AGENTS USED TO TREAT GASTROINTESTINAL DISORDERS

ANTACIDS

HYDROCHLORIC ACID
is constantly secreted by the parietal cells in the lining of the stomach.

The rate of acid secretion in the stomach may vary widely throughout the day, but it is generally at its highest level just before or during the ingestion of a meal

ANTACIDS
-are alkaline chemical agents used for relief of symptoms associated with hyperacidity and peptic ulcer disease -primary goal is for relief of pain

The pain-reducing effect of antacids is believed to be due to their:

acid neutralizing capacity inhibition of the protein-digesting ability of pepsin action to increase the resistance of the stomach lining

The pain-reducing effect of antacids is believed to be due to their:

Ability to increase the tone of the lower esophageal sphincter -this is why antacids are effective in reducing pain associated with GERD

SELECTION OF ANTACIDS An ideal antacid product:

effectively neutralizes large volumes of acid with a reasonably small dose avoids causing acid rebound
has a prolonged action does not interfere with the digestion or absorption of nutrients or drugs

SELECTION OF ANTACIDS An ideal antacid product:

does not cause constipation or diarrhea does not release carbon dioxide gas in the stomach

SELECTION OF ANTACIDS An ideal antacid product:

does not interfere with electrolyte and acid base balance at usual therapeutic doses
is palatable

is inexpensive

CLASSIFICATION
SYSTEMIC ANTACIDS
NON-SYSTEMIC ANTACIDS

SYSTEMIC ANTACIDS
- are highly soluble in gastric fluids; once dissolved, they are absorbed readily -agents this category (sodium bicarbonate) have a rapid onset and a short duration of action

SYSTEMIC ANTACIDS
- most likely to cause acid-base and electrolyte disturbances - May cause rebound hyperacidity

NONSYSTEMIC ANTACIDS
- most useful agents for long-term therapy - although a small proportion of the antacid may be absorbed, most of the dose remains in the GI tract and will not alter systemic acid base balance or electrolyte levels

NONSYSTEMIC ANTACIDS
- caution must be used in administering magnesium-containing antacids to clients with impaired renal function

-as magnesium may accumulate and cause toxicity in such clients

NONSYSTEMIC ANTACIDS
- Most non-systemic antacids will cause either constipation or diarrhea

EXAMPLE OF NONSYSTEMIC ANTACIDS

Aluminum carbonate gel (Basaljel) Aluminum hydroxide gel (Amphogel, Alternagel) Aluminum phosphate gel (Phosphaljel) Calcium carbonate (Tums, Chooz) Dihydroxy-aluminum sodium carbonate (Rolaids Antacid)

EXAMPLE OF NONSYSTEMIC ANTACIDS

Magaldrate (Riopan) Magnesium Hydroxide (Milk of Magnesia, MOM) Magnesium Oxide

EXAMPLE OF SYSTEMIC ANTACIDS

Sodium Bicarbonate (Baking Soda, Soda Mint)

NURSING IMPLICATIONS
Administration with other drugs or food may reduce the absorption of these agents

Do not take other oral drugs within 1-2 hours of antacid administration Monitor quality and consistency of stool during antacid therapy

NURSING IMPLICATIONS
Shake liquid antacid products well prior to use Follow administration of antacid with a small amount of water or milk to facilitate passage into stomach

Do not administer within 1-2 hours of any enteric coated products

NURSING IMPLICATIONS
Assess the clients response to antacid use

OTHER AGENTS AFFECTING GASTROINTESTINAL FUNCTION

LAXATIVES
CONSTIPATION is a condition in which passage of feces through the lower GI tract is slow or nonexistent

This results in a reduction in the frequency and an increase in difficulty of fecal evacuation

FACTORS THAT CONTRIBUTE TO CONSTIPATION

Ignoring the defecation urge
Environmental changes

Ingestion of a low-residue diet

Decreased physical activity Emotional stress

FACTORS THAT CONTRIBUTE TO CONSTIPATION

Ingestion of constipating foods (e.g. dairy products) Use of constipating drugs (e.g. calcium-and/or aluminum-containing antacids, anticholinergics, opiates)

FACTORS THAT CONTRIBUTE TO CONSTIPATION

Chronic misuse or overuse of stimulant laxatives Decreased fluid intake

LAXATIVES
are drugs intended to facilitate the passage and elimination of feces from the colon and rectum

USES OF LAXATIVES
Prepare clients for a lower GI x-ray series or surgery Reduce the strain of defecation in clients with cardiovascular disease or in post-operative clients

Diagnose and treat parasitic infestations of the GI tract

USES OF LAXATIVES
Help remove unabsorbed poisons from the GI tract when oral poisonous substances have been consumed

Prevent or treat constipation

STIMULANT LAXATIVES
-increase the motility of the GI tract by chemical irritation of the intestinal mucosa

-it may also act by increasing the secretion of water into both the small and large intestines

They tend to produce a watery, often diarrheal, stool

EXAMPLE OF STIMULANT LAXATIVES

Bisacodyl (Dulcolax, Bisacolax) Cascara Sagrada Castor Oil Phenolphthalein (Alophen) Senna (Senokot)

NURSING IMPLICATIONS
Contraindicated for use in clients with abdominal pain, nausea, vomiting, or rectal fissures Should only be used for short-term treatment Evaluate effectiveness of laxative

SALINE LAXATIVES
-draw water through the intestinal wall by osmotic action and thereby increase the fluidity of the stool and stimulate greater intestinal motility

Saline laxatives are only employed in the rapid evacuation of the bowel (in preparing a client for endoscopic examination)

EXAMPLE OF SALINE LAXATIVES

Magnesium Citrate Magnesium Hydroxide Magnesium Sulfate, epsom salts Sodium Phosphate (Fleet enema)

NURSING IMPLICATIONS
Should only be used for short-term treatment Contraindicated for use in clients with abdominal pain, nausea, vomiting, or other symptoms of appendicitis Evaluate the effectiveness of laxative

BULK-FORMING LAXATIVES
-among the safest laxatives available. They are natural or semisynthetic compounds that absorb fluid and swell in the intestine, thereby stimulating peristaltic action -tend to produce normally formed stool

EXAMPLE OF SALINE LAXATIVES

Barley Malt extract (Maltsupex) Methylcellulose (Citrucel) Polycarbophil Psyllium (Metamucil, Novo-Mucilax)

NURSING IMPLICATIONS
Laxative effect may not be evident for up to 3 days Contraindicated for use in clients with abdominal pain, nausea, vomiting or other symptoms of appendicitis Evaluate effectiveness of laxative

LUBRICANT LAXATIVES
-this are oils that act as lubricants to facilitate the passage of the fecal mass through the intestine

EXAMPLE: Liquid Petrolatum (Fleet Oil Retention Enema)

Oral form should be administered on an empty stomach because of the drugs ability to impair the absorption of fatsoluble drugs and nutrients

STOOL SOFTENERS
-this are detergent-like drugs that permit easier penetration and mixing of fats and fluids with the fecal mass

-this agent does not irritate the intestine or stimulate peristaltic action

EXAMPLE OF SALINE LAXATIVES

Docusate calcium (Calax, Surfak) Docusate potassium (Dialose) Docusate sodium (Colace, Selax)

NURSING IMPLICATIONS
Liquid dosage form may be given in milk, fruit juice, or formula to mask taste Action may not be evident for up to 3 days Prevents development of constipation. It is not used to treat existing constipation

NURSING IMPLICATIONS
Avoid use for longer than 1 week Evaluate client for the effectiveness of these agents

ANTIDIARRHEAL AGENTS
DIARRHEA is defined as the abnormally frequent passage of watery stools.

It is generally caused by the failure of the small and large colon to adequately absorb fluid from the intestinal contents

POSSIBLE CAUSES OF DIARRHEA Allergy

Amebic dysentery

Antibiotics
Cancer of the GI Tract Food poisoning

POSSIBLE CAUSES OF DIARRHEA Lactose intolerance

Medication

Radiation
Regional enteritis Ulcerative colitis

DRUG THERAPY
is generally aimed at REDUCING the MOTILITY of the GI Tract, thereby permitting normal dehydration of the intestinal contents to take place

DRUGS THAT REDUCE GI MOTILITY

TWO CLASSES:

OPIUM DERIVATIVES