Presentation on theme: "Drugs Affecting the Gastrointestinal System and Nutrition"— Presentation transcript:
1Drugs Affecting the Gastrointestinal System and Nutrition Jan Bazner-Chandler MSN, CNS, RN, CPNP
2Acid-related Pathophysiology Hydrochloric acid (HCL) aids in digestion and serves as a barrier to infection.Pepsinogen is an enzyme that digests dietary protein.Mucous protects the lining of the stomach from both HCL and digestive enzymes.Prostaglandins has an anti-inflammatory and protective function.
3AntacidsAre basic compounds used to neutralize stomach acid.
4OTC ProductsAntacids were the most common products used for acid-indigestion until the 1970’s when histamine-2 (H2 antagonists) were developed.
5ActionPrimary drug effect of antacids is the reduction of symptoms associated with acid-related disorders: pain and reflux (heartburn)Raises gastric pH from 1.3 to 1.6.
6Indications Acute relief of symptoms associated with: peptic ulcer disease (PUD)Gastritisgastric hyperacidityHeartburn or gastro esophageal reflux (GEF)
7GERD Most common disorder of esophagus Characterized by regurgitation of gastric contents into esophagus and exposure of esophageal mucous to gastric acid and pepsin.Main symptom is heart burn - occurs after eatingCause is thought to be incompetent lower esophageal sphincter
9Peptic Ulcer DiseaseUlcer formation in the esophagus, stomach or duodenumMucous exposed to gastric acid and pepsinImbalance between cell-destructive and cell-protective effectsGastric acid and pepsinH. pylori – infectious process
11Adverse EffectsMagnesium preparations especially milk of magnesium or MOM can cause diarrhea.Calcium products can cause kidney stones.Sodium bicarbonate products can cause systemic alkalosis.Self-treatment can result in masking symptoms of a disease (bleeding ulcer or stomach cancer).
17Administration Chewable forms needs to be thoroughly chewed. Liquid forms need to be shaken well before taking.Take with 8 ounces of water to enhance absorption.Do not take within 1 to 2 hours of taking other medications – may effect absorption
19H2 antagonist HAs Action: blocks the H2 receptor of acid-producing parietal cellsReduce hydrogen ion secretions to increase pH of stomach
20Therapeutic Uses GERD or gastro-esophageal reflux PUD or peptic ulcer diseaseZollinger-Ellison Syndrome (excessive gastric acidity)
21Adverse Effects Overall very low incidence of adverse effects May cause some CNS effects in the geriatric patient.Smoking reduces effectivenessH2 antagonist should be taken 1 hours before taking any antacids
22Proton Pump Inhibitors Newest drugs used in the treatment of acid-related disorders.lansopraxole (Prevacid)omeprazole (Prilosec)rabeprzole (Acephex)pantoprazole (Protonix)exomepraxole (Nexium)
23PPIsAction: Binds directly to the hydrogen-potassium - ATPase pump mechanism, inhibiting the action of the enzyme which results in a total blockage of hydrogen ion secretion from the parietal cells.
24Adverse Effects Long term use might promote malignant gastric tumors. Concern about over prescribing resulting in reduction of normal acid-mediated antimicrobial protection.May need a probiotic when using PPI drug therapy.
25Miscellaneous Acid-Controlling Drugs sucralfate (Carafate)Uses: long-term therapy for PUDAction: acts locally binding directly to the surface of the ulcer.Note: not used as often due to short-term action and multiple daily dosing.
26Cytotec Generic: misoprostol Action: acts on prostaglandin E analogue Indication: reduces the incidence of gastric ulcers in patients taking NSAIDs.
27Mylicon Generic: simethicone Action: alters the elasticity of mucus-coated gas bubbles, causing them to break down into smaller ones
28MyliconUsed to reduce the discomfort of gastric or intestinal gas (flatulence)Used post-operatively and in post-partum patients to relieve gas pain.Often used in combination with activated charcoal in oral poisoning (overdose).
29ProbioticsProbiotics are live microorganisms (in most cases, bacteria) that are similar to beneficial microorganisms found in the human gut. They are also called "friendly bacteria" or "good bacteria." Probiotics are available to consumers mainly in the form of dietary supplements and foods. They can be used as complementary and alternative medicine.
30ProbioticsProbiotics are available in foods and dietary supplements. Examples of foods containing probiotics are yogurt, fermented and unfermented milk, miso, and some juices and soy beverages. In probiotic foods and supplements, the bacteria may have been present originally or added during preparation.
31ProbioticsMost probiotics are bacteria similar to those naturally found in people's guts, especially in those of breastfed infants (who have natural protection against many diseases). Most often, the bacteria come from two groups, Lactobacillus or Bifidobacterium. A few common probiotics, such as Saccharomyces boulardii, are yeasts, which are different from bacteria.
32Uses Chronic Diarrhea Irritable Bowel Syndrome Digestive disorders Clients on oral or IV antibiotic therapyStatus post abdominal surgery
34Antidiarrheal Drugs Used to treat diarrhea. Adsorbents Antimotility (anticholenergic and opiates)Intestinal flora modifiers or bacterial replacement drugs
35Adsorbents Act by coating the walls of the GI tract. Bind with the causative bacteria or toxin to their adsorbent surface for elimination through the stool.
36Pepto-Bismul and Kaoectate Generic: bismuth subsalicylateSame chemical structure as salicylateuse with caution in children. May cause Reyes SyndromeUse with caution in clients who are on anti-coagulation therapy.
38FDA WarningThe main ingredient, bismuth subsalicylate, has been linked with Reye Syndrome, a potentially life-threatening disorder that has been associated with kids that have viral illnesses, especially the flu and chicken pox, and who take aspirin and other salicylate containing medications, like Pepto-Bismol.Label advises not to give to children under age 12 years.
39AnticholinergicsUsed either alone or in combination with other antidiarrheal drugs.Acts by slowing GI tract motilityAtropinehyoscyaminehyoscine
40Opiates Products containing Codeine Nursing consideration: clients on opioids for post-operative pain control may suffer from constipation.Atropine: often used to control secretions during surgical procedure – may contribute to post-operative constipation
41Imodium A D Generic name: loperamide Classification: Opiate antidiarrhealAction: inhibits both peristalsis in the intestine and intestinal secretions, decreasing the number of stools and their water content.Contraindications: ulcerative colitis, acute diarrhea due to E-coli (Escherichia coli)
42Laxatives Laxative act by: Affecting the consistency of the stool Increasing fecal movement through the colonFacilitating movement through the colon
43ConstipationDefinition: abnormally infrequent and difficult passage of feces.Constipation is a symptom not a disease.
44Bulk-forming Laxatives Composed of water-retaining natural and synthetic cellulose derivates.Psylium is an example of natural bulk-forming laxative.Methylcellulose is an example of a synthetic cellulose derivative.
45Bulk-forming Laxative Action: increases water absorption, which results in greater bulk of the intestinal contents.Tend to produce normal, formed stools.Action limited to GI tract so adverse effects are minimal.
47Nursing Alert Have client take with 8 ounces of water. If powdered form needs to be mixed with 8 ounces of water.Fluid must be taken immediately to avoid swelling of the product in the throat or esophagus or fecal impaction.Best for clients with chronic constipation.
48Emollient laxative Generic classification: docusate salts Trade names: Colace, SurfakAction: work by lowering the surface tension of GI fluids; more water and fat are absorbed into the stool and intestine.
49Emollients Uses: Outcomes: soft stool with easier defecation post partumpostoperative patientsClients on long-term pain controlOutcomes: soft stool with easier defecation
50Mineral OilAction: eases the passage of stool by lubricating the intestines and preventing water from escaping the stool.ContraindicationsAbdominal painNausea and vomitingIntestinal obstruction
51Hyperosmotic Laxatives GlycerineAction: promotes bowel movement by increasing the osmotic pressure in the intestine.Note: given in the form of a suppository
52Stimulant LaxativesThrough the use of natural plant products and synthetic chemical drugs induces intestinal peristalsis.Note: the stimulant class is the most likely to cause dependence.
53Stimulant Laxatives Generic: senna Trade: Senokot Action: stimulates the GI tractAdverse effects: may cause abdominal pain.Onset of action: complete bowel evacuation in 6 to 12 hours.
54Irritable Bowel Syndrome IBS A condition of chronic intestinal discomfort, including cramps, diarrhea / or constipation.Two drugs to manage symptoms:Lotronex (alostron) – approved for women onlyZelnorm (tegaserod) – approved for men and womenAction: works on serotonin receptors in the intestinal tissue.
56Chemoreceptor Trigger Zone (CTZ) The area of the brain that is involved in the sensation of nausea and the action of vomiting.
57Vomiting Center (VT)The area of the brain that is involved in stimulating the physiologic events that lead to nausea and vomiting.
58Antiemetic Drugs Drugs used to relieve nausea and vomiting. All emetic drugs work at some site in the vomiting pathways.
59Syrup of IpecacAAP recommendations in 2003 issued an alert to stop the use of this drug to induce vomiting after drug overdose.
60Anticholinergic Drugs Act by binding to and blocking acetylcholine receptors (ACh) in the vestibular nuclei, located deep in the brain.One drug scopolamineMost commonly used drug for treatment and prevention of nausea and vomiting associated with motion sickness and postoperatively.
61AntihistaminesAction: binds to H1 receptors, potentiate anticholinergic activity.Most popular OTC medicationsGeneric name: dimenhydrinateTrade name: Dramamine and BenadrylOTC drugs used for motion sickness
62NeurolepticsAction: antidopaminergic, antihistamine and anticholinergic properties.Trade names: Compazine, Thorazine, PhenerganOften given as preoperative medication.Used to treat psychotic disorders due to effect on dopamine.
63Compazine: Nursing Alert Adverse reaction: extrapyramidal reaction--a muscle spasm of the tongue. Other typical adverse extrapyramidal reactions include tremors, drooling, and muscle spasms that usually involve muscles in the shoulders, neck, or eyes.Antidote: Benadryl
64Prokinetics Metoclopramide Trade name: Reglan Action: promote the movement of substances through the GI tract and increases motility.Often given in patients getting tube feeding to promote gastric emptying time.
65Serotonin BlockersCalled 5-HT3 receptor blockers because they block the 5-HT3 receptors in the GI tract, CTZ and vomiting centers VC.Four drugs in this category
66ondansetron Trade name: Zofran is the prototype drug. Approved in 1992.Major break through in treating chemotherapy induced nausea and vomiting and postoperative nausea and vomiting.Approved for use in pregnancy.
67Side effects from all antiemetics May cause dizzinessCaution with use while driving.CNS depressionHypotension
68Herbal Therapies Ginger Root May increase absorption of all oral mediations, may increase bleeding in clients taking Coumadin and Plavix.