1Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Chapter 18Chapter 18

Gastrointestinal Medications

2Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Chapter 18

Lesson 18.1

3Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Learning ObjectivesLearning Objectives

• Identify common uses for antacids and histamine H2-receptor antagonists

• Compare and contrast the actions of anticholinergic and antispasmodic medications on the gastrointestinal (GI) tract

• Compare the actions and adverse reactions of the five major classifications of laxatives

4Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Learning Objectives (cont.)Learning Objectives (cont.)

• Identify indications for the use of at least two common antidiarrheals, antiflatulents, digestive enzymes, and emetics

• Describe indications for disulfiram use and what is meant by "disulfiram reaction"

5Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Overview Overview

• Three major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colon

• Miscellaneous medications: antiflatulants, digestive enzymes, emetics, and medications to treat gallstones and alcoholism

6Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Digestive System Digestive System

• Functions

• Structures

• Protective factors

• Digestion variables

7Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Digestive SystemDigestive System

8Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors

• Stomach lining and acid production

• External factors that contribute to ulcer formation

• Protective medications

• Table 18-1

9Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Action and Uses• Antacids neutralize hydrochloric acid and

decrease gastric pH; inhibit pepsin• Histamine H2-receptor antagonists displace

histamine from the receptor site and prevent stimulation of the secretory cells (neutralize acid and promote healing of ulcers)

• Proton pump inhibitors irreversibly stop the acid secretory pump imbedded in the parietal cells

10Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Adverse Reactions• Antacids: weakness, anorexia, diarrhea, frequent

burping, bowel obstruction, constipation, hypermagnesemia

• H2-receptor antagonists: dizziness, headache, somnolence, mild/brief diarrhea, hematology changes, muscle pain

• Proton pump inhibitors: headache, diarrhea, abdominal pain, and nausea; rarely rash, vomiting, and dizziness

11Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Drug Interactions • Antacids prevent absorption of many drugs• Dicumarol absorbed 50% faster when taken

with antacids

12Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)

Nursing Implications and Patient Teaching• Assessment: interaction possibilities• Diagnosis: smoking/alcohol intake, stress• Planning: increase fluid intake• Implementation: forms and routes of administration vary• Evaluation: continued symptoms of GI distress• Patient and Family Teaching: administration times and

drug specificity, adverse reactions, drug storage and efficacy, medical follow-up, drug interactions

13Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Anticholinergics and Antispasmodics

Anticholinergics and Antispasmodics

• Motility

• Symptoms

• Classes of medications: anticholinergics, antispasmodics, antidiarrheals

• Table 18-2

14Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Anticholinergics and Antispasmodics (cont.)

Anticholinergics and Antispasmodics (cont.)

Action and Uses • Anticholinergic-antispasmodic preparations reduce GI

tract spasm and intestinal motility, acid production, and gastric motility, thus reducing pain– Use: peptic ulcer, pylorospasm, biliary colic, hypermotility,

irritable colon, and acute pancreatitis

• Antidiarrheals reduce the fluid content of the stool and decrease peristalsis and motility of the intestinal tract; increase smooth-muscle tone and diminish secretions– Use: treatment of nonspecific diarrhea or diarrhea caused by

antibiotics

15Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Anticholinergics and Antispasmodics (cont.)

Anticholinergics and Antispasmodics (cont.)

Adverse Reactions • Anticholinergics: due to high dosages• Antidiarrheals

16Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Anticholinergics and Antispasmodics (cont.)

Anticholinergics and Antispasmodics (cont.)

Drug Interactions • New GI stimulants, when combined with other

drugs that inhibit cytochrome P-450 4A4 systems, should be monitored for cardiac dysrhythmias

Nursing Implications and Patient Teaching • Assessment, diagnosis, planning,

implementation, and evaluation

17Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Laxatives Laxatives

• Aid in the elimination of stool from the rectum

• Bulk-forming agents• Fecal softeners• Hyperosmolar or saline solutions• Lubricants• Stimulant or irritant laxatives• Tables 18-3 and 18-4

18Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Laxatives (cont.)Laxatives (cont.)

Action and Uses • Bulk-forming laxatives absorb water and expand,

increasing the bulk and moisture content of the stool; peristalsis increases, and absorbed water softens the stool

• Fecal softeners lower the surface tension, which allows the fecal mass to be softened by intestinal fluids

• Hyperosmolar laxatives produce an osmotic effect by drawing water into the bowel, thereby promoting peristalsis and bowel movement

19Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Laxatives (cont.)Laxatives (cont.)

Action and Uses (cont.) • Lubricant laxatives create a barrier between

feces and the colon, preventing colon reabsorption and causing softening of the stool

• Stimulant or irritant laxatives work according to the agent

20Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Laxatives (cont.)Laxatives (cont.)

Adverse Reactions • Nausea and vomiting, obstruction,

hypersensitivity

• Cramping, diarrhea

• Electrolyte disturbances

21Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Laxatives (cont.)Laxatives (cont.)

Drug Interactions • Reduced effectiveness of antibiotics,

anticoagulants, digitalis, and salicylates when combined with laxatives

Nursing Implications and Patient Teaching • Assessment (CHF)

22Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Miscellaneous Gastrointestinal Drugs

Miscellaneous Gastrointestinal Drugs

• Antiflatulents

• Pancreatic digestive enzymes

• Emetics

• Disulfiram

• Table 18-5

23Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Antiflatulents Antiflatulents

• Break up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric pain

• Intended for short-term use

24Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Gallstone-Solubilizing Agents Gallstone-Solubilizing Agents

• Act on the liver to suppress cholesterol and cholic acid synthesis; biliary cholesterol desaturation is enhanced, and breakup occurs

• Used in selected patients with radiolucent stones in gallbladder

• Adverse reactions: dose related; diarrhea, anorexia, constipation, cramps, dyspepsia, epigastric distress, flatulence, heartburn, nausea, nonspecific abdominal pain, and vomiting

25Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Digestive Enzymes Digestive Enzymes

• Promote digestion by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking, not secreted, or not properly absorbed

26Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Disulfiram Disulfiram

• Used in the management of alcoholism

• Unpleasant reaction when combined with alcohol

27Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Emetics Emetics

• Used in emergencies to induce vomiting

• Poison Control Center

• Gastric lavage

• Syrup of ipecac

• Apomorphone

28Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

Complementary and Alternative TherapiesComplementary and Alternative Therapies

• Common products

• Conditions

• Drug interactions