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97 Cards in this Set
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Drugs affecting the GI system
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Adsorbents
Emetics Antiflatulants Digestive Agents Antidiarrheals Laxatives Antiemetics Peptic Ulcer Agents |
Adsorbents
Antidiarrheals Antiemetics Antiflatulants Digestive Agents Emetics Laxatives PUD |
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Adsorbents
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Activited Charcoal-attracts molecules to its surface (non-specific) Draw molecules in and holds on
used in acute poisoning excreted in feces w/out being absorbed |
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Emetics
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Amorphine
action: 1.stimulates vomiting ctr in medulla 2.regurgitates contents in the stomach and upper duodenum |
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Emetic drug-Amorphine
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Amorphine- parenteral use(cousin to morphine)
advantage: causes vomiting in 15 min disad.: narcotic sedative effect *monitor carefully - do not want pt to vomit while passed out* |
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Emetic drug-Syrup of Ipecac
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Syrup of Ipecac-oral use
adv: safe disad: causes vomiting w/in 30 min |
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Emetic nursing implications
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1.don't give to pts with decreased gag reflex-have to be alert
2.don't give to pts who have ingested petroleum distilants or caustic materials 3.administer charcoal after emetic |
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Antiflatulents-anti-gas
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Simethicone/Mylicon
act: disperses gas pockets indication for use: prior to diagnostic procedures of the abdomen adver.eff.:expulsion of excessive gas |
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Digestive Agents
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Admin to pts who do not have enough gastic juices
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Digestive agents-Gastric agents
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HCI
use: treats hypochlorhydria acidic PH required to change pepsinogen to pepsin admin: via straw to prevent damage to tooth enamel contraind: PUD-do not want to increase gastic juices if have ulcer |
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Digestive Agents-Pancreatic agents- Pancreatin
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Pancreatin- large tablets
use:replacement therapy taken w/meals (i.e.Cystic fibrosis) |
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Digestive Agent-Hepatic agents-Bile Salts
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use:1.Stimulate prod, of bile and promote bile flow from liver
2.prevent biliary calculi(gallstones) Contrain: Biliary obstruction if bile is obstructed do not want to make more |
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Antidiarrheals
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K+ (potassium) is lost with diarrhea!
Systemic & Topical |
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Antidiarrheals- Systemic
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Opium derivatives(Opioids cause constipation) (Paragoric) Lomotil
act: decrease peristalsis in large and small intestines uses:1.acute, non-specific diarrhea 2. additive to tube feedings to prevent diarrhea(most common use-give b4 feedings) |
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Antidiarrheal - Topical
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not systemic
Kaopecate act:1.adsorbent and has soothing effect on intestines 2. mild action use: treat diarrhea caused by bacteria or toxin (food poisoning) s.e.: decreases the absorption of some meds. Nursing actions: 1. assess bowel function-est. fluid and electrolyte (K+) levels 2.should not use for more than 48 hrs |
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Kaopectate problems
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non-specific in what it absorbs - can absorb medications
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Laxatives
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Hyperosmolar- MOM,Fleets,Glycerin Suppository
Fiber/Bulk forming-Metamucil Emollient/Stool softener-Surfak/Colase Stimulants/Irritants-Dulcolax Lubricant-Mineral Oil |
flesh
Fiber/bulk lubricant emollient suppository hyperosmolar |
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Laxatives- Hyperosmolar-MOM, Fleet, Glycerin Suppository
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nurses make the decision on laxatives
treats constipation act: draws water into bowel-stool softens onset of act: PO-12-24hrs(overnight) supp.-30min use: to evacuate the large bowel s.e.: hypovolemia, electrolyte imbalance, abd. cramping |
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Laxatives-Fiber/Bulk forming- Metamucil
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can also treat diarrhea**
act: increase fecal bulk and holds onto water content(must drink lots of water w/admin.) onset of act: 2-4 days(prevention not treatment) uses: prevent constipation-treat diarrhea s.e.:obstruction due to decreased water intake during admin this is the drug for long-term use |
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Laxatives-Emollient/Stool softener- Surfak Colase
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preventative
act: causes water to enter stool onset of act: 1-3 days uses: 1.for pt who should avoid straining at stool (cardiac or hemeroids, hypertension) 2. for pts with diseases of the rectum or anus |
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Laxatives-Stimulants/Irritants-Dulcolax
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one of the most potent laxatives you can give**
act: directly irritates the bowel and stimulates the nerve endings of the intestinal smooth muscle works overnight onset: po 6-12HRS supp- 30min use: to empty bowel (very potent) increases peristalisis** s.e.:discolor urine, cause rectal fissure-*watch pt does not have constipation or large stools* contrain: abd pain, nausea, vomiting, rectal fissures |
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Laxatives-Lubricant-Mineral Oil
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cheap-but blocks K+ abs.which leads to bleeding-KADE-vitamins are fat soluable -stops abs. of them
act: creates a barrier btw stool and colon wall, retaining water in the stool onset: PO 6-8 hrs, enema- 2 hrs use: to treat & prevent constip, treat impaction s.e.: decreased abs. of fat sol. vits, lipid aspiration contrain: in pts who have recently had rectal surgery |
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Patient teaching for Laxatives
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1.adequate bulk & fluid
2. adequate exercise 3.respond readily to defecation impulses 4.decrease emotional stress |
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GI Case scenarios
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a 58 yr man, admitted with MI. begin teaching in prep. for discharge. you are aware of his history:chronic constipation. which lax. would you advise? Metamucal for prevention, Sulfak-stl softener for prevention
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GI Case scenarios
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an 87 woman, admit. from nursing home with abd distention and a history of BM 7 days prior. diagnosed w/fecal impaction. which las. would be ordered? none until pt is disimpacted then mineral oil enema
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GI Case scenarios
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you are working at a health unit and 24 girl presents with bronchiitis and sinusitis. she is taking antihistamines and decongestants. says that she has occasional problems w/constipation and which lax to use? increase fluid intake, MOM for current, Metamucil/Surfak for prevention
antihistamines are anticholinergic decongestant-sympathetic slows peristalsis |
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anticholinergic
peristalsis hypovolemia |
reduces effects of acetycholine in CNS & perpherial nervous systems- competive inhibitors of receptors(dry mouth, sore throat,constipation, urinary retention)
2. rythmatic contraction of smooth muscle in digestive tract.sympathetic slows this (flight or fright-slows GI motility) 3. decreased blood volume |
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Antiemetics
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stops vomiting,stops motion sickness
Antihistamine Antiemetics-Benadryl Phenothiazide antiemetics-Phenergan others- Emetecon, Scopolamine reglan |
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Antiemetics- Antihistamine
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Benadryl-
act: unclear use: treat motion sickness & nausea assoc. w/narcotics admin: PO, IM, supp s.e.: sedation, anticholinergic (dry mouth, constipation, urinary retention) |
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Antiemetics-Phenothiazide antiemetics
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Phenergan
act: CNS acting effect-blocks CNS receptors s.e: sedation, photosensitivity |
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Antiemetics-others
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Emetecon- centrally inhibits nausea assoc. w/anesthesia
rarely causes sedation Scopolamine- used to treat nausea from motion sickness transdermal patch-3 day duration & new-7 day patches Reglan-increases GI motility and suppresses vomiting center often used with tube feedings **monitor for aspiration, moves quickly through GI tract & contracts Cardiac sphincture |
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Overview of Gastric A&P
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1.gastric secretions, HCI, pepsin, Intrinsic factor, gastrin
PH-1-2 Mucous layer PH - 7.0 2.intestinal secretions -pancreatic enzymes, bile, creates alkaline env. PH above 7.0 |
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Peptic Ulcer Disease - PUD
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1.caused by: increased HCI production-build up mucosal layer & decrease acid
2.damage to mucosal layer due to drugs (ASA, NSAIDS) 3.increased nocturnal acid production treatment aimed at reducing the causes & usually takes 4-6 wks |
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Peptic Ulcer Agents
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Antacids-increase the PH of the stomach, stops esophageal ulcerations
act: mix with stomach contents to raise PH (3-3.5) dur.of act; 1 hr-empty stomach 3 hrs-with meals use: treat or prevent heartburn and PUD should take around the clock not just for symptoms admin: around the clock, not prn if treating PUD-MOM is also an antacid s.e: diarrhea(magnesium) constipation(aluminum) electrolyte imbalance |
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PUD agents-Nursing Implications
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1.don't give w/oral meds when possible-drug interactions with antacids
2.shake b4 admin. most antacids 3.chew tablets & follow w/H2O 4.don't give w/enteric coated tablets 5.pt teaching-may speckle stool |
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Histamine (H2) receptor antagonists-PUD
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they block hydrocholegic acid production
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Histamine (H2) receptor antagonists- PUD
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Tagamet/cimetidine-not good for elderly-don't give- not a good drug-cheap-lots of drug interactions-best for use with someone who is on one or no other drugs
Pepcid/famotidine Zantac/rantidine act: binds w/ H2 receptor sites and prevents HCI secretion potency varies with drug type |
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HCI
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hypochlorhydria or achlorhydria - conditions where gastric acid levels are low or non-existent-happens with use of antiacids,H2 receptor antagonist (Tagamet,Pepcid,Zantac) or proton pump inhibitors (Prilosec)
treatment would be injections of B12, or treatment of H. pylori, or other treatments |
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Sucralfate/carafate-PUD
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taken on empty stomach
act: adhers to ulcer site, forming a protective barrier over ulcerations adm: 30 min ac and hs-hard to schedule |
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other drugs to treat PUD
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Cytotec/misoprostol:used to treat NSAID induced PUD **induces abortions**
action unclear Prilosec/omeprazole- a proton pump "turns off water at the street"- expensive used in the short term treatment of reflux esophagitis works by inhibiting a step in the acid production process Antibiotics- used to treat H.pylori |
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Activated Charcoal:
is does |
absorbant
used in acute poisoning excrete in feces w/out absorbtion |
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Amorphine:
is does adva disadv |
vomiting agent from sm.ints.& stomach & upper duodenum
emetic causes vomit in 15 min narcotic sedative |
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Syrup of Ipecac:
is adv disad |
emetic
oral only safe slow vominting (w/in 30min) |
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Simethicone/Mylicon
is action indica.for use adver eff |
antiflatulent-antigas
gets rid of gas pockets given b4 surgery on abd. excessive farting |
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Gastric agents:
are use admin contrain |
treats HCI-changes env.to acidic PH so stomach can change pepsinogen to pepsin
via straw PUD |
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Pancreatin:
is use |
enzyme mix
replaces pancreatic enzymes,caused by ie cystic fibrosis, pancreatitis taken w/meals |
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Laxatives
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Hyperosmolar- (osmolarity-water, high water)MOM,Fleets,Glycerin Suppository
Fiber/Bulk forming-Metamucil Emollient/Stool softener-Surfak/Colase Stimulants/Irritants-Dulcolax Lubricant-Mineral Oil |
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|
|
Laxatives- Hyperosmolar-MOM, Fleet, Glycerin Suppository
|
nurses make the decision on laxatives
treats constipation act: draws water into bowel-stool softens onset of act: PO-12-24hrs(overnight) supp.-30min use: to evacuate the large bowel s.e.: hypovolemia, electrolyte imbalance, abd, cramping |
|
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|
Laxatives-Fiber/Bulk forming- Metamucil
|
can also treat diarrhea**
act: increase fecal bulk and hold onto water content(must drink lots of water w/admin.) onset of act: 2-4 days(prevention not treatment) uses: prevent constipation-treat diarrhea s.e.:obstruction due to decreased water intake during admin this is the drug for long-term use |
|
|
|
Laxatives-Emollient/Stool softener- Surfak Colase
|
preventative
act: causes water to enter stool onset of act: 1-3 days uses: 1.for pt who should avoid straining at stool (cardiac or hemeroids, hypertension) 2. for pts with diseases of the rectum or anus |
|
|
|
Laxatives-Stimulants/Irritants-Dulcolax
|
one of the most potent laxatives you can give**
act: directly irritates the bowel and stimulates the nerve endings of the intestinal smooth muscle works overnight onset: po 6-12HRS supp- 30min use: to empty bowel (very potent) increases peristalisis** s.e.:discolor urine, cause rectal fissure-*watch pt does not have constipation or large stools* contrain: abd pain, nausea, vomiting, rectal fissures |
|
|
|
Laxatives-Lubricant-Mineral Oil
|
cheap-but blocks K+ abs.which leads to bleeding-KADE-vitamins are fat soluable -stops abs. of them
act: creates a barrier btw stool and colon wall, retaining water in the stool onset: PO 6-8 hrs, enema- 2 hrs use: to treat & prevent constip, treat impaction s.e.: decreased abs. of fat sol. vits, lipid aspiration contrain: in pts who have recently had rectal surgery |
|
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|
Patient teaching for Laxatives
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1.adequate bulk & fluid
2. adequate exercise 3.respond readily to defecation impulses 4.decrease emotional stress |
|
|
|
GI Case scenarios
|
a 58 yr man, admitted with MI. begin teaching in prep. for discharge. you are aware of his history:chronic constipation. which lax. would you advise? Metamucal for prevention, Sulfak-stl softener for prevention
|
|
|
|
GI Case scenarios
|
an 87 woman, admit. from nursing home with abd distention and a history of BM 7 days prior. diagnosed w/fecal impaction. which las. would be ordered? none until pt is disimpacted then mineral oil enema
|
|
|
|
GI Case scenarios
|
you are working at a health unit and 24 girl presents with bronchiitis and sinusitis. she is taking antihistamines and decongestants. says that she has occasional problems w/constipation and which lax to use? increase fluid intake, MOM for current, Metamucil/Surfak for prevention
Anticholinergic is antihistamines decongestant-sympathetic slows peristalsis |
|
|
|
anticholinergic
peristalsis hypovolemia |
reduces effects of acetycholine in CNS & perpherial nervous systems- competive inhibitors of receptors(dry mouth, sore throat,constipation, urinary retention)
2. rythmatic contraction of smooth muscle in digestive tract.sympathetic slows this (flight or fright-slows GI motility) 3. decreased blood volume |
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|
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Antiemetics
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Antihistamine Antiemetics-Benadryl
Phenothiazide antiemetics-Phenergan others- Emetecon, Scopolamine reglan |
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Antiemetics- Antihistamine Antiemetics
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Benadryl-
act: unclear use: treat motion sickness & nausea assoc. w/narcotics admin: PO, IM, supp s.e.: sedation, anticholinergic (dry mouth, constipation, urinary retention |
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Antiemetics-Phenothiazide antiemetics
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Phenergan
act: CNS acting effect-blocks CNS receptors s.e: sedation, photosensitivity |
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Antiemetics-others
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Emetecon- centrally inhibits nausea assoc. w/anesthesia
rarely causes sedation Scopolamine- used to reat nausea from motion sickness transdermal patch-3 day duration & new-7 day patches Reglan-increases GI motility and suppresses vomiting center often used with tube feedings **monitor for aspiration, moves quickly through GI tract & contracts Cardiac sphincture |
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|
|
overview of gastric A&P
|
1.gastric secretions, HCI, pepsin, intrinsic factor, gastrin
PH 1-2 Mucous layer PH- 7.0 2.Intestinal Secretions-pancreatic enzymes, bile, creates alkaline env. PH above 7.0 |
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PUD
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caused by: increased HCI production- builds up mucusal layer and decreases acid
2.damage to mucosal layer due to drugs (ASA, NSAIDS) 3.increased nocturnal acid produ. treatment aims at reducing the causes and usually takes 4-6 wks |
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PUD agents - Antacids
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Antacids-increases PH of the stomach-stops esophageal ulcerations-
act: mix w/stomach contents to raise PH (3-3.5) Duration of act: 1-hr-empty stomach 3 hrs-with meals use: treats or prevents heartburn and PUD should take around the clock not prn s.e: diarrhea (magnesium) constipation (aluminum) electrolyte imbalance |
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Nursing Implicatons of antacids
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1.don't give with oral meds-drug interaction w/other antacids
2.shake b4 admin most antacids 3.chew tablets and follow w/H2O 4.don't give w/enteric coated tablets 5.pt teaching-may speckle stools |
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PUD-Histamine (H2) receptor antagonist
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block HCI acid production
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PUD-HRA's
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Tagament-do not give to elderly-not good drug-cheap-lots of drug interactions-only use on someone who is not taking other drugs
Pepcid/famotidine- Zantac/rantidine act: binds w/ H2 receptor sites and prevents HCI secretion potency varies |
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PUD-Sucralfate/Carafate
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take on empty stomach
act: adheres to ulcer site, forms protective barrier adm: 30 min ac and hs-hard to schedule |
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Other PUD drugs
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Cytotec/misoprostol-***induces abortions*** used to treat NSAID induced PUD, its action is unclear
Prilosec/omeprazole- proton pump "turns off water at the street", expensive, used shorterm treatment of reflux esophagitis works by inhibiting a step in the acid production process Antibiotics- used to treat H.pylori |
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GI drugs- Activated Charcoal
does used ends |
absorbs
acute poisoning excreted in feces |
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Emetics-Amorphine
does use adv disadv |
vomiting from stomach,sm intestine/upper duodenum
parenteral use vomits in 15 min-fast narcotic sedation |
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Parenteral use
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effect is systemic, substance is given by other routes than the digestive tract -injection or infusion or patches
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Syrup of Ipecac- emetic
route adv disav. |
PO
safe slow vomit-30min |
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Nursing implications of emetics
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do not give if not alert
do not give if ingested petro.products or caustic products adm. charcoal after emetics |
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Antiflatulents-Simethicone/Mylicon
use action indication for use adverse eff |
anti-gas
gets rid of gas pockets use b4 operations on abd excessive farting |
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Digestive agents-gastric agents
what treats admin contrain |
HCI-need acid env.to change pepsinogen to pepsin
via straw PUD |
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Pancreatic agents-Pancreatin
what use |
mix of enzymes-large tabs
treats(replaces) low enzyme levels due to cystic fibrosis or pancreatitis- taken with meals |
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Hepatic agents-Bile salts
use contrain |
makes bile, from liver
prevents gallstones biliary obstructions |
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Antidiarrheals-systemic-Opium derivatives Paragoric/Lomotil
action uses |
decreases peristal waves in intestines
for acute diarrhea or when feeding by tube (give b4) |
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Antidiarrheals-Topical?-(not systemic)-Kaopectate
action uses s.e. |
adsorbent-causes film to sooth, mild
treats diarrhea by bacteria or food poisoning stops other meds from absorbing |
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Nursing actions-antidiarrheals
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1. assess bowel func.fluid and electrolyte (K+)levels
should not use for more than 2 days |
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Laxatives- Hyperosmolar-MOM, fleets, glycerin
treats action time use s.e. |
treats constipation
osmotic-draws water in PO 12-24 hrs supp - 30min cleans large bowel hypovolemia, electrolyte imbalance,cramping |
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Laxative-Fiber/Bulk forming-
Metamucil treats action time uses s.e |
diarrhea & constipation
increase bulk & water 2-4 days treats diarrhea, prevents constipation impacts if not drink enough water during admin long term use drug |
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Emollient/Stool softener-Surfak
does action time uses |
preventitive
gets water to stool 1-3 days pts with problems that should not strain (cardiac, hemeroids, hypertension) or pts with disease of rectum or anus |
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Laxative-Stimulants/Irritants-Dulcolax
is action time use s.e. contraind. |
very potent
irritate the bowel, stimulates nerve endings PO 6-12 hr supp-30min emptys bowel-increase peristalsis rusty color urine, rectal fissure abd. pain, nausea, vomiting, rectal fissures, constipated or large stools |
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Laxative-Lubricant-Mineral Oil
does action time use s.e contraind. |
lubricates
makes bowel wall greasy,retains water PO 6-8hrs, enema- 2 hrs treats impaction, constipation decrease absorbtion of KADE vitamins, lipid aspiration do not give to pts with recent rectal surgery stops absorption of K+-leads to bleeding |
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Antiemetics-Antihistamine-Benadryl
action use admin s.e. |
unclear
treats motion sickness & nausea associated w/narcotics PO, IM, supp sleepiness, anticholinergic (drymouth, const. urinary retentin) |
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Antiemetics-Phenothiazide -Phenergan
action s.e |
blocks CNS receptors
sleepiness, tendency to sunburn |
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Antiemetics-other -Emetecon
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CNS inhibits nausea assoc.w/anesthesia
does not cause sleepiness |
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Antiemetics-other-Scopolamine
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treats nausea from motion sickness
patch-3 & 7 day |
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Antiemetics-other-Reglon
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increase GI motility & supresses vomiting
used with tube feedings monitor for aspirations constricts cardiac spincture |
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PUD agents- Antacids
does action how long use admin s.e. nursing imp |
stops esophageal ulcers
increase PH of stomach mix w/stomach contents to make ph 3-3.5 1 hr on empty stomach 3 hrs w/meals treats or prevents heartburn and PUD around the clock,not prn diarrhea(magnesium) constipation(aluminum) electrolyte imbalance dont give w/oral meds, shake,tablets follow with water, don't give with enteric coated tablets,may speckle stools |
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PUD agents-Histamine H2 receptor antagonists
Tagamet/cimetidine |
bad drug, drug interactins, cannot give to elderly (they take too many other drugs),blocks HCI production
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PUD agent antagonists-Pepcid/famotidine
Zantac/rantidine- |
binds w/H2 recepter sites, prevents HCI production
potency varies |
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PUD agents- Sucralfate/Carafate
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give on empty stomach
adheres to ulcer site,forms barrier 30min ac & hs (b4 meals, at bedtime) |
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PUD-other drugs-Cytotec/misoprostol
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treasts NSAID induced PUD
action unclear **induces abortions** |
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PUD-other drugs
Prilosec/omeprazole |
proton pump
expensive short term treatment of reflux inhibits step in acid prod. |
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PUD- other drugs
Antibiotics- |
treats H.pylori
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