chamberlain college of nursing nr565 week 7 study guide lesson notes nr 565 week 7 study guide lesson notes latest
2020
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NR 565 (NR565)
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NR565 Week 7 Study Guide _ Lesson Notes
Management of GI Discomfort
Click on each category below to explore its characteristics further.
ANTACIDS
Antacids neutralize acids in the gastrointestinal (GI) tract. Different combinations have
differing acid neutralizing capacities. Sodium bicarbonate and calcium carbonate have
the highest absolute neutrophil count (ANC).
Pharmacodynamics
Antacids neutralize gastric acid in the gastrointestinal (GI) tract. Causing an increased
pH in the stomach and the duodenal bulb. Antacids contain various combinations of
metallic cation.
Metallic cation + basic ion
Common metallic cation
Aluminum
Calcium
Magnesium
Basic anion
Hydroxide
Bicarbonate
Carbonate
Different combinations have differing acid neutralizing capacities.
Sodium bicarbonate and calcium carbonate have the highest absolute neutrophil
count (ANC).
Pharmacokinetics
Aluminum- and magnesium-based antacids are not absorbed with normal routine use.
Chronic use increases absorption by 5%-20%. Renally excreted. Calcium-containing
antacids require vitamin D for absorption. Excreted in feces
Clinical Uses:
Hyperacidity: antacids used for symptomatic relief of heartburn
May take four times per day (QID) or more
Discuss maximum dosages with patient
Peptic ulcer disease
May be used as adjunct to peptic ulcer disease (PUD) triple therapy treatment
, Used after meals and at bedtime
Gastroesophageal reflux disease (GERD)
Antacids are over-the-counter (OTC) and often-used first before patient seeks
care.
May be given every 30 to 60 minutes until symptoms subside
Maintenance after meals and bedtime
Histamine2 receptor antagonists or proton pump inhibitors (PPIs) are first-line
therapy.
Calcium deficiency
Chronic renal failure: 1,000 mg calcium
carbonate daily
Osteoporosis prevention
Men and premenopausal women: 1,000 mg daily
Postmenopausal women: 1,500 mg daily
Doses higher than 2,000 mg/day not recommended
Rational Drug Selection
Combination products have the highest ANC
Sodium content
Cost
OTC
Inexpensive, but may vary
Generics OK
Monitoring
Magnesium level in elderly patients who use magnesium-containing products
chronically
Precautions and contraindications
Abdominal pain of unknown cause
Calcium-based antacids contraindicated if patient is hypercalcemic or has renal
calculi.
Magnesium-based antacids are contraindicated in patients with renal failure or
renal insufficiency.
Aluminum-based antacids should not be used in patients with renal failure on
dialysis.
Sodium content may affect patients with hypertension, congestive heart failure,
or renal failure.
Adverse drug reactions (ADRs)
Magnesium-based antacids may cause diarrhea.
Aluminum- and calcium-based antacids may cause constipation.
, Drug interactions
Antacids have many drug interactions; may affect the absorption of most drugs
Separate antacid administration with other drugs by at least 2 hours.
Administration Tips
Usually taken 1 to 3 hours after meals and at bedtime
Chewable tablets must be chewed.
Antacids affect absorption of other drugs.
Separate by 2 hours.
Do not use antacids without consulting with provider.
Calcium-based antacid absorption is decreased by oxalic acid and phytic acid
and increased by acidic fruit juice.
Patient Education
Contact provider if using longer than 2 weeks.
If you experience extreme pain, cramping or see any blood in your stool contact
your medical provider; these may be symptoms of GI bleed.
Aluminum- and calcium-based antacids cause constipation; May need a stool
softener
Magnesium-based products cause diarrhea.
Lifestyle changes: Stop smoking, elevate head while sleeping, avoid spicy foods,
alcohol, or foods that affect lower esophageal sphincter tone (fatty food,
chocolate, caffeine).
ANTIDIARRHEALS
Diarrhea is commonly treated with over the counter medications and can be resolved
with or without any treatment. Most diarrhea if seen in the clinical setting is caused by
an infection, food or drug ingestion, or inflammatory bowel disease. Infections are either
from food or a drug that the patient has ingested. Most diarrhea does not require
medication but can be use in acute and chronic diarrhea and inflammatory bowel
disease. Clinicians seek to treat the source of diarrhea.
Pharmacodynamics
There are three main classes of drugs used to treat diarrhea. Absorbents (kaolin-pectin
or bismuth subsalicylate) are administered after each loose stool. Opioids are also
utilized in the treatment of diarrhea. Maintaining hydration is of utmost importance in
children and the elderly. Electrolyte solutions are used in infants and young children and
flat soda or water in adults.
Absorbent preparations
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