Acid-Controlling, Bowel, and Antinausea Medications

CH 50 Acid Controlling Medications

Lifestyle Changes to Help Treat GERD

• Quit smoking.
• Exercise regularly.
• Sit up straight.
• Eat small meals throughout the day.
• Chew food slowly.
• Avoid heartburn triggers (coffee, wine).
• Wear loose and comfortable clothing.
• Sleep with your head and shoulders propped up.
• Minimize caffeine and alcohol consumption.
• Avoid lying down for at least 3 hours after a meal.

Types of Acid-Controlling Drugs

• Antacids
• H2 antagonists
• PPIs

Antacids

• Used alone or in combination (OTC medication).
• Neutralize acid to relieve pain and heartburn, treat symptoms of GERD and PUD.
• Overuse can lead to metabolic alkalosis.

Types of Antacids

• Aluminum salts
• Magnesium salts
• Calcium salts
• Sodium bicarbonate

Aluminum Hydroxide

• Indications: Peptic ulcer disease (GERD), lowers phosphate levels with chronic kidney disease.
• Mode of Action: Neutralizes stomach acid and binds phosphate in the stomach.
• Side Effects: Constipation
• Administration: Administer after meals and at bedtime. Take 1-2 hours before or after other medications.

Calcium Carbonate

• Drug Class: Antacid-Calcium Salt
• Uses: Heartburn, symptoms of PUD, gastritis, calcium supplements.
• Contraindications: Renal disease.
• Side Effects: Kidney stones, constipation, gas, bloating.
• Patient Teaching:
  • Not for long-term use (may cause rebound symptoms).
  • Neutralizes acid to relieve pain.
  • Take with a full glass of water.
  • Do not take with milk (can cause headache, confusion, nausea, vomiting, and hypercalcemia).
  • Take separately from other medications.
  • If too much gas, can take with simethicone.

Aluminum Hydroxide/Magnesium Hydroxide

• Drug Class: Antacid
• Uses: Heartburn, symptoms of PUD, gastritis.
• Contraindications: Aluminum salts are okay for renal patients, but magnesium salts are not.
• Side Effects: Aluminum antacids cause constipation, while magnesium antacids cause diarrhea.
• Patient Teaching: Do not take within 1-2 hours of other medications.

Sodium Bicarbonate

• Drug Class: Antacid
• Uses: Heartburn, symptoms of PUD, gastritis.
• Contraindications: Not for patients with cardiac disease like CHF, HTN, or renal insufficiency.
• Side Effects: Metabolic alkalosis.
• Patient Teaching:
  • Dissolve effervescent tablets.
  • Do not take within 1-2 hours of other medications.

Simethicone

• Drug Class: Antiflatulence
• Uses: Helps relieve gas symptoms.
• Contraindications: Hypersensitivity
• Side Effects: Headache, nausea, vomiting.
• Patient Teaching: Chew tablets or swallow if soft gels.

Antacids – Nursing Implications

• Most medications should be administered 1 to 2 hours before/after an antacid.
• Ensure that chewable tablets are chewed thoroughly and liquid forms are shaken well before giving.
• Administer with at least 8 oz of water to enhance absorption (except for “rapid-dissolve” forms).
• Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.
• If symptoms remain ongoing, the patient should seek medical evaluation.

H2 Receptor Antagonists: Ranitidine (Zantac), Famotidine (Pepcid)

• Indications: Duodenal and gastric ulcers, GERD, Zollinger-Ellison syndrome.
• Mode of Action: Blocks H2 receptors in the stomach, reducing gastric acid secretion.
• Side Effects: Headache, GI upsets, impotence, confusion.
• Patient Teaching:
  • Smoking decreases effectiveness.
  • Take 1-2 hours before antacids.
  • Confusion is an adverse effect.
  • Administer with meals at bedtime.

PPIs (Proton Pump Inhibitors): Lansoprazole (Prevacid), Omeprazole (Prilosec), Rabeprazole (AcipHex), Pantoprazole (Protonix), Esomeprazole (Nexium)

• Indications: Duodenal and gastric ulcers, GERD, Zollinger-Ellison syndrome, H. pylori, stress ulcer prophylaxis.
• Mode of Action: Inhibits an enzyme needed for gastric acid secretion.
• Side Effects: GI upsets, C. difficile and bone fractures (with long-term use).
• Patient Teaching:
  • Monitor for diarrhea, cramping, bloody stools.
  • Can open capsule, but do not crush.
  • Take on an empty stomach – at least 30 minutes before meals.

Sucralfate (Carafate)

• Indications: Duodenal ulcers.
• Mode of Action: Reacts with stomach acid to form a thick paste that adheres to ulcers.
• Side Effects: Constipation
• Administration: Take 1 hour before meals and at bedtime (4 times a day). Increase intake of fluids and fiber.

CH 51 Bowel Medications

Nonpharmacological treatment

• Treatment for diarrhea: Bananas, fluid, BRAT diet.
• Treatment for constipation: Fiber, fluids, movement.

Treatments for Diarrhea

• Adsorbents (Pepto-Bismol: bismuth salicylate, activated charcoal): Coat walls of the GI tract and bind to causative bacteria or toxin. Used for mild diarrhea. Side effects include increased bleeding time, constipation, dark stools, confusion, and metallic taste.
• Opiates (Opium, loperamide, codeine): Decrease GI contractions and gastric secretions. Used for severe diarrhea. Side effects include drowsiness, dizziness, nausea/vomiting, constipation, urinary retention, and respiratory depression.
• Anticholinergics (Belladonna atropine): Decrease GI motility, drying effect with secretions. Side effects include urinary retention, impotence, headache, dizziness, anxiety, hypotension, and blurred vision.
• Probiotics (Culturelle, Florastor - Lactobacillus acidophilus): Supply missing bacteria to the GI tract to decrease diarrhea. Used to treat antibiotic-induced diarrhea.

Treatments for Constipation

• Bulk forming laxatives (Metamucil, Citrucel): Absorb H_2O to increase bulk and high fiber. Distends bowel . Side effects include fluid disturbances, electrolyte imbalance, and gas formation.
• Emollient (Docusate, mineral oil): Softens stool and expands stool to promote bowel distension. Side effects include skin rash, decreased absorption of vitamins, and electrolyte imbalance.
• Hyperosmotic (Miralax, PEG 3350, glycerin, sorbitol, lactulose): Increase fecal water content leading to distension leading to increased peristalsis and evacuation. Lactulose can also treat high ammonia levels! Side effects include abdominal bloating, rectal irritation, and electrolyte imbalances.
• Saline laxative (Milk of magnesia): Increase osmotic pressure in the GI tract.
• Stimulant (Senna (sennakot), bisacodyl): Stimulate intestinal nerves, resulting in increased peristalsis. Side effects include nutrient malabsorption, skin rash, gastric irritation, electrolyte imbalances, and rectal irritation.
• Excessive laxative use may cause damage to the bowel.

Docusate Sodium (Colace)

• Indications: Prevention of constipation.
• Mode of Action: Draws water into stool, resulting in softer bowel movements.
• Side Effects: Mild cramping, diarrhea.
• Administration: Administer with a full glass of water. Increase fiber and fluid intake. Increase mobility to promote regularity. Laxatives can create electrolyte imbalances such as low potassium.

Bisacodyl (Dulcolax)

• Indications: Constipation, bowel prep before surgery/procedure.
• Mode of Action: Stimulates peristalsis, which causes bowel evacuation.
• Side Effects: Cramping, nausea/vomiting.
• Administration: Administer with a full glass of water. Increase fiber and fluid intake, and increase mobility to promote regularity.

Lactulose (Ammonia Levels)

• Indications: Constipation, bowel prep before surgery/procedure. Also used for hepatic encephalopathy (due to a buildup of ammonia in the body).
• Mode of Action: Draws water into the intestine and promotes peristalsis. Lactulose lowers the pH in the colon, which promotes ammonia excretion.
• Side Effects: Cramping, bloating, diarrhea.
• Make sure to ask the patient if they take any supplements for constipation and document it Review of Herbal Supplements used for Constipation

General Patient Education

• Notify provider if symptoms persist, as this may be a sign of a worse problem.
• Diarrhea does not always need immediate treatment, especially if infectious.
• Assess fluid volume status and electrolytes.
• Consider laxative abuse in older adults.
• Take all laxatives with 8 oz of water.
• Bisacodyl: no milk, antacids, or juices—only water.

CH 52 Antinausea Medications

Ondansetron (Zofran)

• Indications: Nausea and vomiting.
• Mode of Action: Blocks serotonin receptors in CTZ (chemoreceptor trigger zone).
• Side Effects: Headache, constipation, diarrhea.
• Adverse Effects: QT interval prolongation.
• Administration: For chemo, administer prior to therapy (vs. treating n/v that is already occurring), at least 30-60 mins prior to scheduled medication.

Metoclopramide (Reglan)

• Indications: Nausea/vomiting, gastroparesis, GERD.
• Mode of Action: Accelerates gastric emptying and blocks dopamine and serotonin receptors in the CTZ (chemoreceptors trigger zone).
• Side Effects: Drowsiness, GI upsets, extrapyramidal symptoms (rigidity, tremors, twitching, tardive dyskinesia, restlessness).
• Administration: Administer tablets 30 minutes before meals and at bedtime. Extrapyramidal symptoms. Tardive dyskinesia.. Parkinson's like Symptoms- muscle rigidity, tremors, slow movement. Neuroleptic Malignant Syndrome (NMS)- life threathening characterized by fever, muscle rigidity, altered mental status, autonomic dysfunction. Notify Provider if symptoms arise. Have to DC immediately.