Test Bank for Mosby-s Fundamentals of Therapeutic Massage, 27th Edition by Sandy Fritz.pdf

R
RABEprazole (Rx) e


(rab-ee-pray′zole)
Aciphex, Aciphex Sprinkle, Pariet e e e e


Func. class.: Proton pump inhibitor Che
e e e e e e


m. class.: Benzimidazole
e e


Do not confuse: Aciphex/Aricept/Accupril RABEprazole/ARIPiprazole
e e e e




ACTION:
Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in the gastr
e e e e e e e e e e e


ic parietal cell; characterized as a gastric acid pump inhibitor, since it blocks the final step of aci
e e e e e e e e e e e e e e e e e


d production
e




Therapeutic outcome: e



Absence of duodenal ulcers; decreased gastroesophageal reflux
e e e e e e




USES:
Gastroesophageal reflux disease (GERD), severe erosive esophagitis, poorly responsive systemi
e e e e e e e e e


c GERD, pathologic hypersecretory conditions (Zollinger-
e e e e e


Ellison syndrome, systemic mastocytosis, multiple endocrine adenomas); treatment of duodena
e e e e e e e e e


l ulcers with or without antiinfectives for Helicobacter pylori; daytime, nighttime heartburn
e e e e e e e e e e e




Pharmacokinetics

Absorption 50%
Distribution Protein binding 96.3% e e




Metabolism Liver, extensively by CYP2C19
e e e e
Copyrighte©e2023.eMosby.eAllerightsereserve




Excretion Kidneys, feces, metabolites e e




Half-life 1-2 hr e




Pharmacodynamics
d.




Skidmore-Roth,eL.e(2023).eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-booke:eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-
book.eMosby.e Createdefromegeorgebrown-ebookseone2024-07-10e17:08:20.

, Unknown


CONTRAINDICATIONS
Hypersensitivity to this product or proton pump inhibitors (PPIs) e e e e e e e e




Precautions:
Pregnancy, breastfeeding, children, e e e


Asian patients, diarrhea, geriatric patients, gastric cancer, hepatic/GI disease, IBS, osteoporosi
e e e e e e e e e e e


s, pseudomembranous colitis, ulcerative colitis, vit B12 deficiency
e e e e e e e




DOSAGE AND ROUTES e e




Healing of duodenal ulcers e e e


Adult: PO 20 mg/day × ≤4 wk, to be taken after breakfast
e e e e e e e e e e e




Erosive esophagitis/GERD e


Adult: PO Delayed release tabs 20 mg/day × 4-8 wk
e e e e e e e e e


Adolescent and child ≥12 yr: PO Delayed release tabs 20 mg/day up to 8 wk, may use an addition
e e e e e e e e e e e e e e e e e e


al course
e


Child 1- e


11 yr (≥15 kg): PO (sprinkle) 10 mg qday up to 12 wk; (<15 kg) 5 mg qday up to 12 wk; may increa
e e e e e e e e e e e e e e e e e e e e e e e


se to 10 mg qday if needed
e e e e e e




H. pylori eradication
e e



Adult: PO 20 mg bid × 7 days with amoxicillin 1 g bid × 7 days with clarithromycin 500 mg bid
e e e e e e e e e e e e e e e e e e e e e


× 7 days
e e




Available forms: e


Del rel tabs 20 mg; delayed release caps 5, 10 mg
e e e e e e e e e e




ADVERSE EFFECTS e e




CNS:
Headache, dizziness e
Copyrighte©e2023.eMosby.eAllerightsereserve




EENT:
Tinnitus, taste perversion e e




GI:
Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid regurgitation, abdomi
e e e e e e e e e


nal swelling, anorexia, Clostridium difficile–
e e e e
d.




associated diarrhea, hepatitis, hepatic encephalopathy e e e e




Skidmore-Roth,eL.e(2023).eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-booke:eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-
book.eMosby.e Createdefromegeorgebrown-ebookseone2024-07-10e17:08:20.

, MISC:
Back pain, infection, arthralgia, myalgia, osteoporosis, fractures, Stevens-Johnson syndrome
e e e e e e e e




INTERACTIONS

Individual drugs e




Digoxin, methotrexate, nelfinavir/omeprazole: increased levels of each of these products
e e e e e e e e e


Ketoconazole, itraconazole, iron salts, atazanavir/ritonavir, ampicillin, cycloSPORINE: decr
e e e e e e e


eased levels of each of these products
e e e e e e


Calcium carbonate, sucralfate, vitamin B12: decreased rabeprazole levels Clarithromycin,
e e e e e e e e e


phenytoin: increased levels of rabeprazole e e e e


Warfarin, clopidogrel: increased bleeding risk, monitor PT, INR
e e e e e e e




Drug classifications
e




Benzodiazepines, antacids, other proton pump inhibitors, H2 blockers: increased levels of r
e e e e e e e e e e e


abeprazole
Protease inhibitors: Decreased level of protease inhibitors
e e e e e e




Drug/herb

St. John’s wort: decreased levels of rabeprazole
e e e e e e




Drug/lab test e




Decreased: magnesium e




NURSING CONSIDERATIONS e




Assessment

• Assess GI system: bowel sounds q8hr, abdomen for pain and swelling, anorexia
e e e e e e e e e e e


• CDAD may occur with most antibiotic therapy; assess for watery diarrhea, abd
e e e e e e e e e e e


ominal pain, fever, may occur several weeks after treatment concludes
e e e e e e e e e


• Vitamin B12 deficiency/cyanocobalamin/hypomagnesemia: may occur several w
e e e e e e


eeks after treatment concludes; use magnesium, vit B12, cyanocobalamin suppleme
Copyrighte©e2023.eMosby.eAllerightsereserve




e e e e e e e e e


nt; if severe, discontinuing of product may be needed
e e e e e e e e


• Monitor hepatic enzymes: AST, ALT, increased alkaline phosphatase during
e e e e e e e e


treatment
• Assess for low magnesium level: tremors, muscle soreness, spasms, anxiety, change in h
e e e e e e e e e e e e


eart rate, palpitations, obtain magnesium level
e e e e e
d.




Skidmore-Roth,eL.e(2023).eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-booke:eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-
book.eMosby.e Createdefromegeorgebrown-ebookseone2024-07-10e17:08:20.

, • Obtain susceptibility testing if H. pylori treatment is ineffective; another antiinfective ma
e e e e e e e e e e e


y be needed
e e


• Osteoporosis/fractures: May occur with prolonged high- e e e e e


dose use, usually in those 50 yr, make sure adequate vitamin D and calcium are taken
e e e e e e e e e e e e e e e


• Beers: Avoid scheduled use >8 wk in older adults unless for high-risk patients
e e e e e e e e e e e e




Patient problem
e




Pain (uses) I e e




mplementation P e




O route
e




• Do not break, crush, or chew del rel tab
e e e e e e e e


• Give after breakfast daily with a full glass of water, without regard to food
e e e e e e e e e e e e e


• Delayed-
release capsule: Open, use on a spoonful of applesauce or liquid, give immediately, (wi
e e e e e e e e e e e e e


thin 15 min) 2h before a meal; do not crush, chew delayed-release product
e e e e e e e e e e e e




Patient/family education e




• CDAD: Advise patient to report severe diarrhea; product may have to be disc
e e e e e e e e e e e e


ontinued
• Inform diabetic patient that hypoglycemia can occur; monitor blood glucose closely
e e e e e e e e e e


• Caution patient to avoid driving and other hazardous activities until response to product is
e e e e e e e e e e e e e


known, take delayed release tab whole, do not cut, break; that cap should be opened and
e e e e e e e e e e e e e e e e e


sprinkled on food (applesauce), to take within 15 min and 30 min before a meal
e e e e e e e e e e e e e e


• Caution patient to avoid alcohol, salicylates, NSAIDs; may cause GI irritation
e e e e e e e e e e


• Advise patient to wear sunscreen, protective clothing to prevent burns
e e e e e e e e e


• Advise patient to notify prescriber if pregnancy is planned or suspected
e e e e e e e e e e


• Advise patient that fractures may occur with use > 1 yr
e e e e e e e e e e




Evaluation

Positive therapeutic outcome
e e
Copyrighte©e2023.eMosby.eAllerightsereserve




• Absence of epigastric pain, swelling, fullness; decreased symptoms of GERD after 4-
e e e e e e e e e e e


8 wk e e




raloxifene (Rx) e


(ral-ox′ih-feen)
Evista
d.




Skidmore-Roth,eL.e(2023).eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-booke:eMosby'sedrugeguideeforenursingestudentsewitheupdatee-ee-
book.eMosby.e Createdefromegeorgebrown-ebookseone2024-07-10e17:08:20.