1. Gastrointestinal Drugs
Pharmacology I: NURS 1950

2. Objective 1: list the components of gastric juice that contribute to the pain associated with peptic ulcers
Objective 2: describe the physiology of gastric secretions

3. Objective 3: list drugs considered to be ulcerogenic

4. Objective 4: explain the actions of the antiulcer drugs
Decrease acidity
Block histamine receptors
Gastrointestinal prostaglandins

5. Gastric acid pump inhibitors
Coating agents
Prokinetic agents
Antispasmodic agents

6. Objective 5: describe the pain reducing effects of antacids

7. Decreased pain Raise the pH of gastric contents
Higher pH, less acidity
Decreased pain

8. Objective 6: identify the features of an ideal antacid
Cheap
Effective
No constipation or diarrhea
No systemic effects
No rebound acidity

9. Objective 7: differentiate between the various antacids

10. Riopan, Maalox, Mylanta II, low sodium
Calcium carbonate, Aluminum hydroxide: constipation
Magnesium: diarrhea, electrolyte imbalance
Calcium carbonate & sodium bicarbonate: rebound acidity

11. Simethicone: defoaming agent
Alginic acid: highly viscous solution—sodium alginate

12. Objective 8: describe the nursing implications associated with antacid therapy

13. What are the assessments and interventions the nurse would do for a client taking an antacid?

14. Objective 9: state the mechanism of action of anticholinergic and antispasmodic agents

15. What would you see with anticholinergics?
Anticholinergics and antispasmodics the same
Drugs include belladonna, probanthine, bentyl
Used for spastic conditions of GI tract, peptic ulcers and irritable bowel syndrome
Block parasympathetic nervous system
Activity is systemic
What would you see with anticholinergics?

16. Which clients should not use anticholinergics?

17. Objective 10: identify appropriate nursing actions relative to caring for clients receiving antispasmodic drugs

18. Assess: mental status, teach about orthostatic hypotension
In the elderly: increased constipation
If arrhythmia or palpitations: stop the drug, call the physician

19. Objective 11: describe the effects and uses of H2 receptor antagonists, and proton pump inhibitors

20. Used for GERD, duodenal ulcers, Zollinger-Ellison syndrome
H2 receptor antagonists
Block histamine 2 receptors
Raises pH of gastric contents
Used for GERD, duodenal ulcers, Zollinger-Ellison syndrome
Used to prevent or treat stress ulcers

21. Drugs include Cimetidine (Tagamet) Famotidine (Pepcid)
Nizatidine (Axid)
Rantidine (Zantac)

22. Drugs can cause Dizziness, HA, diarrhea, constipation
If confusion, disorientation, hallucination, see MD
Can cause gynecomastia, hepatotoxicity

23. Proton pump inhibitors
Inhibit gastric acid pump
Treat: severe esophagitis, GERD, gastric and duodenal ulcers, Zollinger-Ellison syndrome
Can be used with antibiotics for H pylori

24. SE: diarrhea, HA, muscle pain and fatigue
If rash: call MD

25. Drugs include Esomeprazole (Nexium) Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

26. Objective 12: Explain the nursing interventions associated with H2 receptor antagonists and proton pump inhibitors

27. Objective 13: identify causes of constipation
Objective 14: explain the uses of laxatives and cathartics
Objective 16: describe the actions of the types of laxatives
Objective 17: identify laxatives according to type

28. Causes of constipation
What are some things or conditions that can cause constipation?

29. laxatives Act three ways Affect fecal consistency
Increase fecal movement
Remove stool from rectum

30. Laxatives OTC; misused
Dependence
Damage bowel
Cause problems in bowel

31. Contraindications, Precautions
Caution: surgical abdomen; appendicitis; N/V; fecal impaction; intestinal obstruction; undiagnosed abdominal pain
Contraindicated: hypersensitivity

32. Groups of Laxatives Bulk-forming Emollient Hyperosmotic Saline
Stimulant

33. Mechanism of action Best for long term use
Bulk-forming: natural fiber-like
Absorb water
Distends bowel
Initiates reflex bowel activity
Best for long term use

34. Lowers surface tension Allows more fat & water to be absorbed
Emollient laxatives
Stool softener (Docusate salts)
Lowers surface tension
Allows more fat & water to be absorbed
When should these be used?

35. Lubricates fecal material & intestinal wall
Lubricant laxative (mineral oil)
Lubricates fecal material & intestinal wall
Prevents H20 from leaking out of gut
Stool expands & softens

36. The emollients and lubricants do not seem to increase peristalsis
Oils a problem in constantly recumbent clients

37. Hyperosmotic increase water content in large intestine
Distends bowel
Increases peristalsis
Evacuates the bowel
Non-absorbable ion exchange
Used before diagnostic tests

38. Saline laxatives increase osmotic pressure in small intestine
Inhibit absorption of water & elytes
Increase amount of water & elytes

39. Results: watery stool
Increased distention of bowel
Promotes peristalsis & evacuation
Example: citrate of magnesia

40. Increases bulk Softens stool Stimulant laxatives stimulate nerves
Increases peristalsis
Increase fluid in colon
Increases bulk
Softens stool

41. Drug effects Few systemic effects Therapeutic Uses
Primary site of action the gut
Therapeutic Uses
Common constipation
Bowel preparation pre-op, diagnostic tests

42. Side Effects/Adverse Effects
Bulk forming: impaction above strictures, fluid overload, electrolyte imbalance, gas
Emollient: skin rash, decreased absorption vitamins, lipid pneumonia, elyte imbalance
Hyperosmotic: abdominal bloating, rectal irritation, elyte imbalance

43. Saline: magnesium toxicity, elyte imbalance, diarrhea, increased thirst
Stimulant: nutrient malabsorption, gastric irritation, elyte imbalance, discolored urine, rectal irritation

44. Interactions
Bulk-forming: interfere with absorption antibiotics, digoxin, salicylates, oral anticoagulants
Mineral oil: decrease absorption fat soluble vitamins
Hyperosmotic: increased CNS depression with barbiturates, general anesthetics, opioids, antipsychotics

45. Oral antibiotics decrease effect of lactulose
Stimulants: decrease absorption antibiotics, digoxin, tetracycline, oral anticoagulants

46. Objective 15: identify features of an ideal laxative and cathartic
What do you think makes an ideal laxative?

47. Objective 18: describe the major nursing implications associated with the administration of laxatives

48. Assess: drugs client takes including OTC and herbs
Assess bowel elimination pattern
Assess diet and fluid intake
Assess activity and exercise
Assess for travel, dehydration
Assess for any past GI problems

49. Objective 19: identify causes of diarrhea
What things, conditions can cause diarrhea?

50. Objective 20: describe the uses of antidiarrheal agents
Objective 21: identify the antidiarrheal agents

51. Antidiarrheal drugs: local or systemic action
Local: adsorb water to cause a formed stool
Systemic: act on autonomic nervous system to decrease peristalsis

52. Antidiarrheals Groups based on mechanism of action Adsorbents
Antimotility
Bacterial replacement
Antisecretory
Enzymes

53. Mechanism of action Treat underlying cause
Adsorbents: coat walls of GI tract; bind causative bacteria, toxin
Bismuth subsalicylate (Pepto-Bismol)
Attapulgite (Kaopectate)
Aluminum hydroxide (AlternaGel, Maalox)
Kaolin-pectin

54. Anticholenergics Decrease: peristalsis, muscle tone
Use with adsorbents, opiates
Examples:
Atropine
Hyoscyamine
Hyosine

55. Opiates Decrease bowel motility Reduce pain
Increased absorption of water & elytes (absorption time)

56. Drug Effects Adsorbents: bismuth subsalicylate: form of ASA
Activated charcoal
Side Effects
Adsorbents: can increase bleeding time, dark stools, tinnitus, metallic taste, blue gums
Anticholinergics: urinary retention, impotence, anxiety, brady or tachy-cardia, blurred vision, photophobia

57. Interactions
Adsorbents: decrease digoxin, clindamycin, oral hypoglycemics. Methotrexate-toxicity
Anticholinergics: decreased effect with antacids. Increased anticholinergic effect with tricyclic antidepressants, MAOIs, amantadine & antihistamines

58. Opiates: additive CNS depression-alcohol, narcotics, sedative-hypnotics, antipsychotics, skeletal muscle relaxants
Pepto + oral anticoagulants

59. Objective 22: describe the nursing implications associated with antidiarrheal agents

60. Assess for cause of diarrhea
Medications
Infections
Diet
Lactulose intolerance
Emotional stress
Hyperthyroidism
Inflammation of gut
Surgical bypass of gut

61. Objective 23: discuss the pathophysiology of nausea and vomiting
Nausea: sensation of abdominal discomfort that is intermittently accompanied by the desire to vomit
Vomiting: the forceful expulsion of gastric contents up the esophagus and out of the mouth

63. Objective 24: identify antiemetic drugs and their classification
Dopamine antagonists
Serotonin antagonists
Anticholinergics
Corticosteroids
Benzodiazepines
Cannaboinoids

64. Objective 25: identify the mechanism of action, indications for use and desired effects of antiemetic drugs

65. Dopamine antagonists
Phenothiazines, butyrophenones (Haldol) and metoclopramide (Reglan)
Phenothiazines include Thorazine and Compazine
Drugs act to inhibit dopamine receptors that are part of the pathway to the vomiting center.
Also block other dopamine receptors in the brain
Can cause EPS

66. Phenothiazines mostly used
Reglan popular

67. Serotonin Antagonists: chemotherapy, radiation, post op
Block serotonin receptors in the CTZ and GI tract
Drugs include
Dolasetron (Anzemet); granisetron (Kytril) and ondansetron (Zofran)

68. Often for motion sickness; may see for clients on chemotherapy
Anticholinergics: counterbalance the amount of acetylcholine at the CTZ
Often for motion sickness; may see for clients on chemotherapy
Drug examples
Cyclizene (Marezine), dimenhydrate (Dramamine), meclizene (Antivert), scopolamine

69. Corticosteroids
Sometimes see Decadron
Don’t know its action

70. Do cause mind altering effects Can be abused
Cannaboinoids
Active ingredient THC from marijuana
Inhibit various pathways to the CTZ
Drugs include: dronabenol (Marinol)
Do cause mind altering effects
Can be abused

71. Benzodiazepines: various activities such as sedation, depression of vomiting center, can cause amnesia
Examples: diazepam, lorazepam and midazolam

72. New for chemo clients Neurokinin receptor antagonist
Aprepitant (Emend)

73. Objective 26: explain the use of emetics

74. Fresh supplies are needed as the drug will expire
Emetics are used when the stomach needs to be emptied
Use after overdose
Example: syrup of Ipecac: NO LONGER used for kids
Fresh supplies are needed as the drug will expire

75. Objective 27: Describe the nursing process related to the administration of emetics/antiemetics
What assessments would you make?
What interventions would you initiate?

76. Objective 28: demonstrate the ability to calculate drug dosages