NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin
GASTROINTESTINAL AGENTS
• ANTIDIARRHEALS
➢ An anti-diarrhoeal drug is any
medication which provides
symptomatic relief for
diarrhoea.
➢ Inhibits the release of
acetylcholine and
prostaglandins, thereby
reducing peristalsis, and
increasing intestinal transit
time, which also favorably
affects water and electrolyte
movement through the
bowel.
➢ These drugs are
contraindicated in patients
whose diarrhea is associated
with organisms That can
harm the intestinal mucosa
(Escherichia coli, Salmonella,
and Shigella).
➢ Patients with
pseudomembranous colitis,
abdominal pain of unknown
origin, and obstructive
jaundice also should not take
antidiarrheals.
➢ Antidiarrheal drugs are
contraindicated in
childrenyoungerthan2years
of age.
➢ The antidiarrheal drugs are
used cautiously in patients
with severe hepatic
impairment or inflammatory
bowel disease.
➢ Antidiarrheal drugs are
classified as pregnancy
category C drugs and should
be used cautiously during
pregnancy and lactation.
➢ Loperamide is a pregnancy
category B drug yet is not
recommended for use during
pregnancy and lactation.
Adverse Reactions in GI System:
anorexia, nausea, vomiting, constipation,
abdominal discomfort, pain, and distention
Other System Reactions:
Dizziness, drowsiness, headache, sedation
and euphoria, rash.
➢ Drug interactions may occur
when antidiarrheal drug is
administered with another
agent such as:
a) Antihistamine, Opioids,
Sedatives, or Hypnotics
b) Antihistaminea and General
Antidepressants
c) Monoamine Oxidase
Inhibitor Antidepressants
• ANTIFLATULENTS
➢ An antiflatulent (or
deflatulent) agent is a drug
used for the alleviation or
prevention of excessive
intestinal gas.
➢ For the alleviation of
flatulence, an antifoaming
agent such as simethicone
may be taken orally. This
agent will coalesce the
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin
smaller gas bubbles into
larger bubbles, there by
easing therelease of gas
within the gastrointestinal
tract viaburpingorflatulence.
➢ Simeticone or (simethicone)
is a type of medicine called
an 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 with
trapped wind and bloating as
well as colic in babies.
➢ No adverse reactions have
been reported with the use
of antiflatulents.
➢ In terms of interactions,
there may be a decreased
effectiveness of other drugs
because of absorption by
charcoal, which can also
absorb other drugs in the GI
tract.
➢ There are no known
interactions with
Simethicone
➢ Antiflatulents are used to
relieve painful symptoms of
excess gas in the digestive
tract that may be caused by
the following:
a) postoperative
gaseous distention
and air swallowing
b) Dyspepsia (fullness or
epigastric discomfort)
c) Peptic ulcer
d) Irritable Bowel
Syndrome or
Diverticulosis
➢ In terms of interactions,
there may be a decreased
effectiveness of other drugs
because of absorption by
charcoal, which can also
absorb other drugs in the GI
tract.
➢ There are no known
interactions with
Simethicone
• LAXATIVES
➢ A laxative is a substance that
you use to help you have a
bowel movement. A stool
softener is a type of laxative,
called an emollient laxative.
So, all stool softeners are
laxatives, but not all laxatives
are stool softeners.
➢ Laxatives are a group of
drugs that either accelerate
fetal passage or decrease
fecal consistency. They are
used primarily to treat
constipation.
➢ The term is often used
interchangeably with
cathartics, purgatives, or
evacuants, but there are
subtle differences in the
meaning especially between
laxatives and cathartics.
➢ Cathartics decrease the
absorption of substances by
accelerating their expulsion
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin

from the GI tract. Cathartics potentially can have

often are administered with serious problems.
charcoal to hasten toxin • If laxatives of any type are heavily
elimination from the GI tract used, not necessarily to the point of
before absorption. abuse, diarrhea will be common, as
➢ Laxatives are often placed in well as a tendency to nausea and
one of four categories that fluid and electrolyte imbalance as
include: well as “laxative habit”, that is
a) Bulk forming dependence on laxative to have a
laxatives- The bulk- bowel movement.
forming laxatives are • Laxatives come in many different
mild laxatives with forms. Some are used by mouth and
little adverse effects some are used in your rectum.
b) Osmotic laxatives - • Stool softeners are available as:
The osmotic laxatives -oral softgel capsules
and especially the -oral liquids
stimulants have -rectal enemas
strong laxative • Other laxatives come in these forms:
activity and can - oral capsule
produce serious - chewable tablet
adverse effects. - oral tablet
c) Stimulant laxatives- - oral granules (powder)
Stimulant laxatives - oral gummy
work by stimulating - oral liquid
intestinal motility and - oral wafer
secretion of water - rectal suppository
into the bowel. - rectal enema
Stimulant laxatives
generally take 6 to 12 • ANTACIDS
hours to take effect ➢ Antacids are a class of
and may cause medicines that neutralize
abdominal cramping acid in the stomach. They
and diarrhea. contain ingredients such as
d) stool softeners or aluminum, calcium,
surfactant laxatives - magnesium, or sodium
The stool softeners bicarbonate which act as
also produce little bases (alkalis) to counteract
adverse effects and stomach acid and make its
are usually safe but pH more neutral.
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin
➢ The antacids act by
neutralizing the acid in the
stomach and by inhibiting
pepsin, which is a proteolytic
enzyme.
➢ An antacid is a substance
which neutralizes stomach
acidity and is used to relieve
heartburn, indigestion or an
upset stomach.
➢ Drug interactions: When
antacids are taken with acidic
drugs (for example, digoxin
[Digitek], phenytoin
[Dilantin], chlorpromazine
[Thorazine], [isoniazid]), they
cause the absorption of the
acidic drugs to be decreased,
which causes low blood
concentrations of the drugs,
which ultimately results in
reduced effects of the drugs.
➢ Indications:
Heartburn symptoms in
GERD
Duodenal and gastric ulcers
Stress gastritis
Pancreatic insufficiency
Non-ulcer dyspepsia
Diarrhea caused by bile-acid
Biliary reflux
➢ Administer the drug apart
from any other oral
medications
approximately1hourbefore
or 2 hours after to ensure
adequate absorption of the
other medications
➢ Note number and
consistency of stools.
Constipation is common and
dose related. Intestinal
obstruction from fecal
concretions has been
reported.
➢ Lab tests: Monitor periodic
serum calcium and
phosphorus levels with
prolonged high-dose therapy
or impaired renal function.
➢ Antacid may cause stools to
appear speckled or whitish.
➢ Report epigastric or
abdominal pain; it is a clinical
guide for adjusting the
dosage. Keep physician
informed. Pain that persists
beyond 72h may signify
serious complications.
➢ Seek medical help if
indigestion is accompanied
by shortness of breath,
sweating, or chest pain, if
stools are dark or tarry, or if
symptoms are recurrent
when taking this medication.
• H2-RECEPTOR ANTAGONIST
➢ H2 blockers are a group of
medicines that reduce the
amount of acid produced by
the cells in the lining of the
stomach.
➢ They are also called
'histamine H2-receptor
antagonists' but are
commonly called H2
blockers.
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin
➢ They include cimetidine,
famotidine, nizatidine and
ranitidine, and have various
different brand names.
➢ Histamine H2-receptor
antagonists, also
knownasH2-blockers, are
used to treat duodenal ulcers
and prevent their return.
➢ They are also used to treat
gastric ulcers and for some
conditions, such as Zollinger-
Ellison disease, in which the
stomach produces too much
acid.
➢ Mechanism of action: H2RAs
decrease gastric acid
secretion by reversibly
binding to histamine H2
receptors located on gastric
parietal cells, there by
inhibiting the binding and
action of the endogenous
ligand histamine. H2 blockers
thus function as competitive
antagonists.
➢ Nursing assessment for a
patient using H2 antagonists
include:
a) Assess for possible
contraindications and
cautions: history of
allergytoanyH2antago
nists to prevent
potential allergic
reactions; impaired
renal or hepatic
function, which could
affect the metabolism
and excretion of the
drug; a detailed
description of the GI
problem, including
length of time of the
disorder and medical
evaluation to
evaluate the
appropriate use of
the drug and
possibility of
underlying medical
problems; and
current status of
pregnancy and
lactation because of
the potential for
adverse effects on
the fetus or newborn.
b) Perform a physical
examination to
establish baseline
data before beginning
therapy, determine
effectiveness of the
therapy, and evaluate
for any adverse
effects associated
with drug therapy.
c) Assess
cardiopulmonary
status, including
pulse, blood pressure,
and
electrocardiogram (if
IV use is needed), to
evaluate the cardiac
effects of the drug.
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin

d) Perform abdominal i) Ensure therapeutic

examination, levels. Administer
including assessment drug with or before
of the liver, to meals and at bedtime
establish a baseline (exact timing varies
and rule out with product) to
underlying medical ensure therapeutic
problem. levels when the drug
e) Monitor the results of is most needed.
laboratory tests, j) Prevent serious
including liver and toxicity. Arrange for
renal function tests, decreased dose in
to predict changes in cases of hepatic or
metabolism or renal dysfunction to
excretion of the drug prevent serious
that might require toxicity
dose adjustment. k) Monitor IV doses
f) Inspect the skin for carefully. Monitor the
evidence of lesions or patient continually if
rash to monitor for giving IV doses to
adverse reactions. allow early detection
g) Evaluate neurological of potentially serious
status, including adverse effects,
orientation and including cardiac
affect, to assess CNS arrythmias
effects of the drug l) Assess for potential
and to plan for drug-drug
protective measures. interactions. Assess
h) Administer a once- the patient carefully
daily dose at bedtime for any potential
to promote drug-drug
compliance. Twice interactions if given in
daily dose should be combination with
administered in the other drugs because
morning and evening; of the drugs effects
multiple doses, with on liver enzyme
meals and at systems.
bedtime. m) Provide patient’s
comfort. Provide
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin

comfort, including some drugs is affected by the

analgesics, ready to presence of acid in the
access bathroom stomach, and because PPIs
facilities, and reduce acid in the stomach,
assistance with they may affect the
ambulation, to absorption of these drugs.
minimize possible ➢ The most common side
adverse effects effects reported include
n) Reorient patient headache, diarrhea, nausea,
thoroughly. and vomiting.
Periodically reorient ➢ Reports of more serious side
the patient and effects include kidney
institute safety disease, fractures, infections
measures if CNS and vitamin deficiencies, but
effects occur to these are very rare and are
ensure patient safety generally associated with
and improve and long-term use (using these
improve patient products for more than a
tolerance of the drug year).
and drug effects. ➢ Nursing considerations
➢ In combination with
antibiotics, proton pump
• PROTON PUMP INHIBITORS inhibitors are used to
➢ Proton-pump inhibitors are eradicate H.pylori infection,
members of a class of one of the main causes of
medications whose main recurring stomach ulcers.
action is a profound and ➢ The differences between
prolonged reduction of proton pump inhibitors in
stomach acid production. clinical efficacy and safety
➢ Within the class of are considered to be
medications, there is no clear minimal.
evidence that one agent ➢ - Patients who require long-
works better than another. term symptom management
They are the most potent should reduce their use of
inhibitors of acid secretion prescribed medication
available. stepwise: using the lowest
➢ Proton pump inhibitors effective dose, then as
interact with few drugs. The required before returning to
absorption into the body of
NCM212-PHARMACOLOGY (GASTROINTESTINAL AGENTS)
Prepared By: Kristine Kaye Camin

self-treatment with antacid

and/or alginate therapy.
➢ Medically used proton pump
inhibitors:
- Omeprazole
- Lansoprazole
- Dexlansoprazole
- Esomeprazole
- Pantoprazole
- Rabeprazole
- Ilaprazole