1. GASTROINTESTINAL DRUGS KIM EASTMAN, RN, MSN, CNS

2. ANTIEMETICS (ANTIVOMITING AGENTS) Nonpharmacologic methods Weak tea, flattened carbonated beverage, Gatorade, pedialyte, crackers, dry toast Use for pregnancy Nonprescription Dramamine, Benadryl & Pepto-Bismol Pg 697

3. ANTIEMETICS Prescription Antiemetics Compazine, Phenergan, Zofran Reglan: used in tx of postop emesis, CA chemo & radiation therapy Pg 698-700

4. EMETICS (INDUCE VOMITING) When a pt has consumed toxic substances, induced vomiting maybe indicated to expel the substance before absorption occurs. Vomiting should not be induced if caustic substances have been ingested. Ammonia, chlorine bleach, lye, battery acid Pg 702

5. EMETICS Activated charcoal is given when emesis is contraindicated Gastric lavage Ipecac Should not be administered routinely in the management of poisoned individuals Give if pt alert & w/in 60 min of poisoning Pg 702

6. ANTIDIARRHEALS (TX HYPERMOTILITY) Opiates & opiate related agents Decrease intestinal motility; thus, peristalsis Lomotil w/prolonged use physical dependence may occur Imodium OTC Pg 703

7. ANTIDIARRHEALS Somatostatin analogue Adsorbents Act by coating the wall of the GI tract & adsorbing bacteria or toxins that cause diarrhea Bismuth subsalicylate (Pepto-Bismol) Tx for traveler’s diarrhea Miscellaneous Antidiarrheals Pg 704

8. LAXATIVES (ELIMINATE FECAL MATTER) Most stimulate peristalsis Pg 705-706 Chronic use is a common problem Osmotic (saline) Laxatives GoLYTELY Hyperosmolar salts pull water into the colon Increase water in the feces Contraindicated for pt w/heart failure Used for bowel prep for diagnostic & surgical procedures

9. LAXATIVES Stimulant Increase peristalsis by irritating sensory nerve endings in the intestinal mucosa Bisacodyl (Dulcolasx), senna (Senokot) Used to empty bowel before diagnostic tests Fluid & electrolyte imbalances w/excessive use Pg 707

10. LAXATIVES Bulk forming Natural fiber that promote large, soft stools by absorbing water into the intestine Metamucil & Citrucel Should be taken w/sufficient water to prevent intestinal obstruction (fecal impaction) Pg 708

11. LAXATIVE (STOOL SOFTENERS) Emollients Docusate sodium (Colace) Used to prevent constipation Decrease straining during defecation Prescribed for pt after MI or surgery Pg 709

12. ANTIULCER DRUGS Helicobacter Pylori Gram negative bacillus Linked with the development of peptic ulcers Causes gastritis, gastric ulcers & duodenal ulcers Pg 715

13. TREATMENT OF PUD (PEPTIC ULCER DISEASE) Treatment focus is dual, triple or quadruple drug therapy program Amoxicillin, tetracycline, clarithromycin, omeprazole (Prilosec), Iansoprazole (Prevacid), metronidazole (Flagyl), bismuth subsalicylate (Pepto-Bismol) & ranitidine bismuth citrate (Tritec) 7 to 14 day treatment plan Pg 715

14. TX OF PUD & GERD (GASTROESOPHAGEAL REFLUX) H 2 blockers – inhibit histamine at the H 2 receptor site Ranitidine (Zantac), famotidine (Pepcid) Prevent acid reflux in the esophagus PPI – suppress gastric acid secretion Omeprazole (Prilosec) Treats gastroesophageal reflux disease (GERD) Both neutralize gastric contents and suppress gastric acid secretions Pg 715 - 721

15. OTHER ANTIULCER DRUGS Pepsin inhibitor Sucralfate (Carafate) Pg 724 Coats the ulcer protecting it from acid & pepsin Prostaglandin E1 analogue Misoprostol Treats gastric bleeding from NSAID therapy Pg 726

16. ANTIULCER DRUG Antacids Promotes ulcer healing via neutralizing hydrochloric acid and reducing pepsin activity Systemic or nonsystemic effect Nonsystemic Magnesium hydroxide – cause diarrhea Aluminum and calcium compounds – cause constipation Therefore combination -- Maalox