stomach meds

3 gastric glands in stomach

• Parietal cells - Produce HCL (keeps stomach acidic)

• Chief cells - Protein breakdown (produce pepsinogen -> pepsin -> acid)

• Mucous cells - Protect stomach lining from acid and pepsin/prevents ulcers

what is peptic ulcer disease

• Gastric or duodenal ulcers

• Eat through stomach lining

• Usually caused by H. Pylori

what is H. pylori

• Found in ulcer patients

• Treated with combination therapy - usually a 10-14 day treatment

what is stress-related mucosal damage

• GI lesions

• Usually found in ICU patients - start developing within first 24 hours

• They form because decreased blood flow, mucosal ischemia, or reperfusion injuries

• The risk increases if the PT has an NG tube or on a ventilator

what is GERD

• Backflow of acid or food into esophagus because the esophageal sphincter is weak or relaxes at the wrong time

antacids example meds

• Made up of salts (aluminum, magnesium, calcium, and/or sodium); may also contain simethicone

contraindications of antacids

Allergy, renal failure, GI obstructions

adverse effects of antacids

metabolic alkalosis

antacids side effects

• Constipation (aluminum; safe for kidney PT)

• diarrhea (magnesium; not safe for kidney PT)

• constipation, kidney stones, reflux acid (calcium; not safe for kidney PT)

• Fast acting, but short in duration; not safe for HF, HTN, and kidney PT (sodium)

nursing considerations/pt teaching antacids

• Caution in HF or HTN patients and with other meds 

• Chew thoroughly; shake liquids well

• Give with minimal amount of water

• Other medications need to be taken 1-2 hours apart from antacids

H2 antagonists example drugs

• All in OTC form (Cimetidine, Nizatidine, Famotidine)

H2 antagonists are used for

PUD, GERD, Zollinger-Ellison syndrome, upper GI bleed

H2 antagonists adverse effects

• CNS - Increased confusion

• Impotence and gynecomastia with Cimetidine

• Thrombocytopenia with Famotidine

nursing considerations/pt teaching H2 antagonists

• Smoking decreases effects

• 1-2 hours before antacids

• Monitor renal and liver function

• Use with caution in elderly

proton pump inhibitors example drugs

• OTC and prescription availability - “Prazole”

PPIs are used for

GERD, ulcers, Zollinger-Ellison syndrome, part of H. Pylori combination therapy

PPI adverse effects

• GI tract infections (C. Diff)

• osteoporosis (fractures)

• pneumonia

• hypomagnesemia

drug interactions PPI

“SPAWKDD”

• Sucralfate

• phenytoin

• ampicillin

• Warfarin

• Ketoconazole

• Diazepam

• digoxin

nursing consid/pt teaching PPI

• Monitor liver function; Do not crush or chew

• Pantoprazole granules can be given per 16g NG or larger

• Given 30 minutes - 1 hour before a meal

• Given 1-2 hours before given sucralfate

sucralfate key fx

• Miscellaneous Acid-controlling drug

• Mucosal protectant by coating lining

• May impair absorption of other drugs - give other drugs 2 hours before this

• S/E: Constipation

misoprostol key fx

• Miscellaneous Acid-Controlling Drug

• Promotes cell regeneration to help maintain mucosal blood flow

• Prevents NSAID induced ulcers

• S/E: abdominal cramps and diarrhea

simethicone 

• Miscellaneous Acid-Controlling Drug

• Antiflatulent 

• Used for bloating and gas discomfort

3 problems with the bowel

• Diarrhea

  • Abnormal stool passage with increased frequency and fluidity

  • Many causes - Bacteria, viruses, medications, tumors, IBS, endocrine d/o

  • Acute - 3 days - 4 weeks

  • Chronic - Over 4 weeks

• Constipation

  • Abnormal stool with decreased frequency and difficulty of passage

• IBS

  • Chronic intestinal discomfort

tx of diarrhea meds

• absorbents

• anti motility drugs

• probiotics

absorbents key fx

• Coat walls of GI tract - for diarrhea

• Example: Bismuth subsalicylate and activated charcoal

• May cause increased bleeding time, tinnitus, blue tongue, dark stools

• Use caution in children (can cause Reye’s Syndrome) and elderly

anti motility drug key fx

• Slow down movement of stool - for diarrhea

• Example: Loperamide, diphenoxylate + Atropine

• May cause Toxic Megacolon (rare)

• Avoid use with hepatic impairment

• S/E: DIzziness, dry mouth, urinary retention, hypotensive, sleepiness

probiotics key fx

• (also known as intestinal flora modifiers and bacterial replacement drugs): supply missing bacteria to GI tract

• Examples: Lactobacillus, saccharomyces, Acidophilus

nursing consid/pt teaching for all antidiarrheals

• Assess bowel patterns, allergies, fluid volume status 

tx of constipation meds

• bulk forming

• emollient 

• hyperosmotic

• saline

• stimulant

• naloxegol

bulk forming key fx

• For constipation

• Absorb water (Can be used long-term) 

• Examples: Psyllium, methylcellulose

• May cause impaction or esophageal blockage

emollient key fx

• For constipation

• Promote water and fat; create slick surface

• Examples: Docusate, mineral oil, glycerin, castor oil

• Do not give castor oil to pregnant women because it can cause contractions & premature delivery

hyperosmostic key fx

• For constipation

• Increases water content

• Examples: Polyethylene glycol, lactulose, sorbitol, glycerin (suppository)

• Lactulose may be used to decrease Potassium levels

saline key fx

• For constipation

• Increases water

• Examples: Magnesium citrate, milk of magnesia

• May cause cramping

• Watch for magnesium toxicity

• Dangerous to use with renal impairment

stimulant key fx

• For constipation

• stimulates nerves

• Examples: Senna, Bisacodyl

• May cause discolored urine

• Used cautiously because they are the most likely to cause dependence

naloxegol key fx

treatment for opioid induced constipation

nursing consid/pt teaching for laxatives in general

• Assess abdomen 

• Baseline blood sugar - They draw things into the colon -> can become hypoglycemic

• Take with plenty of water

• Teach ways to prevent adverse effects

• Never give laxatives to someone having abdominal pain, an obstruction, or appendicitis

drugs for IBS-D

• Alosetron (Lotronex): for women with severe symptoms

• Rifaximin (Xifaxan): non-absorbable antibiotic

• Eluxadoline (Viberzi): Slows GI motility; avoid giving with gallbladder disease

drugs for IBS-C

• Lubiprostone (Amitiza): softens stool

• Linacotide (Linzess): increases fluid secretion and motility

nursing consid/pt teaching for IBS meds

• Assess symptoms before treatment and identify type

• Monitor response to meds and watch for complications

• Report constipation or rectal bleeding

• Avoid triggers: Spicy foods, caffeine, alcohol, dairy

• Teach that they do not cure IBS, they only manage the symptoms

drugs to treat n/v

• phenothiazines

• anticholinergics

• antihistamines

• 5HT3

• dopamine antagonists

phenothiazines key fx

• For n/v

• promethazine, prochlorperazine

• Motion sickness; adjunct during surgery

• Can cause neuroleptic malignant syndrome

• Never give IV promethazine straight into a vein because it can cause tissue necrosis →  always give diluted slowly in 25-50mL of saline 

anticholinergics key fx

• for n/v

• scopolamine

• Motion sickness, post-op n/v

• Usually given 2-3 hours before someone has surgery

• Patch usually left on for 72 hours -> teach to pinch it off so that it traps the medication in the middle, and immediately wash hands after because it can dilate eyes if you touch them

antihistamines key fx

• for n/v

• meclizine

• Motion sickness, vertigo

5HT3 key fx

• ondansetron

• for N/V associated with chemo

• Also given to those who can’t tolerate other drugs

• Most effective when given before nausea starts

• Don’t drink any water 5-10 minutes after orally disintegrating tablet so it can absorb 

dopamine antagonist key fx

• for n/v

• metoclopramide

• Post op gastric stasis

• Speeds up gastric emptying

• Can cause tardive dyskinesia