Medications Affecting the Gastrointestinal System and Nutrition PDF

MEDICATIONS AFFECTING THE GASTROINTESTINAL SYSTEM AND NUTRITION - Excessive consumption of large, fatty meals or alcohol, as well as emotional stress, may result in hyperprod...

MEDICATIONS AFFECTING THE GASTROINTESTINAL SYSTEM AND NUTRITION - Excessive consumption of large, fatty meals or alcohol, as well as emotional stress, may result in hyperproduction of hydrochloric acid and lead to OVERVIEW hypersecretory disorders such as peptic ulcer disease One of the conditions of the stomach requiring drug therapy is hyperacidity, or excessive acid production. Parietal cell is the primary target Three types of receptors: DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM AND NUTRITION 1. Acetylcholine (Ach) ACID-RELATED PATHOPHYSIOLOGY 2. Histamine - Hydrochloric acid-aids digestion; barrier to infection 3. Gastrin - Bicarbonate-natural mechanism to prevent hyperacidity - Once these receptors have become occupied, a second messenger is sent - Pepsinogen- digest dietary proteins inside the cell, - Intrinsic Factor- facilitates gastric absorption of vitamin B12 - occupation results in the production of adenylate cyclase. - Mucus- protects the stomach lining - Adenylate cyclase converts adenosine triphosphate (ATP) to cyclic adenosine - Prostaglandins – anti-inflammatory and protective functions monophosphate (CAMP), which provides energy for the proton pump - Proton pump will be able to transport hydrogen ions needed for the production STOMACH: 3 FUNCTIONAL AREAS/ GLANDS of hydrochloric acid. - Cardiac - - Pyloric A. PEPTIC ULCER DISEASE - Gastric term for gastric or duodenal ulcers that involve digestion of the Gl mucosa by the enzyme pepsin GASTRIC GLANDS Factors: - Parietal cells- secrete hydrochloric acid (HCI) - Pepsin normally breaks down only food proteins and is the activated form of - Chief cells- secrete pepsinogen pepsinogen - Mucous cells- also called surface epithelial cells, serve as a protective coating - sight, smell, and taste of food and its presence in the stomach are the primary against the digestive action of hydrochloric acid and digestive enzymes. stimulus for the release of hydrochloric acid from the parietal cells - Helicobacter pylori HYDROCHLORIC ACID - Stress Natural Pharmacological management of peptic ulcer disease addresses the imbalance - secreted by the parietal cells, maintains the environment of the stomach at a between gastric mucosal defenses, including mucus and bicarbonate, and antagonistic pH of 1 to 4 factors (H. pylori infection, gastric acid, pepsin, smoking) and use of NSAIDs. - aids in the proper digestion of food For clients who have H. pylori, antibiotics are used to eradicate the disease process. All - serves as one of the body's defenses against microbial infection by the of the other medications prescribed are used to promote healing of the Gl tract. gastrointestinal (GI) tract Synthetic - Food, caffeine, chocolate, and alcohol  ANTIBIOTICS Pharmacological Action Therapeutic Use Nursing Administration Amoxicillin, Bismuth, Eradication of H. pylori Therapy should include combination of two or three Administer metronidazole with food to decrease gastric disturbances. Clarithromycin, bacteria antibiotics for 14 days to increase effectiveness and Metronidazole, to minimize the development of medication Nausea and diarrhea are common adverse effects Tetracycline, Tinidazole resistance. Take the full course of prescribed medications HISTAMINE 2-RECEPTOR ANTAGONIST Pharmacological Therapeutic Use Complications Contraindications/ Interactions Nursing Administration Action Precautions Cimetidine, Block H2 Prescribed to prevent decreased libido, Pregnancy Risk Increase the levels of Famotidine can be administered IV for Famotidine, receptors, which or treat gastric and gynecomastia, Category B warfarin, phenytoin, acute situations Nizatidine suppress duodenal ulcers, and impotence theophylline, and lidocaine. secretion of GERD, Older adult clients are Avoid smoking, which can delay healing. gastric acid and hypersecretory lethargy, more likely to Concurrent use of antacids lowers the conditions (Zollinger- hallucinations, experience adverse can decrease absorption of Availability of these medications OTC can concentration of Ellison syndrome), confusion, CNS effects histamine2 receptor discourage clients from seeking appropriate hydrogen ions in heartburn, and acid restlessness antagonists. health care. Encourage clients to see a the stomach indigestion decrease gastric provider if manifestations persist constipation, acidity, which promotes Smoking can decrease the Used in conjunction diarrhea, nausea bacterial colonization of effectiveness of histamine2 Famotidine can be taken with or without with antibiotics to the stomach and the receptor antagonists food. treat ulcers caused respiratory tract. by H. pylori Treatment of peptic ulcer disease is usually Use cautiously in started as an oral dose twice a day until the Management of clients who are at a high ulcer is healed, followed by a maintenance urticaria risk for pneumonia, dose, which Usually is taken once a day at COPD bedtime. PROTON PUMP INHIBITORS Pharmacological Therapeutic Complications Contraindications/ Interactions Nursing Administration Action Use Precautions Omeprazole, Block basal and Short-term Pneumonia Pregnancy Risk Digoxin, Do not crush, chew, or break sustained-release Pantoprazole, stimulated acid therapy of Category C methotrexate. capsules Lansoprazole, production, and gastric and Decreased acid Diazepam, Dexlansoprazole reduce gastric duodenal production can lead to Hypersensitivity tacrolimus, antifungal Do not open capsule and sprinkle contents over Rabeprazole, acid secretion ulcers, decreased calcium agents and phenytoin food to facilitate swallowing. Esomeprazole erosive absorption (Osteoporosis Liver Disease levels can increase esophagitis, and fractures) when used Pantoprazole can be administered to clients and GERD Client at high risk for concurrently with Intravenously. There can be irritation at the Rebound acid pneumonia, COPD omeprazole. Injection site leading to thrombophlebitis. Monitor hypersecretion the IV site for indications of Inflammation The beneficial effects Hypomagnesemia of clopidogrel can Take omeprazole once per day prior to eating in decrease with the morning. concurrent use. MUCOSAL PROTECTANT Pharmacological Action Therapeutic Use Complications Contraindications/ Interactions Nursing Precautions Administration Sucralfate The acidic environment of the Treatment of acute no systemic effects Pregnancy risk category Sucralfate can interfere do not crush or stomach and duodenum changes duodenal ulcers and because sucralfate is B with the absorption of chew the tablet. sucralfate into a protective barrier maintenance therapy. minimally absorbed phenytoin, digoxin. that adheres to an ulcer and most of it is Hypersensitivity warfarin, and ciprofloxacin. complete the Neutralize or reduce eliminated in the feces. course of treatment The viscous substance can stick to the acidity of gastric Chronic kidney disease Antacids interfere with the the ulcer for up to 6hr. acid. constipation or diabetes mellitus effects of sucralfate. ANTACIDS Pharmacological Action Therapeutic Use Complications Contraindications/ Interactions Nursing Administration Precautions Aluminum Neutralize or reduce the Treatment of peptic - Constipation Antacids should be Antacids decrease the Chew tablets thoroughly and then hydroxide, acidity of gastric acid; ulcer disease. - Diarrhea used with caution in absorption several drink at least 8 oz of water or Magnesium can reduce pepsin - Fluid retention clients who have GI medications, including milk. hydroxide, activity if the pH is raised Prevention of stress- - Hypophosphat perforation or famotidine and cimetidine. above 5. induced ulcers. emia obstruction.  Calcium - Hypercalcemia Aluminum compounds bind Shake liquid formulations to carbonate Mucosal protection can Relief of the - Alkalosis Use cautiously in to warfarin, digoxin, and ensure even dispersion of the occur from stimulation manifestations of - Hypermagnese clients who have tetracycline interfering with medication. of the production of GERD mia abdominal pain absorption and reducing prostaglandins their effects. Take all medications at least 1 hr before or after taking an antacid. PROSTAGLANDIN E ANALOG Pharmacological Action Therapeutic Use Complications Contraindications/ Nursing Nursing Evaluation of Precautions administration Medication Effectiveness Misoprostol Acts as an endogenous Used in clients taking - Diarrhea Pregnancy risk take misoprostol Reduced frequency or absence of prostaglandin in the Gl tract long-term NSAIDs to - Dysmenorrhea, category X with meals and at GERD manifestations (heartburn, that decreases acid prevent gastric ulcers. spotting bedtime. bloating, belching(dighay)) secretion, Increases the Lactation (can secretion of bicarbonate and Unlabeled use: Used in cause severe Absence of GI bleeding protective mucus, and clients who are pregnant diarrhea) promotes vasodilation to only to Induce labor by Healing of gastric and duodenal maintain submucosal blood causing cervical ripening ulcers flow. These actions serve to or induce medical prevent gastric ulcers. termination of pregnancy No recurrence of ulcer B. GASTROINTESTINAL DISORDERS The medications in this section affect some aspect of the gastrointestinal tract to treat or prevent nausea, vomiting, motion sickness, diarrhea, or constipation; treat hiatal hernia by controlling reflux; and treat gastroesophageal reflux disease (GERD) by increasing gastric motility, protecting stomach lining, and inhibiting secretion of gastric acid. Medications include antiemetics, laxatives, antidiarrheals, prokinetic agents, medications for irritable bowel syndrome (IBS), 5‑aminosalicylates, probiotics, and medications for hiatal hernia ANTIEMETICS Pharmacological Therapeutic Use Complications Contraindications/ Interaction Nursing Action Precautions administration Glucocorticoids: antiemetic Usually used in Adrenal Glucocorticoids are CNS depressants (opioids and prevent or treat dexamethasone mechanism is combination with other insufficiency, contraindicated in clients alcohol) can intensify CNS nausea and unknown antiemetics to treat infection, who have active, untreated depression of antiemetics. vomiting chemotherapy-induced osteoporosis, infection, hypersensitivity. glucose  nausea and vomiting intolerance, Avoid long term use during Concurrent use of (CINV). peptic ulcer lactation. antihypertensives can intensify disease, sodium hypotensive effects of Administer PO or IV retention, and antiemetics. hypokalemia. Substance Inhibits substance For best results, it should Fatigue, Aprepitant is CNS depressants (opioids and To prevent P/neurokinin1 P/neurokinin1 in be used in combination diarrhea, contraindicated for clients alcohol) can intensify CNS postoperative antagonists: the brain with a glucocorticoid and dizziness, taking pimozide or are depression of antiemetics. nausea and aprepitant serotonin antagonist to possible liver breastfeeding. It should be vomiting, prevent postoperative damage used cautiously in children Concurrent use of administer a single nausea, vomiting, and and in clients who have antihypertensives can intensify dose within three CINV. severe liver and kidney hypotensive effects of hours of anesthesia disease. antiemetics. induction. Extended duration of action makes it effective Aprepitant can decrease the For CINV, for immediate use and effectiveness of warfarin and administer one hour delayed response. ethinyl estradiol, and increase before the levels of glucocorticoids. chemotherapy. The Administer PO or IV. Many medications can alter the client will take one blood levels of aprepitant. dose daily the next two days. Serotonin Prevents emesis by Prevents emesis related to Headache, Ondansetron is CNS depressants (opioids and Administer IV 1 our antagonist: blocking the chemotherapy, radiation diarrhea, contraindicated in clients alcohol) can intensify CNS before ondansetron, serotonin therapy, and postoperative dizziness who have long QT syndrome. depression of antiemetics. chemotherapy, or granisetron receptors in the recovery. PO 1 hour before chemoreceptor Prolonged QT Concurrent use of anesthesia to trigger zone (CTZ), Off-label uses include interval can lead antihypertensives can intensify prevent nausea and and antagonizing treatment of nausea and to a serious hypotensive effects of vomiting the serotonin vomiting related to dysrhythmia antiemetics. receptors on the pregnancy and childhood (torsades de For clients receiving afferent vagal viral gastritis. pointes). radiation, neurons that travel administer PO three from the upper GI Administer PO, IM, or IV. times a day tract to the CTZ. Dopamine Antiemetic effects Prevents emesis related to Extrapyramidal Promethazine is CNS depressants (opioids and Obtain orthostatic antagonists: result from chemotherapy, toxins, and symptoms contraindicated in children alcohol) can intensify CNS blood pressure and prochlorperazine blockade of postoperative recovery. (EPSs) younger than 2 years old and depression of pulse readings, (a phenothiazine), dopamine should be used with extreme antiemetics. respiratory rate, and metoclopramide, receptors in the Administer PO, IM, rectal, Hypotension caution in older children. ECG before therapy, promethazine CTZ or IV Respiratory depression from Concurrent use of and periodically. Sedation promethazine can be severe. antihypertensives can intensify Monitor for Q- and hypotensive effects of T-wave changes. Dry mouth, Dopamine antagonists, antiemetics. urinary antihistamines, and retention, anticholinergic antiemetics constipation should be used cautiously in clients who have urinary retention or obstruction, asthma, and narrow angle glaucoma Use dopamine antagonists cautiously, if at all, with children and older adults due to the increased risk of extrapyramidal manifestations. Cannabinoids: Antiemetic - To control CINV - Potential - CNS depressants (opioids - For appetite dronabinol mechanism is and to increase for and alcohol) can intensify stimulation, unknown appetite in clients dissocia CNS depression of administer who have AIDS. tion, antiemetics. before lunch Reserved as dysphori - Concurrent use of and supper. second-line a antihypertensives can For emesis therapy who - Hypoten intensify hypotensive prevention, cannot take or was sion, effects of antiemetics. administer not responsive to tachycar every 4 hr as other medications. dia needed. - Administer PO Anticholinergic: Interferes - Prevention and - Sedation Dopamine antagonists, - CNS depressants (opioids - To prevent scopolamine with the treatment of - Anticholi antihistamines, and and alcohol) can intensify motion transmission of motion sickness. nergic anticholinergic antiemetics CNS depression of sickness, nerve impulses - Administer effects should be used cautiously in antiemetics. apply traveling from the transdermally, PO, clients who have urinary - Concurrent use of transdermal vestibular IV, or retention or obstruction, antihypertensives can patch apparatus of the subcutaneously asthma, and narrow angle intensify hypotensive behind the inner ear to the glaucoma effects of antiemetics. ear four vomiting center - Concurrent use of hours before (VC) in the brain. anticholinergic travel or medications take the (antihistamines) can tablet one intensify anticholinergic hour before effects of antiemetics. travel Antihistamines: Muscarinic and - Treats motion - Sedation Dopamine antagonists, - CNS depressants (opioids - prevent or dimenhydrinate, histaminergic sickness. - Anticholi antihistamines, and and alcohol) can intensify treat nausea hydroxyzine receptors in nerve - Administer PO, IM, nergic anticholinergic antiemetics CNS depression of and vomiting pathways that or IV. effects should be used cautiously in antiemetics. connect the inner clients who have urinary - Concurrent use of ear and VC are retention or obstruction, antihypertensives can blocked. asthma, and narrow angle intensify hypotensive glaucoma effects of antiemetics. Benzodiazepines: Depresses nerve - Used in - Sedation Lorazepam is - CNS depressants (opioids - Administer lorazepam function at combination with and contraindicated for clients and alcohol) can intensify with food to multiple CNS sites other medications complex who have CNS depression, CNS depression of prevent GI to suppress CINV sleep- angle-closure glaucoma, antiemetics. upset. by causing related severe hypotension or - Concurrent use of sedation, behavior uncontrolled, severe pain. antihypertensives can anterograde s Can cause fetal harm during intensify hypotensive amnesia, and - Paradoxi the third trimester of effects of antiemetics. emesis cal pregnancy, and adverse suppression. effects effects to the breastfeeding - Administer PO, IM, infant. or IV  LAXATIVES Pharmacological Therapeutic Use Complications Contraindications/ Interaction Nursing Nursing Evaluation Action Precautions administration Of Medication Effectiveness Bulk‑forming Bulk-forming laxatives - For temporary Bulk-forming agents Applicable to all take bulk-forming Depending on laxatives: soften fecal mass and treatment of can cause obstruction - Laxatives are and surfactant therapeutic intent, psyllium increase bulk, which constipation. of the esophagus or contraindicated laxatives with 8 oz effectiveness can be evidenced by the is identical to the intestines. in clients who water. following. action of dietary fiber. Decrease diarrhea in clients have fecal - Return to who have diverticulosis and impaction, regular IBS. bowel bowel Control stool for clients obstruction, and function who have an ileostomy or acute surgical - Evacuation colostomy. abdomen to of bowel in preparation Surfactant Surfactant laxatives Treatment of constipation. Laxatives with sodium prevent take bulk-forming for surgery laxatives: lower surface tension salts (sodium perforation. and surfactant or docusate of the stool to allow Softening of fecal phosphate) place - Laxatives are laxatives with 8 oz diagnostic sodium penetration of water. impaction. clients at risk for contraindicated water. tests This softens the stool sodium absorption in clients who so it can be passed and fluid retention have nausea, more easily. cramping, and Stimulant Stimulate intestinal Bowel preparation prior to Do not crush or chew abdominal pain. Milk and Administer laxatives: peristalsis and surgery or diagnostic tests enteric-coated - Laxatives, with antacids can bisacodyl at bisacodyl, increase the volume (including colonoscopy). tablets. the exception of destroy bedtime for senna of water and bulk-forming enteric results in 6 to 12 electrolytes in the Short-term treatment of Do not use bisacodyl laxatives, are coating of hr. intestines constipation caused by suppositories on a contraindicated bisacodyl. Bisacodyl high-dose opioid use or regular basis. in clients who suppositories are slow intestinal transit. have ulcerative effective within an colitis and hour. Osmotic Osmotic laxatives Low dose: Laxatives with diverticulitis. laxatives: draw water into the magnesium salts  magnesium intestine to increase - Prevent painful (magnesium - Use cautiously hydroxide, the mass of stool, elimination (clients hydroxide) can lead to during lactulose stretching who have accumulation of toxic pregnancy and musculature, which episiotomy or levels of magnesium. lactation. results in peristalsis. hemorrhoids). Bisacodyl and High dose: Osmotic diuretics can docusate are - Client preparation cause dehydration Pregnancy Risk prior to surgery or Category C diagnostic tests (a colonoscopy). - Rapid evacuation of the bowel after ingestion of poisons or following anthelmintic therapy to rid the body of dead parasites ANTIDIARRHEALS Pharmacological Therapeutic Complications Contraindications/ Interaction Nursing administration Nursing Action Use Precautions Evaluation Of Medication Effectiveness Diphenoxylate Antidiarrheals Specific At recommended There is an increased risk Alcohol and Administer initial dose of Depending on plus atropine, activate opioid antidiarrheal doses for diarrhea, of megacolon in clients other CNS diphenoxylate plus atropine 5 therapeutic Loperamide, receptors in the GI agents can be diphenoxylate does who have inflammatory depressants mg, and monitor client intent, Paregoric tract to decrease used to treat not affect the CNS bowel disorders. This can enhance response, administering further effectiveness intestinal motility the underlying system. could lead to a serious CNS medication as needed. The can be and to increase cause of complication (perforation depression maximum dose 8 tabs/day. evidenced by the absorption of diarrhea. For At high doses, clients of the bowel). return of normal fluid and sodium example, can experience Loperamide is an analog of the bowel pattern as in the intestine antibiotics can typical opioid Diphenoxylate is opioid meperidine. This evidenced by be used to effects, (euphoria or contraindicated in clients medication is not a controlled decrease in  treat diarrhea CNS depression). who have severe substance, and at high doses frequency and caused by a However, the electrolyte imbalance or does not mimic morphine-like fluid volume of bacterial addition of atropine, dehydration. It is a effects. stool. infection. which has Schedule V agent under Nonspecific unpleasant adverse the Controlled Substances Clients who have severe cases antidiarrheal effects (blurred Act (CSA). of diarrhea can be hospitalized agents vision, dry mouth, for management of dehydration. minimize the urinary retention, Paregoric is manifestation constipation, contraindicated in clients Management of dehydration s of diarrhea tachycardia) in who have COPD. It is a should include monitoring of (decrease in diphenoxylate Schedule III CSA agent. weight, I&O, and vital signs. A frequency and discourages hypotonic solution (0.45% fluid content ingestion of doses Antidiarrheals are sodium chloride) might be of stool) higher than those Pregnancy Risk Category prescribed. prescribed. C. PROKINETIC AGENTS Pharmacological Therapeutic Use Complications Contraindications/ Interaction Nursing Nursing Evaluation Action Precautions administration Of Medication Effectiveness Metoclopramide Metoclopramide The IV form is used for Tardive Contraindicated in Concurrent use of Monitor for CNS Depending on controls nausea control of dyskinesia: A clients who have GI alcohol and other depression and therapeutic intent, and vomiting by postoperative and complication of perforation, GI CNS depressants EPSs. effectiveness can blocking chemotherapy- high-dose, long- bleeding, bowel increases the risk of be evidenced by dopamine and induced nausea and term therapy. obstruction, and seizures and The medication can absence of nausea serotonin vomiting, as well as hemorrhage. sedation. be given orally or IV. and vomiting receptors in the facilitation of small Extrapyramidal If the IV dose 10 mg CTZ which bowel intubation and symptoms Contraindicated in Opioids and or less, it can be reduces the examination of the GI clients who have a anticholinergics administered IVP stimulus to empty tract. Sedation seizure disorder due decrease the effects undiluted over 2 the bowels. to an increased risk of of metoclopramide. min. If the dose is The oral form is used Diarrhea seizures. greater than 10 mg, for diabetic it should be diluted  Metoclopramide gastroparesis Use cautiously in and infused over 15 augments action (delayed stomach children and older min. Dilute the of acetylcholine, emptying with gas and adults due to the medication in at which causes an bloating) and increased risk for EPS least 50 mL increase in upper management of GERD dextrose 5% in GI motility, through its ability to water, sodium increasing increase gastric chloride, or lactated peristalsis. motility. Ringer’s. MEDICATIONS FOR IRRITABLE BOWEL SYNDROME WITH DIARRHEA (IBS-D) Pharmacological Therapeutic Use Complications Contraindications/ Interaction Nursing administration Nursing Evaluation Action Precautions Of Medication Effectiveness Alosetron Selective blockade Approved only for Constipation: Contraindicated for clients Medications Alosetron can only be Depending on of 5-HT3 receptors, female clients who Can result in GI who have chronic that affect prescribed by providers therapeutic intent, which innervate the have severe IBS-D toxicity constipation, history of cytochrome enrolled in a special risk effectiveness can viscera and result in that has lasted more (ischemic bowel obstruction, Crohn’s P450 enzymes management program. The be evidenced by increased firmness than 6 months colitis, bowel disease, ulcerative colitis, (phenobarbital) client must sign a Client- relief of diarrhea, in stool and and has been obstruction, impaired intestinal can alter levels Physician Agreement and decrease in decrease in urgency resistant to impaction, or circulation, diverticulitis, a of alosetron. discussing risks and urgency and and frequency of conventional perforation). history of toxic megacolon, benefits, and indications frequency of defecation management. GI perforation or adhesions, that the medication must defecation or thrombophlebitis. be stopped MEDICATIONS FOR IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (IBS-C) Pharmacological Therapeutic Use Complications Contraindications/ Nursing administration Nursing Action Precautions Evaluation Of Medication Effectiveness Lubiprostone Increases fluid Irritable bowel - Diarrhea Pregnancy Risk Dosing for IBS-C is lower than for chronic Depending on secretion in the syndrome with - Nausea Category C idiopathic constipation or opioid-induced therapeutic intent, intestine to constipation. effectiveness can  promote intestinal constipation in Contraindicated for be evidenced by motility females clients who have Oral dosage should be taken BID. relief of bowel obstruction constipation. Chronic constipation Take the medication with food to decrease nausea. MEDICATIONS FOR INFLAMMATORY BOWEL DISEASE Pharmacological Therapeutic Use Complications Contraindications/ Interaction Nursing Nursing Action Precautions administration Evaluation Of Medication Effectiveness Sulfasalazine A Management of Blood disorders Clients who are pregnant, Iron and Administer with Depending on 5-aminoslicylate Crohn’s disease plan to become pregnant, antibiotics can food or after meals. therapeutic intent, 5‑aminosalicylates: that decreases Nausea, fever, or who are breastfeeding alter the effectiveness can Mesalamine, inflammation by Relief of mild to rash, arthralgia should consult the absorption of Ensure at least be evidenced by olsalazine inhibiting moderate acute provider about continued sulfasalazine. 1,200 to 1,500 mL the following. Glucocorticoids: prostaglandin episodes of use of sulfasalazine. of daily fluid intake - Decreased Hydrocortisone synthesis ulcerative colitis. Mesalamine can to prevent bowel Immunosuppressants 5-aminosalicylates are decrease the crystalluria and inflammati : Azathioprine contraindicated in clients absorption of some calculi formation. on and Immunomodulator: who have sensitivity to medications, relief of GI Infliximab sulfonamides, salicylates, including digoxin Ensure that distress Antibiotics: or thiazide diuretics. and oral controlled-release - Return to Metronidazole antidiabetic and enteric-coated normal Use cautiously in clients medications forms of the bowel who have liver or kidney medications are function disease or blood not crushed or dyscrasias. chewed PROBIOTICS: DIETARY SUPPLEMENTS Pharmacological Action Therapeutic Use Complications Interaction Probiotics: Various preparations of bacteria and yeast, which Probiotics are used to treat the Flatulence and bloating If antibiotics or antifungals Dietary are normal flora of the intestine and colon, help to manifestations of IBS, are used concurrently, they supplements metabolize foods, promote nutrient absorption, and ulcerative colitis, and should be administered at  reduce colonization by pathogenic bacteria. They Clostridium difficile- Infection has been reported among clients least 2 hr apart from also can increase nonspecific cellular and humoral associated diarrhea and who are severely ill or immunocompromise probiotics. immunity. rotavirus diarrhea in children. after long-term antibiotic use. MEDICATIONS FOR HIATAL HERNIA see other info on peptic ulcer Pharmacological Action Nursing Evaluation Of Medication Effectiveness PROTON PUMP INHIBITORS: Omeprazole, Proton pump inhibitors block the final step of gastric acid Reduced frequency of manifestations of hiatal hernia Esomeprazole, Lansoprazole production to prevent reflux in sliding hiatal hernia (heartburn, belching, and dysphagia). ANTACIDS: Aluminum hydroxide, Sodium bicarbonate, Antacids neutralize gastric acid to provide relief of Calcium carbonate manifestations (heartburn, belching, dysphagia). VITAMINS AND MINERALS Vitamins and minerals have important roles in the body, including the production of red blood cells, building bones, making hormones, regulating body fluid volume, and supporting nerve cell function. Vitamin and mineral deficiencies can increase the risk for health problems (anemias, heart disease, cancers, and osteoporosis). Supplements of vitamins and minerals can help prevent multiple health conditions. IRON PREPARATIONS Pharmacological Therapeutic Use Complications Contraindications/ Nursing administration Nursing Evaluation Action Precautions Of Medication Effectiveness Oral: Ferrous Iron preparations Iron preparations are used to GI distress (nausea, Contraindicated for Take iron on an empty Depending on sulfate, provide iron treat and prevent iron-deficiency constipation, clients who have stomach (1 hr before meals) as therapeutic intent, Ferrous needed for RBC anemia. heartburn) previous stomach acid increases effectiveness is gluconate, development and - Ferumoxytol is limited to hypersensitivity to absorption. evidenced by the ferrous oxygen transport clients who have chronic Teeth staining (liquid iron, anemias other following. fumarate to cells. During kidney disease, form) than iron-deficiency Take with food if GI adverse - Increased Parenteral: times of increased regardless if on dialysis or anemia. effects occur. This might reticulocyte Iron dextran, growth (in growing receiving erythropoietin. Staining of skin and increase adherence to therapy count is Ferumoxytol, children or during Ferumoxytol requires only other tissues (IM Oral preparations even though absorption is also expected iron sucrose, pregnancy) or two doses over 3 to 8 days injections) should be used with decreased. within 4 to 7 sodium-ferric when RBCs are in compared with SFGC and caution in clients days after  gluconate high demand iron sucrose, which Anaphylaxis who have peptic Space doses at approximately beginning iron complex (after blood loss), require 3 to 10 doses over - Risk with ulcer disease, equal intervals throughout day therapy. (SFGC) the need for iron several weeks. parenteral regional enteritis, to most efficiently increase red - Increase in can be greatly - SFGC is used for clients administration ulcerative colitis, blood cell production. hemoglobin of increased. Iron is who are undergoing long- of iron dextran. and severe liver 2 g/dL is poorly absorbed term hemodialysis and - Anaphylaxis is disease Anticipate a harmless dark expected 1 by the body, so are deficient in iron. It is triggered by the green or black color of stool. month after relatively large always used along with dextran in iron Concurrent Dilute liquid iron with water or beginning amounts must be erythropoietin. dextran, not by administration of juice, drink with a straw, and therapy. ingested orally to - Iron sucrose is used for the iron. antacids or rinse the mouth after - Fatigue and increase Hgb and clients who have chronic - Anaphylaxis is tetracyclines swallowing. pallor (skin, Hct levels kidney disease, are minimal with reduces absorption mucous receiving erythropoietin, SFGC, iron of iron. Increase water and fiber intake membranes) and are hemodialysis- or sucrose, and (unless contraindicated) and should peritoneal dialysis- ferumoxytol Caffeine and dairy maintain an exercise program subside, and dependent; and clients products can to counter the constipation the client who have chronic kidney Hypotension, Can interfere with effects. reports disease, are not receiving progress to circulatory absorption. increased erythropoietin, and are collapse with Therapy can last 1 to 2 energy level. not dialysis-dependent. parenteral Food reduces months. Usually, dietary Iron preparations are used to administration absorption but intake will be sufficient after prevent iron deficiency anemia reduces gastric Hgb has returned to a for clients who are at an Fatal iron toxicity in distress. therapeutic level. increased risk (infants, children, children, Can occur and pregnant clients). when an overdose of Perform concurrent intake of Parenteral forms should only be iron (2 to 10 g) is appropriate quantities of foods used in clients who are unable to ingested high in iron (liver, egg yolks, take oral medications, in which muscle meats, yeast, grains, case the IV route is preferred green leafy vegetables). VITAMIN B12/CYANOCOBALAMIN Pharmacological Action Therapeutic Complications Contraindications/ Interaction Nursing administration Nursing Use Precautions Evaluation Of  Medication Effectiveness Vitamin B12 Vitamin B12 is necessary to Treatment of Hypokalemia Moderate vitamin Masks Monitor for manifestations Depending on convert folic acid from its vitamin B12 B12 deficiency can manifestations of vitamin B12 deficiency therapeutic intent, OTHER inactive form to its active form. deficiency be managed with of vitamin B12 (beefy red tongue, pallor, effectiveness can All cells rely on folic acid for vitamin B12 alone. and neuropathy). be evidenced by MEDICATIONS: deficiency with DNA production. Megaloblasti the following. Intranasal Vitamin B12 deficiency can c Severe vitamin B12 concurrent Clients who have - Disappeara cyancobalamin result in megaloblastic (macrocytic) deficiency should administration malabsorption syndrome nce of (macrocytic) anemia and anemia be treated with of folic acid can use intranasal or megaloblas cause dysrhythmias and heart related to vitamin B12 and parenteral preparations. ts (in 2 to 3 failure if not corrected. vitamin B12 folic acid weeks) Damage to rapidly multiplying deficiency Intranasal cyanocobalamin - Increased cells can affect the skin and Oral and intranasal should be administered 1 hr reticulocyte mucous membranes, causing cyanocobalamin are before or after eating hot count GI disturbances. Neurologic Pregnancy Risk foods, which can cause the - Increase in damage, which includes Category A. medication to be removed hematocrit numbness and tingling of from nasal passages - Improveme extremities and CNS damage Parenteral without being absorbed, nt of caused by demyelination of cyanocobalamin is because of increased nasal neurologic neurons, can result from secretions. injury Pregnancy Risk deficiency of this vitamin. (absence of Vitamin B12 deficiency affects Category C. Clients who have tingling all blood cells produced in the irreversible malabsorption sensation bone marrow. syndrome (parietal cell of hands - Loss of erythrocytes atrophy or total and feet leads to heart failure, gastrectomy) will need and cerebral vascular lifelong treatment, usually numbness insufficiency, and parenterally. If oral therapy of hypoxia. is used, doses must be very extremities) - Loss of leukocytes high. Improveme leads to infections nt can take - Loss of thrombocytes Encourage concurrent months, leads to bleeding and intake of quantities of foods and some hemorrhage. high in vitamin B12 (dairy clients - Loss of intrinsic factor products). never attain within the cells of the full stomach causes an Perform a Schilling test to recovery. inability to absorb determine vitamin B12  vitamin B12, making it absorption in the necessary to gastrointestinal tract. administer parenteral or intranasal vitamin Monitor blood counts and B12 or high doses of vitamin B12 levels every 3 to oral B12 for the rest of 6 months. the client’s life. FOLIC ACID Pharmacological Therapeutic Use Contraindications/ Interaction Nursing administration Nursing Evaluation Of Action Precautions Medication Effectiveness Folic acid Folic acid is Treatment of megaloblastic Avoid indiscriminate Folic acid levels Assess for manifestations of Depending on therapeutic essential in the (macrocytic) anemia use of folic acid to are decreased by megaloblastic anemia (pallor, easy intent, effectiveness is production of DNA secondary to folic acid reduce the risk of methotrexate fatigability, palpitations, evidenced by the following. deficiency and erythropoiesis Masking and paresthesias of hands or feet). - Folate level within (RBC, WBC, and Prevention of neural tube manifestations of sulfonamides. expected reference platelets). defects that can occur early vitamin B12 Obtain baseline folic acid, Hgb and range during pregnancy (thus deficiency. Folic acid can Hct levels, and RBC and - Return of RBC, needed for all females of decrease reticulocyte counts. Monitor reticulocyte count, and child-bearing age who might phenytoin blood periodically. Hgb and Hct to levels become pregnant) levels because of within expected increased If with folic acid deficiency, reference range Treatment of malabsorption syndrome (sprue) metabolism. concurrently increase intake of - Improvement of food sources of folic acid (liver, anemia findings Supplement for alcohol use green leafy vegetables, citrus fruits, (absence of pallor, disorder (due to poor dietary and dried peas and beans). Monitor dyspnea, easy intake of folic acid and injury for risk factors indicating that folic fatigability) to the liver acid therapy is needed (heavy - Absence of neural tube alcohol use and child-bearing age). defects in newborns POTASSIUM SUPPLEMENTS Pharmacological Therapeutic Complications Contraindications/ Interaction Nursing administration Nursing Action Use Precautions Evaluation Of Medication Effectiveness Potassium Potassium is Treating Local GI Contraindicated for Concurrent use ORAL FORMULATIONS Depending on chloride, essential for hypokalemia ulceration and clients who have of potassium- - Mix powdered formulations in at therapeutic Potassium conducting nerve (potassium less GI distress, severe kidney sparing diuretics least 90 mL to 240 mL (3 to 8 oz) of intent, gluconate, impulses, than 3.5 mEq/L). Nausea, disease (spironolactone) cold water or juice and drink slowly effectiveness is Potassium maintaining vomiting, or or ACE over 5 to 10 min. evidenced by phosphate, electrical For clients diarrhea, hypoaldosteronism inhibitors - Effervescent tablets should be blood Potassium excitability of receiving abdominal (lisinopril) dissolved in 90 mL to 240 mL (3 to 8 potassium level bicarbonate muscle, and diuretics discomfort, increases the oz) of cold water. within the regulation of resulting in and risk of Client education expected acid/base potassium loss esophagitis hyperkalemia. - Take potassium chloride with a meal reference range balance. (furosemide) with oral or at least 8 oz of water to reduce (3.5 to 5.0 administration the risk of adverse GI effects. mEq/L) For clients who - Do not to crush or chew extended- have potassium Hyperkalemia release tablets. loss due to (potassium - Notify the provider of any difficulty excessive or more than 5.0 swallowing thepills. Medication can prolonged mEq/L) be supplied as a powder or a vomiting, sustained-release tablet that is diarrhea, easier to tolerate. excessive use of IV ADMINISTRATION laxatives, - Never administer IV bolus. Rapid IV intestinal infusion can result in fatal drainage, and GI hyperkalemia. fistula - Use an IV infusion pump to control the infusion rate. - Dilute potassium and give no more than 40 mEq/L of IV solution to prevent vein irritation. - Infuse slowly, generally no faster than 10 mEq/hr. - Cardiac monitoring is indicated for blood potassium levels outside of expected reference ranges. ECG changes (prolonged PR interval and  peaked T-waves) can indicate potassium toxicity. - Infuse potassium through a large bore needle. Assess the IV site for local irritation, phlebitis, and infiltration. Discontinue the IV immediately if infiltration occurs. - Monitor I&O to ensure an adequate urine output of at least 30 mL/hr MAGNESIUM SULFATE Pharmacological Therapeutic Use Complications Contraindications/ Interaction Nursing administration Nursing Action Precautions Evaluation Of Medication Effectiveness Parenteral: Magnesium Magnesium Muscle Avoid administering Magnesium NURSING CARE Depending on Magnesium activates many supplements are used weakness, within 2 hr of sulfate can - Monitor blood magnesium, therapeutic sulfate intracellular for clients who have flaccid delivery. Present in decrease the calcium, and phosphorus. intent, Oral: enzymes, binds hypomagnesemia paralysis, milk during absorption of - Monitor blood pressure, heart effectiveness is Magnesium the messenger (magnesium level less painful muscle lactation. tetracyclines rate, and respiratory rate when evidenced by hydroxide, RNA to than 1.3 mEq/L). contractions, and digoxin. given intravenously. blood magnesium ribosomes, and suppression of Contraindicated in - Assess for depressed or magnesium oxide, plays a role in Oral preparations of AV conduction clients who have AV Monitor the absent deep tendon reflexes levels within magnesium regulating skeletal magnesium sulfate are through the block, rectal therapeutic as a manifestation of toxicity. expected citrate muscle used to prevent or treat heart, bleeding, nausea, effect to - Calcium gluconate is given for reference range contractility and low magnesium levels respiratory vomiting, and determine if magnesium sulfate toxicity. (1.3 to 2.1 magnesium blood and as laxatives. depression abdominal pain. absorption Always have an injectable form mEq/L) hydroxide coagulation. has been of calcium gluconate available and Parenteral magnesium Diarrhea Use cautiously with affected when administering magnesium is used for clients who clients who have magnesium sulfate by IV. oxide act as have severe renal and/or cardiac - Teach clients about dietary antacids hypomagnesemia. disease sources of magnesium when (whole‑grain cereals, nuts, administered  in a low dose, IV magnesium sulfate is legumes, green leafy and all three used to stop preterm vegetables, bananas) act as labor and as an laxatives anticonvulsant during labor and delivery. MEDICATIONS AFFECTING URINARY OUTPUT Indications for medications that affect urinary output include management of blood pressure; excretion f edematous fluid related to heart failure and kidney and liver disease; and prevention of failure. Medications include high-ceiling loop diuretics, thiazide diuretics, potassium sparing diuretics, and osmotic diuretics. HIGH-CEILING LOOP DIURETICS Pharmacological Therapeutic Use Complications Contraindications/ Interactions Nursing Administration Action Precautions Furosemide High-ceiling loop High-ceiling loop - Dehydration, Avoid using these Digoxin toxicity Avoid administering the medication diuretics work in the diuretics are used hyponatremia, medications during (ventricular late in the day to prevent nocturia. OTHER loop of Henle. when there is an hypochloremia pregnancy unless dysrythmias) can MEDICATIONS: - Block emergent need for - Hypotension absolutely required. Due occur in the presence If potassium level drops below 3.5 Ethacrynic reabsorption rapid mobilization of - Ototoxicity to excessive diuresis, of hypokalemia. mEq/L, monitor the ECG, and notify acid of sodium fluid. - Hypokalemia furosemide can the provider because the client might Bumetanide and - Pulmonary decrease milk Concurrent use of require a potassium supplement. Torsemide chloride, edema cause production in antihypertensives an and water by heart breastfeeding clients’s. have additive Client education: - Causes failure hypotensive effect. Report significant weight loss, extensive - Conditions Contraindicated in lightheadedness, dizziness, GI diuresis not clients who have anuria Lithium carbon blood distress, or general weakness to the even with responsive to (no urine output). levels can increase, provider. These can indicate severe renal other which can lead to hypokalemia or hypovolemia. impairment diuretics Use cautiously in clients toxicity, if (edema who have cardiovascular hyponatremia occurs Consume foods high in potassium. caused by disease, DM, due to loop diuretics. liver, cardiac, dehydration, electrolyte Obsreve manifestations of low or kidney depletion, and gout. Use NSAIDs decrease magnesium levels (weakness, cautiously in clients blood flow to the muscle twitching, tremors), low  disease, or taking digoxin, lithium, kidneys, which calcium levels (muscle twitching, hypertension) ototoxic medications, reduces the diuretic muscle cramps, tingling in hands and NSAIDs, or effect. feet), and ototoxicity (tinnitus or antihypertensives. hearing loss). THIAZIDE DIURETICS Pharmacological Therapeutic Use Complications Contraindications/ Interactions Nursing Administration Action Precautions Hydrochlorothiazide THIAZIDE Often the - Dehydration and Avoid during pregnancy Medication Monitor potassium levels, weight, blood diuretics work in medication of first hyponatremia because the and food pressure, I&O, OTHER early distal choice for essential - Hypokalemia and medication decreases interactions MEDICATIONS: consulted tubule. hypertension hypochloremia maternal blood volume are same as Alternate-day dosing can decrease Chlorothiazide - Hyperglycemia and placental for loop electrolyte imbalances Methylclothiazide Blocks the Use for edema of - Hyperuricemia, perfusion, reducing diuretics Thiazide-type reabsorption of mild to moderate hypomagnesemia, nutrients supplied to If potassium level drops below 3.5 mEq/L, diuretics sodium and heart failure and increased lipids the fetus Cause no monitor the ECG, and notify the provider - Indapamine chloride, and liver and kidney risk of because the client might require a - Chlorthalidone presents the disease During lactation, hearing loss potassium supplement. - Metolazone reabsorption of advise clients not to and can be water at this site Used in breastfeed, diuretics combined Client education: