excreted
PPI → avoid alcohol in the kidneys
Nursing application: Acid-controlling drugs:
• Famotidine treats symptoms of hyperacidity by preventing parietal cell stimulation from
histamines.
• Calcium carbonate → neutralizes acid in the stomach
• Milk of Magnesia → most likely to cause diarrhea
• Increased stomach pain when stopping calcium carbonate → rebound acidity
• Food ok to eat: fruits, leafy greens, watereat earlier in the day
• Should be avoided: wine, eating before bed, fast food, soda, cheese and dairy, coffee
• Antacids do not prevent the overproduction of acid but NEUTRALIZE acids that are
present.
• Contraindications → known allergy severe electrolyte disturbance, GI distention
Not Contraindications → Pregnancy
Antiemetic and antinausea drugs:
Relieves nausea and vomiting
• Seven categories → Anticholinergics, antihistamines, antidopaminergics, neurokinin
receptor antagonists, prokinetics, serotonin blockers, and tetrahydrocannabinols o
Different mechanisms of action, the majority work by blocking one of the vomiting
pathways → blocking the neurologic stimulus that induces vomiting Indications:
o Anticholinergics → motion sickness, pre-op secretion reduction, N/V
AE’s → dizziness, tachycardia, vision changes, dry mouth, difficulty
urinating, constipation, rash, erythema
o Antidopaminergics → intractable hiccups, N/V
, lOMoAR cPSD| 47061011
AE’s → orthostatic hypotension, tachycardia, HA, vision changes, urinary
retention, dry mouth, N/V, anorexia, and constipation
Interactions → CNS depression other alcohol or other CNS depressants
o Antihistamines (H1) → motion sickness, N/V
AE’s → dizziness, vision changes, urinary retention
Interactions → CNS depressants when given with barbiturates, opioids,
hypnotics, tricyclic antidepressants or alcohol
o Neurokinin antagonists → vomiting associated with chemo
AE’s → hypotension, bradycardia, fatigue, dizziness, diarrhea, abdominal
pain and discomfort
Interactions → induce warfarin and reduce oral contraceptive
effectiveness
o Prokinetics → delayed gastric emptying, gastroesophageal reflux, N/V
AE’s → hypotension, SVT, sedation, restlessness, HA, dry mouth, N/V,
diarrhea
Interaction → Added CNS depression with alcohol o Serotonin
blockers → Post-op vomiting & vomiting associated w/ chemo
Neurologic stimulus - vomiting center (medulla), chemoreceptor trigger
zone (CTZ), GI tract
No significant interactions
AE’s → HA, Diarrhea, rash, bronchospasms, prolonged QT interval o
Tetrahydrocannabinols → vomiting associated w/ chemo
AE’s → drowsiness, dizziness,anxiety, confusion, euphoria, visual
change, dry mouth NO interactions
Serotonin blockers:
Ondansetron works by blocking the serotonin effects at the 5-HT3 receptor sites, which are
located in vagal nerve terminals and chemoreceptor trigger zone of the central nervous system.
• Medication class: Antiemetic
• Ondansetron → given for chemo, radiation, and Post-operative N/V o Routes → PO,
IV, IM
o Therapeutic effect → decrease incidence and severity from N/V after chemo,
radiation and surgery (take before chemo tx begins)
o Contraindications: known allergy, clients with oral disintegrating tablets in
patients w/ phenylketonuria, congenital long QT syndrome, concurrent use of
apomorphine, contraindicated during first trimester of pregnancy d/t increased
incidence of cleft palate in the infant
o Use CAUTION: hepatic impairment, abdominal surgery, phenylketonuria,
pregnancy, lactation, and children under 3 years old. Assess for history
dysrhythmias. o Adverse effects → serotonin syndrome, prolonged QT
interval, HA, dizziness, drowsiness, fatigue, weakness, constipation, diarrhea,
abdominal pain, dry mouth, increase in liver enzymes, steven johnson
syndrome, toxic epidermal necrolysis
o IM - rapid - 40 minutes peak - unknown. Duration o PO/IV - rapid - 15-30 min
peak - 4 -8 hours duration o ½ life →
NR 293 Week 5, 6, 7 Questions and Answers
100% Verified UPDATED!!!
Week 5 - Nutrition Acid-controlling
drugs:
Either prevent, neutralize, or control the secretion of acid in the stomach. These drugs also
affect how medications are absorbed. Normal pH of stomach acid is 1-4
• Parietal cells → Produces and secrete hydrochloric acid o Three types of receptors:
Gastrin, histamine, Acetylcholine (ACh) if any are stimulated → acid is produced
o Secondary response → activates hydrogen-potassium-adenosine triphosphatase
(ATP) pump
• Chief cells → Secrete pepsinogen which is a precursor to pepsin
• Mucosa cells → Provide a protective coating for the stomach
• Antacids: work by neutralizing acid in the stomach o Calcium containing antacids
(tums)
• Proton pump inhibitors (PPI) → prevent ATP from working within the parietal cell o
Ranitidine (zantac)
• Histamine 2 blockers → block histamine receptors o Pantoprazole (Protonix)
• Hyperacidity (GERD) → acid peptic disorders → H. Pylori infection (bacteria in gastric
tract)
• Smelling, seeing, or tasting food can cause the stomach to secrete acids.
o Lifestyle changes to prevent/reduce heartburn → Changing diet and reducing
stress
Antacids: OTC medication
Raises stomach pH, neutralizes stomach acids, allows ulcers time to heal, provide relief from
s/s of hyperacidity
• Antacids: Contains salt compounds → magnesium, aluminum, sodium, Calcium o
Maalox → aluminum hydroxide & magnesium carbonate o Mylanta → aluminum
hydroxide & magnesium hydroxide
o Tums
o Rolaids → Calcium carbonate
• Magnesium o SE → diarrhea o Excreted by the kidneys o Contraindications: renal
disease
o Nursing considerations: use cautiously in patient with renal disease
• Aluminum o SE → constipation o Excreted in feces o Contraindications: abdominal
pain, no bowel sounds o Nursing considerations: hypercalcemia, hypophosphatemia
• Calcium o SE → constipation/Diarrhea o Excreted in feces, urine, and sweat
o Contraindications: no bowel sounds, renal stones, hypercalcemia
, lOMoAR cPSD| 47061011
o Nursing considerations: milk-alkali syndrome, which is associated
w/hypercalcemia
• Sodium
o SE → flatulence, gastric distention o Excreted by the kidneys o
Contraindications: hypernatremia
o Nursing considerations: metabolic alkalosis if the drug is abused or used over
the long term. Patient education:
o Work within 15 minutes and last up to 4 hours o Should not be taken 1 hour
before or 2 hours after any prescription medications o You can combine two salt
compounds in an antacid to prevent SE from each salt compound.
• Drug interactions:
o Adsorption → reduces ability of the other drug to be absorbed into body o
Chelation → chemical inactivation of other drugs that produces insoluble
complexes
o Increased stomach pH → increase the absorption of basic drugs and decreases
the absorption of acidic drugs
o Increased urinary pH → increases the excretion of acidic drugs and decreases
the excretion of basic drug
Ex. Digoxin → narrow therapeutic range so the change in Absorption can
have an effect on the bioavailability of digoxin.
H2 Receptor antagonists:
• Mechanism of action: H2RAs → blocks H2 receptors of acid producing parietal cells →
reduces hydrogen ion secretion from parietal cells → increases pH of stomach
• Drug names → Suffix -tidine o Cimetidine o Famotidine!!
o Ranitidine
• Side effects → confusion, dizziness, drowsiness, constipation, gynecomastia
• Routes → IV, PO, IM
• Famotidine (Pepcid) o Fewer side effects o IV, PO dosings are the same o Peak IV
0.5-3 hours, PO 1-4 hours
o Duration 6-12 hours IV, PO, IM administration routes o Medication
schedule → 1 hour before or 2 hours after medication
o AE → mental status changes
• Patient education → can be administered at night
• Nursing consideration→ Renal and hepatic diseases should use caution when taking
H2 receptor antagonists
• Older adults → dose should be decreased d/t slower renal function
Proton pump inhibitor (PPI):
Prevent secretion of hydrogen ions out of parietal cells → reducing hyperacidity → treating
GERD and allows GI ulcers to heal
• Newest acid reducing medication on the market and most effective out of the two
above.
, lOMoAR cPSD| 47061011
Indications → heartburn & GI
bleeding o H. Pylori treatment o
Zollinger-ellison syndrome
o Peptic ulcer disease → sometimes used as a prophylactic treatment to prevent
stress ulcers
• Patient assessment → prior to administering o Assess for osteoporosis → long term
can lead to reduced calcium absorption.
Assess for h/o fractures o Assess hepatic
and renal functions of elders
o Assess diet and lifestyle history. Educate on foods and behaviors that
initiate hyperacidity
o During treatment assess elderly population for diarrhea. Possible SE o
High dose or long term use can be associated with C. Diff
Symptoms may present as diarrhea, fever, abdominal pain and nausea
Omeprazole (Prilosec)!!!
o PO → 20 mg → daily → 4-8 weeks o PO → 60-120 mg →
daily → ongoing o Therapeutic effect→ 24 hours o take
20-30 mins before meals
o Metabolized in the liver and excreted
PPI → avoid alcohol in the kidneys
Nursing application: Acid-controlling drugs:
• Famotidine treats symptoms of hyperacidity by preventing parietal cell stimulation from
histamines.
• Calcium carbonate → neutralizes acid in the stomach
• Milk of Magnesia → most likely to cause diarrhea
• Increased stomach pain when stopping calcium carbonate → rebound acidity
• Food ok to eat: fruits, leafy greens, watereat earlier in the day
• Should be avoided: wine, eating before bed, fast food, soda, cheese and dairy, coffee
• Antacids do not prevent the overproduction of acid but NEUTRALIZE acids that are
present.
• Contraindications → known allergy severe electrolyte disturbance, GI distention
Not Contraindications → Pregnancy
Antiemetic and antinausea drugs:
Relieves nausea and vomiting
• Seven categories → Anticholinergics, antihistamines, antidopaminergics, neurokinin
receptor antagonists, prokinetics, serotonin blockers, and tetrahydrocannabinols o
Different mechanisms of action, the majority work by blocking one of the vomiting
pathways → blocking the neurologic stimulus that induces vomiting Indications:
o Anticholinergics → motion sickness, pre-op secretion reduction, N/V
AE’s → dizziness, tachycardia, vision changes, dry mouth, difficulty
urinating, constipation, rash, erythema
o Antidopaminergics → intractable hiccups, N/V
, lOMoAR cPSD| 47061011
AE’s → orthostatic hypotension, tachycardia, HA, vision changes, urinary
retention, dry mouth, N/V, anorexia, and constipation
Interactions → CNS depression other alcohol or other CNS depressants
o Antihistamines (H1) → motion sickness, N/V
AE’s → dizziness, vision changes, urinary retention
Interactions → CNS depressants when given with barbiturates, opioids,
hypnotics, tricyclic antidepressants or alcohol
o Neurokinin antagonists → vomiting associated with chemo
AE’s → hypotension, bradycardia, fatigue, dizziness, diarrhea, abdominal
pain and discomfort
Interactions → induce warfarin and reduce oral contraceptive
effectiveness
o Prokinetics → delayed gastric emptying, gastroesophageal reflux, N/V
AE’s → hypotension, SVT, sedation, restlessness, HA, dry mouth, N/V,
diarrhea
Interaction → Added CNS depression with alcohol o Serotonin
blockers → Post-op vomiting & vomiting associated w/ chemo
Neurologic stimulus - vomiting center (medulla), chemoreceptor trigger
zone (CTZ), GI tract
No significant interactions
AE’s → HA, Diarrhea, rash, bronchospasms, prolonged QT interval o
Tetrahydrocannabinols → vomiting associated w/ chemo
AE’s → drowsiness, dizziness,anxiety, confusion, euphoria, visual
change, dry mouth NO interactions
Serotonin blockers:
Ondansetron works by blocking the serotonin effects at the 5-HT3 receptor sites, which are
located in vagal nerve terminals and chemoreceptor trigger zone of the central nervous system.
• Medication class: Antiemetic
• Ondansetron → given for chemo, radiation, and Post-operative N/V o Routes → PO,
IV, IM
o Therapeutic effect → decrease incidence and severity from N/V after chemo,
radiation and surgery (take before chemo tx begins)
o Contraindications: known allergy, clients with oral disintegrating tablets in
patients w/ phenylketonuria, congenital long QT syndrome, concurrent use of
apomorphine, contraindicated during first trimester of pregnancy d/t increased
incidence of cleft palate in the infant
o Use CAUTION: hepatic impairment, abdominal surgery, phenylketonuria,
pregnancy, lactation, and children under 3 years old. Assess for history
dysrhythmias. o Adverse effects → serotonin syndrome, prolonged QT
interval, HA, dizziness, drowsiness, fatigue, weakness, constipation, diarrhea,
abdominal pain, dry mouth, increase in liver enzymes, steven johnson
syndrome, toxic epidermal necrolysis
o IM - rapid - 40 minutes peak - unknown. Duration o PO/IV - rapid - 15-30 min
peak - 4 -8 hours duration o ½ life →
