Page 1547 - Saunders Comprehensive Review For NCLEX-RN

with mechanical obstruction, perforation, or gastrointestinal
hemorrhage

G. Can precipitate hypertensive crisis in clients with

pheochromocytoma
H. Safety in pregnancy has not been established
I. Metoclopramide can cause parkinsonian reactions; if this occurs,
the medication will be discontinued by the health care provider.
J. Anticholinergics, such as atropine, and opioid analgesics, such as
morphine, antagonize the effects of metoclopramide.
K. Alcohol, sedatives, cyclosporine, and tranquilizers produce an
additive effect.
VII. Bile Acid Sequestrants (Box 49-3)
A. Act by absorbing and combining with intestinal bile salts, which
then are secreted in the feces, preventing intestinal reabsorption
B. Used to treat hypercholesterolemia in adults, biliary obstruction,
and pruritus associated with biliary disease
C. With powdered forms, taste and palatability are often reasons for
noncompliance and can be improved by the use of flavored
products or mixing the medication with various juices.

D. Side and adverse effects include nausea, bloating,

constipation, fecal impaction, and intestinal obstruction.
E. Stool softeners and other sources of fiber can be used to abate the
gastrointestinal side effects.

Bile acid sequestrants should be used cautiously in clients with suspected

bowel obstruction or severe constipation because they can worsen these conditions.
VIII. Treating Hepatic Encephalopathy
A. Medication: Lactulose
B. Used in the prevention and treatment of portal systemic
encephalopathy, including hepatic precoma and coma; also used
in the treatment of chronic constipation

C. Promotes increased peristalsis and bowel evacuation,

expelling ammonia from the colon and thus lowering the
ammonia level (normal ammonia reference interval is 10 to
80 mcg/dL [6 to 47 mcmol/L])
D. Improves protein tolerance in clients with advanced hepatic
cirrhosis
E. Administered orally in the form of a syrup or rectally
IX. Pancreatic Enzyme Replacements
A. Pancrelipase
B. Used to supplement or replace pancreatic enzymes and thus
improve nutritional status and reduce the amount of fatty stools (a

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