GI-test1
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| Hydrochloric Acid [HCl] | secreted by parietal cells
maintains stomach pH at 1 to 4
stimulants to secretion:
large, fatty meals
excessive amounts of ETOH
emotional stress
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| Antacids | Pharmacodynamics
Agents used to reduce gastric hyperacidity
large group Rx & OTC drugs
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| Antacids | Pharmacotherapeutics
Gastritis; indigestion; PUD;
Reflux Esophagitis; phosphate binder in chronic renal failure (CRF)
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| Drug Interactions Antacids | Tetracyclines; quinidine; flecanide; amphetamine
Slows absorption of most oral medications
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| Nursing Implications Antacids | Take medications 1 hour after meals
Avoid taking antacids for 2 hours when taking other medications
Monitor for adverse effects
Reinforce need to alter life-styles to avoid/reduce hyperacidity; avoid spicy, greasy foods, alcohol
Limit intake of ASA,
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| Antiflatulents | drugs used to relief painful symptoms associated with gas
gas in GIT results from:
diverticulitis, dyspepsia, peptic ulcers, postoperative gaseous distention, spastic or irritable colon; paralytic ileus
Major agent: simethicone
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| nti-Ulcer Agents | Axid
Pepcid
Tagam
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| H-2 Antagonists | histamine type 2 receptor [H-2] antagonist
prototypical acid secretory antagonists
reduce not abolish acid secretion
one of most frequently Rx’d drugs
efficacy & safety profile
four FDA-approved:
cimetidine [Tagamet] / famotidine [Pepcid]
nizatidi
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| Pharmacotherapeutics: H-2 Antagonists | proven effective:
PUD = gastric & duodenal ulcer
gastroesophageal reflux dz [GERD]
upper GI bleed [GIB]
may be effective:
stress ulcers
peptic esophagitis
prevention & mgt allergic conditions
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| Adverse Effects: H-2 Antagonists | overall low < 3%
Specific:
CNS:
lethargy, confusion, depression, & hallucinations
ENDO:
impotence, increased prolactin, & gynecomastia
HEME:
thrombocytopenia
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| PPI | omeprazole
Prilosec
lansoprazole
Prevacid
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| Proton Pump Inhibitors | General Description:
omeprazole = first
lansoprazole = newest [1995]
Pharmacodynamics
final common step in acid production
energy needed to pump out H+ ions
a.k.a. “Proton Pump”
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| Pharmacotherapeutics Proton Pump Inhibitors | GERD
unresponsive to conventional tx
Erosive esophagitis
endoscopically proven
Zollinger-Ellison syndrome [ZE]
PUD
recurrent [Helicobacter pilori]
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| Adverse Effects & Drug Interactions Proton Pump Inhibitors | Proton Pump Inhibitors
similar to those of the H-2 antagonists
low & uncommon
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| Other Drugs | sucralfate
Carafate
&
misoprostol
Cytotec
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| Nursing Implications sucralfate Carafate & misoprostol Cytotec | Teach patient best time to take meds:
AC & HS
Do not stop taking meds abruptly
Avoid alcohol and other CNS depressants
Avoid taking meds with antacids
Monitor for drug interactions and adverse effects
Reinforce alteration in life-styles
t
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| Diarrhea | defined as abnormal frequent passage of loose stools
acute diarrhea
sudden in onset in a previously healthy person
lasts 3 to 14 days
self-limiting
resolves without sequelae
chronic diarrhea
lasts 3 to 4 weeks
recurring diarrhea, fever, loss of
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| Antidirrheal Agents | Description:
Act systemically or locally to slow down or inhibit intestinal peristalsis
Pharmacodynamics
slows down the effects of the mesenteric plexus of the intestines
inhibits intestinal peristalsis
decreases expulsive contractions
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| Pharmacodynamics Anticholinergics | decrease muscle tone
of GIT& decrease
Peristalsis
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| Pharmacodynamics Absorbents | coat walls of GIT
absorbing bacteria
or toxins causing
diarrhea and passing
them out with stool
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| Pharmacodynamics Intestinal Flora Modifiers | bacterial cultures Lactobacillus
natural bacterial flora
supplies missing bacteria
suppresses growth of diarrhea
causing bacteria
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| Pharmacodynamics Opiates | decrease motility of bowel
reduce pain assoc w/ rectal spasms
decrease transit time / permit longer
absorptive surface of bowel
contact of intestinal contents with
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| Prototype: Specific Agents | Adsorbents
bismuth subsalicylate [Pepto-Bismol]
attapulgite [Kaopectate]
Anticholinergics
belladonna alkaloids [Donnatal]
Intestinal Flora Modifiers
Lactobacillus acidophilus [Lactinex]
Opiates (tincture of…)
diphenoxylate & atropine [Lomotil]
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| Adverse Effects bismuth subsalicylate | ncreased bleeding time
constipation & dark stools
hearing loss & tinnitus
blue gums & black tongue
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| Adverse Effects anticholinergics | urinary retention, hesitancy, & impotence
HA dizziness, confusion, anxiety, & drowsiness
dry skin, rash, and flushing
blurred vision, photophobia, & inc. IOP
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| Adverse Effects opiates | drowsiness, sedation, and lethargy
n/v/anorexia and constipation
respiratory depression
urinary retention, flushing, rash, and urticaria
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| Nursing Implications Antidirrheal Agents | Monitor closely for adverse effects and drug interactions
Do not administer opium preparations to patients with conditions that contraindicate its use
Teach patient/family that diarrhea is a symptom that should last only 48 hours. If it persists longe
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| Antiemetics Pharmacotherapeutics | Indicated to relieve nausea and vomiting.
All agents work at some site along the vomiting pathway leading to the vomiting center located within the brain.
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| Antiemetics Major Drug Groups | Antihistamines
Phenothiazines
Anticholinergics
Serotonin Blockers
Prokinetic
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| Antiemetics Pharmacokinetics | Absorbed well throughout the body
Metabolized by the liver
Excreted by the kidneys
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| Antiemetics Pharmacodynamics | Motion sickness
Vertigo
Post-op nausea / vomiting
Chemotherapy antiemetic
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| Antiemetics Prototypes: Specific Agents | Antihistamines
promethazine (Phenergan)
Phenothiazines
prochlorperazine (Compazine)
Serotonin Blockers
ondansetron (Zofran)
Prokinetic
metoclopramide (Reglan)
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| Antiemetics Additional Agents | benzquinamide HcL (Emete-Con)
scopolomine (Trans-Derm)
ganisetron (Kytril)
droperinol (Inapsine)
dimenhydrinate (Dramamine)
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| Antiemetics Adverse Effects | Antihistamine / Phenothiazines
CNS reactions
Anticholinergic effects
Hypersensitivity reactions
Blood dyscrasias
Hypotension, tachycardia, orthostatic hypotension syncope and dizziness
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| Antiemetics Nursing Implications | changes in V.S; LOC
administered ½hr - 3hrs prior to chemotherapy for therapeutic effect
monitor safety when taking antiemetics as they can cause changes in perception
Administer antihistamine antiemetics with food or milk to minimize nausea
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| Emetics Pharmacodynamics | Designed to stimulate the vomiting center in the medulla of the brain
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| Emetics Prototype: Specific Agents | Ipecac syrup (Orally)
High doses can lead to dysrythmias; overdose may lead to heart failure or death
Apomorphine HcL (SQ)
Used when ipecac is ineffective
Activated charcoal (Orally)
For use when caustic substances have been ingested
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| Emetics Nursing Implications 1 | Do not administer emetics if patient has ingested lye or caustic substances
Do not administer to semi-conscious patients or patient with loss of gag reflex; seizures
If necessary, repeat initial dose in 30 minutes
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| Emetics Nursing Implications 2 | Administer water or clear liquid following
ipecac syrup to aid in absorption
If caustic agent has been ingested, administer activated charcoal to neutralize agent prior to vomiting
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