Gastrointestinal System

Antiulcer

Pharmacology I

Antacids

Action

  • Antacids neutralize gastric hydrochloric acid (HCl).

  • They increase gastric pH.

  • Decreases gastric acidity, thereby reducing irritation of mucosa.

Indications

  • Hyperacidity.

  • Heartburn.

  • Acid indigestion.

  • Acid reflux.

  • Gastro Esophageal Reflux Disease (GERD).

  • Peptic Ulcer Disease (PUD).

Additional Indications

  • Electrolyte imbalance, particularly those related to low magnesium or calcium.

  • Hyperphosphatemia (specific aluminum-based antacids bind phosphate).

  • Calcium supplementation (calcium carbonate).

  • Magnesium deficiency (magnesium-containing antacids).

Goals of Antacid Therapy

  • Reduce pain and discomfort.

  • Increase gastric pH (normal gastric pH is approximately 1.5–3.5).

  • Reduce acidity to decrease irritation of gastric and esophageal mucosa.

Antacids - Drugs

  • Magnesium Hydroxide (Milk of Magnesia).

  • Aluminum Carbonate (Basaljel).

  • Aluminum Phosphate (Phosphagel).

  • Aluminum Hydroxide (Amphojel).

  • Calcium Carbonate (Tums).

  • Sodium Bicarbonate (Alka Seltzer).

  • Combination Products: Maalox, Mylanta, Gaviscon.

Adverse Effects

  • Magnesium: Associated with diarrhea.

  • Aluminum: Linked to constipation.

  • Calcium: May cause constipation and possible rebound acidity.

  • Sodium Bicarbonate: Risk of fluid retention, potential for metabolic alkalosis.

  • Common to all categories: interference with drug absorption, altered bowel patterns.

Nursing Implications

  • Administration methods: suspension versus solid.

  • Consideration of its relationship to other drugs.

  • Potential stool changes.

  • Over-the-counter concerns.

  • Electrolyte monitoring.

H2 Blockers / Antisecretory

Action

  • Block H2 receptors on parietal cells.

  • Decrease both volume and acidity of gastric secretions.

  • Reduce daytime and nocturnal acid production.

Indications

  • Short term treatment (4-8 weeks).

  • Hypersecretory conditions, including:

    • Peptic Ulcer Disease (PUD).

    • Gastroesophageal Reflux Disease (GERD).

H2 Blockers - Drugs

  • Cimetidine (Tagamet).

  • Famotidine (Pepcid).

  • Nizatidine (Axid).

Adverse Effects

  • CNS: Including dizziness, drowsiness, headache, confusion (higher risk in elderly or those with renal impairment).

  • GI: Diarrhea or constipation.

  • Cardiac: Rare instances of arrhythmias and decreased blood pressure (particularly with IV usage).

  • Musculoskeletal/Skin: Skin rash, muscle pain.

  • Drug Specific: Gynecomastia and impotence more common with cimetidine.

Interactions

  • Cigarettes.

  • CNS depressants.

  • Antiarrhythmics.

  • Methylxanthines.

  • Warfarin.

  • Phenytoin.

  • Tricyclic Antidepressants.

Contraindications

  • Known hypersensitivity.

  • Pregnancy and lactation (with caution).

  • Severe liver disease.

  • Severe kidney disease.

  • Allergy testing.

  • Gastric acid testing.

  • Acute porphyria (genetic disorders).

  • Situations where reduced acidity may mask symptoms of a more serious gastric issue.

Nursing Implications

  • For oral administration: Give with food (except for nizatidine).

  • IM administration: Deep muscle injection.

  • IV infusion: Monitor vital signs.

Monitoring

  • CNS depression and mood changes.

  • Signs of bleeding.

  • Foods to avoid.

  • Resolution of gynecomastia.

  • Smoking can reverse drug effects.

Proton Pump Inhibitors (PPIs)

Action

  • Suppress gastric acid secretion.

  • Block the final step in the production of HCl.

  • Bind with enzymes in gastric acid (Hydrogen, Potassium, and Adenosine Triphosphatase).

Indications

  • Peptic Ulcer Disease (PUD).

  • Gastroesophageal Reflux Disease (GERD).

  • Treatment for Helicobacter Pylori.

PPIs - Drugs

  • Omeprazole (Prilosec).

  • Lansoprazole (Prevacid).

  • Esomeprazole (Nexium).

  • Pantoprazole (Protonix).

  • Rabeprazole (Aciphex).

Adverse Effects

  • Gastrotoxicity: Risks include hypersensitivity reactions.

  • Respiratory Issues: Possible complications or adverse effects.

  • CNS Issues: Range of effects, specifics not detailed.

  • Muscular Issues: Adverse impacts that may not be explicitly listed.

Nursing Implications

  • Oral forms should be taken on an empty stomach.

  • For sustained release capsules, sprinkle on applesauce for administration.

  • Procedures for administration via NGT (nasogastric tube) should be referenced in manual.

H Pylori Treatment

  • Pylera pack contains:

    • Bismuth (Pepto-Bismol).

    • Tetracycline (antibiotic).

    • Metronidazole (Flagyl, also used for C-diff).

  • Administer with PPI (e.g., omeprazole).

  • Duration of treatment: 10 - 14 days or longer.

Cytoprotective Agents

Drug

  • Sucralfate (Carafate).

Action

  • Forms a complex that adheres to the ulcer crater.

  • Provides protection from irritation.

Indications

  • Short-term treatment for 4 to 8 weeks.

  • Management of PUD.

  • Treatment in GERD.

Sucralfate - Dosing

  • 1g, administered 4 times daily (AC and HS).

Adverse Effects

  • Constipation.

  • Dry mouth.

  • Dizziness.

Nursing Implications

  • Administer on an empty stomach.

  • Note that it decreases absorption of most drugs—should be taken 1-2 hours before or after administration.

  • Antacids should be taken ½ hour before or after sucralfate.

  • H2 blockers should also be spaced ½ hour before or after.

  • Consider prophylactic treatment for constipation as necessary.

Prostaglandins

Action

  • Protects the mucosal surface of the stomach.

Indications

  • Prophylaxis related to Aspirin (ASA) and NSAID usage.

Prostaglandin - Drug

  • Misoprostol (Cytotec).

    • Dose: 100 - 200 mcg, administered 4 times daily.

Adverse Effects

  • Abdominal pain.

  • Diarrhea.

  • Flatulence.

  • Increased uterine contraction.

  • Vaginal bleeding.

Contraindication

  • Use during pregnancy is prohibited.

Nursing Implications

  • Conduct pregnancy testing prior to drug administration.

  • Advise women of childbearing age to use contraception during treatment.

  • Administer with food to mitigate cramping.

  • Advise patients that diarrhea typically resolves in one week.

GI Quick Guide: High-Yield Summary

Administration Guidelines

  • Antacids: Administer 1–3 hours after meals and at bedtime; separate from other medications by 1–2 hours.

  • H2 Blockers: Administer with food; nizatidine can be taken without food.

  • PPIs: Administer 30–60 minutes prior to breakfast; do not crush enteric-coated beads.

  • Sucralfate: Should be given on an empty stomach, before meals and at bedtime.

  • Misoprostol: Administer with food to reduce cramping.

Monitoring Parameters

  • Monitor for electrolyte levels such as Magnesium (with PPIs) and Calcium/Phosphate (with Aluminum/Magnesium antacids).

  • Assess renal function—avoid Magnesium/Aluminum antacids in patients with chronic kidney disease (CKD).

  • Monitor blood pressure/heart rate with IV H2 blockers.

  • Pregnancy status is crucial for Misoprostol administration.

Alerts

  • Sodium bicarbonate should be avoided in patients with heart failure/hypertension.

  • Be aware that Cimetidine may cause CNS changes in the elderly or those with renal impairment.

  • Misoprostol can induce uterine contractions; it is contraindicated in pregnancy.

  • Long-term use of PPIs carries risks such as fractures and low magnesium levels.

Classic Traps in Practice

  • Understand that PPIs do not produce instant effects—they require several days.

  • Caution that antacids can interfere with the absorption of many medications.

  • Be aware that Sucralfate blocks absorption unless the timing is managed appropriately.

  • Distinguish that H2 blockers do not neutralize acid, whereas antacids do not reduce acid production.

NCLEX High-Priority Safety & Red Flags in GI Medications

Safe Administration Practices

  • Time administration of PPIs appropriately before meals; do not crush delayed-release beads.

  • Space antacids and Sucralfate from other medications to avoid interference.

  • Infuse IV H2 blockers slowly to prevent hypotension and arrhythmias.

Red Flags Leading to Action

  • Presence of melena, hematemesis, or severe epigastric pain may require evaluation for GI bleeding.

  • New confusion in individuals taking Cimetidine should prompt assessment of renal function; consider alternatives if necessary.

  • Persistent reflux symptoms in patients solely taking antacids may necessitate escalation to H2 blockers or PPIs while evaluation is conducted.

  • Severe diarrhea from Magnesium-based antacids or Misoprostol leads to reassessing therapy and hydration needs.

Significant Interactions

  • Cimetidine may increase the levels of Warfarin, Phenytoin, and Theophylline.

  • PPIs can reduce absorption of antifungal medications and may interact with Clopidogrel (Pantoprazole is preferred for such cases).

  • Be aware that Sucralfate can reduce absorption of Digoxin, Warfarin, Levothyroxine, and certain Fluoroquinolones.

High-Risk Populations

  • Patients with CKD should avoid Magnesium/Aluminum antacids due to the potential for accumulation.

  • Patients with heart failure or hypertension should avoid Sodium Bicarbonate due to fluid retention risks.

  • Pregnant individuals should avoid Misoprostol altogether.

  • Elderly patients are more susceptible to increased CNS effects with H2 blockers.

Gastrointestinal Laxatives

Overview

  • Laxatives promote the evacuation of the bowel.

Indications

  • Constipation.

  • Preoperative diagnostic testing preparation.

  • Preparation for surgery.

  • Removal of poisonous substances from the GI tract.

Contraindications

  • Abdominal pain of unknown cause.

  • Nausea and Vomiting.

  • Colitis.

  • Suspected appendicitis.

  • Intestinal obstruction.

  • Diarrhea.

  • Hemorrhage.

  • Long-term use or abuse of laxatives.

Classifications of Laxatives

  • Bulk.

  • Lubricant.

  • Stimulant.

  • Saline.

  • Osmotic.

  • Chloride Channel Activators.

Bulk Laxatives

  • Action: Increase stool bulk and stimulate peristalsis.

  • Onset: 12 - 72 hours.

Bulk Laxatives - Indications

  • Chronic constipation.

  • Constipation related to pregnancy or postpartum.

  • Irritable bowel syndrome.

  • Diverticulitis.

Bulk Laxatives - Drugs

  • Methylcellulose (Citrucel).

  • Psyllium (Metamucil).

  • Polycarbophil (Fibercon).

  • Barley malt extract (Malt Suprex).

Adverse Effects of Bulk Laxatives

  • Constipation.

  • Fecal impaction.

  • Intestinal obstruction.

Administration Advice

  • Bulk laxatives should be in powder form, reconstituted and taken with a full glass of water to mitigate the risk of impaction from insufficient fluid intake.

Lubricants / Emollients

  • Action: Soften stools and ease fecal passage.

  • Indication: Prevention of chronic constipation.

  • Onset: 6 - 8 hours.

Lubricants / Emollients - Adverse Effects

  • Risk of deficiencies in fat-soluble vitamins.

  • Aspiration leading to lipid pneumonia if not administered correctly.

Drugs for Lubricants / Emollients

  • Mineral Oil.

Nursing Implications for Lubricants

  • Position the patient upright during administration.

  • Administer slowly.

  • Address storage conditions and mask unpleasant tastes.

  • Monitor for vitamin deficiencies due to nutrient absorption interference.

Stimulants / Irritants / Contacts

  • Action: Irritate the bowel, stimulating peristalsis and drawing water into the bowels.

  • Result: Watery stools.

  • Onset: 6 - 8 hours.

Stimulants / Irritants - Indications

  • For intermittent use.

  • Preparation for diagnostic testing (e.g., barium GI series and colonoscopy).

Stimulants / Irritants - Adverse Effects

  • Abdominal pain.

  • Diarrhea.

  • Discoloration of feces and urine.

  • Potential laxative dependency.

  • Skin rash.

Stimulants / Irritants - Drugs

  • Bisacodyl (Dulcolax).

  • Cascara sagrada.

  • Castor oil.

  • Senna (Sennosides, Senokot).

Hyperosmotic Laxatives

  • Key components include magnesium-based solutions (e.g., Mg citrate, Mg hydroxide, Mg sulfate) and polymer remedies (e.g., PEG solutions).

Saline Laxatives

  • Action: Attract water from tissues into the bowel via osmosis.

  • Indications: Bowel preparation for surgery or diagnostic tests (including sigmoidoscopy and colonoscopy).

  • Onset: 1 to 3 hours.

Saline Laxatives - Adverse Effects

  • Potential for fluid and electrolyte imbalance.

  • Symptoms may include abdominal cramps, bloating, diarrhea, and anal irritation.

Drugs For Saline Laxatives

  • Magnesium Citrate.

  • Magnesium Hydroxide (Milk of Magnesia).

  • Magnesium Sulfate (Epsom Salt).

  • Sodium Phosphate (Fleet's).

Nursing Implications for Saline Laxatives

  • Ensure that patients have a gag reflex.

  • Watch for impaired absorption of other drugs.

  • Caution is advised in elderly patients and those with cardiac disease.

  • Not recommended for long-term use to avoid dependence and constipation.

Osmotic Cathartics / Polymer

  • Action: Hyperosmotic, osmotic electrolyte laxatives cleanse the bowel via fluid overload.

  • Indications: Colon surgery, colonoscopy preps, barium studies, and intravenous pyelograms (IVP).

Drugs for Osmotic Cathartics

  • Polyethylene Glycol (Miralax).

  • Polyethylene Glycol-Electrolyte Solution (GoLYTELY).

  • Onset: 30 to 60 minutes.

Nursing Implications for Osmotic Cathartics

  • Administer Powder or ready-mix solution (typically 4 L).

  • Patients should refrain from eating for at least two hours prior to administration.

  • Administer in 8 oz (240 mL) increments every 10 minutes, if appropriate; can be provided via NG tube.

  • Contraindications include nausea/vomiting, GI obstruction, and presenting abdominal pain.

Lactulose

  • Action: Hyperosmotic, sugar-like laxative.

  • Drug: Lactulose (Generlac, Enulose, Cholac).

  • Indications: Constipation and decreasing blood ammonia levels.

  • Onset: 24 to 48 hours.

Chloride Channel Activator

  • Indications: Treatment of chronic constipation and IBS with constipation, specifically for women over 18.

  • Drug: Lubiprostone (Amitiza).

Chloride Channel Activator - Adverse Effects

  • Nausea and vomiting.

  • Bloating.

  • Headaches.

Fecal Softeners

  • Action: Draws water into stools to soften them for easier passage.

  • Indication: To prevent constipation and straining, particularly after myocardial infarction (MI), abdominal surgeries, eye surgeries, or during prolonged bed rest.

Fecal Softeners - Adverse Effects

  • May cause nausea and skin rash.

Drugs

  • Docusate Sodium (Colace).

  • Docusate Calcium (Surfak).

  • Docusate Potassium (Dialose).

Nursing Implications for Fecal Softeners

  • Contraindications include signs and symptoms of appendicitis (N&V, abdominal pain).

  • Liquid forms should be mixed with H2O or fruit juice for palatability.

  • Encourage a high fiber diet and adequate fluid intake (2 to 3 liters per day).

  • Assess for adequate bowel sounds.

Antidiarrheal Agents

  • Types:

    • Local agents (Bismuth).

    • Demulcents.

    • Adsorbent/absorbent (Kaopectate).

    • Probiotics.

    • Systemic actions (Opiates, Anticholinergics).

Actions

  • Antidiarrheal agents work to decrease peristalsis.

  • Characteristics of systemic agents include:

    • Opiates and anticholinergics.

Local Agents

  • Demulcents: Soothing the bowel (Bismuth).

  • Adsorbents/Absorbents: Absorb fluid from stool (Kaopectate).

  • Probiotics: Re-seeding the bowel with normal flora (e.g., Lactobacillus acidophilus).

Antidiarrheal - Systemic Actions

  • Used for diarrhea associated with ulcerative colitis and diverticulosis; effective primarily in cases of hypermotility rather than infection.

Opiates - Drugs

  • Loperamide Hydrochloride (Imodium) – 2 mg tablets.

  • Diphenoxylate/Atropine (Lomotil) – 2.5 mg/0.025 mg tablets.

Opiates - Action

  • Act through the CNS to decrease peristalsis and spasms while moderating gastrointestinal motility.

Opiates - Adverse Effects

  • Issues may arise in respiratory, ophthalmic, and cardiac systems; effects may be present in skin and mucosa.

Nursing Implications for Opiates

  • Diphenoxylate is a Schedule V controlled substance with a potential for dependence.

  • Monitor for CNS depression and increased drowsiness; contraindicated in children under 2 years of age.

Anticholinergics

  • Action: Act through the parasympathetic nervous system to reduce peristalsis, spasm, gastric acid, and overall GI motility.

  • Derived from belladonna alkaloids.

Drugs for Anticholinergics

  • Atropine sulfate. - Scopolamine (Transdermal patch - 72-hour use).

Nursing Implications for Anticholinergics

  • Monitor for common adverse effects, including those affecting respiratory, ophthalmic, and cardiac systems.

Antidiarrheals - Nursing Implications

  • Record stool: noting color, frequency, amount, and consistency.

  • Monitor fluid and electrolyte balance along with intake and output (I&O).

  • Daily weight assessments are crucial for measuring hydration status.

Additional Nursing Considerations

  • Inspect perianal tissue and maintain cleanliness after each bowel movement.

  • Be cautious with elderly patients, as antidiarrheals may increase drowsiness.

  • Administer antidiarrheals best after a loose bowel movement to gauge effectiveness.

Gallstone Stabilizers

  • Function: Dissolve uncomplicated cholesterol gallstones by reducing hepatic cholesterol secretion, decreasing biliary cholesterol saturation, and suppressing cholesterol and bile acids.

  • Drug: Ursodiol (Actigall, Urso 250, Urso Forte).

High Priority Safety-GI Medications

  • Caution: Never administer laxatives in the presence of severe abdominal pain, fever, or suspected obstruction.

  • Systemic antidiarrheals (Lomotil, loperamide) are contraindicated with fever or bloody stools as they may trap infectious organisms.

  • Magnesium-based laxatives (Mg citrate, MOM) should be avoided in renal impairment due to risk of magnesium accumulation.

  • Mineral oil carries a high aspiration risk; use cautiously in dysphagia or older adults.

  • Bulk laxatives (psyllium) require adequate fluid intake to mitigate obstruction risk.

  • Stimulant laxatives should be reserved for short-term use only to avoid dependency.

Smart Study: Laxatives

  • Classification Overview:

    • Bulk (psyllium): the safest and slowest option; requires water.

    • Stimulants (bisacodyl, senna): swift but harsher; risk of dependency.

    • Saline (Mg citrate): powerful and rapid; risk of electrolyte imbalance.

    • PEG solutions: full bowel preparation with minimal electrolyte shift.

    • Lubricants (mineral oil): risk of aspiration and loss of vitamins A/D/E/K.

    • Stool softeners (docusate): crucial for preventing strain during recovery (post MI, post-surgery).

Key Logic Cues for GI Medications

  • Remember indicators for common conditions—pain with no bowel sounds should delay laxative use.

  • PEG indicated for colonoscopy prep is regarded as safe for kidney function; saline is not.

  • Use docusate for preventive measures post-MI or surgery.

Smart Study: Antidiarrheals

  • Match medications with patient conditions:

    • Local agents are preferred for mild diarrhea without systemic action.

    • Opiates like loperamide are reserved for non-infectious diarrhea while monitoring for CNS effects.

    • Anticholinergics should be avoided in glaucoma, BPH, and urinary retention.

Red Flags in Antidiarrheal Use

  • Immediate action is warranted in response to fever combined with diarrhea, bloody stools, severe cramping, and signs of drowsiness or sedation, particularly in older patients receiving opiate antidiarrheals.

  • Fluid weight changes indicate hydration status—monitor closely as they may signal dehydration or adverse gastrointestinal effects.

Gastrointestinal System: Digestants - Antiemetics
Digestants
Action

  • Function by breaking down fats, starches, and proteins.

Indications

  • Treatment for pancreatic enzyme deficiency.

  • Application in cystic fibrosis, diseases of salivary glands, or following stroke.

Adverse Effects

  • Potential nausea and vomiting.

  • Diarrhea.

  • Increased uric acid levels.

Drugs

  • Pancrelipase (Viokace, Cotazym, Creon, Pertzye, Ultresa, Zenpep).

    • Provided in enzyme units and can be delivered in powder form, commonly sprinkled on food.

Nursing Implications

  • Closely monitor food and fluid intake.

  • Conduct daily weight checks.

  • Assess bowel sounds and examine stool appearance.

  • Monitor for the onset of diabetes.

Adsorbent Agents

  • Action: Activated charcoal acts by attracting various substances to its surface, preventing absorption in the GI tract.

  • Indications: Primarily utilized for ingestion of poison or drug overdose situations.

Nursing Implications for Activated Charcoal

  • Contraindications: Should not be used with cyanide, ethanol, methanol, iron, inorganic acids, or solvents.

  • Adverse Effects: Notably causes black stools; patient education regarding stool changes is essential.

  • Administration: Typically delivered orally or via NG tube, often prepared as a slurry with 30 g of charcoal in 250 mL of water or fruit juice.

  • If Ipecac has been utilized, charcoal should be administered before it.

Antiflatulent Agents

  • Action: Breaks up gas bubbles in the GI tract.

  • Indications: Commonly used in post-operative and post-partum settings.

  • Drug Example: Simethicone (Mylicon).

Antiemetic Categories

  • Various drug classes include:

    • Dopamine antagonists.

    • Gastric stimulants.

    • Antihistamines.

    • Anticholinergics.

    • Serotonin antagonists.

    • Cannabinoids.

    • Benzodiazepines.

General Antiemetic Action

  • Suppress the vomiting center located in the medulla.

  • Often used prophylactically.

  • Indications extend to: nausea and vomiting (N&V), post-operative N&V (PONV), hiccoughs, vertigo, and motion sickness.

Dopamine Antagonists
Action

  • Blocks dopamine receptor sites in the Chemoreceptor Trigger Zone (CTZ).

Phenothiazine Classification

  • Indications include short-term treatment for N&V associated with anticancer drugs or PONV.

  • Drugs:

    • Chlorpromazine.

    • Prochlorperazine.

Phenothiazines Extend Beyond Nausea

  • Used also for treatment of psychosis.

  • Classifications include antipsychotics and major tranquilizers.

Non-Phenothiazine Effects

  • Examples include Trimethobenzamide (Tigan) and Metoclopramide (Reglan)—useful in conditions like paralytic ileus.

Adverse Effects of Dopamine Antagonists

  • Anticholinergic effects such as drowsiness.

  • CNS depression possibilities.

  • Additional adverse effects include blood dyscrasias and extrapyramidal effects.

  • Risks associated with hypersensitivity.

Gastric Stimulants

  • Action: Helps to expedite the movement of gastric contents into the small intestine by increasing upper GI motility.

  • Indications: Gastric stasis, paralytic ileus, and N&V management.

  • Drug: Metoclopramide (Reglan).

Antihistamines

  • Action: Block pathways to the CTZ to reduce vomiting impulses.

  • Indication: Effective for motion sickness and vertigo prevention.

Antihistamines - Drugs

  • Hydroxyzine (Vistaril) – potentiation.

  • Diphenhydramine (Benadryl).

  • Meclizine for vertigo.

  • Dimenhydrinate (Dramamine).

Anticholinergic Antiemetics

  • Action: Blocks pathways to the CTZ to decrease nausea and vomiting.

  • Indication: Primarily used for motion sickness and vertigo.

  • Drug: Scopolamine (transdermal patch).

Serotonin Antagonists

  • Action: Block the 5-HT3 serotonin receptor site in the CTZ.

  • Indications: N&V associated with cancer treatments, including post-operative settings.

  • Drugs include: Ondansetron (Zofran) and granisetron.

Cannabinoids

  • Action: Remains unclear, but serves as appetite stimulants and anti-N&V agents.

  • Indications: Used in N&V related to anticancer treatments.

  • Drugs: Dronabinol (Marinol) and nabilone (Cesamet).

  • Adverse Effects: Includes mental depression, lack of concentration, and the potential for addiction.

Benzodiazepines

  • Therapeutic Action: Primarily used to reduce anxiety.

  • Indications: Effective for anxiety management, may induce amnesia when necessary.

  • Adverse Effects: Anticholinergic characteristics and CNS depression.

  • Drugs: Lorazepam (Ativan) and midazolam (Versed).

Glucocorticoids in Antiemetic Use

  • Indication: Utilized as adjunct therapy for N&V associated with anticancer treatments.

  • Drugs: Dexamethasone and methylprednisolone (Solu-Medrol).

Nursing Implications for Antiemetics

  • Assess any potential allergies before administration.

  • Monitor vital signs throughout the treatment.

  • For parenteral forms, rotate the injection site carefully, monitor for precipitation in solution, and utilize Z-track injections for intramuscular (IM) options.

  • Transdermal forms should be placed behind the ear to ensure appropriate delivery.

General Nursing Considerations

  • Provide hygiene and comfort throughout the treatment.

  • Monitor intake and output as well as hydration levels.

  • Address dryness that may be induced by medication action.

  • Watch metabolic pH changes as medications exert effects on acidity.

Antiemetic Nursing: Daily Monitoring

  • Inspect bowel sounds on a daily basis to assess for any signs of obstructions or ileus.

  • Always remain cautious that medications can mask other diseases that may cause N&V, which might require further investigation.

GI Meds: Quick Summary

  • Digestants replace pancreatic enzymes and are taken with meals.

  • Adsorbents (activated charcoal) bind to toxins and are time-sensitive regarding other oral medications; should be given approximately 1 hour apart from all other PO medications.

  • Antiflatulents (simethicone) break gas bubbles and should be taken post-meals.

  • Antiemetics are classified into different drug types, including dopamine blockers, serotonin blockers, antihistamines, anticholinergics, cannabinoids, and benzodiazepines.

  • Always assess the cause of N&V before medicating, as misidentifying may mask serious underlying conditions.

NCLEX High-Priority “Report Immediately” Considerations

  • New involuntary movements occurring with metoclopramide could indicate tardive dyskinesia.

  • Severe sedation or respiratory depression in patients receiving benzodiazepines or antihistamines should prompt urgent reevaluation.

  • Patients exhibiting chest pain, palpitations, or severe dizziness after receiving antiemetics should be monitored and addressed immediately.

  • Monitor for absent bowel sounds or severe abdominal pain prior to administering antiemetics to rule out possible obstructions.

  • Black stools are expected with activated charcoal; however, report any severe abdominal discomfort or aspiration risks.

  • For digestants, a worsening condition of steatorrhea indicates the medications may not be meeting therapeutic expectations.

Nursing Quick Guide for GI Medications

  • Digestants: Administer with meals or snacks while monitoring stools and weight.

  • Activated charcoal: Prepare as a slurry at 30 g in 250 mL, do not use with other medications; contraindicated in obstructions.

  • Simethicone: Dose at intervals after meals and at bedtime; swallow whole unless prescribed as chewable.

  • Motion sickness medications (antihistamines, scopolamine patch): Administer before expected motion exposure for optimal effects.

  • Serotonin antagonists: Best option for chemo or post-operative N&V; monitor for headache and QT prolongation specifically.

GI Red-Flag Physiology Reminders

  • Vomiting can lead to metabolic alkalosis risks.

  • Persistent vomiting indicates dehydration alongside possible electrolyte depletion (Potassium, Sodium).

  • Antimotility or antiemetic drugs may obscure red flag findings in abdominal examinations.

  • Always re-assess bowel sounds, abdominal distention, and hydration status prior to the next scheduled medication dose.