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What is hyperlipidemia? what does it lead to?
Elevated levels of fatty substances (lipids) in blood-> athersclerosis (plaque formation) in BV's
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what are the 4 types of lipoproteins? describe them.
- 1. VLDL: bad
- 2. LDL: lower the better
- 3. HDL: higher the better
- 4. chylomicrons
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what do anti-cholesterol drugs usually end in?
-statin
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what is the tx for hyperlipidemia?
- 1. diet low in saturated fats and red meats
- 2. exercise
- 3. lipid lowering agents (anti-cholesterol drugs)
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what are the considerations when using lipid lowering agents?
- 1. monitor liver enzymes b/c the may increase (hepaotoxicity) if so, change or d/c drug.
- 2. niacin (nicotinic acid, OTC drug) helps with lowering lipids, but still need to monitor liver enzymes.
- 3. Niacin "fluching" may be decreased with a low dose of ASA.
- 4. may cause muscle breakdown/pain.
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what does the parasympathetic stimulation do in terms of the GI tract?
- 1. increases GI motility
- 2. increases secretions of bile
- 3. increases secretions of saliva
- 4. increases pancreatic/gastric juices
- PRESENCE OF FOOD IN STOMACH-> RELEASES
- 5. gastrin
- 6. secretin
- 7. cholesystokinin
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what is parasympathetic stimulation in terms of the GI tract?
- 1. decreases GI motility
- 2. decreases secretions
- 3. increases vasoconstriction of intestinal mucosa in BV's
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what is absorbed in the small intestine?
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ducts in duodenum receive bile and pancreatic enzymes to?
- 1. digest food
- 2. neutralize pH
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what is the primary function of the large intestine?
- 1. absorb H2O
- 2. receive undigested material (fiber)
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1. What is Gastro-esophageal reflux disease (GERD)? 2. what is it due to?
- 1. stomach acid hits esophagus
- 2. lower esophageal sphincter incompetence
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what is GERD often secondary to?
hiatal hernia
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What is another name for gastric/duodenal ulcers?
Peptic Ulcer disease (PUD)
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What is PUD?
mucosal lining becomes eroded (80% of time it is duodenum)
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what are the 3 causes of PUD?
- 1. Helicobacter pylori (release toxins which destroy gastric mucosa)
- 2. ASA/NSAID/Steroid use
- 3. idiopathic hypersecretion of stomach acid
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what are the S&S of PUD?
- 1. N&V
- 2. epigastric pain (often 2-3 hrs after meals)
- 3. increase in WBC
- 4. anemia (if chronic bleeding)
- 5. hematemesis (blood in vomit)
- 6. melena (black, tarry stools)
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what are the aggravating factors of PUD?
- 1. ETOH
- 2. caffeine
- 3. spicy foods
- 4. stress
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what is the tx of PUD?
- 1. H + blockers
- 2. antibiotics if H. pylori
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What are antacids?
alkaline (high pH:above 7) agents
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do antacids enhance healing?
no, but provide temporary relief of heartburn
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long term use of antacids usually results in?
"acid rebound" making problems worse
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antacids may bind with other drugs esp.?
tetracycline
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what are some side effects of antacids?
- 1. constipation
- 2. diarrhea
- 3. in high doses, may induce changes in blood ph->alkalosis
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when is not a good time to give antacids?
1-2 hrs prior or after other drugs to avoid interactions
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what are the considerations when administering antacids?
- 1. shake liquid products well before use
- 2. follow administration with a small amount of water/milk to facilitate passage into stomach
- 3. never give simultaneous with antibiotics
- 4. antacids should be administered following meals or a snack
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DO not give people with PUD?
- 1. ASA
- 2. ibuprofen
- 3. naproxen
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what are histamine receptor antagonists?
reduce acid in stomach by interfering with its release from gastric parietal cells (blocks histamine stimulation of them)
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when is histamine receptor antagonists contraindicated?
- 1. pregnancy
- 2. people under 16
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what are proton pump inhibitors?
inhibits H+ release from gastric parietal cells
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what should you monitor people taking cimetidine (Tagamet) for?
- 1. diarrhea
- 2. dizziness
- 3. rash
- 4. CONFUSION
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Any patients taking proton pump inhibitors/H2 receptor antagonist and also taking what drugs should watch the blood serum levels of these drugs?
- 1. digoxin
- 2. phenytoin
- 3. warfarin
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what are the enzymes to promote digestion?
- 1. pancreatic enzymes
- 2. lactase enzymes
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what are lactase enzymes?
break down the sugar lactose into absorbable units
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what are pancreatic enzymes?
derived from animals so watch for reactions!
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What are emetics?
agents used to induce vomiting
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what are emetics used to treat?
food/drug poisonings (unless substance is corrosive/ they are unconscious)
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when syrup of ipecac (emetic) is given, what do you not give?
activated charcoal
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why is syrup of ipecac not given to children under 1 year?
the risk of aspiration
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before emetics can be given, what do you do?
call poison control
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what are antiemetics?
agents given to prevent N&V
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what are the methods of action for antiemetics?
- 1. block Ach receptors
- 2. block histamine (which when released trigger N&V)
- 3. block dopamine and/or seratonin
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what are the delivery routes for antiemetics?
- 1. transdermal
- 2. parenteral
- 3. oral
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(antiemetics) if vomiting occurs the nurses job is to?
prevent aspiration
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(antiemetics) assess clients recieving antihistamine and anticholinergic antiemetics for?
- 1. urinary retention
- 2. narrow-angle glaucoma
- 3. constipation
- 4. HYPERTENSION
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what are stimulant laxatives?
- those which increase motility of GI tract by either:
- 1. irritating the mucosa
- OR
- 2. stimulating smooth mucsle in mucosa
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what is the route for stimulant laxatives?
supposititories
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stimulant laxatives are contraindicated in people with?
- 1. abdominal pain
- 2. nausea
- 3. vomiting
- 4. rectal fissures
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is stimulant laxatives short term or long term therapy?
short term
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what are saline (water/salt mix) laxatives? what do they lead to?
agents with an ionic concentration->blood, thereby "pulling" water from intestinal wall into feces to promote defecation
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saline laxatives/bulk-forming laxatives are contraindicated for people with?
- 1. abdominal pain
- 2. nausea
- 3. vomiting
- 4. other symptoms of appendicitis
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is saline laxatives long term or short term tx?
short term
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what are bulk-forming laxatives?
natural or semisynthetic compounds that absorb fluid and swell in the intestine to promote defecation.
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are bulk-forming laxatives short term or long term?
long term
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how long can it take for bulk-forming laxatives to work?
up to 3 days
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how should bulk-forming laxatives be administered?
mixed with liquid and drink immediately. follow with another glass of liquid.
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what are stool softeners?
detergent type agents which promote mixing of fecal fat with water, making stool softer.
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avoid use of stool softeners for?
longer than 1 week
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how may stool softners be adminstered?
- Mixed with
- 1. fruit juice
- 2. milk
- 3. formula
- to mask taste
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how long can stool softners take to work?
up to 3 days
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stool softner prevents what? but does nto cure it.
constipation
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what are antidiarreals?
drugs which slow intestinal mobitlity
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what are the 2 main types of antidiahrrheals?
- 1. opiods
- 2. anticholergics (inhibit peristalsis)
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what should a patient taking antidiahrheals be monitored for?
CNS depression esp if using other CNS depressants
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what should you monitor in a infant taking antidiarrheals?
body weight
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