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Chapter 18

Chapter 18. Gastrointestinal Medications. Chapter 18 Lesson 18.1. Learning Objectives. 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

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Chapter 18

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  1. Chapter 18 Gastrointestinal Medications

  2. Chapter 18 Lesson 18.1

  3. Learning Objectives • Identify common uses for antacids and histamine H2-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

  4. Learning Objectives (cont.) • Identify indications for the use of at least two common antidiarrheals, antiflatulents, digestive enzymes, and emetics • Describe indications for disulfiram use and what is meant by "disulfiram reaction"

  5. Overview • Three major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colon • Miscellaneous medications: antiflatulants, digestive enzymes, emetics, and medications to treat gallstones and alcoholism

  6. Digestive System • Functions • Structures • Protective factors • Digestion variables

  7. Digestive System

  8. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors • Stomach lining and acid production • External factors that contribute to ulcer formation • Protective medications • Table 18-1

  9. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Action and Uses • Antacids neutralize hydrochloric acid and decrease gastric pH; inhibit pepsin • Histamine H2-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 imbedded in the parietal cells

  10. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Adverse Reactions • Antacids: weakness, anorexia, diarrhea, frequent burping, bowel obstruction, constipation, hypermagnesemia • H2-receptor antagonists: dizziness, headache, somnolence, mild/brief diarrhea, hematology changes, muscle pain • Proton pump inhibitors: headache, diarrhea, abdominal pain, and nausea; rarely rash, vomiting, and dizziness

  11. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) Drug Interactions • Antacids prevent absorption of many drugs • Dicumarol absorbed 50% faster when taken with antacids

  12. Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.) 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 interactions

  13. Anticholinergics and Antispasmodics • Motility • Symptoms • Classes of medications: anticholinergics, antispasmodics, antidiarrheals • Table 18-2

  14. Anticholinergics and Antispasmodics (cont.) 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 antibiotics

  15. Anticholinergics and Antispasmodics (cont.) Adverse Reactions • Anticholinergics: due to high dosages • Antidiarrheals

  16. Anticholinergics and Antispasmodics (cont.) Drug Interactions • New GI stimulants, when combined with other drugs that inhibit cytochrome P-450 4A4 systems, should be monitored for cardiac dysrhythmias Nursing Implications and Patient Teaching • Assessment, diagnosis, planning, implementation, and evaluation

  17. Laxatives • Aid in the elimination of stool from the rectum • Bulk-forming agents • Fecal softeners • Hyperosmolar or saline solutions • Lubricants • Stimulant or irritant laxatives • Tables 18-3 and 18-4

  18. Laxatives (cont.) 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 movement

  19. Laxatives (cont.) 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 agent

  20. Laxatives (cont.) Adverse Reactions • Nausea and vomiting, obstruction, hypersensitivity • Cramping, diarrhea • Electrolyte disturbances

  21. Laxatives (cont.) Drug Interactions • Reduced effectiveness of antibiotics, anticoagulants, digitalis, and salicylates when combined with laxatives Nursing Implications and Patient Teaching • Assessment (CHF)

  22. Miscellaneous Gastrointestinal Drugs • Antiflatulents • Pancreatic digestive enzymes • Emetics • Disulfiram • Table 18-5

  23. Antiflatulents • Break up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric pain • Intended for short-term use

  24. Gallstone-Solubilizing Agents • 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

  25. Digestive Enzymes • Promote digestion by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking, not secreted, or not properly absorbed

  26. Disulfiram • Used in the management of alcoholism • Unpleasant reaction when combined with alcohol

  27. Emetics • Used in emergencies to induce vomiting • Poison Control Center • Gastric lavage • Syrup of ipecac • Apomorphone

  28. Complementary and Alternative Therapies • Common products • Conditions • Drug interactions

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