Copyright 2013 2010 2006 2003 2000 1995 1991 by Mosby an imprint of Elsevier Inc Chapter 19 1 Learning Objectives Copyright 2013 2010 2006 2003 2000 1995 1991 by Mosby an imprint of Elsevier Inc ID: 210193
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Slide1
Gastrointestinal Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Chapter 19
1Slide2
Learning Objectives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
2
Identify common uses for antacids and histamine H
2
-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
Slide3
Antacids, H
2-Receptor Antagonists, Proton Pump Inhibitors
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
3
Action and Uses
Antacids neutralize hydrochloric acid
which decreases
gastric pH; inhibit pepsin
Histamine H
2
-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 takenSlide4
Antacids, H
2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
4
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 interactionsSlide5
Antacids
Tumscalcium carbonate
Riospanmagaldrate
Milk of Magnesia
m
agnesium hydroxide
Mag Ox
m
agnesium oxide
Generics:
aluminum carbonate
sodium bicarbonate
Antacid combinations
Maalox
magnesium hydroxide & aluminum hydroxide
Gelusil
a
luminum hydroxide, magnesium hydroxide &
simethicone
**Aluminum tends to constipate a person.Slide6
H2 Receptor antagonists (-tidines
)TagametcimetidinePepcid
famotidineAxidnizatidine
Zantac
ranitidineSlide7
Gastric medications
Treatment for H pyloriMiscellaneous
Helidac
/
Pylera
Bismuth subsalicylate, metronidazole & tetracycline
Get 4 pills with each dose QID
Chew the bismuth and swallow the Metro. & tetra.
Cytotec
misprostol
a
cts to increase gastric mucus layer/ protects
Carafate
sucralfate
c
oats stomach wall/ protects ulcers so they can healSlide8
Proton P
ump Inhibitors (PPIs)-p
razolesNexiumesomeprazole
Prevacid
lansoprazole
Prilosec
omeprazole
Protonix
pantoprazole
Aciphex
rabeprazoleSlide9
Anticholinergics
and AntispasmodicsCopyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
9
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 antibioticsSlide10
Anticholinergics
Belladonna AlkaloidsAnticholinergics
Sal-
Tropine
a
tropine sulfate
Scopace
scopolamine
Librax
clidinium
Robinul
glycopyrrolate
Pro-
Banthine
propantheline
Anticholinergic combo drug
Donnatol
hyoscyamine
, atropine,
scopolamine & phenobarbitalSlide11
Gastrointestinal medications
antispasmodicGI Stimulant
Bentyl
dicyclomine
Reglan
m
etaclopramide
Increase speed at which the stomach emptiesSlide12
Antidiarrheals
Pepto-Bismol Bismuth subsalicylate (think ASA)Lomotil – ‘Lo motility’
diphenoxylate and atropine sulfateKaopectate
k
aolin & pectin
Bacid
/
Lactinex
lactobacillus
Immodium
loperamide
Asacol
– for ulcerative colitis
mesalamine
Azulfidine
– for ulcerative colitis
sulfasalazineSlide13
Question 1
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
13
Antidiarrheals act by:
increasing the fluid content of the stool.
decreasing peristalsis in the intestinal tract.
increasing digestive secretions.
decreasing smooth muscle tone.Slide14
Laxatives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
14
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 movementSlide15
Laxatives (cont.)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
15
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 agentSlide16
Laxatives
Bulk formingFecal softener
Citrucel
methylcellulose
Metamucil /
Fiberall
p
syllium
seed
Colace
docusateSlide17
Laxatives cont.
Saline / hyperosmolarLubricants
Philips Milk of Magnesia
magnesium
Fleet’s enema
s
odium salts
Emulsoil
c
astor oil
Stimulant /
Irritant
Dulcolax
/
Correctol
bisacodyl
Cascara
c
ascara
sagrada
Senekot
/
Ex-Lax
sennaSlide18
Antiflatulents
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
18
Break up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric pain
Intended for short-term useSlide19
Miscellaneous GI Medications
Antiflatulentsactivated charcoal (think liquid briquettes from the grill)Mylanta Gas Relief /
MyliconSimethicone – makes the bubbles smaller so they are easier to pass
Emetics
Syrup of Ipecac – ipecac (will clean out entire GI tract!!)Slide20
Gallstone-Solubilizing Agents
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
20
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
-
ursodiolSlide21
Digestive Enzymes
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
21
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
pancrelipaseSlide22
Disulfiram
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
22
Used in the management of alcoholism
Unpleasant reaction when combined with
alcohol
Anti-alcoholic
product:
Antabuse
-
disulfiramSlide23
Questions?