Pharma W9: GI Tract Drugs
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Questions and Answers

What is a potential adverse effect associated with PPIs that requires caution in certain patients?

  • Nausea and vomiting
  • Increased appetite
  • Dizziness
  • CNS adverse effects such as confusion (correct)

    • How should H2 Antagonist be administered to achieve optimal results?

  • With food
  • After meals
  • At bedtime
  • 1 to 2 hours before antacids (correct)

    • What is classified as acute diarrhea?

  • Sudden onset with a duration between 3 days to 2 weeks (correct)
  • Diarrhea accompanied by chronic weakness and weight loss
  • Frequent loose stools in a previously healthy individual for more than 2 weeks
  • Persistent diarrhea lasting for more than 3 weeks

    • Which of the following is NOT a goal of diarrhea treatment?

    <p>Increasing appetite</p> Signup and view all the answers

    What is an appropriate instruction for a patient taking a PPI?

    <p>Consume the prescribed dosage exactly as directed</p> Signup and view all the answers

    What is the primary mechanism of action of antacids?

    <p>Stimulation of gastric mucus cells</p> Signup and view all the answers

    Which of the following is NOT a common compound found in antacids?

    <p>Potassium chloride</p> Signup and view all the answers

    What indicates a contraindication for the use of antacids?

    <p>Severe renal failure</p> Signup and view all the answers

    How do antacids contribute to the reduction of gastric pain?

    <p>By buffering the acidic properties of hydrochloric acid</p> Signup and view all the answers

    Which of the following is a potential side effect of antacids?

    <p>Constipation</p> Signup and view all the answers

    In which condition are antacids mainly indicated for use?

    <p>Peptic ulcer</p> Signup and view all the answers

    What is a common combination found in many antacid preparations?

    <p>Aluminum and Simethicone</p> Signup and view all the answers

    What effect do prostaglandins have in relation to antacid use?

    <p>Enhance mucus production</p> Signup and view all the answers

    What should be done if the volume aspirated from a feeding tube is more than the volume delivered over the previous two hours?

    <p>Return aspirated content back into tube</p> Signup and view all the answers

    Which sign indicates potential gastric intolerance during enteral feeding?

    <p>Diarrhea</p> Signup and view all the answers

    What is a critical step to ensure patient safety when discontinuing TPN?

    <p>Infuse 5 to 10% glucose solution immediately</p> Signup and view all the answers

    Which of the following is NOT a method to ensure proper tube placement for enteral nutrition?

    <p>Patient's oral intake monitoring</p> Signup and view all the answers

    What adverse effect should be closely monitored for during enteral feedings?

    <p>Fluid overload</p> Signup and view all the answers

    What symptoms are associated with hyperglycemia that should be monitored during TPN administration?

    <p>Headache and weakness</p> Signup and view all the answers

    What is a recommended nursing practice for enteral nutrition to prevent clogging of feeding tubes?

    <p>Flush tubing regularly with water</p> Signup and view all the answers

    How should the rate of enteral feedings be adjusted to ensure patient tolerance?

    <p>Start slowly and gradually increase the rate</p> Signup and view all the answers

    Which laxative class is primarily associated with nutrient malabsorption as an adverse effect?

    <p>Stimulant</p> Signup and view all the answers

    What is a common contraindication for the use of laxatives?

    <p>Abdominal pain</p> Signup and view all the answers

    What nursing implication should be observed when administering bisacodyl?

    <p>Administer with water only on an empty stomach</p> Signup and view all the answers

    Which of the following adverse effects specifically relates to emollient laxatives?

    <p>Skin rashes</p> Signup and view all the answers

    Which type of nausea is specifically characterized as occurring after surgical procedures?

    <p>Postoperative nausea</p> Signup and view all the answers

    What is the primary mechanism of action for adsorbents?

    <p>Coat the gastrointestinal tract and bind to bacteria</p> Signup and view all the answers

    Which of the following is a key indication for the use of probiotics?

    <p>Antibiotic-induced diarrhea</p> Signup and view all the answers

    Which class of drugs is primarily used as anticholinergics in the treatment of diarrhea?

    <p>Antimotility drugs</p> Signup and view all the answers

    Which of the following adverse effects is associated with antimotility opiates?

    <p>Constipation and respiratory depression</p> Signup and view all the answers

    What is the main reason for contraindicating the use of adsorbents in cases of diarrhea caused by C. difficile?

    <p>They allow the infection to run its course</p> Signup and view all the answers

    What is NOT a common side effect of probiotics?

    <p>Increased energy levels</p> Signup and view all the answers

    What is a significant adverse effect of anticholinergic antimotility drugs?

    <p>Urinary retention</p> Signup and view all the answers

    What is a common effect of opiate-based antimotility medications?

    <p>Prolonged intestinal absorption of fluids</p> Signup and view all the answers

    Study Notes

    Factors Affecting Gastric Mucosa

    • Decreased blood flow, mucosal ischemia, hypoperfusion, and reperfusion injury can damage the gastric mucosa.
    • Reperfusion injury occurs when blood flow is suddenly restored after ischemia, overwhelming fragile tissues and causing damage instead of healing.
    • Nasogastric tubes increase the risk of GI bleeding.

    Acid-Controlling Drugs

    • Mnemonic: "PHA"

    1. Antacids

    • Mechanism of Action (MOA):
      • Increase stomach pH by neutralizing gastric acidity.
      • Basic compounds that raise stomach pH.
      • Salts of aluminum, magnesium, calcium, or sodium bicarbonate.
      • Many antacids also contain simethicone, an antiflatulent (antigas) drug.
      • Aluminum and calcium-based formulations often include magnesium.
      • Promote gastric mucosal defense by stimulating the secretion of mucus and bicarbonate.
    • Drug Effects:
      • Mucus: Protective barrier against hydrochloric acid.
      • Bicarbonate: Buffers the acidic properties of hydrochloric acid.
      • Prostaglandins: Prevent activation of the proton pump, which produces HCl acid.
    • Indications:
      • OTC but mainly prescribed for acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn.
    • Contraindications:
      • Stones, hypercalcemia, hypermagnesemia (if taken frequently or in excess).
      • Known allergy.
      • Severe renal failure or electrolyte disturbances.
      • GI obstruction: antacids may stimulate GI motility when it is undesirable due to an obstructive process.

    2. H2 Antagonists

    • Mechanism of Action (MOA):
      • Competitively block H2 receptors on parietal cells, reducing histamine-stimulated gastric acid secretion.
      • Decrease gastric acid production.
    • Indications:
      • Short-term treatment of active duodenal or gastric ulcers; maintenance therapy to prevent ulcer recurrence.
      • GERD.
      • Zollinger-Ellison syndrome (a rare condition characterized by excessive production of gastric acid).
      • Stress ulcers in critically ill patients.
    • Contraindications:
      • Hypersensitivity to H2 antagonists.
      • Severe liver disease.

    3. Proton Pump Inhibitors (PPIs)

    • Mechanism of Action (MOA):
      • Irreversibly inhibit the proton pump, the enzyme responsible for the final step in gastric acid secretion.
      • Block the movement of hydrogen ions (H+) into the stomach.
    • Indications:
      • Short-term treatment of active duodenal or gastric ulcers.
      • Maintenance therapy to prevent ulcer recurrence.
      • GERD.
      • Zollinger-Ellison syndrome.
      • Stress ulcers in critically ill patients.
    • Contraindications:
      • Hypersensitivity to PPIs.
      • Severe liver disease.

    Nursing Implications for PPIs

    • Assess for history of liver disease.
    • May increase serum levels of diazepam and phenytoin.
    • May increase the risk of bleeding with warfarin.
    • Teach patients to take prescribed medications exactly as directed.
    • Omeprazole should not be crushed or chewed (enteric-coated); most PPIs are enteric-coated and should NOT be crushed, chewed, or opened.
    • If a nasogastric route is required, a crushable form of PPI is necessary.

    Diarrhea

    • Definition: Abnormal passage of stools with increased frequency, fluidity, and weight or with increased stool water excretion.
    • Acute Diarrhea:
      • Sudden onset in a previously healthy person.
      • Lasts from 3 days to 2 weeks.
      • Self-limiting.
    • Chronic Diarrhea:
      • Lasts for more than 3 to 4 weeks.
      • Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness.

    Causes of Diarrhea

    • Acute Diarrhea:
      • Bacteria.
      • Viruses.
      • Drugs (drug-induced).
      • Nutritional factors.
    • Chronic Diarrhea:
      • Inflammatory bowel disease (IBD).
      • Crohn's disease.
      • Ulcerative colitis.
      • Tumor.
      • Diabetes.
      • C. difficile infection.

    Goals of Diarrhea Treatment

    • Stop the frequency of stools.
    • Alleviate abdominal cramps.
    • Replenish fluids and electrolytes (often hypomagnesemia).
    • Prevent weight loss and nutritional deficits.

    Antidiarrheal Drugs

    • Mnemonic: "ANA-A, PRO"

    1. Adsorbents

    • MOA:
      • Coat the walls of the gastrointestinal tract, bind to bacteria, and get excreted together.
      • Bind to the causative bacteria or toxin, which is then eliminated through the stool.
    • Examples:
      • Bismuth subsalicylate (Pepto-Bismol®). Contains aspirin.
      • Activated charcoal.
      • Antilepemic drugs (cholestyramine).

    2. Probiotics

    • Definition: Products obtained from bacterial cultures (mainly Lactobacillus organisms).
    • Also known as: "Intestinal flora modifiers" or "bacterial replacement drugs."
    • MOA:
      • Supply missing bacteria to the GI tract.
      • Suppress the growth of diarrhea-causing bacteria.
    • Indications:
      • Antibiotic-induced diarrhea.

    3. Antimotility Drugs

    • Subclasses: Anticholinergics and opiates.
    • MOA: Slow motility through the GI.

    1. Antimotility - Anticholinergics

    • MOA: Slow peristalsis by reducing rhythmic contractions and smooth muscle tone of the GI tract.
    • Effects:
      • Drying effect on liquid stools.
      • Reduces gastric secretions.

    2. Antimotility - Opiates

    • MOA:
      • Decrease bowel motility and reduce pain by relieving rectal spasms.
      • Increase transit time through the bowel, allowing more time for water and electrolytes to be absorbed.
    • Example: Loperamide (Imodium).
    • Note: Opiates in this class do not work the same as opioids.

    Indications for Antidiarrheals

    • Adsorbents: Milder cases.
    • Probiotics: Antibiotic-induced diarrhea.
    • Antimotility drugs (anticholinergics and opiates): More severe cases.

    Contraindications for Antidiarrheals

    • Allergy.
    • Diarrhea caused by bacteria or parasite.
    • Acute GI conditions such as intestinal obstruction or colitis.

    Adverse Effects of Antidiarrheals

    • Adsorbents: Increased bleeding time/bruising when taken with anticoagulants, constipation, dark stools.
    • Antimotility (Anticholinergics): Hypotension, bradycardia, blurred vision (drying effects), urinary retention, CNS effects (headache, dizziness, confusion, anxiety).
    • Antimotility (Opiates): Drowsiness, dizziness, lethargy, nausea, vomiting, constipation, respiratory depression, hypotension, urinary retention.
    • Probiotics: Generally safe and well-tolerated.

    Laxatives

    • Types of Laxatives:
      • Bulk-forming.
      • Emollient.
      • Hyperosmotic.
      • Stimulant.

    Contraindications for Laxatives

    • Intestinal obstruction.
    • Abdominal pain.
    • Nausea and vomiting.
    • Undiagnosed abdominal pain.
    • Acute surgical abdomen.

    Adverse Effects of Laxatives

    • Bulk-forming: Impaction, gas formation, allergic reaction.
    • Emollient: Skin rashes, decreased absorption of vitamin A, lipid pneumonia.
    • Hyperosmotic: Abdominal bloating, rectal irritation.
    • Stimulant: Nutrient malabsorption, gastric irritation, rectal irritation, dependence, electrolyte disturbances.

    Nursing Implications: Laxatives

    • Assess fluid and electrolytes before initiating therapy.
    • Long-term use can result in decreased bowel tone and dependency.
    • All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric-coated.
    • Bulk-forming laxatives should be taken with 240 mL of water (1 cup).
    • Bisacodyl should be taken with water only on an empty stomach.
    • Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible fluid or electrolyte loss.

    Nausea and Vomiting

    • Types:
      • General.
      • Postoperative.
      • Chemotherapy-induced.

    Antiemetics and Antinausea Drugs

    • Purpose: Relieve nausea and vomiting.
    • Classes:
      • Antihistamines.
      • Serotonin Blockers.
      • Phenothiazines.
      • Dopamine Antagonists.
      • Cannabinoids.
      • Other antiemetics.

    Enteral Nutrition

    • Definition: Administration of nutrients through the gastrointestinal tract.
    • Routes:
      • Nasogastric tube.
      • Gastrostomy tube.
      • Jejunostomy tube.
    • Types:
      • Polymeric: Contains intact proteins, carbohydrates, and fats.
      • Monomeric: Contains predigested nutrients, such as amino acids, glucose, and fatty acids.
      • Modular: Allows for the customization of the formula by adding specific nutrients.

    Nursing Implications: Enteral Nutrition

    • Assess for allergies to components of enteral nutritional supplements.
    • Assess for lactose intolerance.
    • Follow facility policy for ensuring proper tube placement (gastric bubble test, residual test, and X-ray) and for checking residual volumes before administering a feeding.
    • Flush tubing to prevent clogging.
    • Monitor for signs of gastric intolerance (cramping, diarrhea, abdominal bloating, flatulence).
    • Monitor fluid balance (intake and output).
    • Increase the rate of feeding gradually to ensure tolerance.
    • Keep the patient's head elevated to prevent aspiration pneumonia.

    Total Parenteral Nutrition (TPN)

    • Definition: Administration of nutrients intravenously.
    • Indications:
      • Unable to meet nutritional needs orally or enterally.
      • Malabsorption syndromes.
      • Severe malnutrition.
      • Gastrointestinal disorders.
      • Post-surgery.
      • Trauma.

    Nursing Implications: TPN

    • Monitor blood glucose levels.
    • Watch for and monitor hyperglycemia (headache, dehydration, weakness) and hypoglycemia (cold, clammy skin, dizziness, tachycardia, tingling of the extremities).
    • Maintain and care for TPN IV lines, including tubing and dressing changes.
    • Monitor patient's temperature.
    • Monitor daily weights and intake and output volumes.
    • Watch for and monitor for fluid overload.
    • If TPN must be discontinued abruptly, infuse 5% to 10% glucose to prevent rebound hypoglycemia.
    • Assess the patient's safety and infusion every 60 minutes.

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