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Drugs that Affect the Gastro- Intestinal or Digestive System CYNTHIA BARTLAU, MSN, RN, PHN GI Disorders GERD Ulcers (gastric, duodenal) N/V Constipation Diarrhea GI Drug Categories Antacids Anti-ulcer drugs Anti-Diarrheals Laxatives (Cathartics) Emetics Anti-emetics...

Drugs that Affect the Gastro- Intestinal or Digestive System CYNTHIA BARTLAU, MSN, RN, PHN GI Disorders GERD Ulcers (gastric, duodenal) N/V Constipation Diarrhea GI Drug Categories Antacids Anti-ulcer drugs Anti-Diarrheals Laxatives (Cathartics) Emetics Anti-emetics Antacids Antacids = aluminum, magnesium, calcium, and sodium compounds. “OTC” They are alkaline substances dec. *acidity of gastric fluids by neutralizing HCL acid in stomach Uses: Peptic Ulcer DZ & Gastro-esophageal reflux dz. (GERDs) Antacids: aluminum/calcium = constipation and magnesium = diarrhea Antacids *May change the color stools (whitish/white streaks *normal) ex. Maalox Antacids (cont.) Antacids can affect the absorption of other drugs if taken simultaneously Please administer Antacids 2 hrs apart from taking other drugs. Those with hypertension, renal, cardiac may want to avoid magnesium or sodium based antacids due to fluid retention (d/t sodium) Assess epigastric pain, monitor stools, (whitish colored) & assess for edema in pt. who may take sodium based antacids (where sodium goes-water follows!) Antacids: Pt. teaching (Amphogel, MOM, Calcium carbonate, Na bicarb, Maalox (magn/alumn based* bowel effects minimized) Shake bottle before pouring, take antacids at least 1 hr. apart from other drugs Chew tablets thoroughly before swallowing and follow with a glass of water Preferred dosage: 7 doses daily 1 & 3 hrs. after each meal and bedtime (PC & HS) Take antacids as directed even if you don’t have pain, report constipation/diarrhea/gas, etc. Anti-Ulcer Meds H-2 Receptor antagonist Mucosal Barriers Synthetic Prostaglandins Proton Pump Inhibitors Antibiotics Anti-cholinergics Anti-Ulcer Meds (cont.) *H-2 drugs = cimetidine (Tagamet), ranitidine (Zantac)=(taken off market in 2019-2020), famotidine (Pepcid), & new drug nizatidine (Axid). Stimulation of Histamine-2 receptors will causes parietal cells in stomach to secrete gastric acid. Excess acid can contribute to Peptic Ulcer Dz. Above drugs block the H-2 receptors (antagonist), thus decrease gastric acid is produced Anti-Ulcer Meds (cont.) H-2 blockers: low incidence of serious s/e except Tagamet( CNS confusion in elderly) (some taken off market 2019-2020) Zantac more preferred over Tagamet – more potent on a weight basis and doses given less frequently. Also, Zantac causes fewer drug interactions compared to Tagamet *Smoking reduces the effectiveness of Tagamet Report any CNS effects (dizziness, mental confusion, H/A, espec. if on Tagamet) Anti-Ulcer Meds (cont.) Mucosal Barriers: sucralfate (Carafate) Cyto-protective barrier Mucosal barrier (paste): protects the stomach up to 6hr Used to tx. peptic and duodenal ulcers Give ½-1 hr before each meal for max effect Never give with other drugs at same time Shake the suspension or take capsules/pills with a full glass of water Anti-Ulcer Meds (cont.) Synthetic Prostaglandin: misoprostol (Cytotec)- antiulcer/cytoprotective agent Prostaglandins = fatty acids that also regulate acid secretion, however, synthetic prostaglandins will suppress this effect! Traditionally used for long-term therapy for indiv. who take NSAID’s, including aspirin, for problems like arthritis (where NSAID drugs eat away and cause GI distress/ulcer formation of stomach.) * Caution=Drug causes spontaneous abortions/miscarriages Anti-Ulcer Meds (cont.) Anticholinergics-not used as much anymore *drugs have atropine (belladonna)- dry up/decrease gastric secretions & slow GI tract like Donnatal & Pro-Banthine. Common S/E that of all anti-cholinergics ([3D effects] dry mouth dec. GI tone & mobility, dec. bladder tone or urinary retention (can’t urinate) dilated pupils,*blurred vision, inc. pulse, B/P, and relax. of bronchioles (lungs) Anti-Ulcer Meds (cont.) Antibiotics=Pepto-Bismol (bismuth sub-salicylate) , metronidazole (Flagyl), tetracycline Effective against Helicobacter-pylori micro-organism which causes 90% of all ulcers Often use (tetracycline/Flagyl/Pepto-Bismol) combination drug “Helidac” S/E-allergy, superinfection espec. yeast and GI disturbances, don’t drink ETOH espec. with Flagyl-acute illness; Drink lots water to flush kidneys. Also,* Pepto-Bismol=black stools/tongue; s/s salicylate toxicity (tinnitus) ringing in the ears! Avoid aspirin! Anti-Diarrheals incl. opioids, anti-cholinergics, anti-spasmodics, bulk forming agents Opioids – diphenoxylate HCL (meperidine derivative) & atropine sulfate = (Lomotil) & A camphorated opioid (Morphine) [C-III] tincture = (Paregoric) (may not have FDA approval?) *Both Scheduled Controlled Substance (locked up in Narcotic Drawer!) (check-CNS depressant) loperamide HCL (Imodium-A-D) is an opioid (low meperidine based) but is OTC drug and has low potential for abuse (without Rx) All Opioid anti- diarrheals *dec. GI Motility Anti-diarrheals (cont.) Absorbents :-subt. attract toxins, poisons, and bacteria ex. “Kaopectate” = result in more formed stools. Also “Pepto-Bismol” which also has an anti- inflammatory effect Often Rx given after each loose BM. Nurse observes stool to make decision to administer the drug Traveler’s Diarrhea (Salmonella, E-coli,etc. often antibiotic *ciprofloxacin (Cipro) Rx’d Belladonna Alkaloid = atropine/scopolamine (Donnatal) = anticholinergic Laxatives Bulk Forming Stool Softeners Irritants/Stimulant Osmotic Saline Laxatives (cont.) Bulk = Fibercon, Metamucil- must follow with a full glass of water or becomes “glue” Softeners = Colace (docusate sodium), Surfak (docusate calcium), Pericolace (softener/laxative) Irritant/stimulant = (bisacodyl) Dulcolax (tab/suppository), Feen-a-mint; (sennosides) Ex-lax, *Senekot = which may turn urine *“reddish’ Laxatives (cont.) Saline laxatives = magnesium hydroxide = Milk of Magnesia (MOM)* used cautiously those renal dz. – works in ~ 6hrs - (magnesium) magnesium citrate (evacuation of colon) Osmotics = lactulose (also used for portal-systemic encephalopathy), polyethylene glycol /electrolyte *(GoLYTELY) for bowel cleansing – ‘til clear Do not use any laxatives if n/v/abd pain! Laxative & Cathartics Abuse! Laxative dependence (vicious cycle) and or used for weight control = eating disorders? Miscellaneous GI Drugs GI Stimulants: metoclopramide (Reglan) Increase GI motility and prevents nausea too! especially if IV - Give 30” before chemotherapy - Reglan s/e=CNS irritability – Parkinsonism = (with high doses or prolonged administration) + *drowsiness restlessness! Gastric Acid Pump Inhibitors = Prilosec (omeprazole), Nexium (esomeprazole) and Prevacid (lansoprazole) = 4-8 wk course to prevent/heal ulcers/erosion of esophagus/ *Used most in tx of H. pylori - active duodenal ulcers + *GERD (may take some of these drugs before meals.) Antisecretory properties – block the last step of acid production Emetic Emetic= Drugs that induce vomiting ex. Swallow poisons, drug overdose Most common drug is Syrup of Ipecac = taken orally irritates GI mucosa and effective in 5-30 min. *(never give if unconscious) Adm. Ipecac as directed by Poison Control Center ! Anti-emetic Anti-emetic=treats n/v Most Common include phenothiazines and the antihistamines prochlorperazine (Compazine), promethazine (Phenergan) Dramamine (meclizine), hydroxyzine (Vistaril) really is a *anti-histamine not phenothiazine metoclopramide (Reglan) – GI stimulant IV/IM * Zofran (ondansetron) works on CNS - for CA n/v – or tx of postop N/V (po disintegrating tablet too) droperidol (Inapsine) a tranquilizer similar to haloperidol Expect many of these drugs cause drowsiness! Check allergy to phenothiazine - Thorazine, Compazine, Phenergan Anti-emetic (cont.) Scopolamine Atropine like drug with antiemetic properties Use Transdermal patch for motion sickness Transdermal patch for post-operative nausea Placed behind the ear Questions?  Antacids Which antacid will cause diarrhea? Which antacid will cause constipation? When is the best time to take an antacid? Which type of patient should be discouraged from using sodium based antacids?  Antacids (cont.) Besides GERD, for what other condition is aluminum hydroxide (Amphogel) used? What is the basic action of the antacid group of GI medications?  Antiulcer Medications 90% of duodenal ulcers are caused by what? Which combination drug containing tetracycline/Flagyl/Pepto-Bismol seems to be most effective for duodenal ulcers? There are many different types of antiulcer medications, which drugs, or classification of drugs, is most likely to cause confusion in the elderly?  Antiulcer (cont.) What is a major side effect of the antiulcer synthetic prostaglandin drug Cytotec? Belladonna an anticholinergic drug may be used as an antiulcer agent. What are the major side effects of this classification of drugs?  Antidiarrheals How do the opioids work as antidiarrheals? What nursing action must take place before administering an antidiarrheal drug? With which drug is “Traveler’s Diarrhea” treated?  Laxative With the use of a bulk forming laxative such as Metamucil, what nursing action must be followed to avoid complications? Osmotic laxatives such as Go-LYTELY may be used for what purpose and what instructions must be followed?  Laxative (cont.) What is a possible SE from the use of the stimulant laxative such as the sennosides (Senokot)? Besides evacuation of the bowels, what is another use for Lactulose? In what situation would the nurse hold (not give) a laxative?  Other GI Meds Which GI stimulant is most commonly given about 30” prior to chemotherapy in order to prevent N/V? Prilosec and Nexium are gastric pump inhibitors most used for which disorder?  Other GI Meds What does Syrup of Ipecac cause and for what is it useful? Antiemetics commonly cause what side effect?