Ati Gastrointestinal System And Nutrition Meds (Gastrointestinal Disorders))

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antiemetics

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proto: glucocorticoids: dexamethasone (Decadron)

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other antiemetics

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p/neurokinin1 antagonist: aprepitant (Emend)
serotonin antagonist: ondasteron (Zofran), granisetron (Kytril)
dopamine antagonist: prochlorperazine, metoclopramide (Reglan)
promethazine (Phenergan)
cannabinoids: dronabinol (Marinol)
anticholinergics: scopolamine (Transderm Scop)
antihistamines: dimenhydrinate (Dramamine), hydroxyzine (Vistaril)
benzodiazipine: lorazepam (Ativan)

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antiemetic adverse

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sedation, EPS, anticholinergic efecs, dissociation, dysphoria
hypotension, tachycardia
fatigue, diarrhea

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antiemetic use

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treat or prevent nausea, vomiting, motion sickness, diarrhea, constipation, or to treat GERD by increasing gastric motility

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antiemetic contraindications

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should not be given to clients who have long QT syndrome
caution to children, and older adults due to increased EPS
caution in urinary retention or obstruction, asthma, or narrow-angle glaucoma
promethazine- not in children under 2 years

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antiemetic interactions

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CNS depressants
antihypertensives can intensify hypotensive effects of antiemetics
concurrent use of anticholinergic meds can intensify anticholinergic effects of antiemetics

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antiemetic admin

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identify cause of vomiting and underlying related factors so that the correct med can be used
chemotherapy: combine three antiemetics and administer them prior to chemotherapy si more effective than to treat nausea that is already occuring

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antiemetic med effectiveness

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absence of nausea and vomiting

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laxatives

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psyllium (Metamucil)
docusate sodium (Colace)
bisacodyl (Dulcolax)
magnesium hydroxide (Milk of magnesia)
senna (Senokot), lactulose (Cephulac)

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bulk-forming laxatives (psyllium)

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soften fecal mass and increase bulk, which is identical to the action of dietary fiber

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surfactant laxatives (docusate sodium)

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lower surface tension of the stool to allow penetration of water
relieve constipation

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stimulant laxatives (bisacodyl)

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result in stimulation of intestinal paralysis

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osmotic laxatives: magnesium hydroxide

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drew water into the intestine to increase the mass of stool, stretching musculature, which results in peristalsis

low dose- prevent painful elimination , prepare clients for surgery or diagnostic tests such as a colonoscopy
rapid evacuation of the bowel

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laxatives adverse

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GI irritation
rectal burning
laxatives with magnesium salts can lead to accumulation of toxic levels of magnesium
laxatives with sodium salts such as sodium phosphate, place clients at risk for sodium absorption and fluid retention
osmotic diuretics may cause dehydration

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laxative interventions

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do not use bisacodyl suppositories on a regular basis
clients who have renal dysfunction should avoid laxatives that contain magnesium
clients who have cardiac dysfunction should avoid laxatives that contain sodium
monitor I and O

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laxative contraindications

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fecal impaction
bowel obstruction
acute surgical abdomen
(prevent perforation)
nausea
cramping
abdominal pain
ulcerative colitis and diverticulitis

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laxative interactions

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milk and antacids destroy enteric coating of bisacodyl- take bisacodyl at least one hour apart from these meds

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laxative admin

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chronic laxative use can lead to fluid and electrolyte imbalances
take bulk-forming and surfactant laxatives with a glass of water

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laxative effectiveness

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return to normal bowel function
evacuation of bowel in preparation for surgery or diagnostic tests

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antidiarrheals

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prototype: diphenoxylate plus atropine (Lomotil)
other meds: loperamide (Imodium), paregotic (camphorated opium tincture)

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antidiarrheals MOA

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activate opioid receptors in the GI tract to decrease intestinal motility and to increase the absorption of fluid and sodium in the intestine

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antidiarrheal use

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may be used to treat underlying cause of diarrhea
nonspecific antidiarrheal agents provide symptomatic treatment of diarrhea (decrease in frequency and fluid content of stool)

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antidiarrheal adverse

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at high doses, clients may experience typical opioid effects, such as euphoria or CNS depression

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antidiarrheal contraindications

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increased risk of megacolon in clients who have inflammatory bowel disorders
contraindicated in severe electrolyte imbalance or dehydration
COPD
pregnancy risk category C

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antidiarrheal interactions

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alcohol or other CNS depressants may enhance CNS depression

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antidiarrheal admin

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avoid caffeine

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antidiarrheal effectiveness

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may be evidenced by return of normal bowel pattern as evidenced by decrease of frequency and volume of stool

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prokinetic agents

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proto: metaclopramide (Reglan)

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prokinetic agents MOA

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controls nausea and vomiting by blocking dopamine and serotonin receptors in the CTZ
augments action of acetylcholine which causes an increase in upper GI motility

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prokinetic agents use

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control of postoperative and chemotherapy induced nausea and vomiting as well as facilitation of intubatio nand elimination of the GI tract
oral form is used for diabetic gastroparesis and management of GERD

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prokinetic agents adverse

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EPS- restlessness, anxiety, spasms of face and neck, administer antihistamine to minimize EPS
sedation
diarrhea

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prokinetic agents contraindications

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GI perforation, bleeding, bowel obstruction, and hemorrhage
seizure disorder
caution to children and older adults

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prokinetic agents interactions

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CNS depressants increase risk of seizures and sedation
opioids and anticholinergics decrease effects of metoclopramide

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prokinetic agents admin

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monitor for CNS depression and EPS
can be given orally or IV- if IV dose is less than or equal to 10 mg it may ve administered IVP undiluted over 2 min
if greater than 10 mg- should be diluted and infused over 15 min

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prokinetic agents effectiveness

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absence of nausea and vomiting

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IBS with diarrhea meds (IBS-D)

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proto: alosetron (Lotronex)

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IBS-D MOA

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selective blockade of 5-HT3 receptors, which innervate the viscera and result in increased firmness in stool and decrease in urgency and frequency of defacation

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IBS-D USE

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approved only for female clients who have severe IBS-D that has lasted more than 6 months and has been resistant to conventional management

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IBS-D adverse

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constipation- may result in GI toxicity such as ischemic colitis, bowel obstruction, impaction or perforation

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IBS-D interventions

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meds that induce cytochrome P450 enzymes, such as phenobarbital, may decrease levels of alosetron

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IBS-D admin

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symptoms should resolve within 1-4 weeks but will return 1 week after med is discontinued
start once a day then may be increased to BID

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IBS-D effectiveness

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relief of diarrhea, decrease of urgency and frequency of defacation

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IBS-C (with constipation)

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proto: lubiprostone (Amitiza)

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IBS-C MOA

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increases fluid secretion in the intestine to promote intestinal motility

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IBS-C use

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irritable bowel syndrome with constipation
chronic constipation

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IBS-C adverse

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diarrhea
nausea

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IBS-C contraindications

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history of bowel obstruction, Crohn's, ulcerative colitis, diverticulitis

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IBS-C interactions

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none significant

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IBS-C admin

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take meds with food to decrease nausea
oral dosage should be taken BID

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IBS-C effectiveness

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relief of constipation

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5-Aminosalicylates

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proto: sulfasalazine (Azulfidine)

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other meds for IBS

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5-aminosalicylates: mesalamine (Asacol, Rowasa), olsalazine (Dipentum)

glucocorticoids: hydrocortisone

immunosuppresants: azathioprine (Imuran)

immunomodulators: infliximab (Remicade)

antibiotics: metronidazole (Flagyl)

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5-aminoglycosalicylate MOA

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decrease inflammation by inhibiting prostaglandin synthesis

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5 aminoglycosalicylate use

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IBS, Chron's UC
IBS is controlled, rather than cured by these meds

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5 aminoglycosides adverse

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blood disorders- agranulocytosis, hemolytic and macrocytic anemia- monitor complete blood count
nausea, cramps, rash, arthralgia

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5 aminoglycosides contraindications

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pregnant or breastfeeding should consult with provider
sensitivity to sulfanomides, salicylates, thiazides
liver or kidney disease, or blood dyscrasiasm

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5 aminoglycosides interactions

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iron and antibiotics may later the absorption of sulfasalazine
mesalamine may decrease the absorption of digoxin

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5 aminoglycoside admin

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do not crush or chew pills

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5 aminoglycoside effectiveness

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decreased bowel inflammation and relief of GI distress
return to normal bowel function

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dietary supplements (probiotics) MOA

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various preparations of bacteria and yeast, which are normal flora of the gut, help to metabolize foods, promote nutrient absorption, and reduce colonization by pathogenic bacteria. They may increase nonspecific cellular and humoral immunity

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probiotics use

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treat the symptoms of IBS, UC, and C-dif associated diarrhea

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probiotics adverse

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flatulence and bloating

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probiotics interactions

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if antibiotics and antifungals are used concurrently, they should be administered at least 2 hours apart