gastrointestinal drugs n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Gastrointestinal Drugs PowerPoint Presentation
Download Presentation
Gastrointestinal Drugs

Loading in 2 Seconds...

play fullscreen
1 / 76

Gastrointestinal Drugs - PowerPoint PPT Presentation


  • 384 Views
  • Uploaded on

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.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Gastrointestinal Drugs' - Antony


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
gastrointestinal drugs

Gastrointestinal Drugs

Pharmacology I: NURS 1950

slide2

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
slide4

Objective 4: explain the actions of the antiulcer drugs

    • Decrease acidity
    • Block histamine receptors
    • Gastrointestinal prostaglandins
slide5

Gastric acid pump inhibitors

  • Coating agents
  • Prokinetic agents
  • Antispasmodic agents
slide7

Raise the pH of gastric contents

    • Higher pH, less acidity
      • Decreased pain
slide8

Objective 6: identify the features of an ideal antacid

    • Cheap
    • Effective
    • No constipation or diarrhea
    • No systemic effects
    • No rebound acidity
slide10

Riopan, Maalox, Mylanta II, low sodium

  • Calcium carbonate, Aluminum hydroxide: constipation
  • Magnesium: diarrhea, electrolyte imbalance
  • Calcium carbonate & sodium bicarbonate: rebound acidity
slide11

Simethicone: defoaming agent

Alginic acid: highly viscous solution—sodium alginate

slide14

Objective 9: state the mechanism of action of anticholinergic and antispasmodic agents

slide15

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?
slide17

Objective 10: identify appropriate nursing actions relative to caring for clients receiving antispasmodic drugs

slide18

Assess: mental status, teach about orthostatic hypotension

  • In the elderly: increased constipation
  • If arrhythmia or palpitations: stop the drug, call the physician
slide19

Objective 11: describe the effects and uses of H2 receptor antagonists, and proton pump inhibitors

slide20

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
slide21

Drugs include

    • Cimetidine (Tagamet)
    • Famotidine (Pepcid)
    • Nizatidine (Axid)
    • Rantidine (Zantac)
slide22

Drugs can cause

    • Dizziness, HA, diarrhea, constipation
    • If confusion, disorientation, hallucination, see MD
    • Can cause gynecomastia, hepatotoxicity
slide23

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
slide25

Drugs include

    • Esomeprazole (Nexium)
    • Lansoprazole (Prevacid)
    • Omeprazole (Prilosec)
    • Pantoprazole (Protonix)
    • Rabeprazole (Aciphex)
slide26

Objective 12: Explain the nursing interventions associated with H2 receptor antagonists and proton pump inhibitors

slide27

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
slide28

Causes of constipation

    • What are some things or conditions that can cause constipation?
laxatives
laxatives
  • Act three ways
    • Affect fecal consistency
    • Increase fecal movement
    • Remove stool from rectum
slide30

Laxatives OTC; misused

    • Dependence
    • Damage bowel
    • Cause problems in bowel
contraindications precautions
Contraindications, Precautions
  • Caution: surgical abdomen; appendicitis; N/V; fecal impaction; intestinal obstruction; undiagnosed abdominal pain
  • Contraindicated: hypersensitivity
groups of laxatives
Groups of Laxatives
  • Bulk-forming
  • Emollient
  • Hyperosmotic
  • Saline
  • Stimulant
mechanism of action
Mechanism of action
  • Bulk-forming: natural fiber-like
    • Absorb water
    • Distends bowel
    • Initiates reflex bowel activity
      • Best for long term use
slide34

Emollient laxatives

    • Stool softener (Docusate salts)
      • Lowers surface tension
        • Allows more fat & water to be absorbed
          • When should these be used?
slide35

Lubricant laxative (mineral oil)

    • Lubricates fecal material & intestinal wall
      • Prevents H20 from leaking out of gut
        • Stool expands & softens
slide36

The emollients and lubricants do not seem to increase peristalsis

    • Oils a problem in constantly recumbent clients
slide37

Hyperosmotic increase water content in large intestine

    • Distends bowel
    • Increases peristalsis
    • Evacuates the bowel
    • Non-absorbable ion exchange
    • Used before diagnostic tests
slide38

Saline laxatives increase osmotic pressure in small intestine

    • Inhibit absorption of water & elytes
    • Increase amount of water & elytes
slide39

Results: watery stool

  • Increased distention of bowel
  • Promotes peristalsis & evacuation
    • Example: citrate of magnesia
slide40

Stimulant laxatives stimulate nerves

    • Increases peristalsis
    • Increase fluid in colon
      • Increases bulk
      • Softens stool
drug effects
Drug effects
  • Few systemic effects
    • Primary site of action the gut
  • Therapeutic Uses
    • Common constipation
    • Bowel preparation pre-op, diagnostic tests
side effects adverse effects
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
slide43

Saline: magnesium toxicity, elyte imbalance, diarrhea, increased thirst

  • Stimulant: nutrient malabsorption, gastric irritation, elyte imbalance, discolored urine, rectal irritation
interactions
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
slide45

Oral antibiotics decrease effect of lactulose

  • Stimulants: decrease absorption antibiotics, digoxin, tetracycline, oral anticoagulants
slide46

Objective 15: identify features of an ideal laxative and cathartic

    • What do you think makes an ideal laxative?
slide47

Objective 18: describe the major nursing implications associated with the administration of laxatives

slide48

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
slide49

Objective 19: identify causes of diarrhea

    • What things, conditions can cause diarrhea?
slide50

Objective 20: describe the uses of antidiarrheal agents

  • Objective 21: identify the antidiarrheal agents
slide51

Antidiarrheal drugs: local or systemic action

    • Local: adsorb water to cause a formed stool
    • Systemic: act on autonomic nervous system to decrease peristalsis
antidiarrheals
Antidiarrheals
  • Groups based on mechanism of action
    • Adsorbents
    • Antimotility
    • Bacterial replacement
    • Antisecretory
    • Enzymes
mechanism of action1
Mechanism of action
  • Treat underlying cause
  • Adsorbents: coat walls of GI tract; bind causative bacteria, toxin
    • Bismuth subsalicylate (Pepto-Bismol)
    • Attapulgite (Kaopectate)
    • Aluminum hydroxide (AlternaGel, Maalox)
    • Kaolin-pectin
anticholenergics
Anticholenergics
  • Decrease: peristalsis, muscle tone
  • Use with adsorbents, opiates
  • Examples:
    • Atropine
    • Hyoscyamine
    • Hyosine
opiates
Opiates
  • Decrease bowel motility
  • Reduce pain
  • Increased absorption of water & elytes (absorption time)
drug effects1
Drug Effects
  • Adsorbents: bismuth subsalicylate: form of ASA
  • Activated charcoal
  • Side Effects
    • Adsorbents: can increase bleeding time, dark stools, tinnitus, metallic taste, blue gums
    • Anticholinergics: urinary retention, impotence, anxiety, brady or tachy-cardia, blurred vision, photophobia
interactions1
Interactions
  • Adsorbents: decrease digoxin, clindamycin, oral hypoglycemics. Methotrexate-toxicity
  • Anticholinergics: decreased effect with antacids. Increased anticholinergic effect with tricyclic antidepressants, MAOIs, amantadine & antihistamines
slide58

Opiates: additive CNS depression-alcohol, narcotics, sedative-hypnotics, antipsychotics, skeletal muscle relaxants

  • Pepto + oral anticoagulants
slide60

Assess for cause of diarrhea

    • Medications
    • Infections
    • Diet
    • Lactulose intolerance
    • Emotional stress
    • Hyperthyroidism
    • Inflammation of gut
    • Surgical bypass of gut
slide61

Objective 23: discuss the pathophysiology of nausea and vomiting

    • Nausea: sensation of abdominal discomfort that is intermittently accompanied by the desire to vomit
    • Vomiting: the forceful expulsion of gastric contents up the esophagus and out of the mouth
slide63

Objective 24: identify antiemetic drugs and their classification

    • Dopamine antagonists
    • Serotonin antagonists
    • Anticholinergics
    • Corticosteroids
    • Benzodiazepines
    • Cannaboinoids
slide64

Objective 25: identify the mechanism of action, indications for use and desired effects of antiemetic drugs

dopamine antagonists
Dopamine antagonists
  • Phenothiazines, butyrophenones (Haldol) and metoclopramide (Reglan)
    • Phenothiazines include Thorazine and Compazine
      • Drugs act to inhibit dopamine receptors that are part of the pathway to the vomiting center.
        • Also block other dopamine receptors in the brain
          • Can cause EPS
slide67

Serotonin Antagonists: chemotherapy, radiation, post op

  • Block serotonin receptors in the CTZ and GI tract
  • Drugs include
    • Dolasetron (Anzemet); granisetron (Kytril) and ondansetron (Zofran)
slide68

Anticholinergics: counterbalance the amount of acetylcholine at the CTZ

  • Often for motion sickness; may see for clients on chemotherapy
  • Drug examples
    • Cyclizene (Marezine), dimenhydrate (Dramamine), meclizene (Antivert), scopolamine
slide69

Corticosteroids

    • Sometimes see Decadron
    • Don’t know its action
slide70

Cannaboinoids

    • Active ingredient THC from marijuana
    • Inhibit various pathways to the CTZ
    • Drugs include: dronabenol (Marinol)
      • Do cause mind altering effects
      • Can be abused
slide71

Benzodiazepines: various activities such as sedation, depression of vomiting center, can cause amnesia

    • Examples: diazepam, lorazepam and midazolam
slide72

New for chemo clients

    • Neurokinin receptor antagonist
      • Aprepitant (Emend)
slide74

Emetics are used when the stomach needs to be emptied

    • Use after overdose
    • Example: syrup of Ipecac: NO LONGER used for kids
      • Fresh supplies are needed as the drug will expire
slide75

Objective 27: Describe the nursing process related to the administration of emetics/antiemetics

    • What assessments would you make?
    • What interventions would you initiate?