GI Drugs

catergory class: sulfasalazine (Azulfidine)

Aminosalicylates

Pharm Action: sulfasalazine (Azulfidine)

TREAT mild-moderate IBD as it converts to:
1)Mesalamine- inhibts prostaglandins to decrease intestine inflam
2)Sulfapyriche- can cause adverse effects

Complications: sulfasalazine (Azulfidine)

nausea, fever, rash, headache, hematologic disorders (agranuloctyosis, hemolytic anemia)

Med Admin: sulfasalazine (Azulfidine)

oral, monitor stool for intact pill, expect change in skin and urine color

Nurse Interventions:sulfasalazine (Azulfidine)

m/r worsening n/v/d- adjust dose or give ER
check if body is capable of dissolving ER
monitor skin for rash and temp
assess if joint pain, monitor CBC

Client Edu: sulfasalazine (Azulfidine)

take w/ food/water, nausea:lie down, report n/v/d/fever, report joint pain (take anaglesics), m/r s/s hematologic disorders (sore throat, fatigue, infections, dizzy, dyspnea)

Contra: sulfasalazine (Azulfidine)

sensitive to salicylate/sulfenamides/trimethropin, folate def, megoblastic anemia, agranulocytosis, renal failure, porphiria, GI/urinary obstruct

PC: sulfasalazine (Azulfidine)

older adults, renal/hepatic dysfunction, blood dyscrasia, asthma, G6PD def

Interactions:sulfasalazine (Azulfidine)

iron and antibiotics ^ sulfasalazin absorp
sulfasalazin decreases absopr of digoxin

Catergory Class: lubiprostone (Amitiza)

5-HT4 Receptor agonist

Therp Use: lubiprostone (Amitiza)

treatment of IBS in women older than 18
treatment of CIC (chronic idiopathic constipation)

Pharm Action: lubiprostone (Amitiza)

decrease viseral pain, increase peristalsis, increase secretion of water and electrolyes from intes wall
activates chorlide channel to ^ excretion of sodium and water

Complications: lubiprostone (Amitiza)

n/v/d, flatuence, headaches

Med admin: lubiprostone (Amitiza)

oral as prescribed, normal 2/day w/food, swallow whole, dont give if diarrhea

Nurse Intervention: lubiprostone (Amitiza)

monitor for n/v/d (stop and notify), monitor for headache and provide mild analgesic

Client Edu: lubiprostone (Amitiza)

take w/food, nausea:lie down, report severe n/v/d (stop and hydrate w/ clear fluid), take OTC for headaches (report if persistent)

Contra: lubiprostone (Amitiza)

severe diarrhea, divericullitis, chrons disease, ulcerative colitis, volvulous, GI obstruct

PC: lubiprostone (Amitiza)

any type of GI disease

Interactions:lubiprostone (Amitiza)

no current known

Catergory Class: loperamide (Imodium)

opioid anti-diarrheal

pharm action: loperamide (Imodium)

Treat diarrhea- smaller, fewer, harder BM
decrease peristalsisis, increase absorp of water from feces

complications: loperamide (Imodium)

cardiac arrest, cardiac arrythmias, drowsy, constipation, dry mouth

med admin: loperamide (Imodium)

oral, up to 4 mg (follow loose stool with 2 mg), DO NOT EXCEED 6 mg, stop if diarrhea persists 48 hrs, no possible SA as an analog of opioid merperidine

nursing interventions: loperamide (Imodium)

monitor ambulation (sedation, dizzy, lighthead, drowsy), reccomen low and short dose, monitor for urinary retention (esp older), monitor anticholingeric effects (hard candy, gum, water)

client edu: loperamide (Imodium)

avoid before driving/mental activity, lighthead: sit/lie down, change postion gradually, urinate every 4 hrs and report undesirable changes

Contra: loperamide (Imodium)

less than 2 yo, IBD, advance hepatic disease, glaucoma, severe F+E imbalance, pseudomembranous enterocolitis, diarrhea from poision, ileus/gi bleed

PC: loperamide (Imodium)

ulcerative colitis, R/L dysfunction, prostatic hypertrophy, chemical abuse history

Interactions: loperamide (Imodium)

^ CNS depression: alcohol, antihistamine, sedatives
^ hypertensive crisis: MAOIS
^ cardiac arrhythmia: cimetidine, erythromycin, quinine

Catergory Class: docusate sodium (colace)

stool softener/surfacant laxatives

therp use: docusate sodium (colace)

treat constipation, prevent fecal impact, straining, painful elim

pharm action: docusate sodium (colace)

change surface tension of stool to ^ absopr of water, act on intest wall to decrease absorp of fluid and increase secretion of sodium and water

complications: docusate sodium (colace)

diarrhea, mild abd cramps, throat irration, rashes

med admin: docusate sodium (colace)

give w/ at least 8oz fluid, softer stool expected several days (1-3) after initating

Nurse Interventions: docusate sodium (colace)

monitor abd distetnion, pattern of BM
assess consistency, color, amount of stool

Client edu: docusate sodium (colace)

report and stop if severe diarrhea, drink 2-3L fluids, increase exercise, increase fiber (bran, fresh fruit, vegetables)

contra: docusate sodium (colace)

GI obstruct/perforation, fecal impact, experiencing n/v, using mineral oil, undiagnosed abd pain

PC: docusate sodium (colace)

suscepetible to developing dependency

Interaction: docusate sodium (colace)

do not admin w/i 2 hrs of any other laxative

catergory class: lactulose

osmotic laxative

therp use: lactulose

lowers level of ammoinium, reliefs constipation

pharm action: lactulose

decrease intestinal production and absorption of ammonia
metabolism of it causes laxative effect, and increases uptake of ammonia from colonic bacteria

complications: lactulose

cramping, flautence, diarrhea, increase bowel sounds, bloating

DM: hyperglycemia

med admin: lactulose

oral (syrup), 15-45 mL, 2-4/day

Nursing Interventions: lactulose

periodic electrolyte monitoring, assess for abd distention bowel sounds and movement, assess ammonia levels, assess BG in DM, monitor neuro

Client Edu: lactulose

^ fluid intake, fiber, exercise, notify if pregger/breastfeeding, notify if diarrhea becomes bothersome

Contra: lactulose

galactosemia

PC: lactulose

diabetics, elderly, preggers

Interactions: lactulose

dont use w/ other laxatives
decrease effectivess: anti-infectives

Cat Class: bisacodyl senna (dulcolax)

stimulant lax

Pharm Action: bisacodyl senna (dulcolax)

stimulate instestinal motility of colon, cause desceased absorption of fluids from intes wall

Complications: bisacodyl senna (dulcolax)

diarrhea, mild abd cramps, burning sensations, proctitis, abuse/dependence

Contra: bisacodyl senna (dulcolax)

GI obstruction/perf, anal fissures, ulcerated hemmorhoids, fecal impaction, undignased abd pain, n/v

PC: bisacodyl senna (dulcolax)

eating disorders

Med Admin: bisacodyl senna (dulcolax)

oral- 6-12 hrs soft stool, at least 1 hr from drinking milk/antiacids
rectal- 15-60 min

Nursing Inter: bisacodyl senna (dulcolax)

severe diarrhea dehydration, suppository can cause burning, rectal discomfort/bleeding/mucus discharge. Monitor bowel elim pattern

Client Edu: bisacodyl senna (dulcolax)

report severe diarrhea,rectal bleeding drink plenty fluids, take high fiber, exercise

Interactions:bisacodyl senna (dulcolax)

antacids or milk, decrease absorp of oral drugs (allow 1 hr between)

Cat Class: psyllium (Metamucil)

Bulk Forming Agents

PharmAction: psyllium (Metamucil)

absorb water to form glutinous mass. Stretch intestinal wall, stimualte peristalsis

Complications psyllium (Metamucil)

esophagheal/intestinal obstruction

contra: psyllium (Metamucil)

esophageal/GI obstruction, intestinal lumen narrowing,fecal impact, dysphagia, n/v, appendicitis, undiagnosed abd pain

Med Admin: psyllium (Metamucil)

give 1-3 times, mix powdered form with 8 oz and drink immediately, can reduce appetite, montior for soft formed stool 1-3 days

Client Edu:psyllium (Metamucil)

take with 8 oz, drink it immedaiely, report diff swallowing, chest pain, absence of BM, diarrhea. Increase exercise and high fiber food

Nursing Inter: psyllium (Metamucil)

take at least with 8 oz of fluid, montior I/O, bowel function, retrosternal pain

Interactions: psyllium (Metamucil)

decrease absoprtion orally ingested meds

Pharm Action: Osmotic Lax

Retains water in intestinal lumen
Fecal mass swells, causing peristalsis

Med Admin: Osmotic Lax

Administer powder in 4-8 oz. of water
Stool in 2-12 hours-dose dependent

Complications Osmotic Lax

Nausea, bloating, cramping, flatulence, diarrhea (high dosing)

Cat Class Milk of Magnesium

Laxative salt

Pharm Action: Milk of magensium

Salt that attracts & retains water, causing fecal mass to swell and soften
Stimulates stretch receptors, increasing peristalsis

Med Admin: Milk of magnesium

orally, Stool in 6-12 hours (low dose), 2-6 hrs (high dose)

Contra: milk of magnesium

renal disease, bowel disorders

Complacitons: Milk of magnesium

Cramping, diarrhea, dehydration (substantial water loss!)
CNS toxicity with renal disease