1. Gastrointestinal Medications
Chapter 16
Gastrointestinal Medications
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2. Digestive System Functions Structures Protective factors
Performs the mechanical and chemical process of digestion, absorbs nutrients, and eliminates waste.
Structures
Mouth, esophagus, stomach, intestines, and accessory structures
Protective factors
The digestive tract must work without being destroyed by the strong acid it makes to digest food.
Digestion variables
Changes in GI blood flow, amount of surface available, and motility are found in very young and older adult patients.
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3. Gastrointestinal Disorders
Overview: nausea, vomiting, motion sickness, diarrhea, constipation, GERD Medications (treat or prevent) antiemetics, laxatives, antidiarrheals, prokinetic agents, medications for (IBS), chemotherapy-induced N+V
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4. Overview GI medications
Three major types
Restore/maintain lining GI tract;
decrease acidity/motility
exert laxative action- colon
Miscellaneous medications: antiflatulents, digestive enzymes, emetics, and medications to treat gallstones and alcoholism
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5. Overview Peptic Ulcer Disease
Therapeutic management outcomes
Lessening of manifestations
Encouragement of healing
Decreased risk of complication
Stopping reoccurrence
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6. Overview Peptic Ulcer Disease
Groups of medications used in the management of peptic ulcer disease
Antibiotics
Antisecretory agents (H2 receptor antagonists and proton pump inhibitors)
Mucosal protectants
Antacids
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7. Peptic Ulcer Disease ANTIBIOTICS
Amoxicillin (Amoxil)
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
Tetracycline
eradication of H. pylori bacteria (combination of two or three antibiotics for 14 days)
Nursing Administration Considerations
nausea and diarrhea- common.
Finish full course- prescribed medications.
contraindications, and interactions.

8. Peptic Ulcer Disease HISTAMINE2-RECEPTOR ANTAGONISTS
ranitidine (Zantac)
cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid) –Purpose
suppress secretion of gastric acid (block H2 receptors in parietal cells)
Theraputic Uses: gastric/peptic ulcers, GERD, Zollinger- Ellison. H. pylori ulcers (with antibiotics)

9. Peptic Ulcer Disease HISTAMINE2-RECEPTOR ANTAGONISTS
Complications Cimetidine (Tagamet)
block androgen receptors (libido and impotence)
Inform clients
CNS effects (lethargy, depression, confusion) older adults kidney or liver dysfunction. should be avoided

10. HISTAMINE2-RECEPTOR ANTAGONISTS Nursing Administration
advise good nutrition.
avoid foods- promote gastric secretion, eat on a regular schedule, relaxed setting, do not overeat.
adequate rest and reduction of stress, avoid smoking, avoid alcohol
avoid aspirin and other NSAIDs
ranitidine (Zantac) with or without food.
monitor GI bleeding

11. PROTON PUMP INHIBITORS
omeprazole (Prilosec)
pantoprazole (Protonix)
lansoprazole (Prevacid)
esomeprazole (Nexium) Purpose
reduce gastric acid secretion
Therapeutic Use: gastric/duodenal ulcers, esophagitis, GERD, Zollinger-Ellison syndrome.
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12. PROTON PUMP INHIBITORS Nursing Administration
do not crush, chew, break sustained-release capsules.
sprinkle the contents
omeprazole (Protonix) daily in AM
avoid alcohol, irritating medications (NSAIDs)
4 to 6 weeks (active ulcers).
monitor IV site (redness, swelling, pain).
monitor GI bleeding
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13. MUCOSAL PROTECTANT sucralfate (Carafate)
Changes-thick substance-adheres to ulcer (6 hr)
Therapeutic Uses acute duodenal ulcers
Complications: constipation (1,500 mL/day)
no systemic effects (caution chronic kidney disease)
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14. MUCOSAL PROTECTANT Nursing Administration
sucralfate (Carafate)
interferes with absorption (phenytoin, digoxin, warfarin, ciprofloxacin) Maintain a 2-hr intervals
antacids should not be administered within 30 min
medication regimen: four times daily, 1 hr before meals, HS
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15. ANTACIDS aluminum hydroxide (Amphojel) aluminum carbonate (Basaljel)
magnesium hydroxide (Milk of Magnesia)
calcium carbonate (Tums)
neutralize gastric acid
Therapeutic Uses: peptic ulcer disease (PUD) + GERD.
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16. ANTACIDS Complications
Aluminum/calcium: constipation.
Magnesium: diarrhea, toxicity –impaired kidney function.
Sodium: fluid retention.
Bicarbonate: alkalosis (impaired kidney function)
Aluminum: hypophosphatemia and hypomagnesemia. (Monitor electrolytes)
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17. ANTACIDS Nursing Administration
chew tablets-drink at least 8 oz water or milk.
shake liquid to disperse
compliance difficult (seven times a day): 1 hr before and 3 hr after meals, and again at bedtime.
other medications at least 1 hr before or after taking an antacid.
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18. ANTIEMETICS ondansetron (Zofran) metoclopramide (Reglan)
dronabinol (Marinol)
scopolamine (Transderm Scop)
hydroxyzine (Vistaril)
lorazepam (Ativan)
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19. Antiemetic Nursing Administration
Prevent or treat N+V
Nursing assessment can identify factors.
Chemotherapy agents cause severe N+V
Administering antiemetics prior to chemo more effective
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21. Anticholinergics Antispasmodics
preparations reduce GI tract spasm, intestinal motility, acid production, gastric motility (reduces pain) Theraputic Uses: peptic ulcer, pylorospasm, biliary colic, hypermotility, irritable colon, and acute pancreatitis
What contributes to the GI discomfort patients often feel?
The anticholinergic-antispasmodic agents act with antacids in prolonging or continuing the therapeutic benefits of both drug categories.
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22. ANTIDIARRHEALS
diphenoxylate plus atropine (Lomotil) loperamide (Imodium) paregoric (Camphorated Tincture of Opium) Action: decrease intestinal motility, increase absorption fluid and sodium- intestine.
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23. ANTIDIARRHEALS Complications
●● At recommended doses for diarrhea, diphenoxylate does not affect the CNS system.
●● At high doses, clients can experience typical opioid effects, such as euphoria or CNS depression.
atropine, which has unpleasant adverse effects (blurred vision, dry mouth, urinary retention, constipation, tachycardia)
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24. LAXATIVES
Psyllium (Metamucil) Docusate sodium (Colace) Bisacodyl (Dulcolax) Magnesium hydroxide (Milk of Magnesia) senna (Senokot), lactulose (Cephulac)
How does the use of laxatives relate to a patient’s age?
When is regular use of laxatives indicated?
What problems may arise with regular laxative use?
Can you identify a procedure in which laxatives may be indicated as patient preparation?
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25. LAXATIVES Bulk-forming laxatives: psyllium (Metamucil)
soften fecal mass
decrease diarrhea IBS
control stool (ileostomy/colostomy)
promote defecation (older adults)
How does the use of laxatives relate to a patient’s age?
When is regular use of laxatives indicated?
What problems may arise with regular laxative use?
Can you identify a procedure in which laxatives may be indicated as patient preparation?
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26. LAXATIVES Surfactant laxatives: docusate sodium (Colace)
lower surface tension of stool allow penetration water.
pregnancy or opioid constipation
prevent painful elimination (hemorrhoids or episiotomy)
prevent straining (aneurysm or post-MI)
promote defecation (older adults)
How does the use of laxatives relate to a patient’s age?
When is regular use of laxatives indicated?
What problems may arise with regular laxative use?
Can you identify a procedure in which laxatives may be indicated as patient preparation?
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27. LAXATIVES Stimulant laxatives: bisacodyl
stimulation peristalsis, increase water in intestine
prepare client prior to surgery or diagnostic tests such as
a colonoscopy
constipation (opioid use)
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28. LAXATIVES Osmotic laxatives: magnesium hydroxide (MOM)
draw water to intestine increases peristalsis.
painful elimination (episiotomy or hemorrhoids)
client preparation (colonoscopy)
rapid evacuation of bowel (poisons/parasites)
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29. LAXATIVES Complications
Laxatives should be used briefly- smallest effective dose
GI irritation Do not crush or chew enteric-coated tablets.
Rectal burning
Discourage suppositories- regular basis.
magnesium hydroxide-toxic levels of magnesium. (renal dysfunction) (sodium salts- risk fluid retention) Cardiac disorders
Monitor for dehydration (skin turgor, I&O, increase water intake (2000mL)
Chronic use-diminish defecatory reflexes

30. PROKINETIC AGENTS metoclopramide (Reglan) controls N+V
Therapeutic Uses
postoperative and chemotherapy-induced N+V
management of GERD.
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31. PROKINETIC AGENTS Complications
Extrapyramidal symptoms (EPS): restlessness, anxiety, spasms of face and neck.(diphenhydramine to minimize)
Sedation: avoid driving.
Diarrhea: Monitor bowel function/dehydration.
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32. Miscellaneous GI Medications
Antiflatulents
Gallstone-Solubilizing Agents
Pancreatic digestive enzymes
Emetics
Disulfiram
How does simethicone work as an antiflatulent?
When would the use of an emetic be contraindicated?
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33. Antiflatulents
Break up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric pain
Intended for short-term use
When is the use of activated charcoal indicated?
What physical assessments would the nurse observe in the patient who has excessive gas?
Antiflatulents are often used in combination with what other GI drug?
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34. Gallstone-Solubilizing Agents
Act on the liver to suppress cholesterol and cholic acid synthesis; biliary cholesterol desaturation is enhanced, and breakup occurs
Used in selected patients with radiolucent stones in gallbladder
Adverse reactions: dose-related; diarrhea, anorexia, constipation, cramps, dyspepsia, epigastric distress, flatulence, heartburn, nausea, nonspecific abdominal pain, and vomiting
What patient characteristics and/or history warrant the use of these agents?
If the patient complains of epigastric pain, where would the pain be located?
Which other drug may reduce the absorption of these medications?
What type of diet education would the patient with a history of gallstones benefit from?
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35. Digestive Enzymes
Promote digestion by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking, not secreted, or not properly absorbed
For which clinical conditions would these enzymes be indicated?
Why is proper dietary balance of fat, protein, and starch indicated for the patient who is receiving these enzymes?
If the patient is receiving supplemental iron while on these enzymes, what side effect can occur?
When are digestive enzymes usually scheduled to be given?
What other patient education should be offered to patients taking these preparations?
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36. Alcoholism Treatment
Diazepam (valium) Lorazepam (Ativan) Theraputic Use: benzodiazepines alcohol detoxification- decrease anxiety, decrease risk seizures. Disulfiram (ANTABUSE) Theraputic Use: aversion (behavioral) therapy. Management-alcoholism
What symptoms would the patient experience if this drug were taken with alcohol?
What physiologic condition within the body produces the disulfiram reaction?
What other medication, when taken with alcohol, produces a reaction similar to the disulfiram-alcohol reaction?
Why is it important for the patient to carefully read label ingredients (food, personal care items, over-the-counter medications) while on this drug?
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37. Disulfiram (ANTABUSE)
acetaldehyde syndrome alcohol ingestion: N+V, weakness, sweating, palpitations, hypotension. (can progress- respiratory depression, cardiovascular suppression, seizures, death)
medication effects) persist for 2 weeks- discontinuation
What symptoms would the patient experience if this drug were taken with alcohol?
What physiologic condition within the body produces the disulfiram reaction?
What other medication, when taken with alcohol, produces a reaction similar to the disulfiram-alcohol reaction?
Why is it important for the patient to carefully read label ingredients (food, personal care items, over-the-counter medications) while on this drug?
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38. Disulfiram (ANTABUSE)
potential dangers of drinking any alcohol (avoid cough syrups, mouthwash,aftershave lotion).
monitor LFT (hepatotoxicity)
medical alert bracelet
participate in a 12-step self-help program.
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