3 Learning ObjectivesIdentify common uses for antacids and histamine H2-receptor antagonistsCompare and contrast the actions of anticholinergic and antispasmodic medications on the gastrointestinal (GI) tractCompare the actions and adverse reactions of the five major classifications of laxatives
4 Learning Objectives (cont.) Identify indications for the use of at least two common antidiarrheals, antiflatulents, digestive enzymes, and emeticsDescribe indications for disulfiram use and what is meant by "disulfiram reaction"
5 OverviewThree major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colonMiscellaneous medications: antiflatulants, digestive enzymes, emetics, and medications to treat gallstones and alcoholismWhat is a common OTC drug used in the treatment of GI disorders?Why would an emetic be ordered?If a patient has undergone a gastric bypass procedure, which GI medication may be prescribed?Laxatives work in several ways. They promote bowel emptying by increasing intestinal bulk, lubricating intestinal walls, softening the fecal mass, increasing peristalsis through local tissue irritation, or by direct action on the intestine.
6 Digestive System Functions Structures Protective factors Digestion variablesWhat are the three functions of the digestive system?How does the amount of blood flow to the digestive tract affect the body’s ability to absorb medications?What is the other name for the digestive tract?What role does age play in the normal digestive process?
8 Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors Stomach lining and acid productionExternal factors that contribute to ulcer formationProtective medicationsTable 18-1What clinical factors may play a role in increased acid production in the stomach?Why would a GI-protective drug be prescribed in combination with NSAIDs?Drug treatment includes the use of antacids, H2-receptor antagonists, and proton pump inhibitors
9 Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Action and UsesAntacids neutralize hydrochloric acid and decrease gastric pH; inhibit pepsinHistamine H2-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 cellsOf the three drugs, which classification is considered first-line therapy in the treatment of peptic ulcer disease over 6 to 8 weeks?What conditions would antacids be used to treat?How are ulcers caused by Helicobacter pylori treated?When would proton pump inhibitors be used for long-term therapy?How do misoprostol and sucralfate differ in their action?
10 Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Adverse ReactionsAntacids: weakness, anorexia, diarrhea, frequent burping, bowel obstruction, constipation, hypermagnesemiaH2-receptor antagonists: dizziness, headache, somnolence, mild/brief diarrhea, hematology changes, muscle painProton pump inhibitors: headache, diarrhea, abdominal pain, and nausea; rarely rash, vomiting, and dizzinessIf the patient overuses antacids that contain magnesium, what symptoms might appear?Which antibiotic should not be taken with antacids?Which drugs, when combined with proton pump inhibitors, may produce serious overdose for the patient?
11 Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Drug InteractionsAntacids prevent absorption of many drugsDicumarol absorbed 50% faster when taken with antacidsWhat are some other examples of drug interactions?
12 Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Nursing Implications and Patient TeachingAssessment: interaction possibilitiesDiagnosis: smoking/alcohol intake, stressPlanning: increase fluid intakeImplementation: forms and routes of administration varyEvaluation: continued symptoms of GI distressPatient and Family Teaching: administration times and drug specificity, adverse reactions, drug storage and efficacy, medical follow-up, drug interactionsWhat administration considerations will the nurse note if the patient is receiving an antacid and an enteric-coated drug scheduled for the same time each day?If the patient is receiving an aluminum-containing antacid, the diet should contain adequate amounts of phosphorus. What foods are naturally high in phosphorus?If the patient is unable to swallow a proton pump inhibitor whole, what might be considered?When is the best time to administer an oral proton pump inhibitor?
13 Anticholinergics and Antispasmodics MotilitySymptomsClasses of medications: anticholinergics, antispasmodics, antidiarrhealsTable 18-2What contributes to the GI discomfort patients often feel?The anticholinergic-antispasmodic agents act with antacids in prolonging or continuing the therapeutic benefits of both drug categories.
14 Anticholinergics and Antispasmodics (cont.) Action and UsesAnticholinergic-antispasmodic preparations reduce GI tract spasm and intestinal motility, acid production, and gastric motility, thus reducing painUse: peptic ulcer, pylorospasm, biliary colic, hypermotility, irritable colon, and acute pancreatitisAntidiarrheals reduce the fluid content of the stool and decrease peristalsis and motility of the intestinal tract; increase smooth-muscle tone and diminish secretionsUse: treatment of nonspecific diarrhea or diarrhea caused by antibioticsWhy would a GI motility agent be prescribed for an elderly patient with gastroesophageal reflux disease?When would it be inadvisable to use an antidiarrheal agent for a patient who has diarrhea?What is the action of bismuth salts on the intestines?
15 Anticholinergics and Antispasmodics (cont.) Adverse ReactionsAnticholinergics: due to high dosagesAntidiarrhealsIf an anticholinergic contains phenobarbital, what adverse reactions should the patient be monitored for?What is a common adverse reaction associated with long-term use of antidiarrheals?
16 Anticholinergics and Antispasmodics (cont.) Drug InteractionsNew GI stimulants, when combined with other drugs that inhibit cytochrome P-450 4A4 systems, should be monitored for cardiac dysrhythmiasNursing Implications and Patient TeachingAssessment, diagnosis, planning, implementation, and evaluationIf anticholinergics containing phenobarbital are combined with anticoagulants without a dosage adjustment, what type of complications could the patient be at risk for?What important questions should the LPN/LVN ask when completing a nursing assessment for GI disorders?The nurse should review the patient’s hydration and nutrition status, especially assessing for dehydration in elderly clients.What dietary considerations should the nurse teach the patient who has diarrhea?
17 Laxatives Aid in the elimination of stool from the rectum Bulk-forming agentsFecal softenersHyperosmolar or saline solutionsLubricantsStimulant or irritant laxativesTables 18-3 and 18-4How does the use of laxatives relate to a patient’s age?When is regular use of laxatives indicated? What problems may arise with regular laxative use?Can you identify a procedure in which laxatives may be indicated as patient preparation?
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 stoolFecal softeners lower the surface tension, which allows the fecal mass to be softened by intestinal fluidsHyperosmolar laxatives produce an osmotic effect by drawing water into the bowel, thereby promoting peristalsis and bowel movementFecal softeners may inhibit the reabsortion of what two products by the intestine?What conditions other than constipation are bulk-forming laxatives used to treat?Why would a stool softener be indicated for the patient after rectal or cardiac surgery?Saline laxatives may be used as a bowel prep before diagnostic and surgical procedures.A patient on prolonged bedrest may be prescribed which type of laxative?
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 stoolStimulant or irritant laxatives work according to the agent
20 Laxatives (cont.) Adverse Reactions Nausea and vomiting, obstruction, hypersensitivityCramping, diarrheaElectrolyte disturbancesWhy is it important to provide sufficient liquids to patients receiving laxatives?If a patient has a history of chronic renal failure and is receiving a hyperosmolar laxative, what is he or she at risk of developing?Which two electrolyte values may be abnormal with excessive laxative use?
21 Laxatives (cont.) Drug Interactions Reduced effectiveness of antibiotics, anticoagulants, digitalis, and salicylates when combined with laxativesNursing Implications and Patient TeachingAssessment (CHF)Why is the use of mineral oil combined with a laxative contraindicated?If the patient chronically misuses laxatives, what clinical condition may result?What medical conditions contraindicate the use of laxatives? Why?What nutritional education for preventing constipation should the nurse provide to the patient?In addition to education about fecal softeners, what nonpharmacologic education should the patient receive?
22 Miscellaneous Gastrointestinal Drugs AntiflatulentsPancreatic digestive enzymesEmeticsDisulfiramTable 18-5How does simethicone work as an antiflatulent?When would the use of an emetic be contraindicated?
23 AntiflatulentsBreak up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric painIntended for short-term useWhen is the use of activated charcoal indicated?What physical assessments would the nurse observe in the patient who has excessive gas?Antiflatulents are often used in combination with what other GI drug?
24 Gallstone-Solubilizing Agents Act on the liver to suppress cholesterol and cholic acid synthesis; biliary cholesterol desaturation is enhanced, and breakup occursUsed in selected patients with radiolucent stones in gallbladderAdverse reactions: dose related; diarrhea, anorexia, constipation, cramps, dyspepsia, epigastric distress, flatulence, heartburn, nausea, nonspecific abdominal pain, and vomitingWhat patient characteristics and/or history warrant the use of these agents?If the patient complains of epigastric pain, where would the pain be located?Which other drug may reduce the absorption of these medications?What type of diet education would the patient with a history of gallstones benefit from?
25 Digestive EnzymesPromote digestion by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking, not secreted, or not properly absorbedFor which clinical conditions would these enzymes be indicated?Why is proper dietary balance of fat, protein, and starch indicated for the patient who is receiving these enzymes?If the patient is receiving supplemental iron while on these enzymes, what side effect can occur?When are digestive enzymes usually scheduled to be given?What other patient education should be offered to patients taking these preparations?
26 Disulfiram Used in the management of alcoholism Unpleasant reaction when combined with alcoholWhat symptoms would the patient experience if this drug were taken with alcohol?What physiologic condition within the body produces the disulfiram reaction?What other medication, when taken with alcohol, produces a reaction similar to the disulfiram-alcohol reaction?Why is it important for the patient to carefully read label ingredients (food, personal care items, over-the-counter medications) while on this drug?
27 Emetics Used in emergencies to induce vomiting Poison Control Center Gastric lavageSyrup of ipecacApomorphoneWhy should the LPN/LVN consult a Poison Control Center before inducing vomiting?If inducing vomiting is contraindicated, what would the indicated treatment be?What amount of time is indicated between poison ingestion time and drug administration time?Which emetic is given IV?When would gastric lavage be indicated in the treatment of poisoning?Why should emetics never be used for unconscious patients?
28 Complementary and Alternative Therapies Common productsConditionsDrug interactionsWhich of these products potentiate bleeding when combined with anticoagulants, aspirin, antiplatelet drugs, or NSAIDs?