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Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 18 Gastrointestinal Medications.

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Presentation on theme: "Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 18 Gastrointestinal Medications."— Presentation transcript:

1 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 18 Gastrointestinal Medications

2 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 2 Chapter 18 Lesson 18.1

3 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 3 Learning Objectives Identify common uses for antacids and histamine H 2 -receptor antagonists Compare and contrast the actions of anticholinergic and antispasmodic medications on the gastrointestinal (GI) tract Compare the actions and adverse reactions of the five major classifications of laxatives

4 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 4 Learning Objectives (cont.) Identify indications for the use of at least two common antidiarrheals, antiflatulents, digestive enzymes, and emetics Describe indications for disulfiram use and what is meant by "disulfiram reaction"

5 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 5 Overview Three major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colon Miscellaneous medications: antiflatulants, digestive enzymes, emetics, and medications to treat gallstones and alcoholism

6 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 6 Digestive System Functions Structures Protective factors Digestion variables

7 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 7 Digestive System

8 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 8 Antacids, H 2 -Receptor Antagonists, Proton Pump Inhibitors Stomach lining and acid production External factors that contribute to ulcer formation Protective medications Table 18-1

9 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 9 Antacids, H 2 -Receptor Antagonists, Proton Pump Inhibitors (cont.) Action and Uses Antacids neutralize hydrochloric acid and decrease gastric pH; inhibit pepsin Histamine H 2 -receptor antagonists displace histamine from the receptor site and prevent stimulation of the secretory cells (neutralize acid and promote healing of ulcers) Proton pump inhibitors irreversibly stop the acid secretory pump imbedded in the parietal cells

10 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 10 Antacids, H 2 -Receptor Antagonists, Proton Pump Inhibitors (cont.) Adverse Reactions Antacids: weakness, anorexia, diarrhea, frequent burping, bowel obstruction, constipation, hypermagnesemia H 2 -receptor antagonists: dizziness, headache, somnolence, mild/brief diarrhea, hematology changes, muscle pain Proton pump inhibitors: headache, diarrhea, abdominal pain, and nausea; rarely rash, vomiting, and dizziness

11 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 11 Antacids, H 2 -Receptor Antagonists, Proton Pump Inhibitors (cont.) Drug Interactions Antacids prevent absorption of many drugs Dicumarol absorbed 50% faster when taken with antacids

12 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 12 Antacids, H 2 -Receptor Antagonists, Proton Pump Inhibitors (cont.) Nursing Implications and Patient Teaching Assessment: interaction possibilities Diagnosis: smoking/alcohol intake, stress Planning: increase fluid intake Implementation: forms and routes of administration vary Evaluation: continued symptoms of GI distress Patient and Family Teaching: administration times and drug specificity, adverse reactions, drug storage and efficacy, medical follow-up, drug interactions

13 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 13 Anticholinergics and Antispasmodics Motility Symptoms Classes of medications: anticholinergics, antispasmodics, antidiarrheals Table 18-2

14 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 14 Anticholinergics and Antispasmodics (cont.) Action and Uses Anticholinergic-antispasmodic preparations reduce GI tract spasm and intestinal motility, acid production, and gastric motility, thus reducing pain –Use: peptic ulcer, pylorospasm, biliary colic, hypermotility, irritable colon, and acute pancreatitis Antidiarrheals reduce the fluid content of the stool and decrease peristalsis and motility of the intestinal tract; increase smooth-muscle tone and diminish secretions –Use: treatment of nonspecific diarrhea or diarrhea caused by antibiotics

15 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 15 Anticholinergics and Antispasmodics (cont.) Adverse Reactions Anticholinergics: due to high dosages Antidiarrheals

16 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 16 Anticholinergics and Antispasmodics (cont.) Drug Interactions New GI stimulants, when combined with other drugs that inhibit cytochrome P-450 4A4 systems, should be monitored for cardiac dysrhythmias Nursing Implications and Patient Teaching Assessment, diagnosis, planning, implementation, and evaluation

17 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 17 Laxatives Aid in the elimination of stool from the rectum Bulk-forming agents Fecal softeners Hyperosmolar or saline solutions Lubricants Stimulant or irritant laxatives Tables 18-3 and 18-4

18 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 18 Laxatives (cont.) Action and Uses Bulk-forming laxatives absorb water and expand, increasing the bulk and moisture content of the stool; peristalsis increases, and absorbed water softens the stool Fecal softeners lower the surface tension, which allows the fecal mass to be softened by intestinal fluids Hyperosmolar laxatives produce an osmotic effect by drawing water into the bowel, thereby promoting peristalsis and bowel movement

19 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 19 Laxatives (cont.) Action and Uses (cont.) Lubricant laxatives create a barrier between feces and the colon, preventing colon reabsorption and causing softening of the stool Stimulant or irritant laxatives work according to the agent

20 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 20 Laxatives (cont.) Adverse Reactions Nausea and vomiting, obstruction, hypersensitivity Cramping, diarrhea Electrolyte disturbances

21 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 21 Laxatives (cont.) Drug Interactions Reduced effectiveness of antibiotics, anticoagulants, digitalis, and salicylates when combined with laxatives Nursing Implications and Patient Teaching Assessment (CHF)

22 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 22 Miscellaneous Gastrointestinal Drugs Antiflatulents Pancreatic digestive enzymes Emetics Disulfiram Table 18-5

23 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 23 Antiflatulents Break up and prevent mucus- surrounded pockets of gas from forming in the intestine; reduce gastric pain Intended for short-term use

24 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 24 Gallstone-Solubilizing Agents Act on the liver to suppress cholesterol and cholic acid synthesis; biliary cholesterol desaturation is enhanced, and breakup occurs Used in selected patients with radiolucent stones in gallbladder Adverse reactions: dose related; diarrhea, anorexia, constipation, cramps, dyspepsia, epigastric distress, flatulence, heartburn, nausea, nonspecific abdominal pain, and vomiting

25 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 25 Digestive Enzymes Promote digestion by acting as replacement therapy when the bodys natural pancreatic enzymes are lacking, not secreted, or not properly absorbed

26 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 26 Disulfiram Used in the management of alcoholism Unpleasant reaction when combined with alcohol

27 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 27 Emetics Used in emergencies to induce vomiting Poison Control Center Gastric lavage Syrup of ipecac Apomorphone

28 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 28 Complementary and Alternative Therapies Common products Conditions Drug interactions


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