Module 5 GI

Classes that tx PUD(Peptic Ulcer Disease)

• Antacids(Only tx temp hrt burn)

• Proton Pump Inhibitors

• H2 antagonists

• Prokinetic agents

• Antispasmodic agents

• Coating agents

also Antibiotics for H. Pylori

Action of Antiacids

Lower acidity Lvl of stomach

• Hydrochloric acid had pH of 1-2

  • Antacids increase that pH to 3-4, making stomach contents less corrosive

How do Antacids work

Antacids act as neutralizing agent

• Antacids are a base - when stomach acids are high, antacid bases normalizes balance

Meds in Antacids

• Baking soda/sodium bicarbonate

• Maalox/magnesium oxide, aluminum hydroxide, simethicone

• Mylanta, Extra strength, supreme/ aluminum hydroxide or calcium carbonate, mag oxide

• Milk of Magnesia/ mag oxide

• Riopan/ simethicone

• Tums/ calcium carbonate

Most Effective antacids

• Aluminum hydroxide, magnesium oxide or hydroxide

• Magnesium trisilicate, calcium carbonate

S/E of Antacids

Chalky taste, diarrhea or constipation

Prior to giving Antacids

• check renal function - BUN, creatinine, electrolytes, magnesium and potassium

• Assess bowels for diarrhea or constipation

• Document gastric pain- screen for coffee ground emesis, bloody stools (Hematemesis)

• Assess for pregnancy, edema, heart failure, HTN, salt restrictions

Pt Teaching for Antacids

• Do not use for > 2wks, consult doc

• Need to take 1hr prior or 2hrs after other meds

• if Pt has edema, HF, HTN, renal failure, pregnancy or salt restrictions need to use low sodium antacids - Riopan, Maalox and Mylanta ll

• Should only be used for occupational hrt burn only, no effect of healing PUD

• Warn calcium or aluminum products may cause constipation

• Magnesium products may cause diarrhea *Mag oxide*

• Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity

• Pt may need to try more than one product to see which is the most effective

• Patients with renal disease should not take antacids with magnesium- could result in hypermagnesemia ( neuro impairment - Rare)

Meds in H2 Receptor antagonist

• Tagamet/cimetidine

• Pepcid, Pepcid AC/ famotidine

• Axid/nizatidine

• Zantac/ ranitidine

Action of H2 receptor antagonists

Through a chemical reaction, parietal cells produces hydrochloric acid.

stops this chemical reaction

Use of H2 receptor antagonists

Treat GERD, duodenal ulcers and treating stress ulcers in critically ill patients

“Unapproved”- preventing aspiration pneumonia, acute upper GI bleed and hyperparathyroidism

S/E of H2 antagonists

Dizziness, HA, diarrhea, constipation, confusion, hallucinations, gynecomastia

Nursing Considerations/ pt teaching for H2 receptor antagonists

• Wait 2 hours after taking H2 antagonists to take an antacid

• Avoid alcohol and smoking

• Tagamet- possible hepatotoxicity, gynecomastia

• Caution when driving

• Bulk laxative to control constipation and diarrhea
  

Meds in PPI(Proton Pump Inhibitors)

• Nexium/ esomeprazole

• Prevacid/ lansoprazole

• Prilosec/ omeprazole

• Protonix/ pantoprazole

• Aciphex/ rabeprazole

P- proton pump inhibitor

Action of PPIs

Inhibit gastric secretions by stopping the gastric acid pump of the stomach’s parietal cells

Use of PPIs

• Treat severe esophagitis, GERD, gastric and duodenal ulcers

• Used in combination with antibiotics to treat H. pylori

PPI S/E

Diarrhea, headache, muscle pain, fatigue, rash

PPI Nursing considerations and pt teaching

When testing for H. pylori do not give PPIs because the patient may test negative even though they are positive-

They need to stop PPIs for a few weeks if they are already taking before testing.

-Teach patient that relief may come in 2-3 weeks

-Avoid alcohol and smoking

-Do not crush or chew this medication

-Should not stop taking unless instructed by physician

long term use can cause decreased bone density

Coating Agents med

Carafate/ sucralfate

action of coating agents

Medication that coats the lining of the ulcer

Does not stop or slow gastric secretions and does not alter gastric pH

Uses of coating agents

Treats duodenal ulcers

Reduces abdominal pain associated with ulcers

Useful in the treatment if patients can not tolerate other therapies

S/E of coating agents

Constipation, dry mouth, dizziness

Nursing considerations/ pt teaching

Prior to med--Evaluate for constipation

- Increase fluids, bulk laxative and roughage to aid in constipation

- Give on an empty stomach- 1 hour before meals

Meds in Prokinetic Agents

Reglan/ metoclopramide

Action in Prokinetic agents

Gastric stimulant, increases peristalsis, quickens the rate of stomach emptying

uses of prokinetic agents

Gastric reflux esophagitis
Diabetic gastroparesis- delayed emptying of the stomach to aid the elimination of barium through the GI tract

Given as an antiemetic for cancer patients
Given postoperatively to decrease nausea/vomiting

S/E of prokinetic agents

Drowsiness, fatigue, lethargy, dizziness
Severe effects- extrapyramidal symptoms(EPS - dystonia, tongue protrusion, bradykinesia)

Pre med assessment for prokinetic agents

- Assess for additional medication that may cause extrapyramidal symptoms

- Assess for history of epilepsy

- Do not give to patient with GI perforation, mechanical obstruction or hemorrhage

Antispasmodic agents meds

Atropine Peracid sulfate

Bentyl/ dicyclomine

Scopace/ scopolamine

Action of antispasmodic agents

cause anticholinergic effects =Slows the motility and decreases secretions of the GI tract

What are antispasmodic agents also known as

AKA Anticholinergic Agent

uses for antispasmodic agents

tx irritable bowel syndrome, biliary spasm, mild ulcerative colitis, diverticulitis, pancreatitis, infant colic, PUD, give post anesthesia for nausea

pre med assess for antispasmodic agents

Assess for glaucoma

Baseline mental status exam

VS

Dopamine antagonists meds

Compazine/ prochlorperazine

Phenergan/ promethazine

Action of dopamine antagonists

medication that stops the nerve impulses to the vomiting center of the brain

uses of dopamine antagonists

mild to moderate nausea and vomiting

S/E of dopamine antagonists

Confusion, dizziness, drowsiness, extrapyramidal effects, HTN, bradycardia, blurred vision, dry mouth, hyperglycemia, respiratory depression

Nursing considerations of dopamine antagonists

Increased sedation in elderly and children

- Inject IM form into deep muscle mass

- Monitor respiratory functions

- Notify MD immediately if tremors, jerky movement is noted

- Use hard candy to relieve dry mouth

Serotonin Antagonists Meds

granisetron/ Kytril

ondansetron/ Zofran

Serotonin Antagonists Action

Blocks serotonin receptors in the chemoreceptor trigger zone in the brain, also at the vagal nerve in the intestines which stimulate vomiting.

Serotonin Antagonists Use

Nausea, Vomiting in patients who are undergoing chemotherapy and radiation, and post-op induced vomiting.(give 1 hour before chemo)

Serotonin Antagonists S/E

Headache, sedation, diarrhea, constipation

Serotonin Antagonists Nursing Considerations/ Patient Teaching

Well tolerated, teach to take medication 1 hour before chemo or radiation to lessen nausea and vomiting.

Disintegrating tablets placed on tongue and allowed to melt, then swallow.

Anticholinergic Agents

diphenhydrinate/ Dramamine

diphenhydramine/ Benadryl

hydroxyzine/ Vistaril

meclizine/Antivert

scopolamine/Transderm-Scop

Anticholinergic Agent Actions

Prevent motion sickness which may induce vomiting.

Anticholinergic Agent Use

Prevent vomiting associated with motion sickness and pregnancy. Not effective in chemo related nausea and vomiting. Not use for glaucoma or BPH pts.

Anticholinergic Agent S/E

Blurred Vision, constipation, urinary retention, dry mouth and throat, sedation

Anticholinergic Agent Nursing Considerations/Patient Teaching

Orthostatic hypotension, Hard candy for dry mouth, force fluids, avoid operating machinery, avoid if acute closed angle glaucoma.

benzodiazepines

lorazepam/ Ativan

Alprazolam/ Xanax

benzodiazepines action

Reduce anxiety, promotes sedation, depresses the vomiting center and amnesic effect.

benzodiazepine Use

Reduce frequency and anxiety associated with nausea and vomiting, optimal benefits if taken with another antiemetic.

(amnesic effect: loss of memory)

Benzodiazepine S/E

Drowsiness, hangover, sedation, lethargy and blurred vision, constipation, diarrhea, respiratory depression

Benzodiazepine Nursing Considerations/ Patient Teaching

Monitor and labs, CBC, liver profile and PT/INR, Avoid driving and operating machinery, Watch for excessive sedation and respiratory depression. Not with alcohol or drug abuse. ANTIDOTE: flumazenil/ Romzicon

Laxatives Contraindicated

Severe abdominal pain, severe nausea, vomiting or fever, diabetics, patient who have undergone abdominal surgery, patients receiving meds causing constipation, person whom laxatives don’t work on and laxative dependent pts.

Laxative S/E

Abdominal spasms, abdominal discomfort with flatulence and nausea. Serious: Abdominal tenderness, pain , bleeding, vomiting, diarrhea, abdominal distention.

Laxative Pre-Med

Assess “normal” bowel pattern for the individual. Asses present symptoms: abdominal pain, fever, distention.

Laxative Nursing Considerations/ Pt Teaching

Encourage fluids, report fever, distention, severe pain, increase exercise, bulk and fluids to prevent constipation.

Stimulant Laxatives Meds

bisacodyl/ Correctol/ Dulcolax

sennosides/Ex-Lax/ Peri-Colace/ Senokot

Stimulant Laxatives Action

Acts directly on the intestine, irritates the colon causing peristalsis, Oral: 6-10 hrs Rectal: 60-90 min

Stimulant Laxatives Use

Acute Constipation and Post barium ingestion

Saline Laxative Meds

magnesium citrate/ Citrate of Magnesia

magnesium hydroxide/ Dulcolax Liquid/ MOM

sodium phosphates/ Fleet Phospho-Soda

Saline Laxative Action

Draw fluid into the intestine from surrounding tissue, extra water softens the stool, creates volume of the colon and stimulates peristalsis. Acts within 1-3 hrs

Saline Laxatives Significant

Use of hypertonic laxatives may alter electrolytes cand cause dehydration. Monitor Labs!! Electrolytes, BUN, creatinine.

Lubricant Laxatives (emollient) Meds

mineral oil/Konremul

Lubricant Laxatives Action

Lubricates the intestinal wall and soften stool

Does not stimulate peristalsis

May inhibit the absorption of fat-soluble vitamins

Acts within 6-8 hour, longer if peristalsis action is slow

Lubricant Laxatives Use

Produce soft stool without spasm

Patients who should not strain

Bulk Forming Laxatives Meds

polycarbophil/ Fiber-con

psyllium hydrophilic muculloid/ Metamucil

Bulk Forming Laxatives Action

Retains water within the stool

Increase bulk

Allow easier elimination

Stimulate peristalsis

Acts within 12-24 hrs or longer depending on pt

Bulk Forming Laxative Use

Medication of choice for long term laxative use in pts with IBS

used for daily laxative need, older pts

Take w/ full glass of water

Fresh fruits, vegetables, and grain are natural bulk forming products.

Fecal Softeners Meds

docustae sodium/Colace

sennosides A/B / Peri-colace

Fecal Softeners Action

‘wetting agents’ draw water into the stool, do not stimulate peristalsis, not effective in treating chronic constipation

Fecal Softeners Use

Assist in prevention of constipation or straining to eliminate stool( used in post-op pts and after a cardiac event.

Anti - Diarrheal Agents Meds

diphenoxylate w/ atropine/ Lomotil

loperamide/ Imodium

Anti-Diarrheal Agents Action

Locally acting agents- absorb excess water which increases bulk and also absorbs bacteria and irritants.

Systemic agents- work on the ANS by reducing peristalsis and motility of the colon ( more adverse effects/ DO NOT use with bacterial infection)

Anti-Diarrheal Agent Use

Diarrhea persists more than 2-3 days, threat of dehydration and electrolyte imbalance, IBS, Post GI Surgery

Anti- Diarrheal Agent S/E

Abdominal distension, nausea, constipation, drowsiness, urinary retention, respiratory depression Severe effects: prolonged or worsened diarrhea.

Anti Diarrheal Agents Nursing Consideration/ Pt Teaching

Teach anticholinergic effects
Drink adequate fluids- Gatorade
Avoid caffeine and carbonated beverages
Monitor for fever, elevated pulse and respirations, low BP
Monitor electrolytes, renal and liver profiles
Do not exceed prescribed dosage
Do not operate machinery or drive if side effects severe
Avoid alcohol