DRUGS USED FOR TREATMENT OF GASTROINTESTIONAL DISORDERS Itawamba Community College Patricia Robbins/RN, MSN

Antiemetic and Antivertigo Drugs Antiemetic- Treat or prevent nausea and vomiting. Antivertigo- Treat or prevent vertigo (a feeling of spinning or rotation type motion) Vomiting due to drugs, radiation, and metabolic disorders usually occur due to stimulation of the chemoreceptor trigger zone (CTZ), a group of nerve fibers located on the 4th ventricle of the brain. When these fibers are stimulated, impulses are sent to the vomiting center in the medulla.

Antiemetic and Antivertigo Drugs These drugs act by inhibition of the CTZ or by depressing the sensitivity of the vestibular apparatus of the inner ear. Those that work on the vestibular apparatus of the inner ear are more effective for motion sickness, whereas those that work on the CTZ are more effective for N/V.

Antiemetic Drugs Prophylactic use- before surgery to prevent N/V, or immediate postop when recovering from anesthesia ( reglan) Give 30 minutes before administration of antineoplastic drugs (tx cancer) due to high incidence of N/V. (Kytril, reglan, Zofran) Before Radiation therapy, with bacterial or viral infections, or N/V due to drugs, Meniere’s disease, motion sickness. Most common S/E is drowsiness.

Nursing Management If vomiting is severe, observe pt for poor skin turgor, dry oral mucous and electrolyte imbalance. Monitor B/P, pulse, resps, q2-4 hrs. Measure I&O. Daily weights if prolonged or repeated episodes. Describe emesis in charting, notify Dr. if blood in emesis or if vomiting becomes more severe suddenly.

Antivertigo Drugs Vertigo s/s- Lightheadedness, dizzy, weakness, and difficulty walking. Have direct or indirect properties of antiemetics. Most common s/e is drowsiness, so seek help when getting out of bed. Teach to avoid driving or performing dangerous tasks when taking these.

Nursing Diagnosis Risk for Fluid Volume Deficient r/t nausea and vomiting. Risk for injury r/t adverse drug effects of drowsiness. Anxiety r/t N/V,(other s/s if present) weakness, dizziness, unsteady gait Major goal is to reduce anxiety, absence of s/s, no injury, normal fluid and electrolyte balance.

Patient Teaching Do not increase dose or frequency of use unless ordered by physician. Avoid Alcohol and other sedative type drugs Avoid driving or performing other hazardous tasks Motion sickness- take the med about 1 hr before travel.

Transdermal Scopolamine For prevention of N/V due to motion sickness Teach pt to apply behind the ear. Apply every 3 days After application, wash hands thoroughly with soap and water. This prevents any traces of the drug from coming in contact with the eyes. Apply new disc behind the opposite ear. Use only one disc at a time. S/E are dizziness, dry mouth, and blurred vision.

Antacids Drugs that neutralize or reduce the acidity of the stomach & duodenum. Tx heartburn, ulcers. May impair absorption of some drugs. Ex: Amphojel, Tums, Riopan, MOM Many antacids contain more than 1 ingredient. Contain magnesium so may have a laxative effect. Aluminum/calcium Give 2hrs before or after giving other oral drugs. Instruct pt to chew the tablet. Flavored antacid may be ordered if taste is a problem. Shake liquid antacid to mix.

Anticholinergics Reduce gastric motility and decrease the amount of acid secreted by the stomach. Treat peptic ulcers. Ex:Robinul, Pro-banthine S/E include dry mouth, urinary retention, blurred vision, N/V. If photophobia occurs, keep room semi-dark.

Gastrointestinal Stimulants Increase the motility of the upper GI tract. Treat GERD(reflux) and gastric stasis (failure to move food out of the stomach) Ex: Propulsid, Reglan, Ilopan S/E may produce CNS symptoms-dizziness, drowsiness, itching, abd pain Observe pts for adverse reactions r/t CNS Dexpanthenol(Ilopan) may be give after Abd surgery to prevent paralytic ileus, can evaluate effectiveness by monitoring Bowel sounds frequently.

Histamine H2 Antagonists Action- inhibit the action of histamine at H2 receptor cells of the stomach, which then reduces the secretion of gastric acid. Treat gastric or duodenal ulcer and GERD. Ex: Tagamet, Zantac, Pepcid, Axid Low incidence of adverse reactions diarrhea, dizziness, fatigue When given IV, monitor infusion closely, too rapid can cause cardiac arrhythmias. Give tagamet before or with meals. Axid and pepcid given at bedtime.

Antidiarrheals Action- decrease intestinal peristalsis, which is usually > with diarrhea. Usually given after each loose stool. Inspect each BM before making decision to give. Notify Dr if elevation of temp or severe abd pain. Ex: Lomotil, Imodium, Maalox caplets Diphenoxylate (Lomotil) may result in n/v, sedation, HA, euphoria. Is a narcotic related drug but has no analgesic effect but drug dependence is a potential. Is combined with atropine to discourage abuse.

Antiflatulents Used to reduce gas formation in the intestines Simethicone (Mylicon) has defoaming action that disperses and prevents formation of gas. Charcoal is an absorbent. No reported adverse reactions.

Digestive Enzymes Pancreatin and pancrelipase made and secreted by the pancreas, necessary to breakdown F/S/P. Necessary to digest food. Prescibed as replacement therapy. Disease processes that can cause a < in pancreatic enzymes include cystic fibrosis, surgery, pancreatitis, cancer, malabsorption syndrome, Available as oral supplements. Ex:Dizymes Tabs, Cotazyme, Ilozyme No adverse reactions reported, however high doses could cause n/v.

Emetics Induces vomiting, acts on CTZ of the medulla. Will empty stomach rapidly in case of poison or drug overdose. Ex: apomorphine can cause CNS depression, and ipecac syrup. A danger associated with any emetic is aspiration of vomitus. Before and after giving, place in a side-lying position. Observe for signs of shock and respiratory depression. When vomiting occurs, suction as needed, watch for aspiration, and monitor vs q5-10mins until stable.

Nursing Alert- Emetics Contact the Poison Control Center for assist regarding treatment. An emetic MUST NOT be given when a corrosive substance (Lye) or a petroleum distillate( paint thinner, gasoline, kerosene) has been ingested. In many cases of poisoning, it is preferred to insert a nasogastric tube to empty the stomach. Emetics are never given to an unconscious or semiconscious pt.

Gallstone- Solubilizing Agents Suppress the production of cholestrol and cholic acid by the liver. Used in nonsurgical tx of gallstones. Ex: Actigall- due to potential toxic effects with long-term use,pts are carefully selected and closely monitored. Adverse reactions are diarrhea, cramps,n/v.Prolonged use can be toxic to liver.

Laxatives Various types with different actions but same results, constipation relief. Ordered for short-term relief of constipation or prevention of straining, also used for prep before rectal examinations, and prep for surgery or diagnostic test. Prolonged laxative use can result in diarrhea and loss of water and electrolytes or create a dependency on laxatives.

Laxatives Bulk-producing laxative- not digested by the body, add bulk and water to contents of intestines and encourages evacuation of stool. Ex: Fibercon, Fiberall, Metamucil. With bulk laxatives, immediately drink a full glass of water.

Emollient Laxatives Lubricate the intestinal wall and soften stool, enhancing passage. Do not promote the retention of water in the stool. Ex: Mineral Oil- give on an empty stomach in the p.m. Avoid long-term use. Daily use may interfere with the absorption of vitamins A,E,D and K.

Laxatives Fecal Softeners- Promote water retention in the fecal mass and soften stool. Ex: docusate sodium (Colace) and Surfak liquid gels. Hyperosmolar agents- dehydrate tissue, cause irritation and increase peristalsis. Ex: Glycerin Stimulant-> peristalsis. Ex: cascara Saline laxative- MOM, pull water into intestines.

Miscellaneous Drugs Misoprostol (Cytotec) inhibits gastric acid secretions and > production of mucus by the lining of the GI tract Carafate- forms a complex with the exudate of the stomach lining. This forms a protective layer over a duodenal ulcer and aids in healing the ulcer.

Nursing Diagnoses Anxiety r/t diagnosis, symptoms, adverse drug reactions Risk for Injury r/t adverse drug reactions Noncomplaince r/t lack of knowledge Risk for Ineffective Management of Theraputic Regimen r/t lack of knowledge of medication regimen