1. Gastrointestinal Medications
Chapter 19
Gastrointestinal Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1

2. Learning Objectives
Identify common uses for antacids and histamine H2-receptor antagonists
Compare and contrast the actions of anticholinergic and antispasmodic medications on the gastrointestinal (GI) tract
Compare the actions and adverse reactions of the five major classifications of laxatives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

3. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors
Action and Uses
Antacids neutralize hydrochloric acid which decreases gastric pH; inhibit pepsin
Histamine H2-receptor antagonists displace histamine from the receptor site and prevent stimulation of the secretory cells (neutralize acid and promote healing of ulcers)
Proton pump inhibitors irreversibly stop the acid secretory pump embedded in the parietal cells for the length of time they are taken
Of the three drugs, which classification is considered first-line therapy in the treatment of peptic ulcer disease over 6 to 8 weeks?
What conditions would antacids be used to treat?
How are ulcers caused by Helicobacter pylori treated?
When would proton pump inhibitors be used for long-term therapy?
How do misoprostol and sucralfate differ in their action?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

4. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Nursing Implications and Patient Teaching
Assessment: interaction possibilities
Diagnosis: smoking/alcohol intake, stress
Planning: increase fluid intake
Implementation: forms and routes of administration vary
Evaluation: continued symptoms of GI distress
Patient and Family Teaching: administration times and drug specificity, adverse reactions, drug storage and efficacy, medical follow-up, drug interactions
What administration considerations will the nurse note if the patient is receiving an antacid and an enteric-coated drug scheduled for the same time each day?
If the patient is receiving an aluminum-containing antacid, the diet should contain adequate amounts of phosphorus. What foods are naturally high in phosphorus?
If the patient is unable to swallow a proton pump inhibitor whole, what might be considered?
When is the best time to administer an oral proton pump inhibitor?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

5. Antacids Tums Riospan Milk of Magnesia Mag Ox Generics:
calcium carbonate
Riospan
magaldrate
Milk of Magnesia
magnesium hydroxide
Mag Ox
magnesium oxide
Generics:
aluminum carbonate
sodium bicarbonate
Antacid combinations
Maalox
magnesium hydroxide & aluminum hydroxide
Gelusil
aluminum hydroxide, magnesium hydroxide & simethicone
**Aluminum tends to constipate a person.

6. H2 Receptor antagonists (-tidines)
Tagamet
cimetidine
Pepcid
famotidine
Axid
nizatidine
Zantac
ranitidine

7. Gastric medications Helidac/ Pylera Cytotec Carafate
Treatment for H pylori
Miscellaneous
Helidac/ Pylera
Bismuth subsalicylate, metronidazole & tetracycline
Get 4 pills with each dose QID
Chew the bismuth and swallow the Metro. & tetra.
Cytotec
misprostol
acts to increase gastric mucus layer/ protects
Carafate
sucralfate
coats stomach wall/ protects ulcers so they can heal

8. Proton Pump Inhibitors (PPIs)
-prazoles
Nexium
esomeprazole
Prevacid
lansoprazole
Prilosec
omeprazole
Protonix
pantoprazole
Aciphex
rabeprazole

9. Anticholinergics and Antispasmodics
Action and Uses
Anticholinergic-antispasmodic preparations reduce GI tract spasm and intestinal motility, acid production, and gastric motility, thus reducing pain
Use: peptic ulcer, pylorospasm, biliary colic, hypermotility, irritable colon, and acute pancreatitis
Antidiarrheals reduce the fluid content of the stool and decrease peristalsis and motility of the intestinal tract; increase smooth-muscle tone and diminish secretions
Use: treatment of nonspecific diarrhea or diarrhea caused by antibiotics
Why would a GI motility agent be prescribed for an elderly patient with gastroesophageal reflux disease?
When would it be inadvisable to use an antidiarrheal agent for a patient who has diarrhea?
What is the action of bismuth salts on the intestines?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

10. Anticholinergics Sal-Tropine Scopace Librax Robinul Pro-Banthine
Belladonna Alkaloids
Anticholinergics
Sal-Tropine
atropine sulfate
Scopace
scopolamine
Librax
clidinium
Robinul
glycopyrrolate
Pro-Banthine
propantheline
Anticholinergic combo drug
Donnatol
hyoscyamine, atropine,
scopolamine & phenobarbital

11. Gastrointestinal medications
antispasmodic
GI Stimulant
Bentyl
dicyclomine
Reglan
metaclopramide
Increase speed at which the stomach empties

12. Antidiarrheals Pepto-Bismol Lomotil – ‘Lo motility’ Kaopectate
Bismuth subsalicylate (think ASA)
Lomotil – ‘Lo motility’
diphenoxylate and atropine sulfate
Kaopectate
kaolin & pectin
Bacid / Lactinex
lactobacillus
Immodium
loperamide
Asacol – for ulcerative colitis
mesalamine
Azulfidine – for ulcerative colitis
sulfasalazine

13. Question 1 Antidiarrheals act by:
increasing the fluid content of the stool.
decreasing peristalsis in the intestinal tract.
increasing digestive secretions.
decreasing smooth muscle tone.
Correct Answer: 2
Rationale: Antidiarrheals reduce the fluid content of the stool and decrease peristalsis and motility of the intestinal tract. They increase smooth muscle tone and diminish digestive secretions. The bismuth salts absorb toxins and provide a protective coating for the intestinal mucosa.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

14. Laxatives Action and Uses
Bulk-forming laxatives absorb water and expand, increasing the bulk and moisture content of the stool; peristalsis increases, and absorbed water softens the stool
Fecal softeners lower the surface tension, which allows the fecal mass to be softened by intestinal fluids
Hyperosmolar laxatives produce an osmotic effect by drawing water into the bowel, thereby promoting peristalsis and bowel movement
Fecal softeners may inhibit the reabsortion of what two products by the intestine?
What conditions other than constipation are bulk-forming laxatives used to treat?
Why would a stool softener be indicated for the patient after rectal or cardiac surgery?
Saline laxatives may be used as a bowel prep before diagnostic and surgical procedures.
A patient on prolonged bedrest may be prescribed which type of laxative?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

15. Laxatives (cont.) Action and Uses (cont.)
Lubricant laxatives create a barrier between feces and the colon, preventing colon reabsorption and causing softening of the stool
Stimulant or irritant laxatives work according to the agent
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

16. Laxatives Citrucel Metamucil / Fiberall Colace Bulk forming
Fecal softener
Citrucel
methylcellulose
Metamucil / Fiberall
psyllium seed
Colace
docusate

17. Laxatives cont. Philips Milk of Magnesia Fleet’s enema Emulsoil
Saline / hyperosmolar
Lubricants
Philips Milk of Magnesia
magnesium
Fleet’s enema
sodium salts
Emulsoil
castor oil
Stimulant / Irritant
Dulcolax / Correctol
bisacodyl
Cascara
cascara sagrada
Senekot / Ex-Lax
senna

18. 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?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

19. Miscellaneous GI Medications
Antiflatulents
activated charcoal (think liquid briquettes from the grill)
Mylanta Gas Relief / Mylicon
Simethicone – makes the bubbles smaller so they are easier to pass
Emetics
Syrup of Ipecac – ipecac (will clean out entire GI tract!!)

20. 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
Gallstone Dissolvers – Actigall - ursodiol
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?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

21. Digestive Enzymes
Promote digestion by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking, not secreted, or not properly absorbed
Digestive enzymes
Creon
pancreatin
Pancrease
pancrelipase
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?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

22. Disulfiram Used in the management of alcoholism
Unpleasant reaction when combined with alcohol
Anti-alcoholic product: Antabuse - disulfiram
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?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

23. Questions?