1. Drugs for Treating GI Disorders Chapter 11

2. GI Disorders  Peptic Ulcer and Acid Reflux Disorders  Laxatives and Cathartics  Antidiarrheals  Antiemetics Vomiting

3. Drugs for Peptic Ulcer and Acid Reflux Disorders  Most of these drugs alter gastric acid and its effects on the mucosa of the upper GI tract  Many promote healing of lesions and prevent recurrence of lesions by decreasing cell destructive effects or increasing cell protective effects

4. Drug Classes  Antacids- Maalox, Mylanta  Histamine-2 receptor antagonists- cimetidine (Tagamet)  Proton pump inhibitors- omeprazole (Prilosec)  Helicobacter pylori (H. pylori) agents- antimicrobials- amoxicillin; bismuth subsalicylate (Pepto Bismol); combinations

5. Drug Selection  Proton pump inhibitors are drugs of first choice in most situations- heal more rapidly and may be combined with other drugs for treatment of H. pylori  H-2 antagonists are now over the counter  Antacids are still used to relieve heartburn and abdominal discomfort

6. Patient Teaching Guidelines  For Gastroesophageal reflux disease (GERD) - elevate head of bed, avoid stomach distention, sit upright for 1 to 2 hrs after eating, minimize acid-producing foods, avoid smoking, lose weight  Take drugs as directed  These drugs may prevent absorption of other drugs taken at the same time  Histamine-2 antagonists may alter the effects of several drugs

7. Lifespan Considerations  Children Antacids have been approved for use in children- others have not but have been used in smaller doses  Elderly All these drugs may be used in the elderly Older adults have less gastric acid, so smaller doses are indicated Monitor for adverse effects

8. Laxatives and Cathartics  Used to promote bowel elimination, such as in cases of constipation  Laxative implies mild effects  Cathartic implies strong effects

9. Drug Classes  Bulk forming laxatives- methylcellulose (Citrucel)  Surfactant laxatives (stool softeners)- docusate sodium (Colace)  Saline cathartics- milk of magnesia, Fleet enema  Stimulant cathartics- bisacodyl (Dulcolax), castor oil  Lubricant laxatives- mineral oil

10. Indications for Use  Relief of constipation  To prevent straining in patients with cardiovascular disease (CVD), hypertension, stroke (CVA), and rectal conditions such as hemorrhoids  As a bowel prep  To accelerate elimination of potentially toxic substances

11. Patient Teaching Guidelines  Diet, exercise, fluid intake can prevent or treat constipation  Eat foods high in dietary fiber- fruits, vegetables, whole grain cereals and breads  Establish regular bowel habits  Laxative use should be temporary  Take as directed

12. Lifespan Considerations  Children Glycerin suppositories in younger children Stool softeners in older children Don’t use strong stimulant laxatives Don’t use saline laxatives if under 2 yrs of age  Elderly Constipation is a common problem Laxatives may be overused Strong stimulants should be avoided Metamucil is drug of choice for use on a regular basis- take with a full glass of liquid

13. Antidiarrheals  Used to treat diarrhea  Drugs may be given to relieve the symptoms or treat the underlying cause of diarrhea

14. Drug Classes  Opiate-related drugs- paregoric; diphenoxylate with atropine (Lomotil)  Antibacterial agents- ciprofloxacin (Cipro); metronidazole (Flagyl)  Miscellaneous drugs- bismuth subsalicylate (Pepto Bismol)

15. Athlete/Patient Teaching Guidelines  Antidiarrheal meds are not always needed  Drink plenty of fluids, avoid spicy foods and fruits and vegetables until diarrhea stops  Good handwashing, proper food storage can prevent diarrhea  Take drugs only as needed and as directed  See health care provider if diarrhea is accompanied by abdominal pain or fever

16. Lifespan Considerations  Children Appropriate fluid replacement is important in conjunction with medications  Elderly Diarrhea is less common than constipation Excessive laxative use may cause diarrhea Watch for fluid volume deficits Most drugs can be given- watch for constipation as a complication

17. Antiemetics  Used to prevent or treat nausea and vomiting from various causes  Drugs from many classes are used to treat nausea and vomiting

18. Drug Classes  Phenothiazines- promethazine (Phenergan)  Antihistamines- hydroxyzine (Vistaril)  Prokinetic agent- metoclopramide (Reglan)  5-HT 3 (serotonin) receptor antagonists- dolasetron (Anzemet)  Miscellaneous- scopolamine (Transderm scopolamine)

19. Drug Selection  Depends on cause of nausea and vomiting 5-HT 3 receptor antagonists for chemotherapy or post-op Anticholinergic and antihistamines for motion sickness promethazine (Phergan)- antihistaminic, antiemetic, and sedative effects Metoclopramide (Reglan) when non- obstructive gastric retention

20. Athlete/Patient Teaching Guidelines  Take early- more effective than when nausea and vomiting have begun  Take fluids to prevent dehydration  Lie down and rest to reduce nausea  Be aware of safety precautions of drugs  Take as directed

21. Lifespan Considerations  Children Use with caution- few studies have been done May cause more adverse effects than in adults  Elderly May cause excessive drowsiness Be aware of dehydration potential May also cause psychoactive effects