NCLEX-RN ATI COMPRHENSIVE

NCLEX-RN ATI COMPRHENSIVE

REVIEW PART 4C PHARMACOLOG Y

Gastrointestinal, Urinary, Immunization, Musculoskeletal

GASTROINTESTINAL MEDICATIONS

• Antacids • Antisecretory/Blocking Agents • Mucosal Protectants • Antiemetics • Antidiarrheals • Stool Softeners/Laxatives

Antacids • Neutralize gastric acid and inactivate pepsin • Aluminum Hydroxide, Magnesium Hydroxide, Sodium Bicarbonate • Uses- peptic ulcers, GERD • Side effects − Aluminum Hydroxide- constipation, hypophosphatemia (too little phosphate) − Magnesium Hydroxide- diarrhea, renal impairment, hypermagnesemia (magnesium can be used as laxative; think Milk of Magnesia) − Sodium Bicarbonate- constipation • Other- take other meds 1hr before/after antacid. DO NOT take for more than 2 weeks

Antisecretory/Blocking Agents • Prevent and block selected receptors in the stomach

• PROTON PUMP INHIBITORS

− Omeprazole, Lansoprazole, Rabeprazole, Esomeprazole − Side effects- increases the risk for osteoporosis, pneumonia in COPD pts.

• H2 BLOCKERS

− Ranitidine, Cimetidine, Nizatidine, Famotidine • Uses- ulcers, GERD • DO NOT use during lactation, caution in COPD pts.

Mucosal Protectants • Sticks to the ulcers upon contact with gastric acid and protects it for 6hrs; does not have a systemic effect • Sucralfate • Uses- ulcers, GERD

• Precaution- renal failure • Give on empty stomach, at least 1hr before meals and 30 minutes apart from antacid

Antiemetics • Uses- postop, chemotherapy, N/V associated with disease process • Promethazine- anticholinergic effects and EPS • Metoclopramide- “ same “ • Ondansetron- headache and EPS • Scopolamine- anticholinergic effects; patch behind ear

• CAUTION IN PTS. W/ CARDIAC DISEASE

*TIP FOR ANTICHOLINERGIC EFFECTS*

“Can’t see, can’t pee. Can’t spit, can’t shit” Meaning= blurred vision, urinary retention, dry mouth, constipation

Antidiarrheals • Diphenoxylate plus Atropine, Loperamide, Paregoric • Side effects- constipation, drowsiness, dry mouth, blurred vision • Contraindications- pt. w/ COPD or IBS • Monitor F/E; no caffeine (increases GI motility)

Stool Softeners/Laxatives • Psyllium- decreases diarrhea (bulk forming) • Docusate Sodium- relieves constipation • Bisacodyl- stimulant • Magnesium Hydroxide- osmotic • Side effects- F/E imbalance, GI irritation, hypermagnesemia, fluid retention • Contraindication- pt. w/ ulcerative colitis and diverticulitis, fecal impaction, bowel obstruction, acute surgical abdomen • Promote regular exercise and regular bowel elimination. Monitor for abuse (b/c laxative help to lose weight). Increase fluids and fiber.

URINARY MEDICATIONS

• Diuretics • Osmotic diuretics • Alpha adrenergic blockers • Anticholinergics • Sexual dysfunction

Diuretics • Uses- pulmonary edema, HTN • LOOP- Furosemide, Bumetanide; THIAZIDE- Hydrochlorothiazide, Chlorothiazide − Side effects for these two- hypovolemia, hypokalemia, hyperglycemia, digoxin & lithium toxicity (dehydration is a risk factor for toxicity), ototoxicity (loop) • POTASSIUM SPARING- Spironolactone, Triamterene − Side effects- hyperkalemia, endocrine effects (like erectile dysfunction or menstrual irregularities) • Monitor I&Os, VS, F/E imbalance, give in AM, increase potassium rich food for loop and thiazide/avoid foods with potassium sparring (salt substitutes have potassium, AVOID)

Osmotic diuretics • Mannitol • Uses-to decrease intracranial pressure, to decrease intraocular pressure, renal failure • Precaution in pt. w/ HF • Side effects- pulmonary edema, F/E imbalance, thirst/dry mouth • Monitor weight, I&O, electrolytes, hypovolemia signs, neuro status

Alpha adrenergic blockers • Tamsulosin (stops smooth muscle contraction in the prostate to improve urinary flow) − Side effects- decrease libido, headache, dizziness, orthostatic hypotension − Precaution- must rule out bladder cancer first w/ other types of hypotensive meds − Take 30 minutes after a meal, at the same time everyday • Bethanechol (increases muscle tone to allow strong start void for post op urinary hesitancy) − Side effects- excessive saliva, abdominal cramps, diarrhea, bradycardia − Precaution- not for pt. w/ urinary tract obstruction, hypotension, decreased cardiac output − Give on empty stomach

Anticholinergics • Decreases muscle spasm and contractions • Oxybutynin, Tolterodine, Darifenacin, Solifenacin, Trospium, Fesoterodine

• Uses- urinary incontinence, urinary urgency/frequency • Precaution- pt. with intestinal obstruction, not with other anticholinergic meds, risk for cognitive impairment for older pt.• Side effects- anticholinergic effect, drowsiness, dyspepsia

Sexual dysfunction • Relaxes muscles in the penis to allow increased blood flow to produce an erection • Sildenafil, Tadalafil, Vardenafil (‘fil’- fill up with blood) • Uses- erectile dysfunction • Contraindication- pt. taking nitrate meds, alpha blocker, antihypertensives, or pt. w/ a history of stroke, uncontrolled diabetes, hypo/hypertension, or HF • Side effects- hypotension, priapism (erection lasting for more than 4 hours), vision impairment, hearing loss (report), headache flushing • Take 1hr before sexual activity, once daily