GI Notes 3010 Pt 1 PDF

Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ⎯ GERD Pathophysiology ° Retrograde flow of GI contents into the esophagus, resulting in inflammation ̴ Results: − Hyperemia − Erosion − Minor bleeding into...

Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ⎯ GERD Pathophysiology ° Retrograde flow of GI contents into the esophagus, resulting in inflammation ̴ Results: − Hyperemia − Erosion − Minor bleeding into the esophagus ° Most common cause is relaxation of the lower esophageal sphincter Pharmacology ° Overview ̴ Inhibiting gastric acid secretion − Histamine receptor antagonists − Proton pump inhibitors ̴ Increasing gastric emptying − Prokinetic medications ̴ Protecting the lining of the stomach − Antacids − Mucosal protectants ⎯ Peptic Ulcer Disease Pathophysiology  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ° Erosions result from corrosive action of acid gastric juice on a vulnerable epithelium caused by an imbalance between mucosal defenses and acid/peptic injury ° Cannot secrete protective enzymes if damaged ° Healing involves replacement with scar tissue ° Causes ̴ Acid erosion ̴ H. Pylori ̴ NSAID use Pharmacology (pg 1397) ° Proton pump inhibitors ° Antiulcer ° Antacids ° Antibiotics ̴ Clarithromycin ̴ Amoxicillin ̴ Tetracycline  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions HISTAMINE RECEPTOR ANTAGONISTS Oral or IV cimetidine famotidine MOA/Purpose block H2 receptors Therapeutic Affect suppressed secretion of gastric acid and lowers the concentration of hydrogen ions in the stomach Therapeutic Use prevent or treat gastric and duodenal ulcers, GERD, heartburn, ulcers caused by H. Pylori CNS effects (lethargy, hallucinations, confusion, restlessness) (careful with these for older adults and people with kidney/liver issues) Complications/SE Constipation, diarrhea, nausea (avoid spicy foods, eating at night before bed, acidic foods, carbonated drinks, alcohol) Bacterial colonization of stomach and respiratory tract GI bleeding(black tarry stools key indicator, upper GI bleed is darker lower GI bleed is more light red) Warfarin (increase levels of histamine receptor antagonists watch out for toxicity, monitor PT INR) Interactions Antacids (decrease absorption, if taking with other GERD drugs should take an hour apart) Smoking (decrease effectiveness of histamine receptor antagonists) PROTON PUMP INHIBITORS Oral or IV omeprazole pantoprazole MOA/Purpose inhibit the enzyme that produces gastric acid Therapeutic Affect reduced acid production and reduce gastric acid secretion Therapeutic Use short term treatment of ulcers and GERD (4-8 weeks) prevention of stress ulcers in acute events  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions bacterial colonization (asthma, COPD, pneumonia) osteoporosis and fractures ANTACIDS Oral Complications/SE rebound acid hypersecretion Aluminum hydroxide hypomagnesemia (signs of low magnesium= tremors, muscle cramps, if prolonged use of PPIs would be seizures) Magnesium hydroxide GI bleeding Calcium carbonate Interactions Digoxin, Stimulatemethotrexate(can the production of increase the absorption prostaglandin( of PPIs can neutralize and the exaggerate production the effects of stomach of them) acid) MOA/Purpose Clopidogrel( can decrease the effectiveness) Therapeutic Affect Neutralize or reduce the acidity of gastric acid, protect the mucosa Peptic ulcer disease Therapeutic Use Prevention of stress-induced ulcers Relief of manifestations of GERD Constipation Complications/SE Diarrhea(magnesium hydroxide side effect) Hypercalcemia(calcium carbonate side effect) Toxicity, hypermagnesemia(magnesium hydroxide side effect) Interactions Famotidine and cimetidine (decrease the absorption of antacids, take an hour between meds) Warfarin, digoxin (GI bleed) PROKINETICS Oral or IV metoclopramide MOA/Purpose enhances action of acetylcholine, blocking dopamine and serotonin in CNS Therapeutic Affect increases gastric emptying (increased action of acetylcholine), controls nausea and vomiting Therapeutic Use postoperative chemo GERD Tardive dyskinesia( use of prokinetics for a long period time, involuntary muscle movement) Complications/SE Extrapyramidal symptoms( a antihistamine can help with the symptoms)( don’t give it to people with seizures) Sedation(don’t drive/operate heavy machinery) Diarrhea (watch out for dehydration)  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions Interactions Alcohol, CNS depressants(decrease effects of prokinetics) MUCOSAL PROTECTANTS Opioids and anticholinergics(decrease effects of prokinetics) Oral sucralfate acidic environment of the stomach changes the medication into a protective barrier that adheres to the walls of MOA/Purpose an ulcer Therapeutic Affect protects the ulcer from further acid and pepsin breakdown Therapeutic Use acute duodenal ulcers and maintenance therapy Complications/SE constipation(take 1 hour before meals)(turns into a gel makes it harder to digest) Interactions digoxin, warfarin, and ciprofloxacin (take 2 hours before meals and apart from each other) antacids (30 minutes after mucosal protectants) PROSTAGLANDIN E ANALOG Oral or IV misoprostol MOA/Purpose endogenous prostaglandin in the GI tract decreases acid secretion, increase the secretion of bicarbonate and protective mucus, promotes vasodilation Therapeutic Affect to damaged areas (helps decrease acidity) Therapeutic Use long-term NSAID use that causes ulcers can also be used to induce labor( not super important) Complications/SE Diarrhea Interactions `  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ⎯ Gastroenteritis Pathophysiology ° Inflammation of the lining of the stomach and small intestine ° Causes increased luminal fluid that cannot be absorbed ° Leads to depletion of intravascular fluid volume and malabsorption of nutrients ° leads to pain,vomiting, and diarrhea Pharmacology ° Antidiarrheals ° Antibiotics ° Antiemetics ̴ Glucocorticoids ̴ Substance P/ Neurokinin 1 antagonists ̴ Serotonin antagonists* ̴ Dopamine antagonists* ̴ Anticholinergics* ̴ Antihistamines ̴ Benzodiazepines ⎯ Hernia Pathophysiology ° Intestines protruding through an abnormal opening ° Causes ̴ Straining ̴ Lifting heavy objects ̴ Sudden twists or pulls  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ̴ Muscle strain ̴ Weight gain ̴ Chronic cough ⎯ Hemorrhoids Pathophysiology ° Swollen or dilated veins in the anorectal area ° Can be internal or external Pharmacology ° Topical anesthetics ̴ benzocaine, lidocaine ° Protectants/emollients ̴ lanolin(kind of like vaseline), mineral oil ° Astringents ̴ Witch hazel (natural remedy) ° Corticosteroids (help with inflammation)  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ANTIDIARRHEALS Oral diphenoxylate plus atropine (Immodium) MOA/Purpose activate opioid receptors in the GI tract Therapeutic Affect decrease intestinal motility and increase absorption of fluid and sodium in the intestines Therapeutic Use diarrhea opioid effects (euphoria or CNS depression) Complications/SE atropine effects (blurred vision, dry mouth, urinary retention, constipation, tachycardia) (careful giving it to people with glaucoma, IBS) Interactions alcohol and other CNS depressants(can decrease the CNS and interact with ,medication) ANTIEMETICS- SEROTONIN ANTAGONISTS Oral, IM, IV (Zofran) blocking the serotonin receptors in the chemoreceptor trigger zone and on the vagus nerve (stops you from MOA/Purpose throwing up and having nausea) Therapeutic Affect prevents and treats nausea pregnancy Therapeutic Use post-op nausea chemo and radiation Complications/SE headache, diarrhea, dizziness, drowsiness(tylenol, don’t drive/operate heavy machinery) prolonged QT interval Interactions (for CNS depressants(alcohol need to avoid) all) Antihypertensives(greater hypotension effects) Anticholinergic medications(greater anticholinergic effects)  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions ANTIEMETICS- DOPAMINE ANTAGONISTS Oral, IM, IV, Rectal (Reglan) (Phenergan) MOA/Purpose blockade of dopamine receptors in the CTZ Therapeutic Affect antiemetic Therapeutic Use chemo post-op recovery Extrapyramidal symptoms(urinary retention, glaucoma) Complications/SE Hypotension Sedation Anticholinergic effects ANTIEMETICS- ANTICHOLINERGICS Transdermally, PO, IV, SubQ scopolamine Interferes with the transmission of nerve impulses from the vestibular apparatus in the inner ear to the MOA/Purpose vomiting center of the brain Therapeutic Use Prevention and treatment of motion sickness Complications/SE Sedation Anticholinergic effects  Gastrointestinal Disorders NURS 3010- Simple and Stable Conditions