McKenna's Pharmacology for Nursing, 2e

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P A R T 1 1  Drugs acting on the gastrointestinal system

■ ■ Monitor for adverse effects (GI effects, CNS changes, dermatological effects, respiratory effects). ■ ■ Monitor the effectiveness of comfort and safety measures and compliance with the regimen. ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug and dosage and describe adverse effects to watch for, specific measures to avoid them and measures to take to increase the effectiveness of the drug).

to determine the effectiveness of the therapy and to evaluate for the occurrence of any adverse effects associated with drug therapy. ■ ■ Inspect the skin for lesions, rash, pruritus and dryness to identify possible adverse effects. ■ ■ Assess neurological status, including level of orientation, affect and reflexes, to evaluate for CNS effects of the drug. ■ ■ Inspect and palpate the abdomen to determine potential underlying medical conditions ; assess for changes in bowel elimination and GI upset to identify possible adverse effects. ■ ■ Assess respiratory status, including respiratory rate and rhythm; note evidence of cough, hoarseness and epistaxis, to monitor for potential adverse effects of the drug. Implementation with rationale ■ ■ Administer drug before meals to ensure that the person does not open, chew or crush capsules; they should be swallowed whole to ensure the therapeutic effectiveness of the drug. ■ ■ Provide appropriate safety and comfort measures if CNS effects occur to prevent injury. ■ ■ Monitor the person for diarrhoea or constipation in order to institute an appropriate bowel program as needed . ■ ■ Monitor the person’s nutritional status; use of small frequent meals may be helpful if GI upset is a problem . ■ ■ Arrange for medical follow-up if symptoms are not resolved after 4 to 8 weeks of therapy because serious underlying conditions could be causing the symptoms. ■ ■ Offer support and encouragement to help the person cope with the disease and the drug regimen. ■ ■ Provide thorough teaching, including the drug name and prescribed dosage; the importance of taking the drug whole without opening, chewing or crushing it; signs and symptoms of possible adverse effects and measures to minimise or prevent them; danger signs that need to be reported to the healthcare provider immediately; nutritional measures, such as small, frequent meals; safety measures, such as avoiding driving and getting assistance with ambulation as needed; methods for dealing with constipation or diarrhoea; and the need for periodic monitoring and evaluation, to enhance knowledge about drug therapy and to promote compliance. Evaluation ■ ■ Monitor response to the drug (relief of GI symptoms caused by hyperacidity; healing of erosive GI lesions).

■■ BOX 57.4  Proton pump inhibitors and interstitial nephritis

Acute renal impairment caused by interstitial nephritis is a recognised complication of treatment with omeprazole. Presenting symptoms may be non-specific and include malaise, fever, nausea, lethargy, weight loss, rash and eosinophilia. People known to be taking omeprazole who exhibit these symptoms should undergo urine microscopy and assessment of renal function. If either or both are abnormal, omeprazole should be withdrawn pending nephrology assessment. 1 Interstitial nephritis should also be considered if there is an unexpected rise in serum creatinine. Since publishing information about omeprazole- induced interstitial nephritis in 2000, 1 there have been 21 further cases reported to CARM; nine were reported in 2005 alone. Interstitial nephritis has also been reported with pantoprazole 2 and lansoprazole 3 ; CARM has received three such reports for pantoprazole. This reaction is thought to be rare but proton pump inhibitors are now believed to be the commonest cause of interstitial nephritis in the Auckland region, perhaps due to their widespread use. 4 This suggests that prescribers should be vigilant for this adverse reaction when using omeprazole or other proton pump inhibitors. References 1. Savage, R. (2001). Omeprazole-induced interstitial nephritis. Prescriber Update, 20 (Feb), 11–13. www.medsafe.govt.nz/profs/PUarticles/omeprazole. htm. 2. Pfizer New Zealand Ltd. (2005). Somac (pantoprazole) tablets data sheet. www.medsafe. govt.nz/profs/Datasheet/s/somacHeartBurnRelieftab. pdf. 3. Wyeth (NZ) Limited. (2002). Zoton (lansoprazole) capsules data sheet. www.medsafe.govt.nz/profs/ Datasheet/z/zotoncap.htm. 4. Simpson, I. J., Marshall, M. R., Pilmore H., et al. (2006). Proton pump inhibitors and acute interstitial nephritis—report and analysis of 15 cases. Nephrology , 11(5), 381–385. Source: MEDSAFE. (2006). Prescriber Updates, 27(1) , 3. www. medsafe.govt.nz/profs/PUarticles/watchingbriefsJune06.htm.