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55 terms

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