1. Medications Used for Gastrointestinal System Disorders
UNIT 22
Medications Used for Gastrointestinal System Disorders

2. Key Terms Amebiasis Chyme Defecation GERD Helminthiasis
Histamine antagonist
Peptic ulcer

3. Common GI Complaints Ulcers GERD Dyspepsia Pyrosis Nausea and vomiting
Diarrhea and constipation
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4. Common GI Complaints Causes of GI complaints Poor diet Stress Alcohol
Caffeine
Smoking
NSAIDs
Infection with H. pylori

5. Helicobacter pylori 80% of gastric ulcers 90% of duodenal ulcers
Diagnosis
Serology for antibodies
Breath test
EGD
Biopsy urease test
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6. Helicobacter pylori Treatment Requires 10–14 days Antibiotics
Bismuth preparations
Proton-pump inhibitors
Histamine antagonist

7. Ulcer Symptoms Gnawing or burning epigastric pain Nausea Vomiting
Loss of appetite
Bleeding

8. Changes That Affect GI Function in Older Adults
Dental deterioration
Weakening of muscles
Difficulty swallowing
Decline in taste bud function
Decreased peristalsis
Reduced hepatic blood flow and function

9. Signs of Dehydration in Children
Weight loss
Irritability and lethargy
Loss of skin elasticity
Dry mucous membranes
Sunken eyes and fontanels
Decreased tearing, salivation, or urination
Subnormal or elevated body temperature
Increased pulse or respirations

10. Antacids Neutralize stomach acid Most are nonsystemic
Sodium bicarbonate can have systemic effect
Aluminum or calcium based
May cause constipation
Magnesium based
May cause diarrhea

11. Antacid Mixtures
Combines aluminum or calcium compound with magnesium salts
Each counters adverse effect of the other
Discussion Question:
What would be some potential adverse effects from long-term use of sodium bicarbonate?

12. Histamine H2-Receptor Antagonist
Inhibit gastric acid secretion
Inhibit gastric acid stimulation
Adverse reactions
Varies with drug
Generally well tolerated
Some may affect libido or sexual function
Should not be used during pregnancy or breastfeeding, or for children younger than 16 years of age

13. Histamine Antagonist Patient Education
Avoid substances and foods that cause duodenum irritation
Caffeine
Nicotine
Alcohol
Spicy foods
OTC medications (aspirin)
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14. Histamine Antagonist Patient Education
Discussion Question:
How would you explain to a patient the difference in action between an antacid and a histamine antagonist?

15. Mucosal Protective Medications
Carafate
Forms coating over surface of ulcer
Cytotec
Prevents NSAID-induced gastric ulcers
Warning!
Cytotec is an abortifacient, and is contraindicated during pregnancy or childbearing potential.

16. Proton-Pump Inhibitors
Suppress gastric acid secretion
Dosage varies with drug
Medication should not be crushed or chewed
Examples:
Prilosec
Aciphex
Prevacid
Protonix
Nexium
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17. Proton-Pump Inhibitors
Warning!
When clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. Patients at risk of heart attacks or strokes using clopidogrel to prevent blood clots will not get the full effect of this medicine.
Discussion Question:
What is the difference in action between histamine antagonists and proton-pump inhibitors?

18. Laxatives Bulk-forming agents Lubricants Osmotic laxatives
Saline laxatives
Stool softeners
Stimulant laxatives
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19. Laxatives Uses Constipation Prep for surgery or diagnostic testing
After anthelmintic therapy, to speed elimination of parasites
Reduction of strain of defecation for cardiac patients
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20. Laxatives Contraindications Impaction Appendicitis
Intestinal or biliary tract obstructions
Acute hepatitis
Third trimester of pregnancy
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21. Laxatives Warning! Lubricant laxatives
May interfere with absorption of vitamins A, D, E, and K.
May increase effect of oral anticoagulants. Be alert for signs of bleeding.
May produce lipid pneumonia if aspirated.

22. Laxative Abuse As with any other drug, laxatives can be abused.
Causes colon to become lazy, causing true constipation
Slowly reduce laxative use until return to normal state
Increase fluids, fiber, and exercise

23. Antidiarrheal Agents Avoid salicylates with Pepto-Bismol
Lomotil is schedule V controlled substance
Do not use Lomotil with MAO inhibitors
Imodium contraindicated for patients with severe ulcerative colitis and pseudomembranous enterocolitis
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24. Antidiarrheal Agents Discussion Questions:
Why should patients avoid ASA while taking Pepto-Bismol?
Why is Lomotil a controlled substance?
How does this help control diarrhea?

25. Diarrhea Facts Diarrhea is a symptom, not a disease
May be acute or chronic
May result in dehydration and electrolyte imbalance
May be caused by infection, allergy, tumors, food poisoning, intoxication, malabsorption, or medications

26. Anthelmintics
Helminthiasis is intestinal infestation by parasitic worms
Nemathelminthes
Roundworms
Platyhelminthes
Flatworms
Associated with unsanitary living conditions
Can be treated with anthelmintic medication
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27. Anthelmintics Discussion Questions:
What are some ways to prevent helminthiasis?
Who are some people who would be at risk in the United States of helminthiasis?

28. Protozoal Infections Often found in developing countries
Travel and military increase incidence in United States
Malaria
Giardiasis
Trichomoniasis
Amebiasis

29. Antiprotozoal Agents Dosage varies with drug
Flagyl and Yodoxin used for both trichomoniasis and amebiasis

30. Antiemetics Agents that prevent or arrest vomiting Treatment of
Vertigo
Motion sickness
Nausea associated with antineoplastic agents and radiation

31. Emetics Induce vomiting Contraindicated if ingested caustic substances
Activated charcoal given after vomiting stops
Warning!
Always have the phone number to poison control nearby.
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32. Emetics Apomorphine HCl Ipecac syrup Onset in 2–10 minutes
Best on full stomach
Ipecac syrup
Available OTC
Onset within 20 minutes
Follow with water