Chapter 19

Gastrointestinal Medications

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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 Compare the actions and adverse reactions of the five major classifications of laxatives 2 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antacids, H

2

-Receptor Antagonists, Proton Pump Inhibitors

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 taken 3 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antacids, H

2

-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 4 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antacids

     Tums  calcium carbonate Riospan  magaldrate Milk of Magnesia  magnesium hydroxide Mag Ox  magnesium oxide Generics:   aluminum carbonate sodium bicarbonate   

Antacid combinations

Maalox  magnesium hydroxide & aluminum hydroxide Gelusil  aluminum hydroxide, magnesium hydroxide & simethicone **Aluminum tends to constipate a person.

H2 Receptor antagonists (-tidines)

    Tagamet  cimetidine Pepcid  famotidine Axid  nizatidine Zantac  ranitidine

Gastric medications

Treatment for H pylori  Helidac/ Pylera    Bismuth subsalicylate, metronidazole & tetracycline Get 4 pills with each dose QID Chew the bismuth and swallow the Metro. & tetra.

Miscellaneous   Cytotec   misprostol acts to increase gastric mucus layer/ protects Carafate   sucralfate coats stomach wall/ protects ulcers so they can heal

Proton Pump Inhibitors (PPIs)

      -prazoles Nexium  esomeprazole Prevacid  lansoprazole Prilosec  omeprazole Protonix  pantoprazole Aciphex  rabeprazole

Anticholinergics and Antispasmodics

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 9 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Anticholinergics

Belladonna Alkaloids   Sal-Tropine  atropine sulfate Scopace  scopolamine

Anticholinergic combo drug

Donnatol hyoscyamine, atropine, scopolamine & phenobarbital Anticholinergics    Librax  clidinium Robinul  glycopyrrolate Pro-Banthine  propantheline

Gastrointestinal medications

antispasmodic  Bentyl  dicyclomine GI Stimulant  Reglan   metaclopramide Increase speed at which the stomach empties

Antidiarrheals

       Pepto-Bismol  Bismuth subsalicylate (think ASA) Lomotil – ‘Lo motility’  diphenoxylate and atropine sulfate Kaopectate  kaolin & pectin Bacid / Lactinex  lactobacillus Immodium  loperamide Asacol – for ulcerative colitis  mesalamine Azulfidine – for ulcerative colitis  sulfasalazine

Question 1

Antidiarrheals act by: 1.

2.

3.

4.

increasing the fluid content of the stool.

decreasing peristalsis in the intestinal tract.

increasing digestive secretions.

decreasing smooth muscle tone.

13 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Laxatives

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 14 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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 15 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Laxatives

Bulk forming   Citrucel  methylcellulose Metamucil / Fiberall  psyllium seed Fecal softener  Colace  docusate

Laxatives cont.

Saline / hyperosmolar   Philips Milk of Magnesia  magnesium Fleet’s enema  sodium salts Lubricants  Emulsoil  castor oil Stimulant / Irritant  Dulcolax / Correctol  bisacodyl   Cascara  cascara sagrada Senekot / Ex-Lax  senna

Antiflatulents

 Break up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric pain  Intended for short-term use 18 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Miscellaneous GI Medications

  Antiflatulents   activated charcoal (think liquid briquettes from the grill) Mylanta Gas Relief / Mylicon  Simethicone – makes the bubbles smaller so they are easier to pass Emetics  Syrup of Ipecac – ipecac (will clean out entire GI tract!!)

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 Gallstone Dissolvers – Actigall - ursodiol 20 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Digestive Enzymes

  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  pancrelipase 21 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Disulfiram

 Used in the management of alcoholism  Unpleasant reaction when combined with alcohol  Anti-alcoholic product: Antabuse - disulfiram 22 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

 Questions?