pharm GI

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ANTIULCER

results when too much acid remains in stomach destroying the lining

Indications of antiulcers

hyperacidity
peptic ulcer disease, (gastric, duodenal)
stress ulcer
GARD
Gastritis

GERD

gastro esophageal reflux disease (acid from stomach flows back into the esophagus.

gastritis-

alcohol or tobacco use. H. pylori. Could be acute with pt with burns, truma, infections, surgeries, organ failure

Antacids contains

Aluminum containing
Magnesium containing
Calcium containing
Combination
Sodium Bicarbonate- good for tricyclic overdose

Antacids actions

work to neutralize acid by raising pH of stomach,
decreases pain, inhibits protein digesting ability of pepsin, increase
in resistance of stomach lining, increase in tone of lower esophageal sphincter

Antacids Adverse effects

G/I-MOM can cause diarrhea
(Aluminum) and calcium may cause constipation
F/E- can cause metabolic alkalosis

Antacids indications

Absorption (chelation) of other drugs to antacids- chemically alter the other drugs
Altered stomach pH- increased
Altered urinary pH- increased

H2 Receptor Antagonists** agents

cimetidine (Tagamet)-impotence
rantidine (Zantac)
famotidine (Pepcid, Pepcid AC)
nizatidine (Axid)

H2 Receptor Antagonists actions

prevents histamine from stimulating the H2 receptors located on the gastric parietal cells
reduces the volume of gastric acid secretion

H2 Receptor Antagonists side effects

Integ: rash , alopecia, dermatitis (itchy)
Endo: gynecomastia (enlargement of mammary gland in male) & impotence (cimetidine)
CNS: headache, lethargy
GI/GU- diarrhea, cramping

H2 Receptor Antagonists interactions

reduces absorption of certain drugs- cimetidine. raises blood concentration of meds metabolized through the liver.
may reduce effects of skin tests for allergies.
timing of antacids-should be given 1 hour before antacid.

Proton Pump Inhibitors-"prazole"* agents

lansoprazole (Prevacid)
omeprazole (Prisolec)
pantoprazole (Protonix)
rabeprazole (Aciphex)

Proton Pump Inhibitors interactions

increases levels of certain drugs- example diazepam, phenotoin
decreases absorption of drugs requiring acid
don't give with protective agents-example carafate, cytotec

Cytoprotective agents

sucralfate (Carafate)-used to treat stress ulcers, esophagel arousions, PUD
misoprostol (Cytotec)

Cytoprotective agents actions

reacts with gastric acid to form a thick paste to selectively adhere to the ulcer surface- these molecules of sulfated sucrose are attracted to and bind with the base of ulcers
decreases gastric acid

Cytoprotective agents side effects

G/U: miscarriage (cytotec) vaginal bleeding, menstrual disorders

Cytoprotective agents interactions

Decreased absorption of meds - tetracycline

ANTIULCER AGENTS contraindications

abdominal pain
elderly/children
pregnancy/lactation,
renal/liver impairment

ANTIULCER AGENTS nursing actions

Hematest-stool
check blood work.
watch for side effects
watch for interaction with other meds

LAXATIVES types

Bulk forming
Osmotic Agents
Saline/Cathartics
Stimulants
Emollients

LAXATIVES indications

constipation
bowel cleansing
remove parasites
obtain stool specimen

Bulk Forming agents

psyllium (Metamucil)-natural*
methycellulose (Citrucel)-synthetic*

Bulk Forming action

usual time span between ingestion and defecation is 24-36 hours.
stimulates peristalsis by absorbing water, increasing bulk of feces to form emollient gel. causes dilation of intestine initiating reflex bowel activity promoting bowel movement.
used for chronic diarrhea.

Bulk Forming side effects

Metamucil: may increase blood glucose (watch diabetic pts).
Citrucel- contraindicated in GI obstruction and hepatitis.
Time for results- 12-24 hours.

Hyperosmotic agents

polyethylene glycol-electrolyte solution (Golytely), lactulose (Enulose), glycerin (fleet suppository)

Hyperosmotic actions

draws water into the G/I tract increasing fecal water content, resulting in distension, increased peristalsis, and evacuation

Hyperosmotic side effects

Golytely- contraindicated in GI obstruction, bowel perforation. Lactulose- low galactose diet. Glycerin- no contraindications- very mild laxative, used on children and adults
Time for results (ONSET)- Golytely- 1 hour. Lactulose- 24 hours. Glycerin- 16-36 minutes

Saline Cathartic agents

magnesium citrate (Citrate of Magnesia)
magnesium hydroxide (MOM)

Saline Cathartic actions

draws water into the small intestine. salt
commonly used for rapid evacuation of the bowel in preparation for some GI diagnostic tests (colonoscopy)

Saline Cathartic side effects

contraindicated in renal insufficiency, abdominal pain/ nausea/ vomiting, intestinal obstruction, rectal bleeding
G/I: diarrhea
F /E: imbalances
Time for results- ½- 3 hours (onset)

Stimulants agents

castor oil
cascara sagrada
senna/ sennosids (Senokot)/(Ex-Lax Gentile Nature)*
bisacodyl (Dulcolax)*

Stimulants actions

Mechanism of action- can affect entire GI tract, action is in proportion to dose, most likely of all laxatives to cause dependence
irritates intestine
stimulates peristalsis

Stimulants side effects

diarrhea, abdominal cramping (increased peristalsis),
fluid and electrolyte disturbances (due to diarrhea)
Time for results- 6-24 hours onset

Emolients

stool softeners
lubricants

Stool softeners agents

docusate potassium (Kasof)
docusate calcium (Surfak)
docusate sodium (Colace, Correctol)*

Stool softeners actions

soften fecal impaction through the passage of water and lipids into fecal matter, facilitate easy bowel movements for patients with anorectal conditions (hemorrhoids), may be used prophalactially to prevent constipation in high risk patients

Stool Softeners side effects

diarrhea, contraindicated in bowel obstruction, nausea/vomiting
Time for results- 6-8 hours

Lubricants

Individual agents- may be given orally or by enema
mineral oil

Lubricants Mechanism of action

eases passage of stool by preventing water from leaving the stool, lubricates the intestines

Lubricants Adverse effect

contraindicated in bowel obstruction, abdominal pain, nausea/vomiting
Time for results- 12-24 hours

Laxatives Assess for contraindications/use cautiously

abdominal pain.
patients with limited fluid intake (bulk-forming).
monitor blood sugar in diabetics.
renal disease.

LAXATIVES Education of the patient/family

take with lots of water(movement and hydration).
encourage other ways to prevent constipation: exercise. increase fluids, increase bran products.
know when to expect results.
dependency.
best on an empty stomach.
suppository works.
refrigerate citrate.
mix castor oil with juice.
senna products may discolor urine (red tint).

ANTIDIARRHEALS Individual agents

Adsorbents.
Anticholinergics.
Synthetic opiates Intestinal flora modifiers.
Indications- chronic diarrhea.

Adsorbents Individual agents

bismuth subsalicylate Pepto-Bismol.
attapulgite Kaopectate.
activated charcoal.

adsorbents Mechanism of action-

coats the walls of the G/I tract, absorbing the bacteria or toxins causing diarrhea.
promotes intestinal adsorption of fluids and electrolytes.

Anticholinergics Individual agents

Atropine
Belladonna alkaloids .Donnatal.

anticholinergics Mechanism of action

Antimotility- decrease peristalsis, decrease muscle tone , used in combination with adsorbents and opiates.

Synthetic opiates agents

Codeine.
loperamide.
diphenoxylate/atropine.

Synthetic opiates actions

decrease bowel motility, secondary- reducing pain related to diarrhea and abdominal cramping, allow for water absorption due to decreased peristalsis

Intestinal Flora Modifiers agents

Lactobacillus acidophilus (Bacid, Lactinex)

Intestinal Flora Modifiers action

suppresses growth of bacteria by restoring the natural flora of the bowel, they are natural organisms obtained from bacterial cultures, may need to be given post antibiotic therapy

ANTIDIARRHEALS Use cautiously in contraindication

geriatric patients with fecal impaction
children <2 yr
abdominal pain

ANTIDIARRHEALS interaction

Pepto-Bismol interferes with absorption of digoxin, tetracycline.
increases the effects of oral anticoagulants (cumdine)
Pepto Bismol-children or teenagers during or after chickenpox or flu-like illnesses; medication may temporarily cause stools and tongue to appear gray-black: salicylate toxicity
assess for constipation.
addictive effect with CNS depressants.

ANTIDIARRHEALS Education of the patient family

shake liquid
instruct patient that this med contains aspirin
notify professional if diarrhea persists for more than 2 days or if accompanied by high fever
dizziness
added CNS depression with alcohol, antihistamines, sedatives, etc.
dry mouth
notify immediately; if blood is passed
fluid replacement

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