1. 27
Drugs Used to Treat Gastrointestinal Conditions

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Slide 4 Digestive System Animation

3. Figure 27-1 The digestive system.

4. Digestive System Animation
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5. Liver Center of metabolic activity in body
Detoxifies blood and secretes bile

6. Peptic Ulcers Caused by hyperacidity and excessive pepsin activity
Alcohol, caffeine, and smoking have been linked to peptic ulcers
Many cases of gastric ulcers or gastritis are due to Helicobacter pylori

7. Table 27-1 Drugs Commonly Used in Peptic Ulcer Disease

8. Table 27-1 (continued) Drugs Commonly Used in Peptic Ulcer Disease

9. Table 27-1 (continued) Drugs Commonly Used in Peptic Ulcer Disease

10. Antacids: Uses Alkaline compounds that neutralize hydrochloric acid
Most common types contain aluminum hydroxide and magnesium carbonate.

11. Antacids: Adverse Effects
Common: diarrhea or constipation, anorexia, weakness, bone pain, tremors
Hypermagnesemia may produce nausea, vomiting, confusion, renal calculi, metabolic alkalosis, and headache

12. Antacids: Contraindications
Contraindicated in patients with hypercalcemia, hyperparathyroidism, vitamin D-overdosage, and decalcifying tumors (depending on type of antacid)
Cautious use in patients with impaired kidney function or dialysis, and in lactation

13. Antacids: Patient Information
Instruct patients to take antacids 1 to 3 hours after meals and at bedtime, and not within 1 to 2 hours of taking other oral medications.
Advise patients to increase fluid intake to prevent kidney stones.
Patients with cardiovascular disease should avoid antacids that are high in sodium.

14. Tums Use by Older Adults
Calcium carbonate (Tums) should be used with caution in older adults. This is because of their likelihood of having the following disorders:
Renal disease or calculi
Ventricular fibrillation
Cardiovascular disease

15. H2-receptor Antagonists: Uses
H2-receptor antagonists reduce secretion of gastric acid by blocking H2-receptors
Used in short-term treatment of active duodenal ulcers and prevention of ulcer recurrence
Also used for heartburn

16. H2-receptor Antagonists: Adverse Effects
Common: GI disturbances, headache, drowsiness, confusion, agitation, hallucinations, and reversible impotence
Serious: cardiac arrhythmias and cardiac arrest after IV bolus dose

17. H2-receptor Antagonists: Contraindications
The agents are contraindicated in:
Pregnancy and lactation
Children younger than 16 years of age

18. H2-receptor Antagonists: Patient Information
Warn patients to avoid smoking and drinking alcohol.

19. Proton Pump Inhibitors: Uses
Act by blocking hydrochloric acid production
Used to heal stomach and duodenal ulcers and relieve symptoms of GERD and esophagitis

20. Proton Pump Inhibitors: Adverse Effects
Common: headache, dizziness, fatigue, diarrhea, abdominal pain, nausea
Rare: hematuria

21. Proton Pump Inhibitors: Contraindications
Long-term use is contraindicated.
Should not be used in children younger than 18 years

22. Proton Pump Inhibitors: Patient Information
Advise patients that treatment is for short term only (4–8 weeks).

23. OTC Gastric Medications in Children
Omeprazole (Prilosec and Zegerid) has not been significantly tested in children.
Do not use in children younger than 18.

24. Prostaglandins: Uses Affect GI motility and gastric acid secretion
Used to prevent complications of gastric ulcers that result from NSAID use

25. Prostaglandins: Adverse Effects and Contraindications
Common adverse effects are: diarrhea and menorrhagia (in women)
Contraindicated in pregnancy and lactation

26. Prostaglandins: Patient Information
Advise women to immediately report pregnancy.
Advise patients that diarrhea may occur but will disappear after the first month of therapy.

27. Table 27-2 Classifications of Antidiarrheal Drugs

28. Table 27-3 The Most Common Antidiarrheals

29. Opioids: Uses
Narcotic analgesics act as stimulants on opioid receptors in the GI tract to increase mixing movements of the gut and decrease peristatic movements
Used to treat diarrhea

30. Opioids: Adverse Effects
Constipation
Nausea and vomiting
Agitation
Drowsiness
Tachycardia
Numbness of hands and feet

31. Opioids: Contraindications
Contraindicated in intestinal obstruction and in children younger than 6 years
Not recommended for treatment of chronic diarrhea.

32. Opioids: Patient Information
Encourage patients to keep a record of bowel movements to determine effectiveness or possible constipation.
Advise patients to drink clear fluids for a few days.

33. Opioids in Elderly Patients
Monitor opioid use in elderly patients carefully because opioids can cause respiratory depression and decreased blood pressure in this population.

34. Absorbents Absorb toxins in GI tract that might be causing diarrhea
Adverse effects: constipation
Contraindications: bowel obstruction, colitis, fever, pregnancy, lactation
Patient education: Instruct patients to report diarrhea that is not controlled within 48 hours.

35. Table 27-4 Categories of Laxatives

36. Table 27-4 (continued) Categories of Laxatives

37. Osmotic Laxatives: Uses
Sodium and magnesium ions attract water into bowel causing a more liquid stool.
Used for short-term treatment of occasional constipation

38. Osmotic Laxatives: Adverse Effects
Common: nausea, vomiting, abdominal cramps, diarrhea, weakness, lethargy, electrolyte imbalances
Serious: hypotension, bradycardia, mental depression, coma

39. Osmotic Laxatives: Contraindications
Contraindicated in renal impairment and hypertension

40. Osmotic Laxatives: Patient Education
Instruct patients that 24 to 48 hours are needed for effect to occur.
Women should not breast feed while taking these drugs.

41. Laxative Abuse
Evaluate laxative use in patients suspected of having bulimia or anorexia.
Elderly patients may perceive constipation and overuse laxatives. Be alert for volume depletion in older adults.

42. Stool Softeners Uses: to ease bowel movements in constipated patients
Adverse effects: mild abdominal cramps, diarrhea, nausea
Contraindications: Atonic constipation, abdominal pain, intestinal obstruction, heart failure, edema, diabetes

43. Stool Softeners
Patient education: Instruct patients to drink lots of fluids and not use these drugs for a long period.

44. Laxative Stimulants Uses: temporary relief of constipation
Adverse effects: anorexia, nausea, gripping, rebound constipation, melanosis
Contraindications: abdominal pain, fecal impaction, GI bleeding, ulcerations, pregnancy, heart failure

45. Laxative Stimulants
Patient education: Advise patients that prolonged use disrupts normal colon function.

46. Bulk-forming Laxatives
Work by absorbing free water in intestinal tract; use in atonic or spastic constipation
Adverse effects: nausea, vomiting, diarrhea, abdominal cramps
Contraindications: esophageal and intestinal obstruction, fecal impaction, children younger than 2 years

47. Bulk-forming Laxatives
Patient education: Advise patients with diabetes that these drugs contain sugar.

48. Emetics Use: to induce vomiting (emergency)
Adverse effects: stiff muscles, myopathy, convulsions, coma, arrhythmias, fatal myocarditis
Contraindications: shock, seizures, impaired cardiac function, sedation
Patient education: Advise patients not to use before calling poison control center.

49. Table 27-5 The Most Commonly Used Antiemetics

50. Table 27-5 (continued) The Most Commonly Used Antiemetics

51. Antiemetics Uses: to prevent or treat nausea and vomiting
Adverse effects: drowsiness, dry mouth, confusion, hypotension, blurred vision
Contraindications: coma, CNS depression, pregnancy, and lactation
Patient education: Advise patients to avoid driving and alcohol.