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what do stimulant laxatives do?
stimulates the bowels (increase muscle contraction)
what do bulk-forming agents do?
absorb liquid in the intestines and swell to form a soft, bulky stool
what do stool softeners / surfactants do?
increases the amount of water and fat that stool absorbs
what do osmotic laxatives do?
draw water into the stool, resulting in softer stools
what does mineral oil do to relieve constipation?
lubricates the fecal mass so it slides better against colon
what type of laxative is psyllium mucilloid (Metamucil)?
bulk-forming
what is a possible adverse effect of Metamucil?
with insufficient water, it may cause obstructions in the intestines
what is the onset of Metamucil?
12-24 hours
what type of laxative is sodium docusate?
surfactant
what is the onset of sodium docusate?
24-72 hours
what is important to know before giving a laxative?
if the cause of constipation is a blockage, then a laxative will do more harm than good D:
when does diarrhea occur?
when the colon fails to reabsorb enough water
what can occur if diarrhea is prolonged?
fluid. electroyte, and acid-base imbalances
what classes of medications treat diarrhea? (4)
absorbents
anticholinergics
opiate-like probiotics
opioids
what are two OTC medications to treat diarrhea?
loperamide (Imodium)
bismuth subsalicylate (Pepto-Bismol)
how do opioids treat diarrhea?
slows peristalsis
what is the onset of opioids in treating diarrhea?
45-60 mins
what class of drug is diphenoxylate (Lomotil)?
opioid
why is atropine added to diphenoxylate?
atropine is added to discourage misuse, it increases HR
what conditions contraindicate antidiarrheals? (3)
severe dehydration / electrolyte imbalance
liver / renal disorders
glaucoma
what is emesis?
vomiting
what part of the brain controls vomiting?
medulla
what is emetogenic potential?
capacity of a drug to induce vomiting
what can excess vomiting lead to? (4)
dehydration
significant weight loss
severe acid-base disturbances
vascular collapse
what drugs treat moderate - severe nausea? (7)
serotonin receptor antagonists
antihistamines
anticholinergics
phenothiazines
corticosteroids
benzodiazepines
cannabinoids
depends on the cause!!
how does prochloroperazine (Semetil) work to treat nausea?
inhibits signals to the vomiting center in the medulla
what are potential adverse effects of prochloroperazine? (5)
dry mouth
sedation
constipation
tachycardia
extrapyramidal symptoms (long term use)
what class of drug is Ondansetron (Zofran)?
serotonin receptor antagonist
how do serotonin receptor antagonists treat nausea?
blocks serotonin
what cause of nausea do serotonin receptor antagonists treat?
nausea from chemo/surgery
what are potential adverse effects of serotonin receptor antagonists? (4)
headache
lightheadedness
drowsiness
constipation
what class of drug is metoclopramide (Raglan)?
prokinetic
how do prokinetic drugs treat nausea?
stimulates the muscles of the gastrointestinal tract
(when nausea is due to a sluggist GI tract)
what could blood in vomit be a sign of?
tear in esophagus
what is the role of the pancreas?
secretes insulin + digestive enzymes
how is pancreatitis treated?
pancreatic enzyme replacement
what are adverse effects of pancreatic enzyme replacement? (2)
GI symptoms (nausea + vomiting, diarrhea)
hyperuricosuria
what is important to ask a patient before giving pancreatic enzyme replacement medications?
if they are allergic to pork, or if they cannot eat pork due to spiritual beliefs
what is the digestive system responsible for? (3)
breaking down food.
absorbing nutrients.
eliminating wastes.
peristalsis
the rhythmic contractions of the layers of smooth muscle along the alimentary canal
what are the two muscular rings in the stomach?
esophageal (cardiac) sphincter
pyloric sphincter
what does the esophageal (cardiac) sphincter do?
keeps food from moving back up into the esophagus
what does the pyloric sphincter do?
regulates the flow of substances leaving the stomach
what do the stomach’s chief cells do?
secrete enzymes
what do the stomach’s parietal cells do?
secrete hydrochloric acid
what protects the stomach muscosa from acid? (2)
thick mucous layer andd bicarbonate ion layer
what is the primary cause of peptic ulcer disease?
infection with Heliobacter pylori
what type of lesions are associated with cancer?
gastric ulcers
where are gastric ulcers located?
the stomach
where are duodenal ulcers located?
the small intestine
what are risk factors associated with peptic ulcer disease? (6)
family history
blood type O
smoking
caffeine
drugs (corticosteroids, NSAIDs, platelet inhibitors)
infection with Helicobacter pylori
what type of bacteria is Helicobacter pylori?
gram negative bacterium
what is the most common cause of peptic ulcer disease that is NOT from H. pylori infection?
NSAIDS
what drugs are used to treat peptic ulcer disease? (4)
proton pump inhibitors
h2 receptor antagonists
antacids
antibiotics
what do bismuth compounds like pepto bismol treat gastric ulcer disease?
inhibit bacterial growth + prevent H. pylori from adhering to gastric mucosa
what are the usual symptoms of duodenal ulcers? (5)
burning upper abdominal pain
nocturnal pain
nausea
vomiting
bloody vomit / stools
when is the onset of abdominal pain for duodenal ulcers?
occurs 1-3 hours after a meal
when is pain worse for duodenal ulcers?
pain is worse when stomach is empty
what are symptoms of gastric ulcers? (3)
anorexia
weight loss
vomiting
what is gastroesophageal reflux disease? (GERD) (2)
caused by loosening of sphincter between esophagus and stomach
acidic stomach contents move up into esophagus
what can esophageal relfux disease (GERD) lead to? (2)
heartburn
esophageal ulcers, esophagitis, or strictures
what drug classes treat GERD? (3)
proton pump inhibitors
h2 receptor blockers
antacids
what is the primary goal in treating GERD?
primary goal is to reduce gastric acid secretion
what is the mechanism of action for proton pump inhibitors?
reduces acid secretion in stomach by binding irreversibly to enzyme H+ K+ - ATPase
what are adverse effects of proton pump inhibitors? (5)
headache
nausea
diarrhea
rash
abdominal pain
what is long term use of proton pump inhibitors linked to?
increased risk of gastric cancer
how long should proton pump inhibitors be used?
4-8 weeks
what is the onset, peak, and duration of proton pump inhibitors?
onset - 1h
peak - 2h
duration - 72h
what do proton pump inhibitors treat? (2)
peptic ulcers
GERD
how should proton pump inhibitors be administered? (2)
before breakfast, on an empty stomach.
should not be crushed, divided, or chewed.
what do h2 receptor blockers treat?
peptic ulcer disease
what is the mechanism of action for h2 receptor blockers?
acts by blocking h2 receptors in stomach to decrease acid production
what are possible adverse effects of h2 receptor blockers? (2)
reduction of WBC, RBC, and platelets.
impotence or loss of libido in men.
when should h2 receptor blockers be administered?
after meals
what should be monitored for drugs used to treat peptic ulcers?
monitor liver and kidney function
what do antacids treat?
heartburn due to PUD or GERD
what is the mechanism of action of antacids?
neutralizes stomach acid by raising pH of stomach contents
what is a possible adverse effect of antacids?
constipation
what should be known about the administration of antacids?
administer aluminum antacids at least 2 hours before or after other drugs, because absorption could be affected
hypermagnesemia
kidneys unable to excrete excess magnesium
why are multiple antibiotics given to treat H. pylori? (2)
increased effectiveness
less potential for resistance
what does sucralfate (Carafate) do?
coats ulcer and protects it from further erosion
what does misoprostol (Cytotec) do?
inhibits acid and stimulates production of mucous
contraindicated with pregnancy
what does metoclopramide (Reglan) do?
causes muscles in the upper intestine to contract
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