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97 Cards in this Set

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Drugs affecting the GI system
Adsorbents
Emetics
Antiflatulants
Digestive Agents
Antidiarrheals
Laxatives
Antiemetics
Peptic Ulcer Agents
Adsorbents
Antidiarrheals
Antiemetics
Antiflatulants
Digestive Agents
Emetics
Laxatives
PUD
Adsorbents
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
Emetics
Amorphine
action: 1.stimulates vomiting ctr in medulla
2.regurgitates contents in the stomach and upper duodenum
Emetic drug-Amorphine
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*
Emetic drug-Syrup of Ipecac
Syrup of Ipecac-oral use
adv: safe
disad: causes vomiting w/in 30 min
Emetic nursing implications
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
Antiflatulents-anti-gas
Simethicone/Mylicon
act: disperses gas pockets
indication for use: prior to diagnostic procedures of the abdomen
adver.eff.:expulsion of excessive gas
Digestive Agents
Admin to pts who do not have enough gastic juices
Digestive agents-Gastric agents
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
Digestive Agents-Pancreatic agents- Pancreatin
Pancreatin- large tablets
use:replacement therapy
taken w/meals (i.e.Cystic fibrosis)
Digestive Agent-Hepatic agents-Bile Salts
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
Antidiarrheals
K+ (potassium) is lost with diarrhea!
Systemic &
Topical
Antidiarrheals- Systemic
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)
Antidiarrheal - Topical
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
Kaopectate problems
non-specific in what it absorbs - can absorb medications
Laxatives
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
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
Laxatives-Fiber/Bulk forming- Metamucil
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
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
Patient teaching for Laxatives
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
antihistamines are anticholinergic
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
Antiemetics
stops vomiting,stops motion sickness
Antihistamine Antiemetics-Benadryl
Phenothiazide antiemetics-Phenergan
others- Emetecon, Scopolamine
reglan
Antiemetics- Antihistamine
Benadryl-
act: unclear
use: treat motion sickness & nausea assoc. w/narcotics
admin: PO, IM, supp
s.e.: sedation, anticholinergic (dry mouth, constipation, urinary retention)
Antiemetics-Phenothiazide antiemetics
Phenergan
act: CNS acting effect-blocks CNS receptors
s.e: sedation, photosensitivity
Antiemetics-others
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
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
Peptic Ulcer Disease - PUD
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
Peptic Ulcer Agents
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
PUD agents-Nursing Implications
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
Histamine (H2) receptor antagonists-PUD
they block hydrocholegic acid production
Histamine (H2) receptor antagonists- PUD
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
HCI
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
Sucralfate/carafate-PUD
taken on empty stomach
act: adhers to ulcer site, forming a protective barrier over ulcerations
adm: 30 min ac and hs-hard to schedule
other drugs to treat PUD
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
Activated Charcoal:
is
does
absorbant
used in acute poisoning
excrete in feces w/out absorbtion
Amorphine:
is
does
adva
disadv
vomiting agent from sm.ints.& stomach & upper duodenum
emetic
causes vomit in 15 min
narcotic sedative
Syrup of Ipecac:
is
adv
disad
emetic
oral only
safe
slow vominting (w/in 30min)
Simethicone/Mylicon
is
action
indica.for use
adver eff
antiflatulent-antigas
gets rid of gas pockets
given b4 surgery on abd.
excessive farting
Gastric agents:
are
use
admin
contrain
treats HCI-changes env.to acidic PH so stomach can change pepsinogen to pepsin
via straw
PUD
Pancreatin:
is
use
enzyme mix
replaces pancreatic enzymes,caused by ie cystic fibrosis, pancreatitis
taken w/meals
Laxatives
Hyperosmolar- (osmolarity-water, high water)MOM,Fleets,Glycerin Suppository
Fiber/Bulk forming-Metamucil
Emollient/Stool softener-Surfak/Colase
Stimulants/Irritants-Dulcolax
Lubricant-Mineral Oil
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
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
Patient teaching for Laxatives
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
Antiemetics
Antihistamine Antiemetics-Benadryl
Phenothiazide antiemetics-Phenergan
others- Emetecon, Scopolamine
reglan
Antiemetics- Antihistamine Antiemetics
Benadryl-
act: unclear
use: treat motion sickness & nausea assoc. w/narcotics
admin: PO, IM, supp
s.e.: sedation, anticholinergic (dry mouth, constipation, urinary retention
Antiemetics-Phenothiazide antiemetics
Phenergan
act: CNS acting effect-blocks CNS receptors
s.e: sedation, photosensitivity
Antiemetics-others
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
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
PUD
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
PUD agents - Antacids
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
Nursing Implicatons of antacids
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
PUD-Histamine (H2) receptor antagonist
block HCI acid production
PUD-HRA's
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
PUD-Sucralfate/Carafate
take on empty stomach
act: adheres to ulcer site, forms protective barrier
adm: 30 min ac and hs-hard to schedule
Other PUD drugs
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
GI drugs- Activated Charcoal
does
used
ends
absorbs
acute poisoning
excreted in feces
Emetics-Amorphine
does
use
adv
disadv
vomiting from stomach,sm intestine/upper duodenum
parenteral use
vomits in 15 min-fast
narcotic sedation
Parenteral use
effect is systemic, substance is given by other routes than the digestive tract -injection or infusion or patches
Syrup of Ipecac- emetic
route
adv
disav.
PO
safe
slow vomit-30min
Nursing implications of emetics
do not give if not alert
do not give if ingested petro.products or caustic products
adm. charcoal after emetics
Antiflatulents-Simethicone/Mylicon
use
action
indication for use
adverse eff
anti-gas
gets rid of gas pockets
use b4 operations on abd
excessive farting
Digestive agents-gastric agents
what treats
admin
contrain
HCI-need acid env.to change pepsinogen to pepsin
via straw
PUD
Pancreatic agents-Pancreatin
what
use
mix of enzymes-large tabs
treats(replaces) low enzyme levels due to cystic fibrosis or pancreatitis-
taken with meals
Hepatic agents-Bile salts
use
contrain
makes bile, from liver
prevents gallstones
biliary obstructions
Antidiarrheals-systemic-Opium derivatives Paragoric/Lomotil
action
uses
decreases peristal waves in intestines
for acute diarrhea or when feeding by tube (give b4)
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
Nursing actions-antidiarrheals
1. assess bowel func.fluid and electrolyte (K+)levels
should not use for more than 2 days
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
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
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
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
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
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)
Antiemetics-Phenothiazide -Phenergan
action
s.e
blocks CNS receptors
sleepiness, tendency to sunburn
Antiemetics-other -Emetecon
CNS inhibits nausea assoc.w/anesthesia
does not cause sleepiness
Antiemetics-other-Scopolamine
treats nausea from motion sickness
patch-3 & 7 day
Antiemetics-other-Reglon
increase GI motility & supresses vomiting
used with tube feedings
monitor for aspirations
constricts cardiac spincture
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
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
PUD agent antagonists-Pepcid/famotidine
Zantac/rantidine-
binds w/H2 recepter sites, prevents HCI production
potency varies
PUD agents- Sucralfate/Carafate
give on empty stomach
adheres to ulcer site,forms barrier
30min ac & hs (b4 meals, at bedtime)
PUD-other drugs-Cytotec/misoprostol
treasts NSAID induced PUD
action unclear
**induces abortions**
PUD-other drugs
Prilosec/omeprazole
proton pump
expensive
short term treatment of reflux
inhibits step in acid prod.
PUD- other drugs
Antibiotics-
treats H.pylori