1. 1 Chapter 8 Drugs for Gastrointestinal Disorders

2. 2 Gastrointestinal (GI) Disorders Peptic ulcer disease Peptic ulcer disease Gastroesophageal reflux disease Gastroesophageal reflux disease Diarrhea Diarrhea Constipation Constipation Intestinal gas Intestinal gas

3. 3 Peptic Ulcer Disease (PUD) Mucosa erosion – stomach or duodenum Mucosa erosion – stomach or duodenum Often asymptomatic Often asymptomatic Damage from Damage from –Alcohol abuse –Cigarette smoking –NSAIDs

4. 4 Signs and symptoms of PUD Dull stomach ache Dull stomach ache Poor appetite Poor appetite Bloating Bloating Burping Burping Nausea Nausea Vomiting Vomiting

5. 5 Treatment Options for PUD Directed towards relieving pain, accelerating ulcer healing, and minimizing recurrence Directed towards relieving pain, accelerating ulcer healing, and minimizing recurrence –H 2 receptor antagonists (Tagamet, Zantac) –Proton pump inhibitors (Prilosec, Prevacid) –Antacids (Tums, Rolaids) –Sucralfate (prescription only) –Bismuth compounds (Pepto-Bismol) –Antibiotics

6. 6 Adverse Effects Diarrhea Diarrhea Constipation Constipation Headache Headache Stomach cramps Stomach cramps Dizziness Dizziness Rash Rash Nausea Nausea Vomiting Vomiting

7. 7 Gastroesophageal Reflux Disease (GERD) Movement of gastric contents into the esophagus Movement of gastric contents into the esophagus Lower esophageal sphincter (LES) does not close properly Lower esophageal sphincter (LES) does not close properly

8. 8 GERD (cont.) Possible problems with GERD Possible problems with GERD –Esophageal strictures (narrowing or constriction) –Esophageal ulcers –Perforations –Hemorrhage –Aspiration –Motility disorders

9. 9 Heartburn Most common symptom of GERD Most common symptom of GERD Pain in center of chest Pain in center of chest Most do not seek treatment right away Most do not seek treatment right away Aggravated by Aggravated by –Foods high in fat –Spices, onions, citric juices, coffee (caffeine) –Alcohol –Body position

10. 10 Treatment and Adverse Effects Goals of treatment Goals of treatment –Eliminate symptoms –Limit frequency and duration –Promote healing –Prevent complications Alter factors that cause reflux Alter factors that cause reflux –Lose weight, proper diet –Loose-fitting clothes –Limit smoking, alcohol, laying down after eating

11. 11 Antacids Relieve mild to moderate symptoms Relieve mild to moderate symptoms –Decrease gastric acidity Rapid onset, short duration Rapid onset, short duration Taken with food = last up to 3 hours Taken with food = last up to 3 hours Adverse effects Adverse effects –Diarrhea –Constipation

12. 12 Table 8-2: Antacid Classifications*

13. 13 Diarrhea Genetic Disorder Abnormal frequency and liquidity of fecal discharge Origin –I–I–I–Infection (Salmonella) –T–T–T–Toxic –D–D–D–Drug-induced –D–D–D–Diet

14. 14 Acute or Chronic Acute (sudden onset) Acute (sudden onset) –Food induced (traveler’s) Chronic (2 weeks or longer) Chronic (2 weeks or longer) Stress or Irritable bowel syndrome Stress or Irritable bowel syndrome

15. 15 Treatment and Adverse Effects Goals of treatment Goals of treatment –Control the loss of fluids (athletes) –Identify and treat cause –Provide symptomatic relief Refer to physician if Refer to physician if –Persists for several days –Blood in stool –Severe abdominal pain, cramps If from a bacterial infection – do not stop movement If from a bacterial infection – do not stop movement

16. 16 Antiperistaltic agents (Imodium) Antiperistaltic agents (Imodium) –Dizziness, dry mouth, rash Bismuths (Pepto-Bismol) Bismuths (Pepto-Bismol) Figure 8-1, pg 111 Figure 8-1, pg 111

17. 17 Constipation Decrease in the frequency of fecal elimination (hard/dry stool) Decrease in the frequency of fecal elimination (hard/dry stool) Diet low in fiber Diet low in fiber Lack of exercise Lack of exercise Insufficient fluid intake Insufficient fluid intake Excessive intake of foods Excessive intake of foods Resisting defecation impulses Resisting defecation impulses Diabetes, pregnancy Diabetes, pregnancy

18. 18 Antidiarrheal medications Antidiarrheal medications –Can cause constipation –Low back pain, headache, distension, abdominal pain

19. 19 Treatment Increase fiber intake Increase fiber intake –Bulk-forming laxatives –FiberCon, Metamucil Increase fluid intake Increase fluid intake Aerobic exercise Aerobic exercise Stimulant laxatives Stimulant laxatives –Dulcolax Saline salt laxatives Saline salt laxatives –Phillips’ Milk of Magnesia/Fleet enema Implications for athletes, pg 113 Implications for athletes, pg 113

20. 20 Intestinal Gas Belching, abdominal discomfort, bloating, flatulence Belching, abdominal discomfort, bloating, flatulence Results from malabsorption of carbohydrates and proteins Results from malabsorption of carbohydrates and proteins –Fruits, vegetables, lactose Simethicone (Gas-X) Simethicone (Gas-X) Alpha-galactoside (Beano) Alpha-galactoside (Beano)

21. 21 Athletic Trainer’s Responsibility Recognize and refer Recognize and refer Trusting relationship Trusting relationship