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Module 12 Pharm

Terms in this set (31)

-A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach's inner layer, producing an ulcer. Treatment of H. pylori includes 10-14 day course of proton pump inhibitor and the antibiotics clarithromycin and either amoxicillin or metronidazole. There other antibiotics used, but this is the most common combination. It's not clear how H. pylori infection spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.

-Regular use of certain pain relievers. Taking aspirin, as well as certain over-the-counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit COX 1. The purpose of Cox 1 is to protect the stomach lining, by inhibiting the action of COX 1, NSAIDs can irritate or inflame the lining of the stomach and small intestine. These medications include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox, others), ketoprofen and others. They do not include acetaminophen (Tylenol).Peptic ulcers are more common in older adults who take NSAID's or in people who take these medications for osteoarthritis.

-Other medications. Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin can greatly increase the chance of developing ulcers.

-Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.

-Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.

-Have untreated stress.

-Eat spicy foods.

-Symptoms: Gnawing, aching pain after eating, burning epigastric pain, feeling full, belching, or indigestion. If the ulcer is bleeding, dark tarry stools and coffee ground emesis.
Assessment:
-Assess bowel sounds
-Assess ability to swallow (with psyllium, because if they have trouble swallowing, this could serve as a contraindication)
-Assess for diagnosis of bowel obstruction, or if the patient has undiagnosed abdominal pain (should not use laxatives if a true obstruction is present)
-Assess fluid and electrolyte status

Implementation:
-Bulk-forming-Psyllium, mix in 8 ounces of water or juice, stir and administer immediately, follow with 8 ounces of water. Do not administer as a dry powder
-Emollients-docusate sodium or docusate calcium, give as prescribed, commonly scheduled after surgery to prevent straining during defecation
-Osmotic-lactulose-if giving to decrease ammonia level in liver disease patient, goal is 3-4 stools per day, contact prescriber once goal is met if no parameters provided.
-Osmotic- polyethylene glycol- administer full amount (3-4 liters) as bowel prep. Stool should be transparent prior to colonoscopy.
-Saline laxatives-monitor electrolytes, especially magnesium. If abused or poor renal function, hypermagnesemia can occur.
-Stimulant-bisacodyl, if given rectally, be sure to know how to give a suppository, monitor for electrolyte imbalances, especially hypokalemia or hypocalcemia.

Patient teaching:
-Take any laxative as prescribed or as recommended on package insert (for OTC medications)
-Do not take psyllium dry, take mixed in 8 ounces of water, followed by 8 ounces of water.
-Chronic use of laxatives can lead to megacolon and electrolyte imbalances. Use nonpharmacologic methods to relieve constipation before using laxative

Evaluation:
-The patient pooped.If it is polyethylene glycol- we can see through the poopIf it is lactulose for liver failure- the patient has 3-4 stools per day and the ammonia level decreases.