Written Report

Republic of the Philippines
PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila
College of Nursing
DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM
In Partial Fulfillment of the

Requirements in Pharmacology
GROUP 8 MEMBERS
Danica M. Tolon
Joey R. Venegas
Camille T. Vidar
Lacelyn Geomarie Lime A. Villacarlos
Treasery J. Villafranca
Maricar B. Villela
To be submitted to:
Professor Josephine S. Sagun
October 2022
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College of Nursing
DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM
Learning Objectives:
1. To have a brief overview about the gastrointestinal system.
2. Discuss drugs that are affecting the gastrointestinal system.
3. Discuss drugs used to treat Peptic Ulcer Disease, Bowel Disorders and Gastrointestinal
Conditions and Nutritional Disorders.
4. Describe the mode of action, indications, pharmacokinetics, contraindications and cautions,
most common adverse reactions, and important drug-drug interactions associated with drugs
used to affect gastrointestinal secretions.
5. Outline the nursing considerations, including important teaching points, for patients receiving
drugs used to affect GI secretions.
I. BRIEF BACKGROUND ABOUT THE GASTROINTESTINAL SYSTEM
Gastrointestinal System
Also called the digestive system or the alimentary canal, this is where the food comes into our
body, how our system breaks down that food, and how waste exits our body. It is uniquely constructed
to turn food into nutrients and energy. The gastrointestinal system is typically divided into two primary
sections:
● The upper tract, which includes organs including the mouth, esophagus, stomach, and
duodenum that help with food ingestion and digestion. The process of extracting vital nutrients
from food is known as digestion. In the mouth, food is mechanically broken down to start the
process. The coating epithelium, intramural glands, and extramural exocrine glands, including
the salivary glands, the liver, and the pancreas, which produce digestive enzymes and hormones
to speed up the breakdown of food particles, produce the best environmental conditions for the
treatment of various food components.
● The small and large intestine make up the lower tract, which the food bolus passes through on
its way to the esophagus. The small intestine is where most of the nutrients are absorbed once
food has finished being digested. The main functions of the large intestine are to absorb water
and electrolytes and to expel waste from digestion. Food fragments that cannot be digested are
held in the sigmoid colon until they can be passed through the rectum.
II. ANTI-ULCER AGENTS
A. Pathophysiology
The stomach contains cells that secrete different substances as part of the digestive process:
parietal cells, chief cells, and surface epithelium cells.
The stomach's lining contains surface epithelial cells, which release mucus as a protective
layer. The stomach glands contain chief cells and parietal cells. Hydrochloric acid (HCl), which
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is produced and secreted by parietal cells, keeps the environment's pH level between 1 and 4
and keeps it acidic. Additionally, intrinsic factor, which is secreted by parietal cells and required
for vitamin B12 absorption in the small intestine. The principal site of action for many
medications used to treat diseases caused by excess acid is the parietal cells. Then we have
pepsinogen, a digestive enzyme, which is secreted by chief cells and turns into pepsin when it
comes into contact with acid. Additionally, the stomach is home to enteroendocrine cells, also
known as enterochromaffin-like cells (ECL), which release chemicals like somatostatin,
histamine, and serotonin. Along these, the stomach also contains G cells that release gastrin,
which encourages the release of digesting chemicals. Even though these cells are important to
the digestive system, problems linked to acid can develop when there is an imbalance in the
secretions.
B. Diseases
● Gastroesophageal Reflux Disease (GERD) - Patients frequently refer to it as heartburn,

indigestion, or sour stomach because it is the most prevalent mild to severe hyperacidic
condition. Excessive hydrochloric acid tends to back up or reflux into the lower esophagus,
which is the root cause of GERD.
● Peptic ulcer disease (PUD) - This happens when the breakdown of the GI mucosa by pepsin
in conjunction with the caustic effects of hydrochloric acid results in gastric or duodenal ulcers.
PUD is the most dangerous disease associated with hyperacidity since it can lead to bleeding
ulcers, a condition that can be fatal.
● Stress-related mucosal damage - Another typical problem that might develop in hospitalized
patients and cause PUD is this one. As a result, many post-operative or critically ill patients are
given medicine, often known as prophylaxis, to stop the development of a stress ulcer.
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C. Anti-ulcer Medication Classes

There are five major classes of medications used to treat hyperacidity conditions: antacids, H2-
receptor antagonists, proton pump inhibitors, and mucosal protectants. Each class of medication
is further described below.
1. Histamine 2 Receptor Antagonist/Blocker

● Indications: Histamine 2 receptor antagonists, also known as can be used to treat
gastroesophageal reflux disease (GERD), duodenal and gastric ulcers, erosive
esophagitis, and hypersecretory conditions, or as adjunct treatment for the control of
upper GI bleeding. They may also be prescribed for a rare disorder called Zollinger-
Ellison syndrome, which causes excess gastric acid production.
● MOA: H2-receptor antagonists block histamine’s action at the H2 receptor of the
parietal cell, thus reducing the production of hydrochloric acid.
● Side Effects: Side effects of H2-blockers are minimal and can include headache or GI
upset.
● Medications: cimetidine, famotidine, nizatidine, ranitidine
HISTAMINE-2 ANTAGONIST
Drug Name Usual Dosage Usual indications Special considerations
cimetidine - 300 mg PO q.i.d Treatment of duodenal ulcer, FDA does not

at meals and at benign gastric ulcer, recommend for children
bedtime or 800 pathological hypersecretory <16 y; up to provider
mg PO at syndrome, GERD; heartburn, judgment
bedtime; acid indigestion, sour
stomach Reduce dose with
- 300 mg IV or IM geriatric patients or
q6-8h or 200 mg patients with renal
PO for heartburn impairment
famotidine - 20-40 mg PO or Treatment of duodenal ulcer, Reduce dose in renal-

IV at bedtime or benign gastric ulcer, imapired or geriatric
20 mg PO b.i.d. pathological hypersecretory patients
- 10 mg PO for syndrome, GERD; heartburn,
prevention or acid indigestion, sour Pediatric dosing varies
relief of heartburn stomach per age and indication
nizatidine - 150-300 mg PO at Treatment of duodenal ulcer, Reduce dose in renal-

bedtime or 150 benign gastric ulcer, imapired or geriatric
mg PO b.i.d. pathological hypersecretory patients
- 75 mg PO 30 min syndrome, GERD; heartburn,
before food to acid indigestion, sour Not recommended for
prevent heartburn stomach use in children
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ranitidine - 150 mg daily to Treatment of duodenal ulcer, Pediatric: (1 mo to 16 y)

b.i.d. PO benign gastric ulcer, - 2-4 mh/kg PO
- 300 mg PO at pathological hypersecretory b.i.d for daily
bedtime,or syndrome, GERD; heartburn, maintenance
- 50 mg IM or IV acid indigestion, sour treatment
q6-8h stomach in adults
- 75 mg PO prn
heartburn
2. Proton Pump Inhibitor

● Indications: These medications are used to treat the same conditions as histamine-2
receptor antagonists. That means PPIs may be used to treat GERD, duodenal and gastric
ulcers, and Zollinger-Ellison syndrome. PPIs may also be given in combination with
antibiotics to treat H.Pylori infections, a common cause of duodenal ulcers.
● MOA: Proton pump inhibitors' mode of action is to inhibit an enzyme, pepsinogen,
that is required for gastric acid secretion. Pepsinogen is secreted into the gastric juice,
which is secreted into the stomach. There, it is activated by stomach acid into the active
protease pepsin. Pepsin is what aids the stomach's ability to digest proteins.
Administering a PPI decreases gastric acid secretion.
● Side effects: GI upset and C. diff, also known as Clostridioides difficile or C. difficile.
C. diff is a germ (bacterium) that causes severe diarrhea and colitis (an inflammatory
reaction in the colon). Long-term use of these medications may lead to bone fractures,
as PPIs are reported to be associated with decreased bone mineral density
(characteristic of osteoporosis).
● Medications: dexlansoprazole, esomeprazole, lansoprazole, omeprazole, rabeprazole
PROTON PUMP INHIBITOR (PPI)
Drug Name Usual Dosage Usual Indications Special

Considerations
dexlansoprazole - 30-60 mg/d PO for Treatment and maintenance

4-8 wk of erosive esophagitis,
treatment of heartburn
associated with GERD
esomeprazole Acute: Treatment of GERD, severe Pediatric varies

- 20-40 mg/d PO for erosive esophagitis, duodenal per indication and
4-8 wk ulcers, and pathological age
- 20-40 mg/d PO for hypersecretory conditions
maintenance
lansoprazole - 15-30 mg/d PO Treatment of gastric ulcer,
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based on condition GERD, pathological

and response hypersecretory syndromes;
- 30 mg IV over 30 maintenance therapy for
min for up to 7d healing duodenal ulcers and
esophagitis; for eradiation of
H.pylori; treatment for
Zollinger-Ellison syndrome
omeprazole - 20-40 mg/d PO for Treatment of gastric ulcer, Pediatric dosage

4-8 wk based on GERD, pathological varies per
condition and hypersecretory syndromes; indication and age
response maintenance therapy for
healing duodenal ulcers and
esophagitis; for eradiation of
H.pylori;available OTC for
relief of heartburn
pantoprazole - 40 mg PO daily to Treatment of GERD in Pediatric dosage

b.i.d. O4 adults, healing of erosive varies per
- 40 -240(max) esophagitis, treatment of indication and age
mg/d IV or hypersecretory syndromes
- 40 mg/d IV for 7-
10 d
rabeprazole Adults and pediatrics > 12: Treatment and maintenance

- 20-60 mg/d PO of GERD; treatment of
based on condition duodenal ulcers, pathological
and response hypersecretory conditions;
Pediatric 1-11 y and >15 used as combination therapy
kg: for the eradication of
- 10 mg/d PO H.pylori infection
Pediatric <15 kg:
- 5 mg/d PO
3. Antacids
● Indications: Antacids are used to treat peptic ulcer disease and GERD
(gastroesophageal reflux disease). Antacids are used to relieve heartburn, acid
indigestion, and upset stomach. They may also be administered to lower phosphate
levels in patients with chronic kidney disease, who should limit their intake of
phosphorus, potassium, and sodium.
● MOA: Antacids are used to relieve heartburn, acid indigestion, and upset stomach.
● Side effects: One key side effect of antacids is constipation. Make sure that the patient
is encouraged to increase their intake of fiber and fluids when taking antacids.
● Medications: calcium carbonate, aluminum hydroxide, and magnesium hydroxide,
sodium-bicarbonate
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ANTACIDS
Drug Name Usual dosage Usual indications
aluminum salts Adult: Symptomatic relief of GI hyperacidity,

- 500-1500 mg 3-6x per day treatment of hyperphosphatemia,
between meals and at prevention of formation of phosphate
bedtime urinary stones
Pediatric:
- 50-150 mg/kg PO q24h in
divided doses q4-6h
calcium salts - 0.5-2 g PO prn as an antacid Symptomatic relief of GI hyperacidity,

treatment of calcium deficiency,
prevention of hypocalcemia
magnesium salts - 280-1500 mg PO q.i.d., dose Symptomatic relief of GI hyperacidity,

based on salt used prophylaxis of stress ulcers, relief of
constipation
sodium Adult: Symptomatic relief of GI hyperacidity,

bicarbonate - 300-2000 mg PO daily to minimization of uric acid crystalluria,
q.i.d. adjunctive treatment in severe diarrhea
4. Mucosal Protectants
● Indications: Sucralfate (Carafate) is a mucosal protectant used in the treatment of
duodenal ulcers. It is used to cover and protect gastrointestinal ulcers. Studies show
that mucosal protective agents (MPAs) can help treat intestinal lesions as mucus
appears to play an important role in the protection of the inner lining of the intestinal
tract.
● MOA: Sucralfate locally covers the ulcer site in the GI tract and protects it against
further attack by acid, pepsin, and bile salts. It is minimally absorbed by the
gastrointestinal tract. It also reacts with the stomach's acid to form a thick paste, which
adheres to the ulcers.
● Side effects: The key side effect with sucralfate is constipation. This is why it is
important to encourage the patient to increase their intake of fiber and fluids.
● Medications: sucralfate
MUCOSAL PROTECTANT
Drug Name Usual dosage Usual indications
sucralfate - 1 g PO b.i.d. To q.i.d. On Short-term treatment of duodenal ulcers;

empty stomach maintenance of duodenal ulcers after
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healing in adults; treatment of oral and

esophageal ulcers due to radiation,
chemotherapy; currently under
investigation for treatment of gastric ulcers,
gastric damage induced by NSAIDs,
prevention of stress ulcers in acutely ill
individuals
5. Prostaglandin E Analogs
● Prostaglandins are the last class of antiulcer agent. Itl is used to prevent gastric ulcers
in patients taking NSAIDs. It also induces labor by ripening the cervix.
● MOA: The mode of action of misoprostol is to decrease stomach acid secretion and
increase the production of protective mucus in the stomach. It also increases the
production of bicarbonate, which helps thicken the mucus, allowing it to produce new
cells. When used for labor induction, misoprostol causes uterine contractions.
● Side effects: Side effects include dysmenorrhea (painful menstruation) and GI upset.
● Medications: misoprostol
PROSTAGLANDIN E ANALOG
Drug Name Usual Dosage Usual Indications
misoprostol - 100-200 mcg Po q.i.d., Prevention of NSAID-induced ulcers

reduce dose in patients in adults at high risk for development
with renal impairment of these gastric ulcers, under
investigation for treatment of
duodenal ulcers in patients who are
not responsive to H2 antagonists, used
in combination therapy with
mifepristone as an abortifacient.
III. ANTIEMETICS
Indication:
Antiemetics are used to manage nausea and vomiting in situations in which these actions are not
beneficial and could cause harm to the patient. Antiemetics act by depressing the hyperactive vomiting
reflex, either locally or through alteration of central nervous system (CNS) actions. The choice of an
antiemetic depends on the cause of the nausea and vomiting and the expected actions of the drug.
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Mode of action:
Antiemetics work on the neural pathways involved with vomiting by blocking specific receptors that
respond to neurotransmitter molecules, such as serotonin, dopamine, and histamine. Most of these are
central receptors found in the vomiting center of the brainstem, while peripheral receptors are found
in the vagus nerve. When the gastrointestinal tract senses a threat, it sends information to the
peripheral receptors, which in turn convey the information to the central receptors in the vomiting
center. In response, the vomiting center triggers nausea and vomiting by stimulating the gastrointestinal
tract, abdominal muscles, and the diaphragm.
1. Anticholinergics
● Indications: Drugs known as anticholinergic agents block and inhibit the
neurotransmitter acetylcholine (ACh) at synapses in the central and peripheral nervous
systems. By selectively blocking ACh's ability to attach to its receptors in neurons,
these medications prevent the parasympathetic nervous system's (the autonomic
nervous system's "relax and digest") functions. The parasympathetic nervous system
regulates a variety of bodily processes, including the involuntary contractions of
smooth muscle in the GI tract, lungs, urinary tract, and other regions.
● Mode of Action: Anticholinergic medications are competitive antagonists of the
neurotransmitter acetylcholine at receptor sites within the cholinergic system. The
cholinergic system utilizes two types of receptors, the plasma membrane-bound G
protein-coupled muscarinic receptors, and the ligand-gated ion channel nicotinic
receptors. Nicotinic receptors are found in the postganglionic dendrites and nerve
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bodies of the autonomic nervous system and on the motor endplate of the
neuromuscular junction.
● Side effect: Even when using this drug properly, side effects can happen. The possible
side effects of anticholinergics depend on the specific drug and dosage you take, but
the side effects can include dry mouth, blurry vision, constipation, hallucinations,
memory problems, and decreased saliva.
● Medication:
ANTICHOLINERGICS
Drug Name Usual dosage Usual indications Special precautions
Atropine 0.4-0.6 mg IV/IM/SC Patients with bradycardia, Do not use other

30-60 minutes before bronchial secretions, or medicines unless they
anesthesia; repeat q4- hypersalivation may have been discussed with
6hr PRN benefit from intravenous your doctor.
(IV) atropine. There may
For the sinus be a need for large doses
bradycardia: and repeat doses. Higher
0.5-1 mg or 0.04 mg/kg doses are notably needed
IV q5min, no more than for ingestions (up to 20
3 mg mg).
Belladonna For stomach/intestine Clinical practitioners have Don’t become overheated

alkaloids problems, Older adults, traditionally utilized during exercise or hot
and teenagers are 1 or 2 belladonna alkaloids to weather while taking this
capsules 2 to 4 times a treat bradycardia, treat medicine.
day. cholinergic
overstimulation, lower
Children - dose must be gastric acid output, and as
determined by the spasmolytics. However,
doctor. too much of these might
be harmful.
Chlordiazepoxide capsule : 5mg/2.5mg irritable bowel syndrome Do not drink alcohol or

(IBS), which causes use street drugs during
stomach pain, bloating, your treatment.
for IBS, and peptic constipation, and diarrhea,
ulcers. enterocolitis, and peptic
1-2 cap PO q6-8hr ac ulcers are all conditions
and hs that are treated with
clidinium in combination
with other medications
(swelling in the intestines).
Dicyclomine Typically, it is taken 4 IBS symptoms are Do not drive a car until
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times a day. managed with you know how this

dicyclomine. Dicyclomine medication affects you.
belongs to the group of
drugs known as
anticholinergics. By
preventing the activity of a
specific natural chemical
in the body, it calms down
intestinal muscular
spasms.
2. Antihistamines
● Indication: Antihistamines are a class of medications used to treat histamine-mediated
illnesses. Histamine receptors fall into two categories: H-1 receptors and H-2 receptors.
Typically, antihistamine medications that bind to H-1 receptors are used to treat allergic
rhinitis and allergies. Treatment for upper gastrointestinal problems brought on by too
much stomach acid involves medications that bind to H-2 receptors.
➔ H-1 antihistamines are further classified according to first and second-generation
agents. First-generation H-1 antihistamines more easily cross the blood-brain barrier
into the central nervous system (CNS), whereas second-generation H-1 antihistamines
do not.
● Mode of Action: Histamine (an endogenous chemical messenger) induces an increased level
of vascular permeability, which leads to fluid moving from capillaries into the surrounding
tissues. The overall outcome of this is increased swelling and dilation of vessels. Antihistamines
stop this effect by acting as antagonists at the H-1 receptors. The clinical benefit is a reduction
in allergy symptoms and any related symptoms.
● Side effects: Like all medicines, antihistamines can cause side effects. Side effects of
antihistamines that make you drowsy can include: difficulty peeing, blurry vision and also,
sleepiness (drowsiness) and reduced coordination, reaction speed and judgement. (do not drive
or use machinery after taking these antihistamines). And the side effects of non-drowsy
antihistamines can include: headache, dry mouth, and feeling sick.
● Medications:
ANTIHISTAMINES
Drug Name Usual dosage Usual indications Special consideration
Azelastine 12 years of age and Astelin is a prescription Do not take other

older should take one or medicine used to treat medicines unless they
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two sprays of ANS per the symptoms of have been discussed with
nostril twice daily. sneezing, runny or stuffy your doctor
nose (Rhinitis) caused by
For children between the seasonal allergies.
ages of 5 and 11 who are
taking ANS, two daily
sprays into each nostril
are advised.
Carbinoxamine The typical dose is 7.5 It is used to treat Use only as instructed. If
mL to 20 mL (6 mg to symptoms of seasonal you use any medications,
16 mg) by mouth every (short-term) or perennial or have allergies, let your
12 hours. (long-term) allergies, doctor know.
such as itching, watery
eyes, hives, skin rash,
itching, or wheezing.
Cyproheptadine 4 mg PO q8hr initially; Cyproheptadine may be Not recommended for

maintenance: 4-20 used to treat life- pregnant women.
mg/day, up to 32 mg/day threatening allergic
divided q8hr responses in patients who
have received blood
products as part of their
medical care.
Desloratadine 10 ml (5 mg) oral It works by blocking Not recommended for

solution once a day. histamine, a substance in children under 1 year old,
the body that causes except on the advice of
allergic symptoms. the doctor.
3. Phenothiazines/Dopamine Antagonist
● Indication: Phenothiazines are used to treat serious mental and emotional disorders,
including schizophrenia and other psychotic disorders. Some are used also to control
agitation in certain patients, severe nausea and vomiting, severe hiccups, and moderate
to severe pain in some hospitalized patients.
● Mode of action: Phenothiazines' specific mode of action is not completely known.
However, phenothiazines predominantly exert their effects via blocking the
mesolimbic pathway's dopamine receptor with a selective action at the D2 receptor. By
inhibiting dopamine's synaptic hyperactivity, this inhibition lessens positive
schizophrenia symptoms including delusions and hallucinations.
● Side effects: Side effects include constipation, trouble urinating, dryness of mouth,
confusion, problems with memory, dizziness or fainting, drowsiness, trembling of the
hands and fingers, and problems with muscle movement, such as decreased or unusual
movements.
● Medication:
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Phenothiazines/Dopamine Antagonist
Chlorpromazine 10 to 25 mg orally every Treatment for nausea and Not recommended for
4 to 6 hours as needed. vomiting considers the pregnant women.
indications, mode of
IM or IV the dose can action, side effects,
range from 25 to 50 mg contraindications, and
every 4 to 6 hours as other essential aspects of
needed. chlorpromazine therapy
in the clinical settings
used by professionals to
treat patients suffering
from schizophrenia,
bipolar disorders, and
related psychoses.
Fluphenazine 2.5 to 10 mg per day For patients who cannot Discuss with the doctor
divided every 6 to 8 accept oral formulations or pharmacist before
hours. or for whom drug
compliance is an issue, a taking the medicine.
long-acting fluphenazine
elderly patients - start at decanoate formulation is
1 to 2.5 mg per day principally utilized as
(divided every 6 to 8 maintenance therapy for
hours also) persistent schizophrenia
and similar psychotic
illnesses.
4. Serotonin Antagonist (SSRIs)

● Indication: Serotonin Antagonist is an activity modulator (SDAMs) are medications
prescribed for the treatment of psychiatric disorders such as schizophrenia and bipolar
disorders. (SDAMs) improve psychiatric symptoms by modulating serotonin and
dopamine. Two neurotransmitters involved in the regulation of mood and emotions.
● Mode of action: Strong antiemetic effects are produced by selective serotonin receptor
(5-HT3) antagonists, which block serotonin at the peripheral level on vagal nerve
terminals in the gastrointestinal (GI) system and at the central level in the
chemoreceptor trigger zone in the region postrema of the fourth ventricle.
● Side effects: Although serotonin antagonists and transport inhibitors are more
frequently prescribed for other diseases like anxiety and sleeplessness, they are
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principally suggested as antidepressant drugs. These medications frequently cause

drowsiness, headaches, dry mouth, dizziness, and blurred vision as adverse effects.
● Medication:
Serotonin Antagonist (SSRIs)
Alosetron 0.5 mg orally twice a Treatment of severe This drug is indicated

day may be increased up diarrhea-predominant only for women with
to 1 mg orally twice a IBS symptoms in female severe diarrhea -
day after 4 weeks of patients without predominant irritable
treatment. anatomic or biochemical bowel syndrome.
GI abnormalities who
max dose: 2 mg/day have not responded to
conventional therapy and
have had chronic
symptoms (usually
lasting longer than 6
months).
Risperidone adults - 2 to 3 Treatment for autistic discussed with the doctor

milligrams (mg) once a disorder-related before taking the
day. irritability and
schizophrenia. medicine.
older adults - 0.5 mg 2 Additionally, it is
times a day. prescribed for the
treatment of acute mania
10 to 17 years of age - or mixed episodes linked
0.5 mg once a day, in the to bipolar I disorder,
morning or evening. either as monotherapy or
in conjunction with
lithium or valproic acid.
5. Cannabinoids
● Indications: The indications for use of cannabis as medication are numerous and cover
all specialty areas of practice. From a nursing perspective, cannabis can be effective
for many common patient problems: chemotherapy-induced nausea and vomiting, lack
of appetite, inability to sleep, pain, depression, and anxiety.
● Mode of action: Cannabinoids modulate diverse pain targets and possess unique
multimodal analgesic mechanisms of action.
● Side effect: Although there are studies that show potential benefits from Cannabinoids,
there are many side effects from taking the drug. This shows that an addiction to this
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natural drug can be hazardous. Some side effects include rapid heartbeat, dizziness,
depression, and hallucination.
● Medication: Cannabidiol (Epidiolex) can be used for certain forms of severe epilepsy
or seizures. Cannabidiol is for use in adults and children who are at least 1 year old.
Taken oral Liquid
6. Substance P/Neurokinin 1 Antagonist (SPA)

● Indication: Substance P binds to the Neurokinin-1 (NK-1) receptors found in the
emetic center of the central nervous system (CNS) to induce emesis. Maropitant is a
selective NK-1 receptor antagonist that inhibits the binding of substance P to NK-1
receptors and is commonly used to prevent and treat vomiting.
● Mode of Action: Specific nutritional and medical management strategies have to be
developed to control and treat such dysfunctions. Substance P (Neurokinin-1 receptor)
antagonist, such as maropitant has become the antiemetic of choice in veterinary
patients for the prevention of chemotherapy-induced vomiting.
● Side effect: when administered orally or intravenously, may cause the following side
effects are anemia, dizziness & urinary tract infection
● Medication: Aprepitant - substance P/neurokinin 1 receptor antagonist used to treat
nausea and vomiting caused by chemotherapy and surgery. Aprepitant comes as a
capsule and as an oral suspension (liquid) to take by mouth. To prevent nausea and
vomiting caused by cancer chemotherapy, aprepitant is usually taken once daily, with
or without food, during the first few days of your cancer chemotherapy treatment.
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IV. PROKINETICS
Indication:
● Prokinetic agents refer to a class of drugs that promote the passage of ingested material in the
gastrointestinal tract. They are mainly beneficial for treating motion problems caused by
various medical conditions and gastroesophageal reflux disorders.
● Prokinetic agents induce all the above actions by stimulating excitatory chemical messengers
(neurotransmitters) like acetylcholine and suppressing inhibitory neurotransmitters like
dopamine and serotonin. These stimulate specific receptors on the smooth muscle cells in the
gastrointestinal tract, thus promoting muscle contractions.
● Prokinetic agents, or prokinetics, are medications that help control acid reflux. Prokinetics help
strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty
faster. This allows less time for acid reflux to occur.
Associated Disease:
Gastroesophageal reflux disease (GERD) occurs when stomach acid repeatedly flows back into the
tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining
of your esophagus. Many people experience acid reflux from time to time.
Prokinetic Medication:
1. Metoclopramide
Indication: is used to treat the symptoms of slow stomach emptying (gastroparesis) in patients with
diabetes. It works by increasing the movements or contractions of the stomach and intestines. It relieves
symptoms such as nausea, vomiting, heartburn, a feeling of fullness after meals, and loss of appetite.
Metoclopramide is also used to treat heartburn for patients with gastroesophageal reflux disease
(GERD). GERD is esophageal irritation from the backward flow of gastric acid into the esophagus.
Mode of Action: Metoclopramide works by blocking a natural substance. It speeds up stomach

emptying and movement of the upper intestines
Side Effects: This drug is not recommended for use in children due to an increased risk of serious side
effects (such as muscle spasms/uncontrolled muscle movements). Ask the doctor or pharmacist for
details.
Medication:
PROKINETICS
Drug Name Usual Dosage Usual Indications Special Considerations
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Metoclopramide Gastroparesis is This medication is a This medication also

treated with 10 mg gastrointestinal causes postoperative
administered orally stimulant and nausea and vomiting
four times daily, 30 antinauseant,
minutes before each prescribed for
meal and at bedtime. heartburn and
Nausea and vomiting esophagitis due to
associated with GERD and for treating
emetogenic cancer patients who have
chemotherapy: gastroparesis (partial
Adults: IV- 2 mg/kg paralysis of the
by infusion 30 min stomach) and
before chemotherapy, prevention of nausea
repeated every 2 hours and vomiting
for 2 doses, then every associated with cancer
3 hours for 3 doses. chemotherapy.
V. LAXATIVE
Indication:
Laxatives are indicated for the short-term relief of constipation (slowed peristalsis), to evacuate the
bowel for diagnostic procedures or surgical procedures such as childbirth and abdominal surgery, and
to remove ingested poisons from the lower GI tract. When people are dehydrated and lack a fiber diet,
lack exercise, or take certain medicine such as antidepressants it often results in constipation. The
simplest remedy for constipation is to drink more fluid and a diet that contains high in fiber (fiber
softened fecal which makes it easy for bowel movement), and exercise. Most laxatives are available in
over-the-counter preparations.
Risk and Special Precautions:
Laxatives can cause diarrhea if taken in overdose, and constipation if overused. The most serious risk
of prolonged use of most laxatives is developing dependence on the laxative for normal bowel action.
Use of laxative therefore should be discontinued as soon as normal bowel movements have been re-
established. Children should not be given laxatives except in special circumstances on the advice of a
doctor.
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Types of Laxatives:
Bulk-forming agents are rapid-acting, aggressive laxatives that cause fecal matter to increase in bulk.
Lubricants make defecation possible without stimulating the movement of the GI tract. Chemical
stimulants cause the bowel muscles to contract, Osmotics act by keeping water in the bowel, thereby
making the bowel movements softer.
1. Bulk-forming agents/ Mechanical Stimulants
● They increase the motility of the GI tract by increasing the fluid in the intestinal
contents which enlarges bulk, stimulates local stretch receptors, and activates local
activity, making the faeces softer and easier to pass.
BULK-FORMING AGENTS/MECHANICAL STIMULANTS
Drug Name Usual Dosage Usual Indications Special Side Effects
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Considerations
Methylcellulose Tablets. Not absorbed into the Reduce dose if Abdominal

1-4x daily. Take a bloodstream but necessary for infants distention,
full glass of water. remains in the and children. flatulence, and
intestine. It absorbs up abdominal pain
to 25 times its volume are rare.
of water, thereby
softening faeces and
increasing their
volume. It is also used
to reduce the
frequency and
increase the firmness
of faeces in chronic
watery diarrhea.
Polycarbophil Tablet Increases the bulk in a Discussed with the Stomach pain,
1-4x daily . stool, an effect that doctor before taking bloating, or gas
helps to cause the medicine. are common.
movement of the Stomach cramps
intestines and and rectal
increases the amount bleeding are
of water in the stool rare,
making it softer and
easier to pass.
2. Stool softener/ Surfactant/ Lubricants

● Make defecation easier without stimulating the movement of the GI tract. It encourages
bowel movements by coating the bowel and the stool mass with waterproof film. When
stool remains moistened it will be soft and eventually make the passage easier.
STOOL SOFTENER/SURFACTANT/LUBRICANTS

Considerations
Docusate Tablet, Liquid Increasing the Not recommended Stomach cramps,

3x daily amount of water to infants. diarrhea, rashes
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the stool absorbs in

the gut, making the
stool softer and
easier to pass.
Mineral Oil Liquid Keeping water in Itching, allergy is

Recommended the stool and rare
dose 10-30ml daily intestines.
3. Chemical Stimulants
● Directly stimulates the nerve plexus in the intestinal wall, causing increased movement
and the stimulation of local reflexes.
CHEMICAL STIMULANTS

Considerations
Bisacodyl Tablet, suppository Emptying bowels Not recommended Nausea,

1-3x daily to pregnant women. Diarrhea,
stomach pain
Senna Tablets Short-term Safe not until Stomach cramps,

2- daily treatment. Irritate overused- 1 week. diarrhea
the lining of the
bowel, which causes
a laxative effect.
4. Osmotics
● It has solutes that increase osmotic pull of fluid into the GI tract. This will increase the
pressure in the GI tract and stimulate more intestinal motility.
OSMOTICS

Considerations
Lactulose Liquid and Powder Softens feces by Reduce dose Stomach cramps,
2x daily (chronic increasing the necessary to and flatulence are
constipation amount of water in children. common, some
the large intestine. rare cases are
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3-4x daily (liver Locally acts in the nausea, diarrhea,

failure) large intestine and and abdominal
is not absorbed into distension.
the body which
makes it safer than
other laxatives.
However, the drug
can cause stomach
pain and flatulence
at the start of the
treatment.
Magnesium Tablets, Liquid, Fast-acting antacid Not recommended Diarrhea is

Hydroxide Powder is given to under 1 year except common.
4x daily with water, neutralize stomach on the advice of a
preferably an hour acid. Also prevents doctor. Reduce the
after food. pain caused by dose necessary for
stomach and older children.
duodenal ulcers,
gastritis, and reflux
esophagitis. Acts as
laxatives by
drawing water into
the intestine from
the surrounding
blood vessels to
soften the feces.
VI. ANTIDIARRHEALS
Indication:
- Antidiarrheals work by decreasing the flow of fluids and electrolytes into the bowel and slowing
down the movement of the bowel to decrease the number of bowel movements.This allows
more fluid to be absorbed into your body which helps in having less diarrhea and more formed
and bulky stools.They help in balancing the way fluid moves through your intestines and thus
reduce inflammation. They also slow the growth of bacteria that might cause diarrhea.
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Associated Disease:
- Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a
variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated
food or drinking-water, or from person-to-person as a result of poor hygiene.
Medications:
- You can buy over the counter (OTC) medicines without a prescription from your doctor. Some
OTC medicines can help you feel better if you have diarrhea. These are called antidiarrheal
medicines. Antidiarrheal medicines include the Loperamide (1 brand name: Imodium).
(capsules or tablets: take 2 capsules or tablets, taken immediately. Then take 1 capsule or tablet
after each runny.
1. Opioid
● Indication: is indicated for the management of pain in patients where an opioid
analgesic is appropriate. When using opioids, it should be in combination with
nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate." In
the same guidelines, the CDC defines the indication of opioid use for acute pain, stating
that "when opioids are used for acute pain, clinicians should prescribe the lowest
effective dose of immediate-release opioids and should prescribe no greater quantity
than needed for the expected duration of pain severe enough to require opioids.
● Mode of action: Opioids act both presynaptically and postsynaptically to produce an
analgesic effect. Presynaptically, opioids block calcium channels on nociceptive
afferent nerves to inhibit the release of neurotransmitters such as substance P and
glutamate, which contribute to nociception. Postsynaptically, opioids open potassium
channels, which hyperpolarize cell membranes, increasing the required action potential
to generate nociceptive transmission.
● Side effect: Because of the distribution of opioid receptors both within and outside the
nervous system, opioid analgesics produce a broad spectrum of adverse effects,
including dysphoria, euphoria, sedation, respiratory depression, constipation,
suppression of endocrine systems, cardiovascular disorders (e.g., bradycardia),
convulsion, nausea, vomiting, pruritus, and miosis
● Medication:
ANTIDIARRHEALS
Drug Name Usual Dosage Usual Indication Special Consideration
Ibuprofen The recommended This medication is a This medication

dose range is 200 to nonsteroidal anti- decreases the hormones
inflammatory drug that cause pain and
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600mg 4-6 hourly. (NSAID), prescribed for inflammation in the

Max: 1.2 g/day. mild to moderate pain, body.
inflammation, and fever.
Loperamide Adults: The This medication is an

recommended initial antidiarrheal agent,
dose is 4mg (two prescribed for diarrhea. It
capsules) followed by slows the movement of
2 mg (one capsule) bowel contents.
after each unformed
stool.
Child- Two to five

years: 1 mg three
times per day (3mg
daily).
Six to eight years: 2

mg two times per day
(4mg daily dose).
VII. MISCELLANEOUS GI DRUGS
1. Anti-inflammatory (bismuth subsalicylate)

● Indication: Bismuth subsalicylate is used to treat diarrhea, heartburn, and upset
stomach in adults and children 12 years of age and older. Bismuth subsalicylate is in a
class of medications called antidiarrheal agents. It works by decreasing the flow of
fluids and electrolytes into the bowel, reduces inflammation within the intestine, and
may kill the organisms that can cause diarrhea.
● Mode of action: It works by helping to slow the growth of bacteria that might be
causing the diarrhea.
● Side Effects: Abdominal pain, anal discomfort, anxiety, black tongue, clay/black-
colored stools, cold symptoms, confusion, constipation, dark urine, diarrhea, dizziness,
indigestion
● Medications:
ANTI-INFLAMMATORY
Drug Name Usual Dosage Usual Special Side Effects

Indication Considerations
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College of Nursing
Loperamide For oral dosage Loperamide is Children 2 years of · Bloating

form (capsules): used to control age and older—Use · Constipation
and relieve the and dose must be · Loss of appetite
Adults—At first, symptoms of determined by your · Nausea
4 milligrams acute diarrhea. It doctor. · Stomach pain
(mg) (2 capsules) is also used to · Vomiting
after the first treat chronic Children younger
loose bowel diarrhea in than 2 years of
movement, then patients with age—Use is not
2 mg (1 capsule) inflammatory recommended.
after each loose bowel disease.
bowel movement Loperamide
after the first helps stop
dose has been diarrhea by
taken. Your slowing down the
doctor may movements of
adjust your dose the intestines.
as needed.
However, dose is
usually not more
than 16 mg (8
capsules) per
day.
Kaopectate Adults and Kaopectate is Children under 12 Constipation

children 12 used for treating years:
years of age diarrhea, nausea, Dark-coloured
heartburn, stools
and older: 2 - Ask a doctor
indigestion, gas
caplets (1 or upset in the drink plenty of Changes in
dose) stomach. It clear fluids to help behaviour
works by helping prevent
- Swallow to slow down the dehydration Nausea
caplets with growth of caused by diarrhea
bacteria that may Vomiting
water; do not
cause diarrhea.
chew Hearing loss
This product
- Repeat dose should not be
every 1/2 hour used for self- Diarrhea
to 1 hour as treatment with
diarrhea if you Worsened Stomach
needed
also have fever Symptoms
- Do not or blood/mucus
in your stools.
exceed 8 doses
in 24 hours
- Use until
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diarrhea stops
but not more
than 2 days
Pepto - Bismol 2 tablets (262 This medication This product should Darkening of the
mg/tab) or 30 is used to treat not be used to self- stools and/or tongue.
mL (regular occasional upset treat diarrhea if you
stomach, also have a fever or
strength) PO
heartburn, and blood/mucus in the
q½-1hr PRN; nausea. It is also stools.
used to treat
Maximum diarrhea and help
daily dose: 8 prevent travelers'
regular- diarrhea. It
strength doses works by helping
to slow the
or 4 extra-
growth of
strength doses bacteria that
might be causing
the diarrhea.
2. Adsorbents
● Indication: Adsorbents have been so named because of their potential to adsorb
intestinal luminal toxins and bacteria associated with some types of infectious diarrhea,
and theoretically they should enhance fecal elimination of the toxins or bacteria.
● Mode of Action: Adsorbent medications work by coating the walls of the GI tract and
binding the causative bacteria or toxin for elimination from the GI tract through the
stool.
● Side Effects: Allergic reaction: Itching or hives, swelling in your face or hands,
swelling or tingling in your mouth or throat, chest tightness, trouble breathing, wew or
worsening abdominal pain, or severe constipation, severe diarrhea, and swelling of
your lower abdomen (belly).
● Medications:
ADSORBENTS

Kremezin For oral use, the Consists of oral, Children 2 years of Constipation,
usual adult dosage spherical carbon age and older— appetite loss,
is 6 g of spherical particles that Use and dose must nausea, and
be determined by
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carbon adsorbent adsorb uremic your doctor. vomiting.

divided 3 times toxins and their
daily. precursors Children younger
than 2 years of
within the
age—Use is not
gastrointestinal recommended.
tract, allowing
them to be
excreted in the
feces.
Attapulgite Adults, children 12 Attapulgite is an

years and older, adsorptive Bloating
and geriatric magnesium
patients: 1.2-1.5 g aluminium Indigestion/heartbur
orally after each phyllosilicate n
loose bowel which binds to
movement; no toxins, bacteria Gas (flatulence)
more than 8.4 g/24 and water.
hours Attapulgite Mild constipation
adsorbs water,
Children 6-12 toxins and Nausea
years old: 600-750 bacteria,
mg orally after contributing to
each loose bowel firmer stools,
movement; no reducing fluid
more than 4.5 g/24 loss from
hours diarrhea.
Children 3-6 years

old: 300 mg orally
after each loose
bowel movement;
no more than 2.1
g/24 hours
3. Antiflatulents (simethicone)
● Indication: Simeticone or (simethicone) is a type of medicine called antiflatulent. It is
used to treat wind (flatulence). It is a mixture of silica gel and dimeticone (or
dimethicone, a type of silicone) and is known as "activated dimeticone". It can help
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with trapped wind and bloating as well as colic in babies. This product is used to relieve
symptoms of extra gas such as belching, bloating, and feelings of pressure/discomfort
in the stomach/gut. Simethicone helps break up gas bubbles in the gut.
● Mode of Action: It works by bringing together the small gas bubbles in your gut to
form bigger bubbles, allowing trapped air to pass through your body more easily.
Aluminum and magnesium antacids work quickly to lower the acid in the stomach.This
medication works only on existing acid in the stomach. It does not prevent acid
production.
● Side effects: Black/tarry stools, slow/shallow breathing, slow/irregular heartbeat,
mental/mood changes (such as confusion), deep sleep, pain with urination,
stomach/abdominal pain, vomit that looks like coffee grounds.
● Medications: It may be used alone or with other medications that lower acid
production (including H2 blockers such as cimetidine/ranitidine and proton pump
inhibitors such as omeprazole).
ANTIFLATULENTS

Gas-X Adults and Gas-X is used to Children—Dose Rash,

teenagers: relieve painful must be determined itching/swelling
pressure caused by the doctor. (especially of the
- (Capsules or by excess gas in face/tongue/throat),
tablets) 60 to 125 the stomach and severe dizziness,
milligrams (mg) intestines. This trouble breathing.
four times a day, medicine is for
after meals and at use in babies,
bedtime. The dose children, and
should not be more adults.
than 500 mg in
twenty-four hours.
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Ovol Adults and Used to relieve Children—Dose No common or

teenagers: the painful must be determined important side
symptoms of by the doctor. effects reported.
- 60 to 125 too much gas in
milligrams (mg)
the stomach and
four times a day,
intestines.
after meals and at
bedtime. The dose
should not be more
than 500 mg in
twenty-four hours.
Phazyme 40-360 mg PO Phazyme is used Rash,

q6hr after meals to relieve itching/swelling
and at bedtime painful pressure (especially of the
face/tongue/throat),
PRN; not to exceed caused by
severe dizziness,
500 mg/day excess gas in the trouble breathing.
stomach and
intestines. This
medicine is for
use in babies,
children, and
adults.
Kremil-S Adult Dose: This is used for If taken more than Headache,
hyperacidity the recommended dizziness, weakness,
- 1 to 2 This product is a dosage, consult a fatigue, muscle
tablets to doctor. weakness, seizures,
combination of
be taken insomnia,
antacids and drowsiness,
one hour simethicone depression,
after each which confusion,
meal and effectively disorientation,
at bedtime. neutralizes the anxiety, decreased
acid produced in sexual desire, and
hallucinations have
the stomach and
been reported.
relieves bloating
and gassiness.
Drug Interactions
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● Antacids decrease the absorption of Tetracycline and Iron. Take Tetracycline 1 hour before or
2 hours after antacids and 2 hours before or 3 hours after Iron-containing preparations.
● Antacids may decrease the absorption of orally administered Digoxin, or Indomethacin,
Isoniazid, Quinolones (e.g., Ciprofloxacin, Ofloxacin), Ketoconazole. Doses of these drugs
should be spaced as far apart as possible from doses of antacids.
● Antacid-induced changes in urine pH increase urinary excretion and decrease blood
concentration of salicylates such as Aspirin.
● Antacid-induced increases in urine pH may decrease excretion of weakly basic drugs (e.g.,
Quinidine, Chlorpromazine, Propranolol, Diazepam) and increase excretion of weakly acidic
drugs (e.g., Phenytoin, Pentobarbital, Warfarin).
● Aluminum-Magnesium antacid combination is reported to increase the absorption of
Dicumarol, Diazepam and Pseudoephedrine.
● Magnesium and Aluminum Hydroxide administration may decrease the rate of
Chlordiazepoxide absorption.
● Antacids reduce the bioavailability of bisphosphonates (e.g., Alendronate, Etidronate,
Risedronate).
VIII. NUTRITIONAL AIDS
1. Digestive Enzymes
- It is a protein that is naturally occurring on our body. It helps us to break down the large
molecules that we eat into the smaller soluble molecules such as glucose, so that the body can
use it as fuel. It can also help in other activities such as hormone production, respiration, cell
regulation.
How do enzymes work?

- Enzyme is also known as the lock and key, which means that the enzyme wouldn’t have its
product if this key is not compatible with the lock. An enzyme active site has a unique shape
same as the substrate, to have a product the enzyme and the substrate must fit together.
- Enzymes can only work on certain conditions, it should be at least around the body temperature,
the enzymes should be in the state of its pH level because there are enzymes that are acidic and
basic. And if some of this condition does not meet, the enzymes may lead into denaturing or
may still be able to work but at a slower pace.
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Enzyme Temperature pH
Lipase (pancreas) 8
Lipase (stomach) 4.0-5.0
Lipase (castor oil) 4.7
Pepsin 1.5-1.6
Trypsin 7.8-8.7
Urease 98.6 degrees Fahrenheit (37 7.0
Invertase degrees Celsius) 4.5
Maltase 6.1-6.8
Amylase (pancreas) 6.7-7.0
Amylase (malt) 4.6-5.2
Catalase 7.0
Common digestive enzymes made in the pancreas:

a. Amylase - made in the mount and pancreas; breaks down carbohydrates.
b. Lipase - made in pancreas; breaks down fats.
c. Protease - made in the pancreas; breaks down proteins.
Some other common enzymes made in the small intestines:

a. Lactase - breaks down lactose
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b. Sucrase - breaks down sucrose

Digestive Enzyme Insufficiency
- Our bodies naturally produce enzymes, meaning that it is made by our body naturally. But, in
other cases some people don’t have enough digestive enzymes to break down certain foods and
absorb nutrients and this might lead to malnutrition or gastrointestinal irritation.
Few types of digestive enzyme insufficiency are:

1. Congenital sucrase-isomaltase deficiency - a genetic condition where it affects the person’s
ability to digest sugars. (Symptoms: Watery diarrhea, abdominal distraction, irritability, acidic
diarrhea, and indigestion.)
2. Exocrine pancreatic insufficiency - occurs when there are not enough enzymes produced by
your pancreas that is why you can’t digest carbohydrates, proteins, and fats. (Symptoms:
Cramping/bloating after meals, large amounts of gas, foul smelling gas, floating stools, oily
stools, frequent loose stools, and unexplained weight loss.)
Disease Treatment Mode of action Usual dosage Side effects
Congenital Sucraid Breakdown and 1 mL (one full Worse abdominal

sucrase- absorption of sucrose but measuring scoop or pain, vomiting,
isomaltase does not break down 28 drops) per meal or nausea, diarrhea,
deficiency starch snack for patients up constipation, and
to 15 kg in body dehydration
weight.
2 mL (two full
measuring scoops or
56 drops) per meal or
snack for patients
over 15 kg in body
weight.
Exocrine ULTRESA Replace deficiency of Infants (up tp 12 Headache,

pancreatic (pancrelipase) pancreatic enzymes and months) - PO 4,000 pharyngolaryngeal
insufficiency act like digestive lipase (one capsule) pain, and epistaxis.
enzymes physiologically per 120 mL of
secreted by the pancreas. formula or per breast
feeding
Children (12 months

and younger than 4
years) - Should begin
with PO 1,000 lipase
units/kg for children
less than 4 years to a
maximum 2,500
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lipase units/kg per

meal (or less than
equal 10,000 lipase
units/kg per day).
Children (4 years and

older adult) - Enzyme
dosing should begin
with PO 500 lipase
unit/kg per meal; 4
years to a maximum
2,500 lipase units/kg
per meal (or less than
10,000 lipase units/kg
per day)
B. Probiotics
- It is a substance which stimulates the growth of microorganisms to improve digestion. A living
organism that is present in our intestines that maintains a healthy digestive system. There are
two types of bacteria: good bacteria (Probiotic) and bad bacteria (e.g., Escherichia Coli (E. coli)
can get from contaminated food and unpasteurized milk). These microbiomes or a diverse
community of organisms are not that bad of what the others viewed about it. This community
is made up of things called microbes and these microbes are a combination of bacteria, fungi
(including yeast), viruses, and protozoa. Good bacteria included in probiotics somehow
maintains our body’s health and functionality, also it fights off harmful bacteria when there are
too many of them.
But there is a characteristic for a microbe to be called probiotic and these include being able to:
1. Isolated from a human
2. Survive in your intestine after ingestion
3. Have a proven benefit
4. Safely consumed
How do probiotics work?

- Probiotic or good bacteria works as it fights off bad bacteria when there is an increase in number
and restores the balance within your body. It also supports our immune function and controls
inflammation.
It can also:
● Help your body digest food
● Keep bad bacteria getting out of control and making you sick
● Create vitamins
● Help support the cells to prevent bad bacteria entering your blood
● Breakdown and absorb medications
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What are the common types of probiotic bacteria?

● Lactobacillus - all yogurts with live and active probiotics, supports the immune system
according to the FDA.
● Bifidobacterium - can be found on yogurt, kefir, buttermilk, miso, pickles, kimchi, and some
wines and vinegars. It may reduce inflammation and support immune health in older adults
according to meta-analysis journal nutrients, January 2017.
As we know that Probiotics can be taken from food and drinks and naturally occurs in our body. But
probiotics can be taken as a food supplement as well. These pills supplement may give you about
billions of Colony Forming Units of Lactobacillus.
Example: Lactobacillus Acidophilus
Supplement Help treats: Release symptoms Usual dosage Side effects

of: (Best with
prescribe of
doctor)
Lactobacillus • Diarrhea • UTI Children • Gas

Acidophilus • Vaginal • Constipation • Bloating
inflammation • Gum disease 100 million and • Upset
• Yeast 50 billion stomach
infection Colony Forming or
Units per day up diarrhea
to 3 months
Adult
50 million and
100 billion
Colony Forming
Units per day
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References:
Acidophilus (Lactobacillus Acidophilus): Uses, Benefits & Side Effects. (n.d.). Cleveland Clinic.
Retrieved September 30, 2022, from https://my.clevelandclinic.org/health/drugs/22650-
acidophilus
Antacid Simethicone Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD.
(n.d.). Retrieved September 26, 2022, from https://www.webmd.com/drugs/2/drug-
56526/antacid-simethicone-
oral/details#:%7E:text=Nausea%2C%20constipation%2C%20diarrhea%2C%20or,the%20risk
%20of%20side%20effects.
Cannabinoid Addiction And Abuse – (2022) Retrieved September 27, 2022,

from https://www.rehabspot.com/drugs/cannabinoids/?fbclid=IwAR0mA_-
u4Fzimt15WZTsfV9OHllgNzNINER4Av5Vm1U6egm64Ox4PjhEEgA
Cannabinoids - Cannabis The Debate Continues – (2022) Retrieved September 27, 2022,
from https://www.atrainceu.com/content/248-
cannabis?fbclid=IwAR042QhF1r0VIQn2kU63dA9q2uWe_uCO7AAKr2NYWf-
_c8AEuXbUf8Vcqmc#group-tabs-node-course-default1
Center for Drug Evaluation and Research. (2018, May 2). Related Information for Sacrosidase Oral
Solution. U.S. Food And Drug Administration. Retrieved September 27, 2022, from
https://www.fda.gov/drugs/drug-shortages/related-information-sacrosidase-oral-solution
Clinical Applications of Substance P (Neurokinin-1 Receptor) Antagonist in Canine Medicine (2021

Nov ) Retrieved September 27, 2022,from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934081/?fbclid=IwAR2MWPfuFJjQdeUOS
dbv87U5vvYBXOSUUfku9k9iblzvpZRG6-
MaAILaGP4#:~:text=Substance%20P%20binds%20to%20the,and%20treat%20vomiting%20
in%20dogs
ClinicalKey. (2020). Clinicalkey.com. https://www.clinicalkey.com/#
Diarrhoeal disease (2017, may 2) Retrieved September 27, 2022,from https://www.who.int/news-

room/fact-sheets/detail/diarrhoeal-
disease?fbclid=IwAR2gjirWTgV7K17ntmQo9JMQEy9UFo3Znjk9Zm2ttsMEr1rB573ER55
M_g8#:~:text=Diarrhoea%20is%20usually%20a%20symptom,a%20result%20of%20poor%2
0hygiene
Digestive Enzymes and Digestive Enzyme Supplements. (2022, February 10). Johns Hopkins
Medicine. Retrieved September 27, 2022, from
https://www.hopkinsmedicine.org/health/wellness-and-prevention/digestive-enzymes-and-
digestive-enzyme-supplements
Digestive System: Function, Organs & Anatomy. (n.d.-b). Cleveland Clinic. Retrieved September 27,
2022, from https://my.clevelandclinic.org/health/body/7041-digestive-system
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College of Nursing
Enzymes: What Are Enzymes, Pancreas, Digestion & Liver Function. (n.d.). Cleveland Clinic.
Retrieved September 27, 2022, from https://my.clevelandclinic.org/health/articles/21532-
enzymes#:%7E:text=All%20living%20things%20have%20enzymes,in%20manufactured%20
products%20and%20food.
Farzam, K., & O’Rourke, M. C. (2020). Antihistamines. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK538188/
Gastrointestinal adsorbent (By mouth) | Drug Notes | Health Information | St. Luke’s Hospital. (n.d.).
Retrieved September 26, 2022, from https://www.stlukes-stl.com/health-content/drug-
notes/45/5307.htm
Ghossein, N., Kang, M., & Lakhkar, A. D. (2020). Anticholinergic Medications. PubMed; StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555893/
HOW DO ANTIDIARRHEALS WORK? (2021, june 06) Retrieved September 27, 2022,from
https://www.rxlist.com/how_do_antidiarrheals_work/drug-
class.htm?fbclid=IwAR042QhF1r0VIQn2kU63dA9q2uWe_uCO7AAKr2NYWf-
_c8AEuXbUf8Vcqmc#:~:text=Antidiarrheals%20work%20by%20decreasing%20the,more%
20formed%20and%20bulky%20stools
HOW DO NK1 RECEPTOR ANTAGONISTS WORK? (2021, June 22) Retrieved September 27,
2022,from https://www.rxlist.com/how_do_nk1_receptor_antagonists_work/drug-
class.htm?fbclid=IwAR2pnNSKCiLHRHiVgAQqeRi9ZCgnsK3IUOiwqDjnKL0H3CTdJWih
EStIu5k
How to use Metoclopramide 10 Mg Disintegrating Tablet GI Stimulants (N/A) Retrieved September

27, 2022,from https://www.webmd.com/drugs/2/drug-8679-2217/metoclopramide-
oral/metoclopramide-disintegrating-tablet-
oral/details?fbclid=IwAR1SOVLoT_5iFbsS2KSZ9m8ONj1VH8IiGrLWGMRpLSKbILQRnI
vjn08a2ck#:~:text=Metoclopramide%20works%20by%20blocking%20a,spasms%2Funcontro
lled%20muscle%20movements
Karch Rn Ms, M. A. (2022, September 6). Focus on Nursing Pharmacology (8th ed.).
Kidron, A., & Nguyen, H. (2022). Phenothiazine. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK556113/#:~:text=Phenothiazines%20are%20a%20g
roup%20of
Kremil-S Full Prescribing Information, Dosage & Side Effects | MIMS Philippines. (n.d.). Retrieved
September 26, 2022, from https://www.mims.com/philippines/drug/info/kremil-s?type=full
BSN 2-6 | GROUP 8

Intramuros, Manila
College of Nursing
Kremezin Full Prescribing Information, Dosage & Side Effects | MIMS Philippines. (n.d.). Retrieved
September 26, 2022, from https://www.mims.com/philippines/drug/info/kremezin?type=full
Lactose intolerance - Diagnosis and treatment - Mayo Clinic. (2022, March 5). Retrieved September
27, 2022, from https://www.mayoclinic.org/diseases-conditions/lactose-intolerance/diagnosis-
treatment/drc-
20374238#:%7E:text=Using%20lactase%20enzyme%20tablets%20or,to%20a%20carton%20
of%20milk.
Medical marijuana Mayo Clinic. (2021, December 4). Retrieved September 27, 2022,from
https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-
marijuana/art-
20137855?fbclid=IwAR0bzppowYbeQQYJ0OjJIG9I9f66_lO6cEPAArMvmhVBbHCwgooD
-
ufESA8#:~:text=The%20U.S.%20Food%20and%20Drug,certain%20forms%20of%20severe
%20epilepsy
Narouze, S.N. (2021). Cannabinoids and Pain: Mechanisms of Action. In: Narouze, S.N. (eds)
Cannabinoids and Pain. Springer, Cham. Retrieved September 27, 2022, from
https://link.springer.com/chapter/10.1007/978-3-030-69186-
8_24?fbclid=IwAR2mo5LnApx3erDux4ulY0lPZIjZEGrS8kwZCb7tuLqpstleGIESZUCzPKA
NHS Choices. (2019). Antihistamines. NHS. https://www.nhs.uk/conditions/antihistamines/
NORD - National Organization for Rare Disorders. (2020, December 1). Congenital Sucrase-
Isomaltase Deficiency. NORD (National Organization for Rare Disorders). Retrieved
September 27, 2022, from https://rarediseases.org/rare-diseases/disaccharide-intolerance-
i/#:%7E:text=The%20orphan%20drug%20sacrosidase%20oral,from%20baker’s%20yeast%2
0and%20glycerin.
Nursing, O. R. F. (n.d.). 7.3 Anti-Ulcer Medications – Nursing Pharmacology. Pressbooks. Retrieved

September 26, 2022, from https://wtcs.pressbooks.pub/pharmacology/chapter/7-3-anti-ulcer/
Opioid Analgesics (2022, may 11) Retrieved September 27, 2022,from

https://www.ncbi.nlm.nih.gov/books/NBK459161/?fbclid=IwAR2gjirWTgV7K17ntmQo9JM
QEy9UFo3Znjk9Zm2ttsMEr1rB573ER55M_g8
Parkes, C. (2022, May 2). Pharmacology, part 36: Gastrointestinal Medications - Antiulcer Agents.
LevelUpRN. Retrieved September 26, 2022, from https://www.leveluprn.com/blogs/nursing-
pharmacology/36-gastrointestinal-antiulcer-agents
Probiotics: What is it, Benefits, Side Effects, Food & Types. (n.d.). Cleveland Clinic. Retrieved
September 30, 2022, from https://my.clevelandclinic.org/health/articles/14598-probiotics
BSN 2-6 | GROUP 8

Intramuros, Manila
College of Nursing
Prokinetic Agents (2020, April 13) Retrieved September 27, 2022,from

https://www.healthline.com/health/gerd/prokinetics?fbclid=IwAR1Niw4LmTkkTp3oP-
rCUoeA6NObrlu2ohqGqlr15w1ZwEV6mRh1D73EO54
Theriot, J., Wermuth, H. R., & Ashurst, J. V. (2021). Antiemetic Serotonin-5-HT3 Receptor Blockers.
PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK513318/#:~:text=Go%20to%3A-
Ultresa (Pancrelipase): Uses, Dosage, Side Effects, Interactions, Warning. (2016, June 9). RxList.
Retrieved September 27, 2022, from https://www.rxlist.com/ultresa-
drug.htm#:%7E:text=The%20mean%20daily%20dose%20of,%2C%20pharyngolaryngeal%2
0pain%2C%20and%20epistaxis.
Wagener, D. (2020, February 4). Serotonin Antagonist and Reuptake Inhibitor (SARI). American
Addiction Centers. https://americanaddictioncenters.org/antidepressants-guide/sari
BSN 2-6 | GROUP 8

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Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM

In Partial Fulfillment of the

BSN 2-6 | GROUP 8

DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM

I. BRIEF BACKGROUND ABOUT THE GASTROINTESTINAL SYSTEM

II. ANTI-ULCER AGENTS

BSN 2-6 | GROUP 8

● Gastroesophageal Reflux Disease (GERD) - Patients frequently refer to it as heartburn,

BSN 2-6 | GROUP 8

C. Anti-ulcer Medication Classes

1. Histamine 2 Receptor Antagonist/Blocker

Drug Name Usual Dosage Usual indications Special considerations

cimetidine - 300 mg PO q.i.d Treatment of duodenal ulcer, FDA does not

famotidine - 20-40 mg PO or Treatment of duodenal ulcer, Reduce dose in renal-

nizatidine - 150-300 mg PO at Treatment of duodenal ulcer, Reduce dose in renal-

BSN 2-6 | GROUP 8

ranitidine - 150 mg daily to Treatment of duodenal ulcer, Pediatric: (1 mo to 16 y)

2. Proton Pump Inhibitor

PROTON PUMP INHIBITOR (PPI)

Drug Name Usual Dosage Usual Indications Special

dexlansoprazole - 30-60 mg/d PO for Treatment and maintenance

esomeprazole Acute: Treatment of GERD, severe Pediatric varies

lansoprazole - 15-30 mg/d PO Treatment of gastric ulcer,

BSN 2-6 | GROUP 8

based on condition GERD, pathological

omeprazole - 20-40 mg/d PO for Treatment of gastric ulcer, Pediatric dosage

pantoprazole - 40 mg PO daily to Treatment of GERD in Pediatric dosage

rabeprazole Adults and pediatrics > 12: Treatment and maintenance

BSN 2-6 | GROUP 8

Drug Name Usual dosage Usual indications

aluminum salts Adult: Symptomatic relief of GI hyperacidity,

calcium salts - 0.5-2 g PO prn as an antacid Symptomatic relief of GI hyperacidity,

magnesium salts - 280-1500 mg PO q.i.d., dose Symptomatic relief of GI hyperacidity,

sodium Adult: Symptomatic relief of GI hyperacidity,

Drug Name Usual dosage Usual indications

sucralfate - 1 g PO b.i.d. To q.i.d. On Short-term treatment of duodenal ulcers;

BSN 2-6 | GROUP 8

healing in adults; treatment of oral and

Drug Name Usual Dosage Usual Indications

misoprostol - 100-200 mcg Po q.i.d., Prevention of NSAID-induced ulcers

BSN 2-6 | GROUP 8

BSN 2-6 | GROUP 8

Drug Name Usual dosage Usual indications Special precautions

Atropine 0.4-0.6 mg IV/IM/SC Patients with bradycardia, Do not use other

Belladonna For stomach/intestine Clinical practitioners have Don’t become overheated

Chlordiazepoxide capsule : 5mg/2.5mg irritable bowel syndrome Do not drink alcohol or

BSN 2-6 | GROUP 8

times a day. managed with you know how this

Drug Name Usual dosage Usual indications Special consideration

Azelastine 12 years of age and Astelin is a prescription Do not take other

BSN 2-6 | GROUP 8

Cyproheptadine 4 mg PO q8hr initially; Cyproheptadine may be Not recommended for

Desloratadine 10 ml (5 mg) oral It works by blocking Not recommended for

BSN 2-6 | GROUP 8

Drug Name Usual dosage Usual indications Special consideration

4. Serotonin Antagonist (SSRIs)

BSN 2-6 | GROUP 8

principally suggested as antidepressant drugs. These medications frequently cause

Serotonin Antagonist (SSRIs)

Drug Name Usual dosage Usual indications Special consideration