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Gastrointestinal Drugs

Gastrointestinal Drugs. Pharmacology I: NURS 1950. 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. Objective 3: list drugs considered to be ulcerogenic.

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Gastrointestinal Drugs

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

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

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

  41. Drug effects • Few systemic effects • 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

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