GI pharm 2

Mucosal Protectant - Carafate (Sucralfate)

• Sucralfate transforms into a protective barrier in the acidic environment of the stomach and duodenum.
• This barrier coats ulcers, shielding them from further damage.
• Constipation is a primary side effect.
• Sucralfate interferes with the absorption of phenytoin, digoxin, warfarin, theophylline, and ciprofloxacin.
• Administer before meals and at bedtime.
• Separate sucralfate administration from interacting medications by a minimum of two hours.
• It can be broken up or dissolved in water for easier intake.
• It should not be crushed or chewed.

Medications for Inflammatory Bowel Disease

• These drugs reduce inflammation in the bowel.
• They are used for managing Crohn's disease and alleviating mild to moderate ulcerative colitis episodes.
• Blood disorders, including agranulocytosis, hemolytic anemia, and macrocytic anemia, can occur.
• GI reactions include abdominal pain, nausea, vomiting, and diarrhea.
• Headache, joint pain (arthralgia), and fever may occur.
• Azulfidine can cause photosensitivity, increasing sunburn risk.
• Azulfidine can cause crystalluria, leading to potential kidney damage from crystal formation in the urine.
• Contraindicated during pregnancy and lactation due to potential risks.
• It can lead to infertility in males and is contraindicated for patients with sensitivities to salicylates or sulfonamides.
• Should not be used in cases of intestinal obstruction or for children younger than two years old.
• Use with caution in patients with liver or kidney disease, or blood dyscrasias.
• Reduces the absorption of digoxin, potentially leading to low levels.
• Increases the risk of immunosuppression when taken with methotrexate.
• Increases the risk of bleeding when taken with warfarin.
• Blood glucose levels can be elevated, necessitating more frequent monitoring in diabetic patients.
• Iron and antibiotics can interfere with the absorption of sulfasalazine.
• Administer with food or after meals to minimize stomach upset.
• A fluid intake of 1200 to 1500 mL is encouraged to prevent crystalluria and kidney damage.
• Examples include azulfidine, Remicade, Del Taco, and dependum.

Anti-Diarrheals

• Reduce bowel motility to manage diarrhea.
• Adverse reactions may include anorexia, nausea, vomiting, constipation, abdominal discomfort, pain, and distension.
• Diphenoxylate with atropine can induce sedation and euphoria at high doses.
• Atropine is added to discourage abuse of diphenoxylate due to its anticholinergic side effects.
• Contraindicated for patients with diarrhea caused by E. coli, Shigella, and Salmonella.
• Also contraindicated in cases of pseudomembranous colitis, abdominal pain of unknown origin, and obstructive jaundice.
• Increased risk of CNS depression when combined with antihistamines, opiates, or other sedatives.
• Increases the risk of hypertensive crisis when given with MAOIs or antidepressants.
• Drugs include Pepto-Bismol, Lomotil, and Imodium.
• Lomotil (diphenoxylate) is sometimes stored in narcotic drawers due to its opioid-like euphoric effects.
• Monitor bowel function and bowel sounds, assess ambulation needs due to potential sedation from lamotil.

Laxatives

• Alleviate constipation, several types available.
• Stimulant laxatives (bisacodyl, senna) are used for bowel prep before surgery and short-term constipation relief due to opioid use.
• Surfactant laxatives (docusate sodium/Colace) treat constipation and soften fecal impactions.
• Bulk-forming laxatives (psyllium, polycarbophil/FiberCon) manage constipation, decrease diarrhea associated with diverticulosis and IBS, and control stool for ileostomy or colostomy patients.
• Osmotic laxatives (lactulose, magnesium hydroxide) prevent painful elimination post-episiotomy or hemorrhoid surgery.
• High doses of osmotic laxatives can be used for surgery or diagnostic tests prep.
• Can cause diarrhea, leading to dehydration and electrolyte imbalances.
• Magnesium-based laxatives can cause toxic magnesium levels.
• GI irritation can occur.
• Sodium-containing laxatives can cause fluid retention.
• Abdominal pain or discomfort is a general side effect.
• Bulk-forming laxatives can cause intestinal obstruction.
• Contraindicated with persistent abdominal pain, nausea, or vomiting of unknown cause.
• Contraindicated in acute abdomen issues (appendicitis, fecal impaction, obstruction, hepatitis).
• Contraindicated with ulcerative colitis and diverticulitis, except for bulk-forming laxatives.
• Milk and antacids can destroy the enteric coating of bisacodyl, they should be taken an hour apart.
• Bulk-forming and surfactant laxatives should be taken with eight ounces of water.
• Bisacodyl should be taken at bedtime.
• Chronic laxative use can cause fluid and electrolyte imbalances and bowel dependence.
• Encourage high-fiber foods (bran, fruits, vegetables) and increased fluids (2-3 liters/day).
• Exercise can help stimulate peristalsis.
• Drugs include Metamucil, Colace, magnesium hydroxide, lactulose, Dulcolax, Senokot, and Miralax.
• Miralax: 17 grams of powder dissolved in any drink, once daily.
• GoLytely: bowel prep, large volume to be consumed for colonoscopies or bowel surgery.
• Evaluate the need for PRN medications and their effectiveness.
• Protect client safety, especially with lamotil due to potential euphoria and sedation.
• Perianal skin irritation can occur requiring care.

H. pylori Treatment

• H. pylori is a bacteria that can cause ulcers in the gut, a combination of drugs is used to eradicate it.
• Treatment involves a combination of two to three antibiotics for about 14 days.
• The combination approach is used to ensure effectiveness and prevent medication resistance.
• Common drugs used in combinations include Prilosec, Biaxin, Amoxil, Omeprazole, Pepto-Bismol, Flagyl, and tetracycline.
• If Flagyl is administered, take it with food to reduce irritation.
• Side effects are nausea and diarrhea.
• Antibiotics are taken for the full course.
• Bismuth must be chewed if given in pill form.
• Avoid administering clarithromycin to pregnant women.
• Avoid gastric irritants such as alcohol, caffeine, and smoking.
• Avoid prolonged sun exposure.
• Bismuth preparations may cause darkening of the tongue and stool.
• Antibiotics may interfere with birth control methods.

Liver Problems

• Liver issues can be managed with medications and interventions targeting specific complications.
• Spironolactone is a potassium-sparing diuretic used to reduce fluid accumulation.
• Neomycin reduces gut flora in hepatic encephalopathy.
• Lactulose binds with ammonia for excretion in stool.
• Vitamin K improves clotting if there are bleeding problems.
• Antihistamines treat pruritus.
• Hepatitis vaccines should be given before exposure.

Pancreatic Problems

• Replacement therapy using enzymes aids in breaking down fats, proteins, and carbohydrates.
• Enzymes should be taken whole, but can be opened and mixed with applesauce or pudding if swallowing is difficult.
• These enzymes should be taken with every meal and with plenty of water.
• Do not administer with iron or antacids.
• Adverse effects include nausea, diarrhea, abdominal pain, and hyperglycemia.
• Contraindications include allergies to pork protein or enzymes, and acute pancreatitis.
• An example medication is pancrease.