NR 565 Final Exam Study Guide
I I I I I
Week 7 I
CYP450 Ienzyme IGI Iinteractions: ICimetidine IH2 Ireceptor Iantagonist, IOmeprazole
IPPI, IAlosetron I(IBS-D)
H. I Pylori I Testing: I consider I if I patient I has I GERD I abdomen I pain I unresolved, I starting
Iaspirin Itherapy, Istomach Ior Iduodenal Iulcer, Iafter Itreatment Ifor Ih. Ipylori
H. IPylori ITreatment: I10-14 Iday Iantibiotic Itherapy, IPPI Ior IH2
Preferred Itherapy: Ilow Iresistant Iregion Iclarithromycin-based Itriple Itherapy
(clarithromycin, Iamoxicillin, IPPI). I**PCN Iallergy, Iuse Imetronidazole Ias Isubstitute.
I
High I resistant I region I bismuth-based I quadruple I therapy I (bismuth, I flagyl,
tetracyline, Iwith IPPI Ior IH2RA.
I
If Ipatients Iunable Ito Itake Iall Itherapies Iat Ione Itime, Isequential Itherapy Iis
I option. IPPI Iplus Iamox I5 Idays, Ithen IPPI Iplus Iclarithromycin Iand Itinidazole I5 Idays.
Lifestyle I Habits: I smoking Icessation, Iavoid INSAIDS, Ibland Ifoods.
IBS: I abd I pain I or I discomfort Ithat Icannot I be Iexplained I structurally I or I chemically I for
I12 Iweeks I or Imore Iand Ihas I pain Ir/t I defecation, Ichange Iin Ifreq I or Iconsistency Iof Istool.
psyllium Ifiber, Iprobiotics/prebiotics, Iantibiotics I(rifaximin), Iantispasmodics
(hyoscyamine, Idicyclomine), ITCA Iantidepressants, IIBS-D Iloperamide, ITCA
I
IBS-D I:Alosetron I(Lotronex I– IGI Itoxicity, Inot Iapproved Iin Imen), IEluxadoline
(Viberzi)
I
IBS-C: ILubriprostone I(Amitiza), ILinaclotide I(Linzess)
GERD: I weight I loss, I HOB I elevated I and I sit I upright I after I meals, I avoid I triggering I food
I(citrus Iand Iacidic, Icaffeine, IETOH, Ispicy, I chocolate). I8-week Icourse I of IPPI I once Ia Iday
I before I first I meal. I If I unresponsive, I increase I BID. I Can I add I H2 I receptor I antagonist Iat
Ibedtime Iwith Idaytime IPPI Iwith Inighttime Ireflux. ISafe Iin Ipregnant Ipatients Iif
Iindicated.
Metoclopramide: I“reglan” Iused Ias Ianti-emetic Iby Iblocking Idopamine Ireceptors
Iand I increase I motility. I Used I in I diabetic I gastroparesis I and I GERD. I Off I label I – I hiccups
Iand IN/V Iin Iearly Ipregnancy
Post-Op INausea I or INausea Ir/t Idrugs, Itoxins, Iradiation Itherapy. I AVOID Iwhile
breastfeeding Iand Iin Iolder Iadults Iand IGI Iobstruction/perf/hemorrhage.
I
D/t Ieffect Ion Idopamine I– Itardive Idyskinesia Iand INMS Ican Ioccur. IInteracts Iwith
Idigoxin. I Monitor I for I extrapyramidal I symptoms. I Patients I should I discontinue I and
Inotify Iprovider Iif Ithis Ioccurs. ICan Icause Idrowsiness.
PPI: I short Iterm I use: I hypocalcemia/hypomagnesemia, I community I acquired
Ipneumonia, Ican Ilead Ito Ic-diff, Iacid Irebound, Ifractures. ILong Iterm Inutritional Idef:
, magnesium, I calcium, I b12. I Can I cause I renal I complications, I dementia, I and I bone
Ifractures.
NSAIDs: Ipromote Isecretion Iof Igastric Iacid, Iirritate Imucosa, Isuppress Imucus
Isecretion Iand Ibicarbonate. IPPI Iomeprazole Ican Ibe Iused Iprophylactically. IFor
Itreatment, Ican Iuse IPPI Ior IH2 Ibut IPPI Ipromotes Ibetter Ihealing.
Constipation: I avoid I lubricants I in I older I adults I and I caution I pregnancy.
I Avoid Istimulants Iin Iabdominal Iobstruction, IN/V Iwith Ifever, Iand Iabd Ipain.
Caution I saline I agents I in I renal I dysfunction, I CV I disease, I dehydration, I DM. I Do I not I use
Iin Iolder Iadults Iand IHF.
Patient-Centered Care Across the Life Span
I I I I I
Laxatives
Life Stage I Patient Care Concerns
I I
Infants Docusate, lactulose, and glycerin suppositories have been
I I I I I I
used to treat constipation safely in infants.
I I I I I I I
Children/adolescents Milk of magnesia, mineral oil, senna, docusate, and
I I I I I I I
bisacodyl can be used to treat constipation in children
I I I I I I I I I
and adolescents.
I I
Pregnant women I Laxatives should be used cautiously in pregnancy because
I I I I I I I
gastrointestinal stimulation can induce labor.
I I I I I
Breastfeeding Senna is safe for use during breastfeeding. Data are lacking
I I I I I I I I I
women
I regarding the use of polyethylene glycol and bisacodyl
I I I I I I I I
(Dulcolax); caution is advised.
I I I I
I I I I I
Week 7 I
CYP450 Ienzyme IGI Iinteractions: ICimetidine IH2 Ireceptor Iantagonist, IOmeprazole
IPPI, IAlosetron I(IBS-D)
H. I Pylori I Testing: I consider I if I patient I has I GERD I abdomen I pain I unresolved, I starting
Iaspirin Itherapy, Istomach Ior Iduodenal Iulcer, Iafter Itreatment Ifor Ih. Ipylori
H. IPylori ITreatment: I10-14 Iday Iantibiotic Itherapy, IPPI Ior IH2
Preferred Itherapy: Ilow Iresistant Iregion Iclarithromycin-based Itriple Itherapy
(clarithromycin, Iamoxicillin, IPPI). I**PCN Iallergy, Iuse Imetronidazole Ias Isubstitute.
I
High I resistant I region I bismuth-based I quadruple I therapy I (bismuth, I flagyl,
tetracyline, Iwith IPPI Ior IH2RA.
I
If Ipatients Iunable Ito Itake Iall Itherapies Iat Ione Itime, Isequential Itherapy Iis
I option. IPPI Iplus Iamox I5 Idays, Ithen IPPI Iplus Iclarithromycin Iand Itinidazole I5 Idays.
Lifestyle I Habits: I smoking Icessation, Iavoid INSAIDS, Ibland Ifoods.
IBS: I abd I pain I or I discomfort Ithat Icannot I be Iexplained I structurally I or I chemically I for
I12 Iweeks I or Imore Iand Ihas I pain Ir/t I defecation, Ichange Iin Ifreq I or Iconsistency Iof Istool.
psyllium Ifiber, Iprobiotics/prebiotics, Iantibiotics I(rifaximin), Iantispasmodics
(hyoscyamine, Idicyclomine), ITCA Iantidepressants, IIBS-D Iloperamide, ITCA
I
IBS-D I:Alosetron I(Lotronex I– IGI Itoxicity, Inot Iapproved Iin Imen), IEluxadoline
(Viberzi)
I
IBS-C: ILubriprostone I(Amitiza), ILinaclotide I(Linzess)
GERD: I weight I loss, I HOB I elevated I and I sit I upright I after I meals, I avoid I triggering I food
I(citrus Iand Iacidic, Icaffeine, IETOH, Ispicy, I chocolate). I8-week Icourse I of IPPI I once Ia Iday
I before I first I meal. I If I unresponsive, I increase I BID. I Can I add I H2 I receptor I antagonist Iat
Ibedtime Iwith Idaytime IPPI Iwith Inighttime Ireflux. ISafe Iin Ipregnant Ipatients Iif
Iindicated.
Metoclopramide: I“reglan” Iused Ias Ianti-emetic Iby Iblocking Idopamine Ireceptors
Iand I increase I motility. I Used I in I diabetic I gastroparesis I and I GERD. I Off I label I – I hiccups
Iand IN/V Iin Iearly Ipregnancy
Post-Op INausea I or INausea Ir/t Idrugs, Itoxins, Iradiation Itherapy. I AVOID Iwhile
breastfeeding Iand Iin Iolder Iadults Iand IGI Iobstruction/perf/hemorrhage.
I
D/t Ieffect Ion Idopamine I– Itardive Idyskinesia Iand INMS Ican Ioccur. IInteracts Iwith
Idigoxin. I Monitor I for I extrapyramidal I symptoms. I Patients I should I discontinue I and
Inotify Iprovider Iif Ithis Ioccurs. ICan Icause Idrowsiness.
PPI: I short Iterm I use: I hypocalcemia/hypomagnesemia, I community I acquired
Ipneumonia, Ican Ilead Ito Ic-diff, Iacid Irebound, Ifractures. ILong Iterm Inutritional Idef:
, magnesium, I calcium, I b12. I Can I cause I renal I complications, I dementia, I and I bone
Ifractures.
NSAIDs: Ipromote Isecretion Iof Igastric Iacid, Iirritate Imucosa, Isuppress Imucus
Isecretion Iand Ibicarbonate. IPPI Iomeprazole Ican Ibe Iused Iprophylactically. IFor
Itreatment, Ican Iuse IPPI Ior IH2 Ibut IPPI Ipromotes Ibetter Ihealing.
Constipation: I avoid I lubricants I in I older I adults I and I caution I pregnancy.
I Avoid Istimulants Iin Iabdominal Iobstruction, IN/V Iwith Ifever, Iand Iabd Ipain.
Caution I saline I agents I in I renal I dysfunction, I CV I disease, I dehydration, I DM. I Do I not I use
Iin Iolder Iadults Iand IHF.
Patient-Centered Care Across the Life Span
I I I I I
Laxatives
Life Stage I Patient Care Concerns
I I
Infants Docusate, lactulose, and glycerin suppositories have been
I I I I I I
used to treat constipation safely in infants.
I I I I I I I
Children/adolescents Milk of magnesia, mineral oil, senna, docusate, and
I I I I I I I
bisacodyl can be used to treat constipation in children
I I I I I I I I I
and adolescents.
I I
Pregnant women I Laxatives should be used cautiously in pregnancy because
I I I I I I I
gastrointestinal stimulation can induce labor.
I I I I I
Breastfeeding Senna is safe for use during breastfeeding. Data are lacking
I I I I I I I I I
women
I regarding the use of polyethylene glycol and bisacodyl
I I I I I I I I
(Dulcolax); caution is advised.
I I I I
