Gi Drugs

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Antacids: Core Drug Knowledge Related to Aluminum Hydroxide with Magnesium Hydroxide.

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Trade name- Milanta
Lower level phosphate in drugs given after meals.

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Antacids Pharmacotherapeutics

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Esophagitis
Acid Indigestion

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Antacids Pharacokinetics

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Minimally Absorbed
Onset of 30 minutes
Duration of 20 to 60 minutes (if taken on empty stomach); 3 hours (if taken after meal)
Should be taken after meal.
Inhibit gastric Emptying

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Antacids Pharmacodynamics

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Contraction of gastric smooth muscle inhibitied, ingibiting gastric emptying (aluminum)
Promotino of gastric emptying (magnesium)

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Antacids Adverse Effects

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Constipation
Diarrhea
Cat C Pregnancy- Notify Doctor

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Antacids Drug Interactions

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Hydantoins- Dyalantin- Dont take with Antacids 30 min 2 hours apart

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Antacids Assesment

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Why they are taking antacids and other drugs.

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Antacids Planning Intervention Minimizing adverse effects

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Give 2 hours after giving other drugs.

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Antacids Providing patient and family education

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Caustion not to use antacid for longer than 2 weeks unless directed by health care provider.

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Drugs clostly related to aluminum hydroxide with magnesium hydroxide

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Aluminum Compounds- Amphagel
Magnesium Compounds- Milk of Magnesia
Calcium Carbonate- Tums

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Drugs significatly different from aluminum hydroxide with magnesium hydroxide

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Sucralfate
Not an antacid
Treatment of duodenal ulcers
Does not lower gastric acidity
Usually have heart burn cause some side effects
Coat lining of ulcer
Given 30 min before eating.

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H2 Receptor Antagonists: Core Drug Knowledge related to famotidine

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Pepcid Slow down the production of acid.

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H2 Receptor Antagonists Pharmacotherapeutics

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Relapsing, Nonerosive GERD
Erosive esophagitis
Upper GI Bleeding
OTC Formulation for heartburn, indigestion, and sour stomach.

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H2 receptor Antagonists Pharacokinetics

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Duration of 10-12 hours (dose and regiment dependent)
Take 2x a day
First pass metabolism (approximately 30%)via liver
Bound to plasma proteins
Widely distribted
Renal Excretion 30% unchanged
Also administered parenterally, can be given IV if stress ulcer.

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H2 receptor Antagonishts Precations

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Hepatic (cirrhosis) or renal impairment.

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H2 receptor Antagonists Adverse effects

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Confusion
Headache
Fatigue

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H2 receptor antagonists Lifestyle, Diet, and Habits

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Alcohol use
Smoking
Stress

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H2 receptor antagonists planning and intervention Maximizing Therapeutic Effects

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Give drug 2 hours after antacid

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H2 receptor antagonists Providing patient and family education

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Instruct to take drug exactly as prescribed for entire course of therapy even if symptoms subside and space drug with antacids by 2 hours.
Encourage smoking cessation, avoidance of alcohol and caffeine, spicy foods, and products containing aspirin

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H2 receptor antagonists Drugs closely related to famotidine

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Nizatidine

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Proton Pump Inhibitors

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Omeprazole- Prilosec
Lansoprasole- Previcid

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Proton Pump Pharmacotherapeutics

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Gastroesophageal reflux disease (GERD)
Severe erosive esophagitis
Treatment of active duodenal ulcers
Pathologis hyper secretory conditions
Stop Acid before production

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Proton Pump Pharmacodynamics

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It blocks the final step of acid production
Lower dose OTC, then more severe need prescribed.

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Proton Pump Adverse Reactions

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CNS: Headache Dizziness
GI: Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence
Resp: URI
Integ: Rash
Misc: Back Pain

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Proton Pump Contraindications

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Hypersensitivity
Bioavailability increased in the elderly
Precautions: Pregnancy, lactation, children

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Proton Pump Nursing Considerations

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Administer before eating.
Do not crush.

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GI Stimulants: Core Drug knowledge related to Metoclopramide

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Reglina

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GI Stimulants Pharmacotherapeutics

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Diabetic gastroparesis
GERD
Postoperative or chemotherapy associated nausea and vomiting
Pre-endoscopy or pre-bowel intubation

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GI Stimulatns Pharmacokinetics

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Crosses blood brain barrier.

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GI Stimulants Pharmacodynamics

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Believed to sensitize tissue to acetylcholine's effects
Cholinergic like effect on upper GI tract
Motility stimulated.

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GI Stimulants Adverse Effects

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CNS Effects
Restlessness
Drowsiness
Fatigue
Confusion

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GI Stimulants Drug Interactions

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Cimetidine
Cyclosproine- Sandmone Immune Booster
Succinylocholine
Used to remove subsaolin after surgery.

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GI Stimulants Planning and Intervention

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Administer IM injection near end of surgery
Contract peralyzing effects.

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Digestive Enzymes Pharmacodynamics

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Consisting of lipase, protease, and amylase
Responsible for fat, protein, and starch breakdown in duodenum and first portion of jejunum

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Digestive Enzymes Contraindications and Precaustions

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Acute Pancreatitis- NPO, TPN, No food no release of Enzymes
Prgnancy risk category C- Some Danger.

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Digestive Enzymes Adverse Effects

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Nausea
Abdominal Cramps
Diarrhea
Hyperuricosuria (high doses)
Hyperuricemia (high doses)
Poor digestion of drugs no affect on them
Decrease Absorption

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Digestive Enzymes Assesment

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Made from pork
Allergy to pork
If lack cystic Fibrosis
Clay color stool
Culture
Moslems
Orthodox Jews
Monitor for decreased steatorrhea and weight gain.

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Digestive Enzymes Planning and Intervention Maximizing Therapeutic Effects

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Administer immediately before or with meals and snacks.
If want to absorb lower antacid in stomach.
Administer antacid or H2 receptor antagonist if prescribed can have both.

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Antiflatulents: Core Drug knowledge related to Simethicone

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Anything related to gas bubbles and makes them larger and easier to expel

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Antiflatulents Pharmacotherapeutics

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Post operative gastric distention

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Antiflatulents Pharmacokinetics

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No interference with absorption of water or nutrients or secretion of mucus in GI tract Better not drink water
Given infants

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Antiflatulents Pharmacodynamics

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Gas bubbles combining into larger ones
Larger bubbles more easily eliminated

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Antiflatulents Adverse Effects

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None Significant
Runs through system

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Antiflatulents Planning and Intervention Maximizing Therapeutic Effects

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Administer after meals and at bedtime
Have patient chew tablet throughly or let tablet dissolve in month.
If suspension form, shake container prior to adminstering
Use calibrated dropper to ensure accurate dose.
Mix with 30 mL of suitable liquid for infants.

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Antidiarrheals Core drug knowledge related to diphenoxylate HCL with Atropine Sulfate

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Lomodal
Anticolenegic, dry things up

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Antidiarrheals Pharmacokinetics

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Hepatic metabolism
Excreted via feces as active metabolite; tiny amount renally excreted as unchanged drug
Synthetic carcotic
Slowing of intestinal motility slow GI tract
Prolongation of intestinal transit time
Increased reabsorption of fluid
Atropiene

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Antidiarrheals Precautions

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Ulcerative colitis- Dont want stop diarrhea, have them expel it. If have like c.diff.

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Antidiarrheals Adverse Effects

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Paralytic ileus- Stop paristalsis
Toxic Megacolon
CNS effects
Anaphylaxis
Dry Mouth- Colonergtic effect, drying out cause diarrhea.

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Antidiarrheals Drug Interactions

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MAOIs
Barbiturates
Tranquilizers
Alcohol

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Antidiarrheals Planning and Intervention Minimizing Adverse Effects

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Monitor stools for decrease to decrease dosage
If no improvement in 10 days with maximum daily dose, unlikely that drug will be effective
Monitor for adverse effects especially with maximum daily dose
Observe for possible atropine toxicity: dry mouth flushing, hyperthermia, tachycardia, and urinary retention
Encourage adequate fluid intake to rpevent dehydration
Warn about dry mouth; suggest use of gum, ice chips, or hard candy

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Drugs Closely related to diphenoxylate HCL with Atropine Sulfate

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Difenoxin- Same thing without Atropine lemodal without Atropine
Loperamide- Imodium

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Drugs Significantly different diphenoxylate HCL with Atropine Sulfate

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Bismuth subsalicylate- Peptobismal
Association with Reye's syndrome in children and adolescents
Kaolin and Pectin
Treatment of mild diarrhea
Non selective adsorbent action

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Laxatives Bulk-Forming

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Act like natural fiber foods; absorb water into the intestine which increases bulk and distends the bowel to initiate reflex peristalsis and bowel evacuation
Used to help prevent constipation and diarrhea
Polycarbophil (FiberCon)- Tablet takes alot of water.
Psyllium (Metamucil)- Safest used for both constipation and diarrhea.
Methylcellulose (Citrucel)

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Laxatives Adversse Effects

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Impaction, abdominal bloating, abdominal cramps make not be drinking enough fluids

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Laxatives Nursing Implications

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Effective treating patients that should avoid straining with bowel movements (after MI; increased intracranial pressure; rectal surgery, TURP)
Administer with a full glass of water and follow with an additional glass of liquid

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Lubricant

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Coats the internal lumen of the bowel and the outside diameter of the stool with a lubricant film to enhance passage of stool through intestines; keeps water content within the stool and helps soften it

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Lubricant Mineral Oil Adverse Effects

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Lipid pneumonia; fat soluble vitamin deficiency

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Lubricant Nursing Implications

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(A,D,E,& K) Dificiencies may occur if taken with meals. Separate by at least 2 hours- Blocks Absorption, limited amount of time

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Lubricant Drug Interactions

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Concurrent administration with stool softner can increase absorption of mineral oil.

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Osmotic Agents ( cathartic, purgative)

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Hyperosmotic solutions that pull water into the stool contents causing distention of the bowel, increased peristalsis and bowel evacuation.
Cause watery diarrhea

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Lactulose (Cephulac)

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Used to treat constipation and also used to prevent absorption of ammonia (adjunct in treatment of cirrohosis associated with hepatic encephalopathy(Amonic in blood)
Intestinal contents and can lead to skin breakdown in incontinent patients; mix with fruit juices to improve palatability

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Polyethlene glycol/electolyte (GoLYTELY)

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Complete evacuation occurs within 4 hours; patient is to drink 8 ounces every 10 minutes until the 4 liters are consumed (rapid drinking of the 8 ounces is preferred over slipping slowly; cooling the solution can increase palatability of this tasting solution); may cause diarrhea and abdominal cramping.

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Glycerin Suppositories-

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Will cause bowel evacuation in 15-30 minutes; mild laxative and ofent used in children

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Saline Laxatives (cathartic, purgative)

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Draw water into the stool contents, causing bowel distention, increasing peristalsis and bowel evacuation.
Causes watery diarrhea
Magnesium Citrate (Citrate of Magnesia) Prior to bowel surgery
Magnesium Hydroxide (MOM) Milk of Magnesia- Mild/no cramping pain.
Magnesium Sulfate (Epsom salt)
Phosphate/biphosphate (fleet Enema, Fleet Phospho-Soda)

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Saline Laxatives Drug Interactions

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May Decrease absorption of some antibiotics (tetracyclines, fluoroquinolones)

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Stimulants (cathartic, purgative)

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Induce intestional peristalsis
Most likely laxative to cause dependence
Bisacodyl (Dulcolax)
Casanthrano (Cascara) often combined with MOM
Senna (Senokot) Given cancer patient high doses of narcotics
Phenolphthalein (ExLax)

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Phenolphthalein (ExLax)Adverse Effects

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Abdominal cramping, diarrhea, hypokalemia protein loss with chronic use, hypocalcemia with chroinic use high doses of Narcotics

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Phenolphthalein (ExLax)

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Drug Interactions; laxative effectiveness is decreased if taken with antacids or H2 blockers

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Stool Softners

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Decrease the surface tension of the stool and allows water to enter fecal mass and soften the stool .
Used to prevent constipation in patients that should otstrain with stooling
Docusate sodium (Colace)(Pericolace)
Docusate calcium (Surfak)
Docusate potassium (kasof)

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Stool Softners Nursing Implications

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TURP to avoid straining with stooling

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Stool Softners Drug Interactions

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Avoid taking with H2 blockers, antacids, or other laxatives.

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Drugs used to treat nausea and vomiting

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Vomiting can be induced by direct stimulation of the vomiting center (abdominal distention or irritation; unpleasant olfactory or visual stimuli; pain; emotional factors; increased intracranial pressure; migraine headaches; vestibular disturbances)

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Antiemtics

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Antiemtic drugs either decrease stimulation of the chemoteceptor trigger zone (CTZ), decrease stimulation of the vomiting center, and/or decrease vestibular input into the CNS.

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Antihistamines

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Hydroxyzine (vistaril, atarax)

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Phenothiazines

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Promethazine (Phenergan)
Prochlorperazine (Compazine)
Thiethylperazine (Torecan)

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Serotonin (5-HT3) Antagonists

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Prevention of nausea and vomiting related to chemotherapy, radiation, and surgery

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Ondansetron (Zofran)

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Given 30-60 min prior to chemo to prevent nausea and vomiting given IV

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Nausea and Vomiting Miscellaneous drugs

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Metoclopramide (Reglan)- increases gastric emptying
Trimethobenzamide (Tigan)

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Nausea and Vomiting Adverse Effects

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Drowsiness, sedation, dry mouth, hypotension, respiratory depression
Monitor for dehydration- number of vomiting episodes and the amount and consistency of vomitus

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Nausea and Vomiting Drug Interactions

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Additiveeffect when used with other CNS depressants higher reaction of narcotic

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Drugs used to treat motion sickness

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Anticholinergics
Antihistamines

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Anticholinergics

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Scopolamine (Scopolaine Transdermal Patch)- apply behind ear 4 hours prior to event, change every 3 days

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Antihistamines

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Dimenhydrinate (Dramamine) - Dizziness and motion Sickness
Meclizine (Antivert)

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Drugs Used to treat Acute Drug Overdose

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Ipecac Syrup
Charcoal

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Ipecac Syrup

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Used to induce vomiting in poisons ingestion; use only yunder direction of poison control. Not really used

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Charcoal

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Used to bind toxins, drugs, or chemicals that have been ingested due to overdose/suicide attempts and allows them to be evacuated in the stool
Prevents absorption of toxic agents
Will cause black stools.