Pharmacology Gastrointestinal drugs from powerpoint

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Antiulcer Drugs:
Include antacids, Histamine Antagonists,
Antacids:
Neutralize gastric acid
Histamine (H2) Receptor Antagonist:
Inhibit production of gastric acid
Mucosal Protectants:
Protect gastric mucosa by coating wall of stomach or ulcer crater
Gastric Acid (Proton Pump) Inhibitors:
Suppress gastric acid secretion at final step of production process
Helicobacter Pylori:
Bacteria associated with about 65% of all peptic ulcers
Laxative:
Used to treat constipation
Stool Softener:
Used to prevent constipation
Antiemetic:
Used to prevent or treat vomiting
Emetic:
Used to induce vomiting
Regurgitation:
backward flowing of solids or fluids to the mouth from the stomach
Dyspepsia:
Indigestion
Flatulence:
Excess gas
Heartburn:
Burning sensation under sternum often due to GERD
Gastroesophageal reflux disease(GERD):
Gastric contents re-enter esophagus; can cause esophageal erosion with risk of strictures
Erosive Esophagitis:
Inflammation of the esophagus with tissue damage; associated with increased risk of cancer
Diarrhea:
liquid consistency of stool; May be due to food poisoning, side effect of medications such as lactose intolerance, laxatives, antibiotics, etc. or symptoms of disease condition; culture for Clostridium difficle or other pathogens
Constipation:
hard, dry consistency of stool; May be due to inactivity, lack of fluid intake, or side effect of medications such as opioids for analgesia
ANTIEMETIC Drugs
ondansetron (Zofran), prochlorperazine (Compazine), promethazine (Phenergan), dimenhydrinate (Dramamine), scopolamine (Trans-derm Scop), trimethobenzamide (Tigan), droperidol (Inapsine), chlorpromazine (Thorazine)
ANTIEMETIC NC:
nasogastric tube for decompression (NG to LIS) should be assessed for patency prior to administering an antiemetic. Provide mouthcare after emesis; Eating dry crackers may reduce vomiting; Monitor fluid and electrolyte balance; If client is taking digoxin (Lanoxin) consider possible digitalis toxicity if severe anorexia, nausea and vomiting; Consider IICP if head injury and vomiting occurs without warning of nausea; Trans-derm Scop changed q 72 hours
ANTIULCER AGENTS:
Antacids, Histamine-Receptor Antagonists, Mucosal Protective Medications, Gastric Acid Pump Inhibitors
ANTACIDS Action:

Neutralize gastric acidity by a local effect, except sodium bicarbonate which is absorbed and can cause systemic electrolyte imbalance

Uses: Relief of heartburn, gas, and indigestion; treatment of peptic ulcers

ANTACIDS Adverse Effects:
Aluminum-based cause constipation; magnesium-based cause diarrhea; sodium-based increase risk of edema/ CHF Caution: Client with renal failure should not take magnesium-based antacids
ANTACIDS NC:
Simethicone reduces flatulence; Avoid long-term use of antacids; Liquid suspensions must be shaken well before administration; Chewable tablets should be chewed well and followed with 8 oz. of water
Antacid Mixtures:
Combination of aluminum and magnesium antacids minimize adverse GI reactions of each
ANTACIDS Common Drugs:
calcium carbonate (Tums), aluminum hydroxide (Amphojel, AlternaGel or Milk of Magnesia), aluminum hydroxide with magnesium hydroxide (Maalox), aluminum hydroxide with magnesium hydroxide and simethicone (Mylanta)
HISTAMINE-RECEPTOR ANTAGONIST Action:

Inhibits both daytime and nocturnal basal gastric acid secretion and inhibits gastric acid stimulated by food, stress, smoking, caffeine, and certain drugs by occupying H2 receptor sites on parietal cells

*Uses*: Active gastric and duodenal ulcers; Prevention of hyperacidity in hospitalized client

HISTAMINE-RECEPTOR ANTAGONIST NC:
Monitor gastric ph (normally below 5); Monitor CBC due to possible blood dyscrasias; Antacids decrease effectiveness; Evaluate improvement of symptoms Client teaching: Avoid substances that irritate stomach such as black pepper, alcohol, harsh spices, aspirin products
HISTAMINE-RECEPTOR ANTAGONIST Drugs:
cimetidine (Tagamet) , rantitidine (Zantac) famotidine (Pepcid)
MUCOSAL PROTECTION AGENTS Action:
Protect mucosal lining from acid, but do not inhibit acid production; coats surface of ulcer. *Uses*: Short-term treatment of active duodenal ulcer
MUCOSAL PROTECTION AGENTS: Drugs:

sucralfate (Carafate)

NC: Do not crush to dissolve; dissolves in water to form slurry

GASTRIC ACID INHIBITOR or PROTON PUMP INHIBITOR Action:

Blocks final step in gastric acid production to suppress gastric acid secretion

*Uses*: Treatment of active ulcers, GERD, and erosive esophagitis; prevention of peptic ulcer

NC: Reconstitute IV Protonix immediately before administration; Do Not Crush delayed-release capsules

GASTRIC ACID PUMP INHIBITOR Drugs:
omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix)
Antiemetic, cholinergic, & GI stimulant (without increasing acid secretion); used in treatment of ?
gastroparesis in DM; administered before meals
metoclopramide HCl (Reglan) (Urecholine) stimulates ?
smooth muscle of bowel or urinary bladder to promote emptying
GI ANTICHOLINERGICS Drugs:
atropine sulfate (Atropine), dicyclomine HCl (Bentyl), propantheline bromide (Pro-Banthine)
Action: anticholinergic action on smooth muscles of GI tract
HELICOBACTER PYLORI ULCERS:

Many peptic ulcers are caused by a bacteria that can be detected with a culture of the gastric lining or by other diagnostic tests Adequate treatment with antimicrobials can cure the peptic ulcer disease and prevent re occurrence,

Two weeks of 3 drug treatment cures up to 90% of patients: omeprazole (Prilosic) clarithromycin (Biaxin), Metronidazole (Flagyl) Treatment for other 10% includes additional drug treatment with: metronidazole (Flagyl), tetracycline or amoxicillin, colloidal bismuth subcitrate (Pepto-Bismol) Must complete entire treatment program to avoid resistant

STIMULANT LAXATIVES:
irritate intestinal mucosa NC: Dulcolax may be administered by mouth or per rectum (suppository)
STIMULANT LAXATIVES Drugs:
cascara sagrada, bisacodyl (Dulcolax), senna (Ex-Lax or Senokot)
BULK FORMING LAXATIVES:
absorbs water and stimulates peristalsis
NC: May cause abdominal distention and flatulence
BULK FORMING LAXATIVES Drugs:
polycarbophil (Fibercon), psyllium (Metamucil)
HYPEROSMOTIC LAXATIVES:
prevent reabsorption of water from stool; also prevents absorption of ammonia and promotes excretion of ammonia in hepatic encephalopathy NC: Report diarrhea for decrease in dose
HYPEROSMOTIC LAXATIVES Drugs:
Lactulose (Chronulac), polyethylene glycol/electrolyte (Go Lytely)
EMOLLIENTS OR LUBRICANTS:

Lubricant Laxatives soften fecal mass

NC: May impair absorption of fat-soluble vitamins; swallow carefully to avoid lipid pneumonia

EMOLLIENT LAXATIVES Drugs:
Mineral oil , Castor oil, Fleets Mineral Oil Enema
SALINE LAXATIVES:

draw water into intestinal contents

NC: Administer Fleets PhosphoSoda over ice due to salty taste; Shake Milk of Magnesia thoroughly prior to administration

LAXATIVES Common Drugs:
sodium phosphate (Fleets Phosphosoda), magnesium hydroxide (Milk of Magnesia) or MOM
STOOL SOFTENERS:
moisten stool; used to prevent constipation, especially when straining is contraindicated such as post myocardial infarction or pelvic surgery
STOOL SOFTENERS Drugs:
docusate calcium (Surfak), docusate sodium (Colace), docusate sodium and casanthranol (Pericolace) is stool softener and laxative
ANTIDIARRHEAL AGENTS:
Diarrhea is characterized by frequent defecation of loose, watery stools. Symptom, not a disease. May be caused by infection, intoxication, allergy, malabsorption, inflammation, tumors of GI tract, food poisoning, and by certain medications.Diarrhea is best defined by consistency of stool , Culture for Clostridium Difficle is done when unexplained, severe diarrhea. Fluid and electrolyte imbalance may occur if prolonged diarrhea (Fluid Volume Deficit and Metabolic Acidosis) Fecal transfer from a healthy person to a client with C-Diff has been successful in re-establishing normal intestinal flora Transfer via NG tube or enema
ANTIDIARRHEAL AGENTS NC:
Monitor potassium level; OTC antidiarrheals may be used without determining cause of diarrhea
ABSORBENT ANTIDIARRHEALS OTC’s drugs:
bismuth subsalicylate (Pepto-Bismol) kaolin mixture with pectin (Kaopectate), loperamide HCl (Imodium)
OPIATE-RELATED ANTIDIARRHEAL AGENTS Prescription Drugs:
diphenoxylate HCL with atropine (Lomotil) {Schedule V controlled drug} paregoric { Schedule II controlled drug}
ANTIDIARRHEAL AGENTS Probiotic:
Promotes Normal Flora Restoration, Lactobacillus acidophilus (Lactinex), Yogurt
ANTIINFLAMMATORY MEDICATIONS USED FOR INFLAMMATORY BOWEL DISEASES:
5-Acetylsalicylic Acid Medications (1st Line Treatment for Crohn’s Disease or Ulcerative Colitis, sulfasalazine (Azulfidine), mesalamine (Asacol or Rowasa), Anti-Inflammatory Corticosteroids (Acute Exacerbation), prednisone
Immune Modulating Agents:
azathioprine (Imuran)
Biologic Agents:
infiximab (Remicade)May not have normal immune response to infection. Monitor closely for signs of infection and reduce risk of infection through universal precautions
EMETIC:
induce vomiting for overdose of oral drugs or certain poisons. Contraindicated of unconscious or semi-conscious or if caustic substance such as lye or acid or petroleum-based substance such as gasoline or kerosene. Recent research questions appropriateness of use. Contact Poison Control Center immediately for instructions
EMETIC Drugs:
Ipecac Syrup followed with full glass of water causes vomiting within 30 minutes, Activated Charcoal may be used to absorb toxic agents from the GI tract without causing vomiting
Procoagulant for decreased production of clotting factors in liver failure-
Vitamin K or Aqua Mephyton, Liver failure causes other problems such as malnutrition, hypoglycemia, hepatomegaly, splenomegaly, ascites, epistaxis, hepatic encephalopathy with confusion, etc.
Ammonia-Lowering Agents to treat Hepatic Encephalopathy:
neomycin (Aminoglycoside antibiotic), kanamycin (Aminoglycoside antibiotic), lactulose/ Chronulac (Laxative)
Diuretics to treat ascites:
cironolactone/ Aldactone (Potassium-Sparing)
Immune Agents used to force virus into remission:
Interferon alfa-2b, recombinant
Immunosuppressive Agents used to prevent rejection of transplanted organs:
Cyclosporine, Tacrolimus (Prograf)
PANCREATIC ENZYME:
used to promote digestion and fat, protein, and CHO absorption
Action: Replaces exocrine secretions of pancreas in cystic fibrosis, chronic pancreatitis, etc.; acts directly in GI tractNC: Given with meal or snack (immediately prior to eating food)

PANCREATIC ENZYME Drug:
pancrelipase (Pancrease)
LACTOSE INTOLERANCE:
Lactose (milk sugar) requires the enzyme lactase for digestion. Symptoms include bloating, cramping, or diarrhea.
CELIAC DISEASE:
Also called nontropical sprue or gluten sensitivity Symptoms include diarrhea, weight loss, and malnutrition. Cause is unknown. Rx: Avoid all food manufactured with grains such as barley, oats, rye, and wheat. May also develop lactose intolerance. Corn, potato, and rice products do not create the malabsorption that occurs with grain products.

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