Pharm Exam 4 - GI drugs

Acid-controlling drugs do not…

Do not prevent acid prod, may inhibit absorption of drugs needing acidic environment

What do we caution w/ acid controlling drugs

Caution enteric coated med

What can long-term use of acid-controlling drugs mask?

Long term use may mask serious illness - contact HCP if lasts longer than 2 weeks

How long do we wait to admin other meds after acid-controlling drugs?

Admin other meds 1-2 hrs after antacid; give w/ 8 oz of water

Antacids (3)

• Aluminum hydroxide

• Mag hydroxide

• Calcium carbonate

Effects of aluminum hydroxide (Amphogel)

Constipating effects

Aluminum hydroxide (Amphogel) is recommended for pts w/…

Renal failure

Magnesium hydroxide (Milk of Magnesia) commonly causes..

Diarrhea

Magnesium hydroxide (Milk of Magnesia) is DANGEROUS for pts w/

Renal disease — DO NOT GIVE!!

Calcium carbonate (TUMS) may cause... (3)

• Constipation

• Kidney stones

• Hyperacidity rebound

Calcium carbonate (TUMS) should be cautioned in pts w/

Renal failure

ranitidine (Zantac) AND cimetidine (Tagamet; PO) drug class

Histamine H₂ Antagonists (‘tidine’) 

MOA of ranitidine (Zantac) AND cimetidine (Tagamet; PO) 

Decreases acid

Adverse effects of Cimetidine

Confusion & disorientation in elderly

Adverse effects of famotidine

Constipation

ranitidine (Zantac) AND cimetidine (Tagamet; PO) may..

Inhibit absorption of drugs needing acidic environment

Nursing implications of ranitidine (Zantac) AND cimetidine (Tagamet; PO) (2)

• Smoking decreases effectiveness

• Short-term use (2 weeks) — then seek HCP

Omeprazole drug class

Proton Pump Inhibitors (‘prazole’) 

MOA of omeprazole

Irreversibly binds to H+/K+ ATPase enzyme – preventing movement of H+ ions from parietal cell to stomach 

What can omeprazole cause?

Achlorhydria — all gastric acid is temporarily blocked

Adverse effect of short term use of omeprazole (2)

• N/V/D

• HA

Adverse effect of long-term use of omeprazole (3)

• Osteoporosis/fracture

• Rebound acid hypersecretion

• Hypomagnesemia

Nursing implications of omeprazole (2)

• H. pylori treatment — PPI used w/ antibiotics for 2 weeks (clarithromycin and amoxicillin or metronidazole) 

• Possible GI infection (C. Diff)

Drug class of sucralfate (Carafate)  

Mucosal Protectant

MOA of sucralfate (Carafate)

Cytoprotective, “band-aid”

Indications of sucralfate (Carafate) (2)

• Stress ulcers

• Can be used to decrease phosphate in CRF as binds w/ phosphate

Nursing implications of sucralfate (Carafate)

Give other drugs at least 2 hrs before to avoid impaired absorption

Misoprostol drug class

Prostaglandin E Analog 

Misoprostol contraindications

Pregnancy X - abortive drug - speeds up labor

Nursing implications of Misoprostol

Stop taking if pregnant

Is diarrhea a disease?

NOO — its a symptom! Can be acute or chronic

Goal of treatment w/ antidiarrheals (4)

• Stop stool frequency

• Alleviate abd cramps

• Replenish F&E

• Prevent weight loss & nutritional deficits

Drug class of loperamide

Antimotility Drugs: Opiates 

MOA of loperamide (2)

• Decrease GI motility

• Reduce pain by relief of rectal spasms

Indications of loperamide

Stop / decrease frequency of diarrhea

Adverse effects of loperamide (2)

• At high doses – Euphoria, CNS & respiratory depression, Urinary retention  

• At recommended doses = no opiate or anticholinergic adverse effects

loperamide FDA new guidelines

Packaging only 8-12 tablets ‘poor man’s methadone’ – heart problems and death  

Is loperamide OTC?

YES - no physical dependance

How do we dose loperamide?

Initially 4mg then 2mg after each loose stool to max of 16mg/day

What do we assess when a pt is taking loperamide? (4)

• Fluid vol stat

• Monitor I&O

• Weight

• Vital signs

Important notes of laxatives (5)

• Take a thorough hx of presenting symptoms & bowel patterns

• All can cause electrolyte imbalances

• Monitor I&O

• Long-term use can lead to decreased bowel tone and dependency

• Encourage a high-fiber diet and increased fluid intake as alternative to laxatives

Contraindication for ALL laxatives

Never give with a diagnosis of ‘abdominal pain of unknown origin!!!

psyllium (Metamucil) drug class

Bulk forming - “fiber”  

Indications for psyllium (Metamucil)  

Promote bowel movements in older adults

Adverse effect of psyllium (Metamucil) (2)

• Impaction

• Esophageal blockage

Nursing implications of psyllium (Metamucil)  (3)

• Can decrease absorption of other meds

• Take w/ at least 8oz of fluid - can cause esophageal blockage or impaction if not taken with enough water (it’s THICKK)

• Only laxative recommended for long-term use  

docusate sodium (Colace) drug class

Surfactant - ‘stool softener’ 

docusate sodium (Colace) indications

• Prevention of painful elimination w/ hemorrhoids or episiotomies

• Prevent straining post MI, cerebral aneurysm 

Nursing implications of docusate sodium (Colace) (2)

• Stool softener - does not aid in defecation just softening - do not need to strain to go

• Take w/ 6-8 oz water or juice

bisacodyl (Dulcolax)  drug class

Stimulant

MOA of bisacodyl (Dulcolax) 

Increase peristalsis via intestinal nerve stimulation

Indications of bisacodyl (Dulcolax) 

Bowel prep for dx & surgical procedures

Adverse effects of bisacodyl (Dulcolax) 

Electrolyte imbalance - MG

Nursing implications of bisacodyl (Dulcolax) (2)

• Give PO bisacodyl w/ water only! (6-8 oz) interactions w/ milk, antacids, juices

• Available as PR (per rectum) but become very crampy