GI Medications and Related Disorders NUR 154 Ivy Tech Community College Pharmacotherapeutics

Gastrointestinal A & P  Esophagus  Stomach  Small intestine Duodenum Jejunum Ileum  Large Intestine

Gastrointestinal Reflux Disease (GERD)  Signs and Symptoms “Heartburn” Bloating/eructation Regurgitation “Hiccups” Angina (chest pain)  Causes Weak cardiac sphincter Leads from esophagus to stomach Delayed emptying Hiatal hernia Obesity Overeating Constriction Increased acid

Peptic Ulcer Disease  Risk Factors Acid/defense imbalance Genetic predisposition Stress Smoking NSAID’s Food/alcohol  Signs & Symptoms Epigastric pain Bloating N & V Anorexia

Treatment of GERD and PUD  Reduce acid  Neutralize acid  Heal by coating ulcers in stomach  Antibiotics for Helicobacter pylori (H. pylori)

Antacids  Maalox  Mylanta  Limit use for 2 weeks for indigestion  Use Low Na diet for renal, cardiac, pregnant clients  Tablets ineffective for PUD  Call MD if S&S worsen  No Mg if renal patient

Antacids  Side Effects Constipation (Ca & Al) Diarrhea (Mg) Chalky taste  Nursing Actions Alternate between types may help constipation & diarrhea Switch brands, try different flavors Try liquids, not tabs

H2 Antagonists  Side Effects Dizziness, HA’s, somnolence Diarrhea, constipation Confusion, hallucinations Gynecomastia (long- term use) Hepatotoxicity  Related Nursing Actions Safety – resolves with time Hydration/bulk; stool softeners Monitor; Safety Monitor Monitor; report labs, S/S

GI Prostaglandin  Misoprostol (Cytotec)  Used for NSAID- induced ulcers  Contradindicated with pregnancy (induces uterine contractions  Side Effects Diarrhea  Nursing Action Take with meals and hs Avoid Mg antacids Roughage may help

Gastric Acid Pump Inhibitors  Omeprazole (Prilosec)  Used for severe esophagitis, GERD, PUD, hypersecretion  Give before meals (ac)  Swallow capsule whole  Side Effects Diarrhea HA Muscle pain Fatigue Rash  Nursing Actions Usu. mild S/S Fluids/Fiber may help diarrhea Report rash

Prokinetic Agents  Metoproclamide (Reglan)  Used for GERD, post- barium, anti-emetic for chemotherapy  PO or IV Dilute IV with 50 ml diluent/infuse over >15 minutes Contraindicated with epilepsy  Side Effects Extrapyramidal S/S (esp. with elderly, children, or higher doses) Drowsiness, nausea May alter absorption of food and drugs  Nursing Actions Monitor at-risk clients; report Drowsy, nausea usu. mild, Resolves with time Watch for signs of increased or decreased action of other routine meds

Antispasmodics  Dicyclomine (Bentyl) Used for irritable bowel, colic, PUD, ulcerative colitis Do not use with closed- angle glaucoma Give with food or milk  Side Effects Anticholinergic effects Blurred vision, constipation, urinary retention, dry mouth Confusion, depression, nightmares, hallucinations Orthostatic hypotension Palpitations; arrhythmias  Nursing Actions Assess, treat S/S Baseline VS and mental state-continued monitoring IV; safety measures Report problems/changes

Drugs used for Nausea/Vomiting  Causes?  Drug therapy utilized Anti-emetics

Anti-Emetics  Phenothiazines Promethazine (Phenergan); Prochlorperazine (Compazine)  Serotonin Antagonists ondansetron (Zofran)  Anticholinergics Dimenhydrinate (Dramamine) Scopalamine (Trans- derm-Scop)  For mild-mod. N/V  Used with chemo, rad. therapy, Pre/post-op  Used for motion sickness; Transdermal Patch commonly used for Hospice pt.s

Phenothiazines  Side Effects Drowsiness Orthostatic hypotension Anticholinergic S/S (e.g. dry mouth, urinary retention) Extrapyramidal symp.s Photosensitivity  Nursing Actions Safety Monitor; Safety Monitor; treat S/S Monitor; Report Avoid UV exposure; Protection

Serotonin Antagonists  Zofran  Side Effects HA Diarrhea Constipation Sedation  Nursing Actions Usually mild Tx symptoms Be alert for allergic rxn Seems to be more common with this drug Stop drug Give Benadryl IV

Anti-Cholinergics  Side Effects:  Sedation  Anticholinergic S/S E.g,. dry mouth  Nursing Actions:  Safety  Treat S/S

Drugs used for Constipation and Diarrhea  Causes? Major cause of constipation is what category of meds? Common cause of diarrhea is what category of meds? Other causes?  Treatment

Laxatives  Stimulant (Dulcolax) PO: 6-10 hrs action PR: minutes action  Saline (MOM) 1-3 hrs action  Lubricant (Mineral oil) 6-8 hrs action  Bulk (Metamucil) hrs action Give with H20  Stool Softeners (Pericolace) 72 hrs action

Laxatives  Side Effects Cramping, diarrhea Abdominal pain, bleeding, vomiting, distention  Nursing Action Assess before administration Hold PRN Report to MD

Diarrhea  Causes?  Treatments

Anti-Diarrheal Meds  Locally-acting (Kaopectate)  Systemic-acting Lomotil (diphenoxylate with atropine)  Give dose with loose BM  Addiction potential r/t systemic effects (atropine added to minimize this potential)

Anti-Diarrheal Meds  Side Effects Abd. Distention Nausea Constipation Dizziness and drowsiness (with Lomotil)  Nursing Actions Monitor Report increased diarrhea

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