Dec 26, 2022
Video OER - GI Pharmacology Case Studies
In this episode, we go into the pharmacology of the Gastrointestinal (GI) system and some relevant case studies. You can find all the GI episodes here at https://www.memorizingpharm.com/oer
Find the book here: https://geni.us/iA22iZ
and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd
Here is the Link to my Pharmacy Residency Courses: residency.teachable.com
Auto Generated Transcript:
Welcome to the Memorizing Pharmacology podcast. I’m Tony Guerra, pharmacist and author of The Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let’s get started with the show. Hey, welcome to the Memorizing Pharmacology podcast. We’re going to be talking about GI case studies today in Pharmacology. I’m Tony Gary, your host, and let’s just get started.
So, we’re gonna actually go all the way to 7.3 which is our critical thinking activity. A patient who underwent surgery recently has a medication order for daily pantoprazole. The nurse reviews the patient’s medical history and finds no history of GERD or peptic ulcer disease. The patient does not report any symptoms of heartburn, stomach pain, or sour stomach. The nurse reviews The Physician orders for an indication for this medication before calling the provider to clarify what is the likely indication for this drug therapy for this patient.
So let’s start there okay so this is an excerpt from Memorizing Pharmacology Relaxed Approach second edition and we see pantoprazole is here with the brand name Protonix. Many students will only memorize the generic names because that’s all that’s going to be required on for example the NCLEX but it actually makes there’s two reasons to memorize brand names one it’s easier to know what it’s for and two if you’ve ever tried to remember somebody’s name and you try to remember their first and last name it’s always easier.
So when I’m taking role for the class and you know we class start classes again here in January I’m going to always put the first and last name and I’m going to take the time to learn their first and last name and although I’ll probably only address them by their first name it just is so much easier for me to remember their name with the first and last.
So here we are in pantoprazole Protonix we see that prezol is the ending and that’s for a proton pump inhibitor something that makes it so that we have less acid in the stomach and the brand name is protonic so it mixes protons that’s where the name came from where it gets rid of protons and pantoprazole like esomeprazole or beprazole comes in an IV form but the most important thing is that now we know what it does but we’re not necessarily sure why it’s there for this particular patient.
So we know it stops proton pumps and that it reduces acid so let’s go back to that case and the patient has no symptoms they don’t have heartburn they don’t have stomach pain they don’t have sour stomach why in the world are there are they on you know this medication well the key is actually here they underwent surgery and because they underwent surgery there’s a stress response where they might get a stress ulcer and by suppressing that HCL or hydrochloric acid that’s why we’re using it we’re trying to avoid stress ulcers.
Alright let’s go on to the next one anti-diarrheal medication a number critical thinking activity 7.4 a a patient has been prescribed loperamide for diarrhea associated with gastroenteritis patients begins to complain of heart palpitation what is the nurse’s best response and then we’ll talk about two what child Aid 6 has diarrhea the mother asked the nurse what OTC medications she can provide her child to help resolve the diarrhea what’s the nurse’s best response.
So let’s go back to the book again and we’ll go to the anti-diarrheals here and we see loperamide and the brand name is imodium so loperamide doesn’t have an ending or a stem that’s going to be useful it’s in a mide but that’s just a chemistry term that’s not really going to help us but what you can do is you look at loperamide and you see low Lo and then per which is the first part of peristalsis Is a way to think of an anti-diarrheal that will slow down peristalsis and will help prevent diarrhea. Also, Imodium is like the word immobile and it is really immobilizing the bow for a little while to prevent that diarrhea as well. So two mnemonics there to help you remember it. So we go back to the question here and what is the deal with the heart palpitations? We know that the patient is taking something for diarrhea. It’s meant for cons it’s meant to actually create a more constipating effect but now we know what to do now we know what to look for and there is a black box warning on low paramide that an abnormal heart rhythm can happen so the nurse will do an assessment. I want to make sure we have understand heart rhythm and heart rate and then obviously contacting the provider is key to provide those results.
Now this age six child it kind of depends if the child is in you know having severe multiple diarrhea over the course of the day that’s a very different thing where the patient might become very dehydrated and that’s a real concern but if this is just a one-time thing maybe we’re thinking about something like adding yogurt which is you know a good source of probiotics or something like that it just kind of really depends and the big thing I want you to take away is that diarrhea is not a disease it is simply a symptom and so if it is a symptom something else is probably going on if just the one-time thing no problem little yogurt that’s fine but if it’s happening more than once we really want to kind of think about contacting a provider.
Let’s go to 7.4 B okay so this is our third of the four cases we’ll do today. A patient went under underwent hip surgery two days ago I was not had a bowel movement since before admission. The patient is receiving Oxycontin ER 10 milligrams every 12 hours an oxycodone five milligrams every four hours for pain. Patient describes abnormal discomfort and the nurse finds decreased bowel sounds in all quadrants. Nurse notifies The Physician follows the bowel protocol and administers docusate sodium to the patient.
One, what are the potential causes of constipation that should be addressed for the patient? Two, what is the mechanism of action for docusate? Three, the patient asks how quickly the medication will work what is the nurse’s best response? Four, what other preventative measures for constipation should the nurse teach the patient? And then if docusate is not effective within 24 hours what other medications can the nurse anticipate to be ordered?
Alright so we’ve got quite a bit to unpack here but let’s let’s kind of go back um so this is a bit of an error to put the not caps here to show that Oxycontin ER is a brand name and that’s this is a long acting opiate and then oxycodone is a short-acting one for breakthrough pain so you’ve got a long-acting opiate and a short-acting one and that amount of opioids is certainly going to cause issues with constipation so we’ve kind of got what’s going on um with that so the opiates for sure and there might be some side effects of anesthesia, the fact that they’re not really moving around they’re sedentary and that you know you’re not really going to take a ton of I can drink a ton of water eat a lot of food um just after surgery so all of those things really kind of come together to necessitate this docusate so the potential causes of constipation that should be addressed you know the opiates are we using the lowest amount possible uh you know are we adding the docusate are they taking it on time and so forth how does the docusate work well it.
It really helps to go back to the mnemonics here and what docusate sodium you would want to think of docusate rhyming with penetrate because what it really does is help water penetrate the bowel and soften the stool. That’s how it works and then you can also think of the brand name Colace that improves the Colon’s pace. So again, I know that you don’t have to have the brand name for many of your exams but makes it so much easier to know what this is for and also remember how to use it but going back to that question.
Docusate softens the stool and then that way we’re going to get more bowel movements. This is a real disappointment for patients or how quickly does it work it can take half a day but it can also take up to three days and the patient will likely have been given this pretty quickly but they’re going to be a bit uncomfortable for a while and they might be asking for something more rapid and it’s tough to say well you know right now we’re just going to kind of stick with this make sure we’re drinking enough water making sure we’re moving around and doing those things but this is the gentlest kind of best way to work with these constipation issues.
So the other preventative measures for constipation would include you know kind of increasing that fluid increasing the fiber moving around and again using the fewest opiates that you need to still provide pain relief for the patient. And then how do we know when to kind of go with docusate you know so if it doesn’t work in a day well it can take up to three days but you can add something a little bit stronger maybe like bicycodile suppository or something like that which would only take only an hour or two or you could use an enema and those go 15 minutes but really you know a little bit of patience here is really good because you know some things really happened you really just kind of need to get moving around need to make sure you get the water in and then things can kind of get going again.
Last one 7.5 antiemetics so critical thinking activity 7.5 a nurse is caring for a patient who underwent surgery earlier today and is experiencing nausea and vomiting. The original post-op orders included Prochlorperazine but the patient continues to experience vomiting despite receiving this medication. Nurse calls the provider receives a new order for ondansetron orally dissolving tablets eight milligrams three times daily as needed. One, how will the nurse assess for symptoms of dehydration? Two, when administering the medication, the patients say this tastes terrible why can’t I have a normal pill to swallow what’s the nurse’s best response? And then what other measures should the nurse teach the patient reduce the feelings of nausea and avoid dehydration?
Okay well let’s take a minute to unpack this I’ll take a minute and go back to memorizing pharmacology. The well this is the Kindle book but most people like the audiobook they’ve got the British narrators we’ll start with prochloroperazine okay so Prochlorperazine is Compazine and it’s a phenotizing that we used as an antiemetic um again it really is more about um you know making sure that the patient understands what the medications are for and what we’re trying to do but ondansetron is that next step up.
And the on Dance Tron does have that ending, the Citron ending, and you may see ODT which doesn’t taste bad because it’s an orally disintegrating tablet and that’s a choice that might make things a little bit easier for someone that’s so sensitive to taste. It does affect neuro, the neurotransmitter serotonin which is located in the GI tract and it’s kind of neat that in the word in dancetron if you’re on dancetron if you’re one of those people that likes word scrambles it’s got every letter but the letter I from serotonin which might have been how they named it.
So going back to the question so now we know these are two antiemetics kind of doing a stepwise process here uh. The first thing we would do in making sure that the patient is not dehydrated, you know we want to check what they’re you know to make sure they’re not hypotensive make sure their heart rate is not tachycardic uh make sure that they do have you know a good urine output um and then check the skin for tenting uh and then you know checking the mucous membranes for dryness any or all of those can kind of let us know okay where are we looking in terms of dehydration.
In terms of uh, you know, the taste terrible if they have a tablet that dissolves um, The ODT that makes it a lot easier for the patient and it really does dissolve super quickly and then what? Other measures to reduce feelings of nausea and avoid dehydration sometimes include giving the medication before a meal, which may not cause as much of an issue with the nausea. Depending on the diet, if you’re a little bit more on the bland side rather than the take-out spicy side, you’re in much better shape. Again, more fluids will take care of the dehydration but that also might make them feel a little bit more nauseous. So the speed at which you rehydrate them, making sure that they’re maybe taking sips rather than just downing something to get rehydrated.
Okay so let’s go back just to the book itself and we’ll kind of go here on Amazon just so you can kind of see. This second edition of Memorizing Pharmacology was meant to be more of a friendly textbook as it were. Most people don’t get the paperback, most people get the Kindle because they like to be able to search. It’s kind of nice when you’re doing your homework, you’re trying to find something and that one’s I think 10 bucks but the audiobook if you’ve never had it before and you just kind of want to get better at pharmacology over the weekend or on the wave to and from school.
The way they work it is if you go to Audible or if you go to Amazon.com and I own it so it’s not going to be up there but they’ll let you have it for free and then make sure you know if you don’t want to be part of that Audible thing you cancel within the first 30 days. But I found that a lot of my students when they make pharmacology part of their day morning and night because this is in a specific order starts with gastrointestinal musculoskeletal and so forth that if they kind of keep hearing it and that they don’t have this kind of jerky I’m going to do some Farm on Tuesday some Farm on Friday or all farm on Sunday night that’s what causes all of that anxiety.
By doing a little bit each day and just kind of embracing it I think it works well so a lot of people will say you know I’m not good at farm and what we really want to say is well I’m not really good at Farm yet. It’s something I got from a chemistry professor here which I’ll have an interview for you a little bit later but you’re just not good at pharmacology yet and it takes some time to do that and it’s really hard to do it if you’re doing it once a week or twice a week and that you’re not really kind of embracing it and listening to it each day and getting the rhythm of it.
Because what happens is that once you kind of get GI, you’re still going to get a couple of other ones for example the musculoskeletal. You’ll have talked a little bit about opioids opiates because you’re going to have to talk about how to deal with the constipation and then when you get to the opiates like oh yeah yeah I remember when I was doing that GI chapter I remember the medications for the opiates and then now you kind of get into musculoskeletal and you think about okay well diazepam is one of those ones that affects muscles but isn’t that used for isn’t that used for seizures and stuff in neuro.
And as you’re going through each chapter, it just makes it a little bit easier for you. So again, I did spend a lot of money on a British narrator because I get it pharmacology is not the most exciting for many people and by having that British narrator, it just kind of elevates it a little bit makes it more pleasant to get through.
So alright well that’s it for this week. The GI pharmacology cases hopefully those are helpful for you and I will bring back a new pathophysiologic class next week. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com again. You can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile thanks again for listening.
Like to learn more?
Find my book here: https://geni.us/iA22iZ
and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd
Here is the Link to my Pharmacy Residency Courses: residency.teachable.com