NUR 221- GI Disorders & Treatment

peptic ulcer disease

peptic ulcer disease

erosion of the gut wall

• severe erosion can be complicated by hemorrhage and perforation

aggressive factor of peptic ulcers

H. Pylori

• gram-negative bacteria that can colonize the stomach and duodenum

pathogenesis (causes) of peptic ulcers

• NSAIDs

  • reduce blood flow, mucus, bicarbonate

• smoking

  • delays ulcer healing and increases risk for reoccurrence

2 major classes of antiulcer drugs

• antibiotics

• mucosal protectants

antibiotic use for peptic ulcers

should be given to all patients with gastric/duodenal ulcers and documented H. Pylori infection

• minimum of 2 antibiotics prescribed

Histamine2 Receptor Antagonists (examples)

• Cimetidine (Tagamet)

• Ranitidine (Zantac)

• Famotidine (Pepcid)

Use of Histamine2 Receptor Antagonists

First choice drugs for treating gastric and duodenal ulcers

• promote healing by suppressing secretion of gastric acid

Ranitidine (Zantac) is more ____ than Cimetidine (Tagamet) and Famotidine (Pepcid)

potent

Proton Pump Inhibitors

most effective drug for suppressing secretion of gastric acid

• Omeprazole (Prilosec)

• Pantoprazole (Protonix)

Omeprazole (Prilosec)

inhibits gastric secretion

• ulcer prophylaxis is indicated only for patients in intensive care units

• may lead to C. Diff

Other popular antiulcer drugs

• sucralfate (Carafate)

• misoprostol (Cytotec)

• antacids

Sucralfate (Carafate)

creates a protective barrier for up to 6 hours

• decreases absorption of other drugs*

• drug interactions

  • antacids may interfere with effects of sucralfate

  • may inhibit absorption of other medications administered simultaneously. Give 2 HOURS BEFORE OR AFTER OTHER MEDICATIONS

Therapeutic use of Misoprostol (Cytotec)

only approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy

• category X (pregnancy)

antacids

react with gastric acid to produce neutral salts or salts of low acidity

antacids magnesium base cause…

diarrhea

antacids aluminum base cause…

constipation

Magnesium Hydroxide (Milk of Magnesia)

avoided in patients with undiagnosed abdominal pain

• diarrhea

Sodium Bicarbonate

inappropriate for treating PUD: brief duration, high sodium content, can cause alkalosis

dietary fiber

proper bowel function is highly dependent on dietary fiber (brain is best source)

• benefits of fiber

  • absorbs water- softens feces and increases size

contraindication of when to use laxitives

fecal impaction or bowel obstruction

classification of laxatives

Bulk-forming laxatives

• Psyllium (Metamucil)

Surfactant laxatives

• Docusate sodium (Colace)

Stimulant Laxatives

• Bisacodyl (Dulcolax)

• Senna

Bulk-forming laxatives

• Psyllium (Metamucil)

function similarly to dietary fiber- swell with water to form a gel that softens and increases fecal mass

• AE = esophageal obstruction

Stimulant Laxatives

• Bisacodyl (Dulcolax)

• Senna

stimulate intestinal mobility

Osmotic Laxatives mech of action

poorly absorbed salts that draw water into intestinal lumen; fecal mass softens and swells, wall stretches, and peristalsis is stimulated

Osmotic Laxatives AE

• dehydration

• renal failure

• sodium retention (heart failure, hypertension, edema)

Glycerin suppository

osmotic agent that softens and lubricates hardened, impacted feces

antiemetics

given to suppress nausea and vomiting

• Ondansetron (Zofran)

• Metoclopramide (Reglan)

• Cannabinoids

  • Dronabinol (Marinol) and Nabilone (Cesamet)

Drug for motion sickness

Scopolamine

Nonspecific Antidiarrheal Agents

Opioids

• most commonly used: Diphenoxylate (Lomotil) and Loperamide (Imodium)

Inflammatory Bowel Disease (IBD)

caused by exaggerated immune response to normal bowel flora

• Chron’s

• Ulcerative colitis

Drugs for IBD

not curative

• Glucocorticoids (Hydrocortisone)

• Immunosuppressants (Azathioprine)

• Immunomodulators (Infliximab)

• Antibiotics (Metronidazole)

immunomodulator example

Infliximab (Remicade)

• for chrons and ulcer colitis