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Gastrointestinal Drugs

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Presentation on theme: "Gastrointestinal Drugs"— Presentation transcript:

1 Gastrointestinal Drugs
Pharmacology I: NURS 1950

2 Objective 1: list the components of gastric juice that contribute to the pain associated with peptic ulcers Objective 2: describe the physiology of gastric secretions

3 Objective 3: list drugs considered to be ulcerogenic

4 Objective 4: explain the actions of the antiulcer drugs
Decrease acidity Block histamine receptors Gastrointestinal prostaglandins

5 Gastric acid pump inhibitors
Coating agents Prokinetic agents Antispasmodic agents

6 Objective 5: describe the pain reducing effects of antacids

7 Decreased pain Raise the pH of gastric contents
Higher pH, less acidity Decreased pain

8 Objective 6: identify the features of an ideal antacid
Cheap Effective No constipation or diarrhea No systemic effects No rebound acidity

9 Objective 7: differentiate between the various antacids

10 Riopan, Maalox, Mylanta II, low sodium
Calcium carbonate, Aluminum hydroxide: constipation Magnesium: diarrhea, electrolyte imbalance Calcium carbonate & sodium bicarbonate: rebound acidity

11 Simethicone: defoaming agent
Alginic acid: highly viscous solution—sodium alginate

12 Objective 8: describe the nursing implications associated with antacid therapy

13 What are the assessments and interventions the nurse would do for a client taking an antacid?

14 Objective 9: state the mechanism of action of anticholinergic and antispasmodic agents

15 What would you see with anticholinergics?
Anticholinergics and antispasmodics the same Drugs include belladonna, probanthine, bentyl Used for spastic conditions of GI tract, peptic ulcers and irritable bowel syndrome Block parasympathetic nervous system Activity is systemic What would you see with anticholinergics?

16 Which clients should not use anticholinergics?

17 Objective 10: identify appropriate nursing actions relative to caring for clients receiving antispasmodic drugs

18 Assess: mental status, teach about orthostatic hypotension
In the elderly: increased constipation If arrhythmia or palpitations: stop the drug, call the physician

19 Objective 11: describe the effects and uses of H2 receptor antagonists, and proton pump inhibitors

20 Used for GERD, duodenal ulcers, Zollinger-Ellison syndrome
H2 receptor antagonists Block histamine 2 receptors Raises pH of gastric contents Used for GERD, duodenal ulcers, Zollinger-Ellison syndrome Used to prevent or treat stress ulcers

21 Drugs include Cimetidine (Tagamet) Famotidine (Pepcid)
Nizatidine (Axid) Rantidine (Zantac)

22 Drugs can cause Dizziness, HA, diarrhea, constipation
If confusion, disorientation, hallucination, see MD Can cause gynecomastia, hepatotoxicity

23 Proton pump inhibitors
Inhibit gastric acid pump Treat: severe esophagitis, GERD, gastric and duodenal ulcers, Zollinger-Ellison syndrome Can be used with antibiotics for H pylori

24 SE: diarrhea, HA, muscle pain and fatigue
If rash: call MD

25 Drugs include Esomeprazole (Nexium) Lansoprazole (Prevacid)
Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (Aciphex)

26 Objective 12: Explain the nursing interventions associated with H2 receptor antagonists and proton pump inhibitors

27 Objective 13: identify causes of constipation
Objective 14: explain the uses of laxatives and cathartics Objective 16: describe the actions of the types of laxatives Objective 17: identify laxatives according to type

28 Causes of constipation
What are some things or conditions that can cause constipation?

29 laxatives Act three ways Affect fecal consistency
Increase fecal movement Remove stool from rectum

30 Laxatives OTC; misused
Dependence Damage bowel Cause problems in bowel

31 Contraindications, Precautions
Caution: surgical abdomen; appendicitis; N/V; fecal impaction; intestinal obstruction; undiagnosed abdominal pain Contraindicated: hypersensitivity

32 Groups of Laxatives Bulk-forming Emollient Hyperosmotic Saline

33 Mechanism of action Best for long term use
Bulk-forming: natural fiber-like Absorb water Distends bowel Initiates reflex bowel activity Best for long term use

34 Lowers surface tension Allows more fat & water to be absorbed
Emollient laxatives Stool softener (Docusate salts) Lowers surface tension Allows more fat & water to be absorbed When should these be used?

35 Lubricates fecal material & intestinal wall
Lubricant laxative (mineral oil) Lubricates fecal material & intestinal wall Prevents H20 from leaking out of gut Stool expands & softens

36 The emollients and lubricants do not seem to increase peristalsis
Oils a problem in constantly recumbent clients

37 Hyperosmotic increase water content in large intestine
Distends bowel Increases peristalsis Evacuates the bowel Non-absorbable ion exchange Used before diagnostic tests

38 Saline laxatives increase osmotic pressure in small intestine
Inhibit absorption of water & elytes Increase amount of water & elytes

39 Results: watery stool Increased distention of bowel Promotes peristalsis & evacuation Example: citrate of magnesia

40 Increases bulk Softens stool Stimulant laxatives stimulate nerves
Increases peristalsis Increase fluid in colon Increases bulk Softens stool

41 Drug effects Few systemic effects Therapeutic Uses
Primary site of action the gut Therapeutic Uses Common constipation Bowel preparation pre-op, diagnostic tests

42 Side Effects/Adverse Effects
Bulk forming: impaction above strictures, fluid overload, electrolyte imbalance, gas Emollient: skin rash, decreased absorption vitamins, lipid pneumonia, elyte imbalance Hyperosmotic: abdominal bloating, rectal irritation, elyte imbalance

43 Saline: magnesium toxicity, elyte imbalance, diarrhea, increased thirst
Stimulant: nutrient malabsorption, gastric irritation, elyte imbalance, discolored urine, rectal irritation

44 Interactions Bulk-forming: interfere with absorption antibiotics, digoxin, salicylates, oral anticoagulants Mineral oil: decrease absorption fat soluble vitamins Hyperosmotic: increased CNS depression with barbiturates, general anesthetics, opioids, antipsychotics

45 Oral antibiotics decrease effect of lactulose
Stimulants: decrease absorption antibiotics, digoxin, tetracycline, oral anticoagulants

46 Objective 15: identify features of an ideal laxative and cathartic
What do you think makes an ideal laxative?

47 Objective 18: describe the major nursing implications associated with the administration of laxatives

48 Assess: drugs client takes including OTC and herbs
Assess bowel elimination pattern Assess diet and fluid intake Assess activity and exercise Assess for travel, dehydration Assess for any past GI problems

49 Objective 19: identify causes of diarrhea
What things, conditions can cause diarrhea?

50 Objective 20: describe the uses of antidiarrheal agents
Objective 21: identify the antidiarrheal agents

51 Antidiarrheal drugs: local or systemic action
Local: adsorb water to cause a formed stool Systemic: act on autonomic nervous system to decrease peristalsis

52 Antidiarrheals Groups based on mechanism of action Adsorbents
Antimotility Bacterial replacement Antisecretory Enzymes

53 Mechanism of action Treat underlying cause
Adsorbents: coat walls of GI tract; bind causative bacteria, toxin Bismuth subsalicylate (Pepto-Bismol) Attapulgite (Kaopectate) Aluminum hydroxide (AlternaGel, Maalox) Kaolin-pectin

54 Anticholenergics Decrease: peristalsis, muscle tone
Use with adsorbents, opiates Examples: Atropine Hyoscyamine Hyosine

55 Opiates Decrease bowel motility Reduce pain
Increased absorption of water & elytes (absorption time)

56 Drug Effects Adsorbents: bismuth subsalicylate: form of ASA
Activated charcoal Side Effects Adsorbents: can increase bleeding time, dark stools, tinnitus, metallic taste, blue gums Anticholinergics: urinary retention, impotence, anxiety, brady or tachy-cardia, blurred vision, photophobia

57 Interactions Adsorbents: decrease digoxin, clindamycin, oral hypoglycemics. Methotrexate-toxicity Anticholinergics: decreased effect with antacids. Increased anticholinergic effect with tricyclic antidepressants, MAOIs, amantadine & antihistamines

58 Opiates: additive CNS depression-alcohol, narcotics, sedative-hypnotics, antipsychotics, skeletal muscle relaxants Pepto + oral anticoagulants

59 Objective 22: describe the nursing implications associated with antidiarrheal agents

60 Assess for cause of diarrhea
Medications Infections Diet Lactulose intolerance Emotional stress Hyperthyroidism Inflammation of gut Surgical bypass of gut

61 Objective 23: discuss the pathophysiology of nausea and vomiting
Nausea: sensation of abdominal discomfort that is intermittently accompanied by the desire to vomit Vomiting: the forceful expulsion of gastric contents up the esophagus and out of the mouth


63 Objective 24: identify antiemetic drugs and their classification
Dopamine antagonists Serotonin antagonists Anticholinergics Corticosteroids Benzodiazepines Cannaboinoids

64 Objective 25: identify the mechanism of action, indications for use and desired effects of antiemetic drugs

65 Dopamine antagonists Phenothiazines, butyrophenones (Haldol) and metoclopramide (Reglan) Phenothiazines include Thorazine and Compazine Drugs act to inhibit dopamine receptors that are part of the pathway to the vomiting center. Also block other dopamine receptors in the brain Can cause EPS

66 Phenothiazines mostly used
Reglan popular

67 Serotonin Antagonists: chemotherapy, radiation, post op
Block serotonin receptors in the CTZ and GI tract Drugs include Dolasetron (Anzemet); granisetron (Kytril) and ondansetron (Zofran)

68 Often for motion sickness; may see for clients on chemotherapy
Anticholinergics: counterbalance the amount of acetylcholine at the CTZ Often for motion sickness; may see for clients on chemotherapy Drug examples Cyclizene (Marezine), dimenhydrate (Dramamine), meclizene (Antivert), scopolamine

69 Corticosteroids Sometimes see Decadron Don’t know its action

70 Do cause mind altering effects Can be abused
Cannaboinoids Active ingredient THC from marijuana Inhibit various pathways to the CTZ Drugs include: dronabenol (Marinol) Do cause mind altering effects Can be abused

71 Benzodiazepines: various activities such as sedation, depression of vomiting center, can cause amnesia Examples: diazepam, lorazepam and midazolam

72 New for chemo clients Neurokinin receptor antagonist
Aprepitant (Emend)

73 Objective 26: explain the use of emetics

74 Fresh supplies are needed as the drug will expire
Emetics are used when the stomach needs to be emptied Use after overdose Example: syrup of Ipecac: NO LONGER used for kids Fresh supplies are needed as the drug will expire

75 Objective 27: Describe the nursing process related to the administration of emetics/antiemetics
What assessments would you make? What interventions would you initiate?

76 Objective 28: demonstrate the ability to calculate drug dosages

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