BACHELOR OF SCIENCE IN NURSING

NCMA 216: PHARMACOLOGY

COURSE MODULE COURSE UNIT WEEK
2 9 10
Drugs Affecting the Body System and Nursing Considerations: GIT

 Read the course and unit objectives

 Read the study guide before class begins
 Read required reading materials and understand terminologies
 Participate in classroom discussion
 Participate in discussion board (Canvas)
 Answer and submit course unit tasks

At the end of the course unit, learners will be able to:

Cognitive:

1. Review the anatomy and physiology of the digestive system

2. Identify the common gastrointestinal disorders that require drug therapy
3. Classify drugs that affect gastric secretion
4. Understand the pathophysiology of nausea and vomiting
Affective:
1. Manifest professionalism in and excellence in planning for safe medication process
2. Listen attentively during discussion
3. Respect other’s opinion during discussion and tactfully make clarifications
 Psychomotor:
1. Participate in an interactive discussion
2. Express suggestions, reactions and opinions in class

Gastrin – hormone secreted by the gastric cells that stimulate production of gastric juice
Histamine 2 receptors – receptors in the parietal cells for histamine 2
Local gastric reflexes – nervous plexuses in the walls of the GIT that generate impulses
throughout the GIT causing peristaltic movement
Nervous plexus – network of nerves innervates by the autonomic nervous system.
Parasympathetic stimulates, while sympathetic inhibits them
Peristalsis – mixing and propulsive contraction of the smooth muscles in the
gastrointestinal wall that promote GI movement
Putrifaction – a process by which bacteria in the colon act on fecal material producing
gasses
Vomiting – complex reflex reaction to various stimuli causing regurgitation of ingested food

REQUIRED READING
Karch, A. M. (2019). Focus on nursing pharmacology. Lippincott Williams & Wilkins.

Chapters on Drugs affecting GIT

All nursing considerations of the given GIT drugs

The digestive system is composed of the

1. Gastrointestinal Tract (GIT)
a. Upper GIT
b. Lower GIT
2. Accessory organs of digestion include the liver, pancreas, salivary glands and the gall bladder
The GIT division is very important clinically. The upper GIT is from the mouth down to the small
intestine where complete digestion is taking place. The lower GIT is from the large intestine to the anus.
Digestion of carbohydrates start in the mouth in the presence of salivary amylases, the enzymes
needed for digestion of starch. These are secreted by the salivary glands, parotid gland, submandibular
gland and sublingual glands. No protein and fat digestion taking place in the mouth. Digestion of
proteins starts in the stomach because the Hydrochloric acid (HCl) produce by the parietal cells help in
the activation of protein enzymes such as pepsin and trypsin. No carbohydrate and fat digestion taking
place in the stomach. Fat digestion starts and ends in the small intestine where bile needed to emulsify
fats are poured into the duodenum via the common bile duct from the gall bladder. The gall bladder
stores and concentrate the bile produced by the liver. The pancreatic juice which contains enzyme are
secreted also in the duodenum so carbohydrate and protein will further be digested in the small
intestine. So complete digestion in the presence of gastric and intestinal secretions held in the digestion
of food. Peristalsis will move the chyme along the tract through the large intestines. There is no more
digestion in the large intestine however, reabsorption of water, synthesis of vitamin K and putrifaction, a
process by which microorganisms in the colon will act on the fecal material, still take place in the large
intestines.

The GIT is innervated by the autonomic nervous system. Parasympathetic stimulates while
Sympathetic inhibits GI movement and secretion. Local reflexes made by nervous plexuses along the
wall of the GIT also participate in normal peristaltic movement. Gastroenteric reflex happens when
stretching of the stomach will cause impulses going to the intestine and stimulate it to produce its
secretion and create peristalsis and stimulate gastric emptying. Gastrocolic reflex happens when the
presence of food stretches the stomach, the nervous plexus will send signal to the colon to cause
peristalsis. Duodenal – colic reflex also happens when chyme passes the duodenum will cause
stretching of the wall thereby sending impulses to the colon to create peristaltic waves and stimulate
defecation.

The interplay of autonomic and local reflexes helps in the release of gastric and intestinal secretions
and peristaltic movement.

There are two centrally mediated reflexes that are important in the function of the GIT. The swallowing
reflex and vomiting.

Swallowing is a reflex controlled by the medulla, this has 3 phases:

1. The voluntary phase
2. The pharyngeal phase
3. The esophageal phase

Act of swallowing is initially voluntary. A person should put the bolus of food at the back of the tongue
and pressed it against your palate, this will require voluntary muscles. The pharyngeal and esophageal
phases are involuntary and made by peristaltic movement of their wall.

Vomiting happens when the chemoreceptor trigger zone (CTZ) in the medulla, anything that stimulate
CTZ will cause nausea and vomiting. Most common stimuli to induce vomiting include:
 1. Tactile stimulation at the back of the throat
2. Excessive gastric distention
3. Any inflammation in the abdominal region
4. Any obstruction in the abdominal region
5. Increased intracranial pressure
6. Certain drugs like anticancer agents

Classifications of drugs affecting the GIT

Drugs affecting gastrointestinal secretions

These drugs are used for treatment of gastroesophageal reflux disease, gastritis and peptic ulcer
disease (PUD). The common etiology for these disorders is the increase corrosive effects of
hydrochloric acid in the mucosal ling of the stomach and small intestines causing inflammation and
erosions.
 Histamine 2 Receptor antagonist - block the receptors for histamine 2 in the parietal cells
to stop release of hydrochloric acid from the parietal cells.
o Pharmacokinetics: readily absorbed after oral administration, liver metabolized
the drug and excreted in the urine.
o Contraindications and Cautions: Contraindicated to clients with known allergy to
the drugs. Pregnancy and lactation
o Adverse effects: drugs may cause diarrhea or constipation, dizziness, insomnia,
gynecomastia and impotence
o Drug – Drug interactions: these drugs may slow down metabolism of some drugs
thereby increasing serum levels and toxicity. This includes anticoagulants, beta
blockers, theophylline, nifedipine, phenytoin and alcohol
o Examples: Ranitidine, Cimetidine, Famotidine
Nursing considerations
o Should be given before meals or at bedtime
o Monitor hepatic toxicity
o Monitor for potential drug – drug interaction
o Assess for GI adverse effects
o Provide Health teaching as to the name of the drug, prescribed dosage, action and
adverse effects to enhance patient’s knowledge and promote good compliance

 Proton – Pump inhibitor (PPI) – suppress gastric acid secretion by specifically

inhibiting the hydrogen – potassium adenosine triphosphate enzyme system on
the secretory surface of the parietal cells hence, decreasing hydrochloric acid
secretion. This classification is now the drug of choice for treatment of PUD,
gastritis and GERD.
  Pharmacokinetics: rapidly absorbed from the GIT. Exessive hepatic
metabolism and excreted in the urine.
 Contraindication: contraindicated in clients with allergy to the drug
 Adverse Effects: dizziness, headache, vertigo, insomnia, GI effects like
diarrhea, nausea and vomiting, respiratory symptoms like cough,
hoarseness and epistaxis
 Examples: Omeprazole, Esomeprazole, Pantoprazole
Nursing Considerations:
o Administer before meals or at bedtime. Do not chew or crush capsules.
o Provide safety measure if CNS effects are seen
o Assess for GI adverse effects
o Provide Health teaching as to the name of the drug, prescribed dosage, action and
adverse effects to enhance patient’s knowledge and promote good compliance

 Antacids – neutralize acidity to decrease symptoms of pyrosis or heartburn.

Antacids do not cure PUD or gastritis but help decease symptoms. The best form
of antacids is liquid form, taken 1 – 2 hours after eating to maximize therapeutic
effects of drugs.
 Contraindication: not given to clients with allergy to the drug. Caution is used
if combined with H2 receptor blockers, tetracycline and NSAIDs
 Adverse Effects: acid base imbalances, constipation or diarrhea, rebound
acidity may happen in prolonged use of antacids
 Examples: Magnesium aluminum hydroxide, Calcium salts
Nursing Considerations:
o Administer 1 – 2 hours after meals
o The best form is liquid form. All tablets must be chewed.
o Do not administer together with tetracycline, NSAIDs, H2 receptor antagonists.
o Monitor for possible drug – drug interaction
o Assess clients for possible acid base and electrolyte imbalances
o Provide health teaching about the name of the drug, prescribed dosage, effects and
adverse reactions to enhance client’s knowledge and compliance

 Anti – peptic drug – these drugs protect the lining of the GIT to prevent further
irritation of mucosa
 Pharmacokinetics: rapidly absorbed, metabolized in the liver and excreted in
the feces. Drugs pass the placenta and breastmilk
 Contraindication: should not be given to client with allergy to the drug. It
should not be given to client undergoing dialysis for renal failure because of
buildup aluminum if antacid contain aluminum.
 Adverse Effects: Constipation, diarrhea,indigestion, gastric discomfort,
dizziness, sleepiness and vertigo
 Examples: Sucralfate
Nursing considerations:
 o Administer 1 hour before meals
o Monitor for GI adverse effects
o If antacids will be administered as well, antacids should be given in between doses of
sucralfate.
o If CNS effects are seen, provide safety
o Provide frequent mouth care and sugarless lozenges
o Give health teaching about the drug, its action and adverse effects to enhance patient’s
knowledge and compliance

Laxatives and Anti – diarrheal drugs

Constipation and diarrhea are most common causes of GI disturbances. The most important
management is fluid administration for both condition. Increase fluid intake in constipation will
soften the stool in the colon, and oral rehydration solution will prevent dehydration from
diarrhea.

Drugs for constipation are called laxatives.

Classifications of laxatives
1. Chemical laxative – directly stimulate the GIT to increase peristaltic movement and
promote defecation
o Examples: Bisacodyl, Cascara, Senna
2. Bulk laxative – increase fluid in the lumen to stimulate local reflexes and promote
defecation
o Examples: Lactulose, Psyllium
3. Lubricant laxative – soften the stool
o Examples: Docusate , Glycerine
 Pharmacokinetics: these drugs are minimally absorbed and exert their effect in the
GIT and excreted in the feces
 Contraindications: Not given to clients with abdominal disorders like appendicitis,
diverticulitis and ulcerative colitis
 Adverse Effects: primary adverse effect is diarrhea, fluid and electrolyte disturbances
and acid – base imbalances

Nursing considerations:
o Laxatives are given if independent interventions are not effective
o Monitor for possible diarrhea as adverse effects
o Monitor for fluid and electrolyte imbalances
o Assess for signs of acid – base imbalances
o Monitor vital signs
 o Provide comfort measures
o Health teaching on the drug name, prescribed dosage, effects, possible adverse
reactions to enhanced client’s knowledge and promote good compliance

Drugs for diarrhea are called anti – diarrheal drugs

Anti – diarrheal drugs

1. Bismuth subsalicylate – locally coat the lining of the mucosa to decrease irritation
that may be causing increase peristalsis
2. Loperamide – direct effect on the muscles of the colon to decrease peristalsis
3. Opium derivatives – block nerve impulses within the GIT, stopping peristalsis, may
cause addiction and tolerance
 Pharmacokinetics: vary from different preparations. Most common
Loperamide is slowly absorbed, metabolized in the liver and excreted in the
urine
 Contraindication: clients with allergy to the drug should not receive them.
Caution is used in pregnancy and lactation
 Adverse effects: Constipation, distention, abdominal discomfort
Nursing considerations:

o Monitor response to the drugs

o Should not be given for a long period of time
o Monitor for constipation or abdominal distention
o Evaluate effect of teaching plan about medication
o Provide comfort measures
o Ensure adequate fluid replacement

Anti – emetic drugs

Vomiting may cause dehydration and metabolic alkalosis, an acid – base imbalance. If the
cause may not be corrected yet, an anti – emetic drug is given to prevent possible complications
of this condition.

1. Phenothiazines – suppress the vomiting center in the medulla

Examples:
o Prochlorperazine, Promethazine
2. Nonphenothiazine – reduce responsiveness of the cells in the CTZ to circulating chemicals
to relieve vomiting
Example:
o Metoclopramide
3. Anticholinergics/Antihistamines – block transmission of impulses to CTZ, very good for client
with vomiting due to vertigo.
Examples: Buclizine, Cyclizine, Meclizine
 4. 5-HT 3 receptor blockers – block the receptors associated with nausea and vomiting both
locally and centrally (CTZ)
Examples: Dolasetron, Ondansetron
5. Substance P/Neurokinin 1 Receptor antagonists – directly act in the CNS to block the
receptors associated with nausea and vomiting little effect on serotonin , dopamine and
corticosteroid receptors
Example: Aprepitant
6. Miscellaneous anti emetic drugs
a. Trimethobenzamide HCl
b. Hydroxyzine
c. Dronabinol

Locally acting anti emetic drugs will block stimulation of the CTZ from it source. Centrally acting anti
emetic would block the receptors in the CTZ or the nerves in the CNS that stimulate the CTZ.
Contraindications: Clients with allergy to the drugs should not receive it. Clients with CNS depression
may worsen their conditions. Caution is used to clients who are taking CNS depressants

Adverse effect: CNs effects, drowsiness, weakness, headache, tremor, autonomic effects and
photosensitivity is seen in some patients

Nursing interventions:
o Monitor response of the client to the drug
o Provide safety if CNS effects occur
o Provide comfort measure including mouth care
o Provide adequate health teaching about the dug to increase client’s knowledge and
good compliance

Karch, A. M. (2019). Focus on nursing pharmacology. Lippincott Williams &  Wilkins.

Kee, Joyce Le Fuer and Hayer, Evelyn R., Pharmacology: A Nursing Process Approach, 5th Edition,
2006, by Elsevier (Singapore) PTE LTD

 Lilley, Linda lane & Harrington, Scott, Pharmacology and the Nursing Process, 5th Edition, by Elsevier
(Singapore) PTE LTD

Rizzo, D. C. (2016) Fundamentals of Anatomy and Physiology 4th edition. Cengage

Lilley, Linda lane & Harrington, Scott, Pharmacology and the Nursing Process, 5 th Edition, by
Elsevier (Singapore) PTE LTD

Rizzo, D. C. (2016) Fundamentals of Anatomy and Physiology 4 th edition. Cengage

 Make a drug study on the individual drugs discussed in this course unit. Write them in an ½
index card and compile them.
 Search new 2 drugs for each classification of GIT drugs not discussed in this course unit
and include them in the drug study.
 DRUG STUDY
DRUG DOSAGE THERAPEUTIC ADVERSE CONTRAINDICATION NURSING
ACTION EFFECTS CONSIDERATIONS