NUR 221- GI Disorders & Treatment

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