GI Drugs NUR 210 Unit 11 (2023) Galen PPP.pptx

Drugs for Gastrointestinal Tract Disorders NUR 210 Unit 11/12  Gastrointestinal disorders Drugs for the  Vomiting Gastrointestinal  Diarrhea  Constipation Tract Drugs to treat these disorders...

Drugs for Gastrointestinal Tract Disorders NUR 210 Unit 11/12  Gastrointestinal disorders Drugs for the  Vomiting Gastrointestinal  Diarrhea  Constipation Tract Drugs to treat these disorders  Antiemetics  Antidiarrheals  Laxative  Cerebral centers affecting vomiting Vomiting  Nonpharmacologic measures Weak tea Flat soda Vomiting Gelatin Pedialyte (for use in children) Gatorade Crackers Toast  Prescriptive antihistamines/antiemetic Many available – think of route Antiemetics - Promethazine Promethazine ◦ Action  Blocks histamine 1 & dopamine receptor sites to CTZ ◦ Uses  Treats and prevents motion sickness, nausea, and vomiting  Side effects/adverse reactions Antiemetics - Drowsiness, dry mouth and eyes Promethazine Photosensensitivity Urinary retention/constipation EPS ◦ Respiratory depression  Caution Glaucoma Liver disease, asthma, hypertension, Antiemetics - Older adults Promethazine Debilitated patients Interactions Other CNS depressants, alcohol False pregnancy test  Action Block serotonin receptors in the CTZ Block vagal nerve terminals in the upper GI tract Antiemetics - Uses Ondansetron Most effective antiemetic available 1 N/V from chemotherapy/radiation Common side effects: headache, dizziness, fatigue and weakness No EPS  Action Blocking dopamine receptors in the CTZ Increases GI emptying Uses Antiemetics - Treatment of postoperative emesis, cancer chemotherapy, and radiation therapy metoclopramide Side effects High doses can cause sedation and diarrhea. Occurrence of EPS is more prevalent in children than in adults. Contraindicated with GI obstruction, hemorrhage, or perforation No alcohol or other CNS depressants  Assessment Nursing Process: Medication/medical history (glaucoma) Antiemetics Assess emesis, number, quantity, appearance, and for possible causes Baseline VS  Interventions Monitor VS – patient may become dehydrated Fluid status Nursing Process: Bowel sounds Antiemetics Provide mouth care Monitor for CNS depression with promethazine Monitor for EPS with promethazine and metoclopramide Give metoclopramide before meals if used to help with GI emptying  Teaching Teach when to take – 30-60 minutes prior to chemo or motion Nursing Process: Do not drive Antiemetics Instruct to non-pharmacological methods of controlling nausea Avoid OTC antiemetic drugs No alcohol and other CNS depressants Instruct to side effects and report EPS  Causes Spoiled foods or excessively spicy foods Bacteria (Escherichia coli, Salmonella), virus (parvovirus, rotavirus), toxins Diarrhea Drug reactions Fecal impaction, laxative abuse Malabsorption disorders, bowel tumor, inflammatory bowel disease Stress, anxiety  Nonpharmacologic measures Clear liquids Diarrhea Oral solutions (Gatorade; Pedialyte or Rehydrate [both for use in children]) IV electrolyte solutions  Action Antidiarrheals: Inhibits gastric motility by slowing Diphenoxylate with peristalsis Combination weak opioid and anti- atropine cholinergic 1 Uses Treat diarrhea  Antidiarrheals: Diphenoxylate with Side effects/adverse reactions atropine ◦ Contains the side effects of 1 opioids and anti-cholinergic ◦ Long-term use – paralytic ileus  Antidiarrheals: Contraindications/interactions Similar to opioids and anti- Diphenoxylate with cholinergic atropine ◦ No CNS depressants 1 ◦ No glaucoma ◦ C. Diff or other infectious diarrhea  o Assessment Nursing Process: o Medication/medical/travel/food Antidiarrheals history o Vital signs o Bowel sounds, diarrhea o Narcotic use history  Interventions/teaching Monitor VS Monitor fluid/electrolyte status Nursing Process: Notify HCP if diarrhea continues longer than Antidiarrheals 48 hours or acute abdominal pain occurs Do not take with CNS depressants Take medication as prescribed Drink a lot of fluids No fried foods or milk products Constipation can result from overuse  Causes Bowel obstruction, fecal impaction Chronic laxative use, ignoring urge to defecate Constipation Neurologic disorders Side effect of drugs Lack of exercise Insufficient consumption of fiber and/or water  Nonpharmacologic treatment Diet (high fiber) Constipation Water Exercise Routine bowel habits  Laxatives Types of laxatives Osmotic (saline – Golightly) Constipation Stimulant (irritants – bisacodyl**) Bulk-forming - Metamucil Emollient (stool softeners – docusate sodium)  Bisacodyl Action Increase peristalsis by direct effect on smooth muscle of intestine Use Laxative - bisacodyl Bowel prep, short-term tx for constipation Results Orally 6 to 8 hours, rectally 15 to 60 minutes Side effects Abdominal cramps, weakness, GI distress, diarrhea Adverse Reaction: dependence, hypokalemia  Contraindications Undiagnosed abdominal pain Inflammatory disorders of the GI tract ◦ Appendicitis, diverticulitis, ulcerative colitis Laxative - bisacodyl Bowel obstruction, fecal impaction Pregnancy Interactions Antacids, H2, PPI Milk  Assessment ◦ Medical/medication history ◦ Baseline vital signs Interventions/teaching Nursing Process: ◦ Monitor I & O, increase fluids/fiber Laxative ◦ Monitor fluid & electrolytes as drug works ◦ Encourage fluid intake, fiber, exercise ◦ Avoid overuse ◦ Do not chew tablets ◦ Use only as needed with water ◦ Do not take within 1 hour of another drug ◦ Take at time it will not interfere with activities or sleep  Ondansetron has been ordered for the patient undergoing cancer chemotherapy to control the severe nausea and vomiting. What side effects Practice Question should the nurse observe for? #1 1 A. Headache, dizziness, and fatigue B. Anorexia and hair loss C. Abdominal cramping and irritability D. Psychosis and middle ear disturbances Practice Question Answer: A #1 Rationale: Side effects of ondansetron 1 (Zofran) include headache, dizziness, and fatigue  Bisacodyl has been ordered for a patient who is constipated. The nurse realizes that Dulcolax Practice Question A. increases peristalsis to produce a bowel #2 movement. 1 B. is incompatible with alcohol consumption. C. should be avoided during pregnancy as it is teratogenic. D. may lead to paralytic ileus.  Answer: A Practice Question Rationale: Dulcolax increases #2 peristalsis by direct effect on intestinal 1 smooth muscle. Alcohol and pregnancy are not affected by Dulcolax. Dulcolax does not cause paralytic ileus.  A patient is ordered bisacodyl. Before administering the drug, it is most important Practice Question for the nurse to assess the patient for what? #3 1 A. Hypertension B. Anemia C. Allergy to penicillin D. Appendicitis  Answer: D Practice Question Rationale: Contraindications to use of #3 bisacodyl (Dulcolax) include 1 hypersensitivity, fecal impaction, intestinal/biliary obstruction, GI bleeding, appendicitis, abdominal pain, nausea, vomiting, rectal fissures.