PHARM EXAM 4: ANTIULCER DRUGS AND LAXATIVES

PUD

ulcer formation in the esophagus, stomach, or duodenum areas of the GI mucosa that are exposed to gastric acid and pepsin

ulcer

lesion or a break in the integrity of the mucosal lining of the GI tract and that extends into the layers beneath the mucosa.

antiacid drugs

Mylanta (prototype), Tums, Maalox

antiacid moa

alkaline substances that neutralize acid (hydrochloric acid) to form salt and water. Primarily work in the stomach. Raise gastric pH to 5 or higher which reduces acid and pepsin activity

antiacid use

short term use, prevention or treatment of PUD, GERD, heartburn, gastritis, stress ulcers

antiacid adverse effects

constipation, diarrhea, hypermagnesemia

antiacid nursing implications

antacids can prevent or increase absorption of other drugs taken at the same time. so Separate drug administration by 1 – 2 hours

Histamine2 Receptor Antagonists drugs

Cimetidine (prototype), Famotidine (Pepcid or Zantac), nizatidine, ranitidine (Zantac)

Histamine2 Receptor Antagonists moa

inhibits the action of H2receptors of the stomach

Histamine2 Receptor Antagonists uses

• prevention and treatment of PUD, GERD, esophagitis, GI bleeding

• Promotes healing of gastric and duodenal ulcers

• Since nocturnal acid secretion is mediated largely by histamine, these drugs are more effective at bedtime

Histamine2 Receptor Antagonists adverse effects

• diarrhea, dizziness, drowsiness, headache, confusion, gynecomastia

• Increased AE with prolonged use, older age, impaired renal or hepatic function

Proton Pump Inhibitors drugs

Omeprazole (Prilosec – prototype), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole

Proton Pump Inhibitors moa

bind irreversibly to the gastric proton pump to prevent the release of gastric acid from the parietal cells into the stomach (blocks the final step of acid production)

Proton Pump Inhibitors use

• Drugs of choice for PUD, including duodenal and gastric ulcers

• GERD

Proton Pump Inhibitors adverse effects

• nausea, diarrhea, and headache

• long term use increase risk of bone fractures

mucosal protective agents

Sucralfate (carafate)

Bismuth Subsalicylate (Pepto-Bismol)

mucosal protective agents: sucralfate MOA

binds to normal and ulcerated mucosa

mucosal protective agents: sucralfate use

prevention and treatment of peptic ulcer disease, long term therapy for gastric and duodenal ulcer

mucosal protective agents: sucralfate adverse effect

constipation, dry mouth

mucosal protective agents: sucralfate nursing intervention

take on an empty stomach

Mucosal Protective Agent – Bismuth Subsalicylate (Pepto-Bismol) moa

coat ulcers, protecting them from stomach acid

Mucosal Protective Agent – Bismuth Subsalicylate (Pepto-Bismol) use

used with other drugs to destroy Helicobacter pylori (H. pylori) in gastric and duodenal ulcer. Also used in heartburn and indigestion.

Mucosal Protective Agent – Bismuth Subsalicylate (Pepto-Bismol) adverse effects

black tongue and stool

Helicobacter pylori (H. pylori) Treatment

At least 2 antibiotics & an acid reducer

• Primary ABX: Clarithromycin, metronidazole, amoxicillin

• Secondary ABX: tetracycline

• Bismuth subsalicylate (Pepto Bismol)

Helicobacter pylori (H. pylori) therapy

aims to destroy H. pylori in the GI tract which promotes healing and reduces recurrence of ulcer

Helicobacter pylori (H. pylori) therapy issue

Compliance is an issue due to amount of medications, treatment duration (14 days), cost – this can lead to resistance

Helicobacter pylori (H. pylori) adverse effects

resistance, diarrhea, nausea

laxative use

to ease or stimulate defecation/treat constipation

what does laxatives do

• Soften the stool

• Increase stool volume

• Hasten fecal passage through the intestine

• Facilitate evacuation from the rectum

misuse of laxatives

comes from misconceptions of what constitutes normal bowelfunction

what is the most common cause of constipation

reduced fluid in the stool due to a diet deficient in fiber and fluid

function of the colon

Absorbs water and electrolytes

colon characterisitcs

• Absorption of nutrients is minimal

• 1500 mL of fluid enters colon each day

• 90% of fluid is absorbed

delayed transport of stool through colon causes

excessive fluid absorption and hard stool

frequency of bowel elimination

varies widely (from 2 to 3 times/day to 2 times/wk)

Bulk Forming Laxatives drug

Psyllium (Metamucil)

Bulk Forming Laxatives

functions similarly to dietary fiber. Swell with water to form a gel that softens and increases fecal mass, thereby stimulating peristalsis and defecation

Bulk Forming Laxatives use

Preferred treatment of constipation,

can also help lower cholesterol when combined with low cholesterol diet

Bulk Forming Laxatives adverse effect

gas, bloatin

Stool Softeners (surfactant laxatives) drug

docusate calcium or docusate sodium (Colace)

Stool Softeners (surfactant laxatives)

decrease surface tension of the fecal mass to allow water to penetrate into the stool. Softens/lubricates the feces

Stool Softeners (surfactant laxatives) adverse effect

minimal nausea, bitter taste

Stool Softeners (surfactant laxatives) nursing implication

has little laxative effect

Stimulant Laxatives (cathartics) drug

Bisacodyl (Dulcolax), Senna (Senokot)

Stimulant Laxatives (cathartics) moa

irritates the GI mucosa and pulls water into the bowel lumen. Feces move quickly through the bowel, limiting colonic absorption, so there is elimination of a watery stool

Stimulant Laxatives (cathartics) use

opioid induced constipation, bowel preparation prior to surgery

Stimulant Laxatives (cathartics) adverse effect

abdominal pain, cramping, nausea, diarrhea

• Senna may color the urine yellow or brow

Stimulant Laxatives (cathartics) what occurs with this drug

abuse

Osmotic Laxatives (saline cathartics) drug

Magnesium citrate, milk of magnesia

Osmotic Laxatives (saline cathartics) moa

increase osmotic pressure in intestine, retaining water

• Soften, then expands fecal mass, forcing peristalsis

Osmotic Laxatives (saline cathartics) use

when rapid bowel elimination is needed. Effects occur within 30 minutes to 6 hours

Osmotic Laxatives (saline cathartics) adverse effects

cramping, dehydration, abuse

Osmotic Laxatives (saline cathartics) teaching

increase fluid intake

A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient?

Senna [Senokot]