Topic 12: GI Drugs

vomiting, diarrhea, and constipation

what are common GI disorders

antiemetics, emetics, antidiarrheals, laxatives

what are the drugs used to treat GI disorders

weak tea, flat soda, gelatin, pedialyte (kids), gatorade, crackers, dry toast

what are the nonpharmacologic measures to treat vomiting

Phenergan

what is the brand/trade name for promethazine hydrochloride

antiemetic, dopamine antagonists

what is promethazine hydrochloride (Phenergan) classified as

to treat and prevent motion sickness, N/V, and sedation induction

what is promethazine hydrochloride (Phenergan) used for

promethazine hydrochloride (Phenergan)

mode of action: acts on CTZ, blocks histamine1 receptors (drowsy)

hypersensitivity, narrow-angle glaucoma, intestinal obstruction, blood dyscrasias, bone marrow depression, CV disease, liver dysfunction, COPD, HTN, older adults, debilitated clients

what are the cautions/contraindications for promethazine hydrochloride (Phenergan)

• increased CNS depression and cholinergic effects when taken with alcohol and other CNS depressants

• lowers seizure threshold when taken with phenytoin and tramadol

• false pregnancy test

what are the interactions of promethazine hydrochloride (Phenergan)

drowsiness, dizziness, confusion, anorexia, fatigue, anticholinergic effects, HTN, hypotension, photosensitivity, erectile/ejaculation dysfunction, injection site reaction

extrapyramidal syndrome, seizures

agranulocytosis, leukopenia, thrombocytopenia, respiratory depression

what are the side/adverse/life threatening effects of promethazine hydrochloride (Phenergan)

assess for dehydration, check VS, monitor bowel sounds, provide mouth care after vomiting, do not use alcohol while taking, avoid during first trimester of pregnancy, do not drive motor vehicles/engage in dangerous activities, utilize nonpharmacologic measures

what are the nursing considerations when giving promethazine hydrochloride (Phenergan)

• spoiled/spicy food

• fecal impaction

• bacteria

• viruses

• toxins

• drug reactions

• laxative abuse

• malabsorption syndrome

• stress

• anxiety

• bowel tumor

• IBD

what are the causes of diarrhea

clear liquids (Gatorade/Pedialyte) and IV electrolyte solution

what are nonpharmacological measures to treat diarrhea

• opiates and opiate-related agents

• somatostatin analogues

• adsorbents

• miscellaneous anti-diarrheals

what medications are anti-diarrheals

antidiarrheal

what is diphenoxylate with atropine (Lomotil) classified as

Lomotil

what is the brand/trade name for diphenoxylate with atropine

treats diarrhea by slowing intestinal motility

what is diphenoxylate with atropine (Lomotil) used for

diphenoxylate with atropine (Lomotil)

mode of action: inhibits gastric motility by exerting effect on smooth muscle cells of GI tracts; diphenoxylate is an opioid and slows intestinal mobility, atropine is anticholinergic and dries out watery diarrhea, slows motility, decreases secretions and abdominal cramping/pain

drowsiness, dizziness, confusion, euphoria, HA, restlessness, N/V, constipation, dry mouth, weakness, flushing, rash, urinary retention

angioedema, pancreatitis, tachycardia

paralytic ileus, toxic megacolon, anaphylaxis

what are the side/adverse/life threatening effects of diphenoxylate with atropine (Lomotil)

assess bowel sounds, determine frequency and consistency of BMs, assess respirations, check for S/S of dehydration, recognize that is may be withheld if diarrhea continues for more than 48 hours or in acute abdominal pain develops, encourage clients to drink clear fluids

what are the nursing considerations of diphenoxylate with atropine (Lomotil)

• insufficient water intake

• poor dietary habits

• fecal impaction

• bowel obstruction

• chronic laxative use

• neurologic disorders (paraplegia)

• ignoring urge to defecate

• lack of exercise

• various drugs

what are the causes of constipation

high fiber diet, water, exercise, routine bowel habits

what are the causes of constipation

osmotic (saline), stimulant (irritants), bulk-forming, emollient (stool softeners)

what are the types of laxatives

laxatives

promote soft stools

cathartics

promote soft to watery stool with cramping

purgatives

promote watery stool with cramping

stimulant (irritant) laxative

what is bisacodyl (Dulcolax) classified as

bisacodyl (Dulcolax)

mode of action: increase peristalsis by irritating sensory nerve endings in intestinal mucosa produces a watery stool

bowel prep for diagnostics or surgery

what is bisacodyl (Dulcolax) used for

abdominal cramps, nausea, diarrhea, reddish brown urine, weakness, fluid and electrolyte imbalances

what are the side effects of bisacodyl (Dulcolax)

bulk-forming laxative

what is psyllium (Metamucil) classified as

psyllium (Metamucil)

mode of action: absorbs water into intestines, increases bulk and peristalsis promoting large, soft stools

mix in glass of water/juice, stir and drink immediately, follow with 1 full glass of water

how should a nurse administer psyllium (Metamucil)

cramps, N/V, flatus, diarrhea, intestinal obstruction may occur if insufficient fluid intake

what are the side effects of psyllium (Metamucil)

must increase fluid to avoid too much “bulking” of stool which could cause a bowel obstruction, renal function, urine output, BUN and Cr, fluid I&O, S/S of fluid and electrolyte imbalances, bowel sounds, avoid inhalation of psyllium dust, do not swallow in dry form, increase fiber and fluids

what are the nurse considerations when giving psyllium (Metamucil)

it takes 4-8 weeks for an ulcer to heal

why does a client have to be on an antiulcer medication for 1-2 months

H. pylori, mechanical disturbances, genetic influences, environmental influences, drugs, stress/critical situation

what are predisposing factors for a peptic ulcer

gnawing, aching pain

what are the S/S of a peptic ulcer

gastroesophageal reflux disease (GERD)

inflammation of the esophageal mucosa caused by reflux of gastric acid content into the esophagus caused by incompetent lower esophageal sphincter and accelerated by smoking, Tx: anti-ulcer drugs

• avoid tobacco and alcohol

• weight loss if obese

• avoid hot, spicy, greasy foods

• take NSAIDs and oral glucocorticoids with food

• sit upright during and after meals

• do not eat before bed

• wear loose-fitting clothes

what are the nonpharmacologic measures to prevent GERD

antiulcer drugs

tranquilizers, anticholinergics, antacids, H2 blockers, PPI, pepsin inhibitors, and prostaglandin E1 analog are all types of what

antacids

mode of action: antiulcer drugs that neutralize HCl and reduce pepsin activity

hypernatremia, water retention, metabolic alkalosis, and acid rebound

what are the side effects of the antacid sodium bicarbonate (Alka-Setlzer)

acid rebound, hypercalcemia

what are the side effects of the antacid calcium carbonate (TUMS)

diarrhea

what are the side effects of the antacid magnesium hydroxide (Milk of Magnesia)

constipation, caution in renal and hepatic disease/dysfunction

what are the side effects of the antacid aluminum hydroxide (Amphogel)

1-2 weeks

how long does it take for antacids to decrease abdominal pain

avoid giving with oral drugs because antacids can delay their absorption, monitor electrolytes, urinary pH, calcium and phosphate levels, and encourage client to drink 2 oz of water after taking to ensure drug reaches the stomach

what are the nursing considerations when giving antacids

Pepcid

what is the brand/trade name for famotidine

famotidine (Pepcid)

mode of action: blocks H2 receptors of parietal cells in the stomach to reduce gastric acid secretion which promotes the healing of ulcers by eliminating the cause

antacid: histamine 2 blockers

what is famotidine (Pepcid) classified as

HA, dizziness, drowsiness, confusion, agitation, GI effects (N/V, diarrhea, constipation), depression, arthralgia, myalgia, weakness, erectile dysfunction/impotence, gynecomastia, palpitations, dysrhythmias, severe allergic reactions, blood dyscrasias

what are the side/adverse/life threatening effects of famotidine (Pepcid)

histamine 2 blockers

what are medications that end in “-tidine”

assess pain and for fluid/electrolyte imbalances, I&O, give just before meals or at bedtime to decrease food-induced acid secretion, avoid smoking, drug-induced impotence and gynecomastia are reversible, avoid foods/liquids that cause gastric irritation

what are the nursing considerations for giving famotidine (Pepcid)

proton pump inhibitors (PPIs) and pantoprazole (Protonix)

mode of action: reduce gastric acid by inhibiting hydrogen/potassium ATPase in the gastric parietal cells, inhibiting gastric secretion and blocking the final step of acid production

antacid: proton pump inhibitors (PPIs)

what is pantoprazole (Protonix) classified as

Protonix

what is the brand/trade name of pantoprazole

the highest success rate for healing erosive GERD, duodenal ulcers, esophagitis, prevention of NSAID induced ulcers

what is pantoprazole (Protonix) used for

take before meals, monitor liver enzyme levels for those with hepatic impairment

what are the nursing considerations for pantoprazole (Protonix)

hepatic impairment, osteoporosis

what are the cautions for taking pantoprazole (Protonix)

digoxin, statins increase absorption and bioavailability, diuretics, beta-blockers, ACE inhibitors, ARBs, and food decreases peak levels

what are the interactions of pantoprazole (Protonix)

HA, dizziness, drowsiness, weakness, depression, blurred vision, fatigue, dry mouth, GI (diarrhea, constipation, abdominal pain), edema (arthralgia, myalgia), erectile dysfunction, Vit B12 deficiency

GI bleeding, anemia, low magnesium and sodium, high triglycerides and bilirubin, bone fractures, tachycardia, palpitations

dysrhythmias, blood dyscrasias

what are the side/adverse/life-threatening effects of pantoprazole (Protonix)

antacid: pepsin inhibitor

what is sucralfate (Carafate) classified as

Carafate

what is the brand/trade name of sucralfate

sucralfate (Carafate)

mode of action: combines with protein to form thick paste covering ulcer protecting ulcer from acid and pepsin

decreases the absorption of tetracycline, phenytoin, fat-soluble vitamins, and some antibiotics; antacids decrease the effects of sucralfate (Carafate)

what are the drug interactions of sucralfate (Carafate)

constipation, flatulence, dizziness, HA, dry mouth

hyperglycemia, hypophosphatemia

what are the side/adverse effects of sucralfate (Carafate)

give on an empty stomach, give before meals and at bedtime, increase fluids, dietary build and exercise to relieve constipation, monitor for severe constipation, quite smoking, avoid foods/liquids that can cause gastric irritation

what are the nurse's considerations when giving sucralfate (Carafate)