NCM 106: Pharmacology

LECTURE 8: DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM

YEAR 2, 1st SEMESTER A.Y.: 2022-2023
ANTIUCERATIVES 4. Teach the patient who has heart failure or
hypertension or who must re- strict sodium
A. MECHANISM OF ACTION intake to check antacid labels for sodium
 Supplement and replace depleted iron content and to use only low-sodium
stores in bone marrow to assist in preparations.
erythropoiesis (RBC production). 5. Instruct the patient not to take antacids for
B. DRUG EXAMPLES more than 2 weeks or for recurring
1. Ferrous sulfate problems without consulting a practitioner.
2. Ferrous gluconate 6. Flush with enough water to make sure the
3. Iron dextran drug reaches the stomach and the tube is
4. Iron sucrose clear if administering through a
C. INDICATIONS nasogastric (NG) tube.
 Prevent and treat iron deficiency and 7. Assess the patient for epigastric or
iron deficiency anemia abdominal pain, frank bleeding, and occult
 Dietary supplement for iron bleeding.
8. Teach the patient to avoid gastric irritants
ANTACIDS (alcohol, containing aspirin, caffeine,
A. MECHANISM OF ACTION smoking products nonsteroidal anti-
 Neutralize gastric acid, thereby inflammatory drugs (NSAID) , and foods
increasing pH in the GI tract. that cause GI irritation); these may
B. DRUG EXAMPLES counteract drug, effects and worsen the
1. Aluminum hydroxide ulcer.
2. Magnesium hydroxide Histamine-2 RECEPTOR ANTAGONISTS
C. INDICATIONS
 Treat indigestion, reflux esophagitis, and A. MECHANISM OF ACTION
peptic ulcers  Inhibit gastric acid secretion by inhibiting
 Bind dietary phosphate in renal failure the action of histamine at histamine-2
(calcium carbonate) (H2) receptors in gastric parietal cells.
D. CONTRAINDICATION & PRECAUTION B. DRUG EXAMPLES
 Contraindicated in abdominal pain of 1. Ranitidine
unknown origin, heart failure, 2. Cimetidine
hypertension, and gastric outlet 3. Famotidine
destruction C. INDICATIONS
 Used cautiously in pregnant patients or  Long-term treatment of pathologic GI
those with renal failure hypersecretory conditions (Zollinger-
E. ADVERSE REACTION Ellison syndrome).
 Constipation, diarrhea, electrolyte  Promote healing of duodenal and gastric
imbalances, and serum aluminum ulcers.
accumulation  Decrease gastric acid production and
F. NURSING RESPONSIBILITIES prevent stress ulcers in severely il
1. Know that antacids containing both patients and those with reflux esophagitis
aluminum and magnesium hydroxide or upper GI bleeding Treat heartburn,
balance the constipating effects of acid indigestion, and sour stomach
aluminum with the laxative effects of (overthe-counter preparations).
magnesium. D. CONTRAINDICATION & PRECAUTION
2. Instruct the patient to shake the  Contraindicated in breast-feeding
suspension well, or, if taking chewable patients and those with known
tablets, to chew them thoroughly and then hypersensitivity.
drink half a glass of water to promote  Used cautiously in pregnant patients,
passage to stomach those with impaired renal or hepatic
3. Give antacids at least 1 hour apart from function, and elderly patients (because of
enteric-coated tablets. increased risk of central nervous system
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 [CNS] effects, such as dizziness and 1. Monitor for diarrhea and abdominal pain.
confusion). 2. Instruct the patient to swallow capsules
E. ADVERSE REACTION whole and not to chew. them chew or
 Headache, dizziness, confusion, mild crush.
diarrhea, and rash 3. Administer 1 hour before meals.
F. NURSING RESPONSIBILITIES 4. Instruct the patient to avoid gastric
1. Teach the patient that smoking worsens irritants (smoking, alcohol, products
ulcer disorders and counteracts the containing aspirin, caffeine, NSAIDs, and
effects of H-receptor antagonists. foods that cause GI irritation which may
2. Don’t give an antacid within 1 hour Don't counteract drug effects and worsen the
give of administering drug; may decrease ulcer.
absorption of drug.
3. Caution the patient about possible ADSORBENTS, ANTIFLATULENTS, AND
dizziness; recommend avoidance of DIGESTANTS
hazardous activities that require
A. MECHANISM OF ACTION
alertness.
 Adsorbents: Attract and bind to toxins
4. Assess for epigastric or abdominal pain,
in GI tract, thereby preventing
frank bleeding, and occult bleeding.
absorption.
5. Teach the patient to avoid gastric irritants
 Antiflatulents: Cause foaming action in
(smoking, alcohol, products containing
GI tract, creating a film on intestines that
aspirin, caffeine, NSAIDs, and foods that
helps to disperse mucus-enclosed gas
cause GI irritation), which may counteract
pockets and to prevent their formation.
drug effects and worsen the ulcer.
 Digestants: Resembles action of
PROTON PUMP INHIBITORS deficient substance (bile acid, which
increases output of bile in the liver, or
A. MODE OF ACTION pancreatic enzymes) normally produced
 Block gastric acid secretions by inhibiting by body.
acid pump in gastric parietal cells. B. DRUG EXAMPLES
B. DRUG EXAMPLES
1. Esomeprazole Adsorbents Activated charcoal
2. Lansoprazole Antiflatulent Simethicone (Flatulex, Gas-X,
3. Omeprazole s Maalox Anti-Gas, Mylanta
4. Pantoprazole Gas, Mylicon, Phazyme)
5. Rabeprazole Digestants Dehydrocholic acid, pancreatic
enzymes (pancreatin,
 Ends in -zole suffix
pancrelipase |Pancrease],
C. INDICATIONS
lipase, protease, amylase)
 Treat erosive esophagitis and GERD. C. INDICATIONS
 Treat duodenal ulcer.
 Antidote for oral ingestion of toxins that
 Short-term treatment of hypersecretory
can lead to poisoning or over dose
conditions.
(activated charcoal).
 Eradicate Helicobacter pylori
 Treat conditions involving excessive air
(esomeprazole, lansoprazole,
or gas in stomach or intestines, such as
omeprazole and rabeprazole).
gastric bloating, diverticular disease, or
 Prevent and treat NSAID-related gastric
spastic or irritable colon (simethicone).
ulcers (lansoprazole).
 Treat constipation and promote bile flow
D. CONTRAINDICATION & PRECAUTION
(dehydrocholic acid).
 Contraindicated in patients with known
 Supplement deficient natural pancreatic
hypersensitivity.
enzymes, such as occurs in patients with
 Used cautiously in pregnant and breast-
pancreatitis or cystic fibrosis (pancreatic
feeding patients.
enzymes).
E. ADVERSE REACTION
D. CONTRAINDICATION & PRECAUTION
 Abdominal pain, nausea, vomiting, and
 Activated charcoal contraindicated in
diarrhea
patients with acute poisoning from
F. NURSING RESPONSIBILITIES
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 mineral acids, alkalines, cyanide, diabetic gastroparesis
ethanol, methanol, iron, inorganic acids, (metoclopramide).
or organic solvents).  Prevent vomiting during surgery
E. ADVERSE REACTION (droperidol).
 Blackened stools and constipation C. CONTRAINDICATION & PRECAUTION
(activated charcoal).  Metoclopramide contraindicated in
 Abdominal cramping, biliary colic, suspected GI obstruction; used
diarrhea, and nausea (digestive cautiously and at reduced dose in
enzymes). patients with renal impairment.
F. NURSING RESPONSIBILITIES  Phenothiazines contraindicated in angle-
1. Know that a patient who has recently closure glaucoma, bone marrow
eaten requires an increased amount of depression, and severe liver or heart
activated charcoal. disease.
2. Be aware that multiple doses of activated  Dimenhydrinate contraindicated in
charcoal may be needed to severe treat patients hypersensitive to drug or its
poisoning involving certain drugs components; I.V. form contains benzyl
(acetaminophen, digoxin, phenobarbital, alcohol, which has been associated with
phenytoin, theophylline, carbamazepine, fatal "gasping syndrome” in neonates.
dapsone, and quinidine). D. ADVERSE REACTION
3. Don't mix activated charcoal with dairy  Hypotension, constipation, blurred
products because activated charcoal vision, dryness of eyes and mouth,
decreases the drug's ability to absorb extrapyramidal reactions, and
toxins. photosensitivity reactions
4. Shake simethicone well before (phenothiazines).
administration to thoroughly mix drug.  Hypotension, pain at I.M. injection site,
5. Administer drug at appropriate time: and rectal irritation (with suppositories)
 Simethicone: After meals and at (trimethobenzamide).
bedtime  Drowsiness (antiemetics)
 Pancreatic enzymes: With meals E. NURSING RESPONSIBILITIES
 Dehydrocholic acid: After meals 1. Decrease initial dose of metoclopramide
by 50% of usual recommended dose if
ANTIEMETICS
creatinine clearance is less than 40
A. MECHANISM OF ACTION ml/minute.
 Aprepitant, dronabinol, granisetron, 2. Instruct the patient to change position
ondansetron, palonosetron, slowly when administering
phenothiazines, and phenothiazines (to minimize orthostatic
trimethobenzamide: Act on CNS to hypotension) and to wear sunscreen and
prevent nausea and vomiting. protective clothing (to prevent
 Dimenhydrinate, meclizine, and photosensitivity reactions).
scopolamine: Reduce motion sickness 3. Assess for nausea and vomiting and fluid
by inhibiting impulses from inner ear to and electrolyte imbalances.
the vestibular pathway. 4. Caution the patient to avoid activities
 Metoclopramide: Increases the rate of requiring alertness until drug response is
gastric emptying and enhances known.
gastroesophageal sphincter tone. 5. Inform the patient that frequent mouth
B. INDICATIONS rinses, good oral hygiene, and sugarless
 Manage nausea and vomiting gum or candy may reduce dry mouth.
associated with chemotherapy 6. Instruct the patient not to consume
(aprepitant, nalonosetron, ondansetron, alcohol when taking an antiemetic to
granisetron, and dronabinol). prevent additive CNS depression.
 Treat motion sickness (dimenhydrinate, 7. Advise the patient to take oral
meclizine). antiemetics 1 hour before exposure to
 Promote gastric emptying in patients conditions causing motion sickness.
receiving tube feedings and those with
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 ANTIDIARRHEALS LAXATIVES

A. MECHANISM OF ACTION A. MECHANISM OF ACTION

 Camphorated opium tincture,  Bulk-forming laxatives: Increase water
difenoxin, diphenoxylate, and content of stools, forming a viscous
loperamide: Slow intestinal motility, solution that promotes peristalsis and
ultimately reducing water absorption from improves elimination rate.
stools.  Lubricant laxatives: Increase water
 Bismuth, kaolin and pectin mixture, retention in stools, prevent water
and polycarbophil: Reduce fluid content absorption from stools, and lubricate
of stools. and soften intestinal contents.
 Octreotide: Decreases volume of gastric  Hyperosmotic laxatives: Increase
and intestinal secretions and diarrhea water content of stools and soften
secondary to vasoactive intestinal tumors stools; lactulose also inhibits diffusion of
(such as carcinoid tumors). ammonia from the colon into the blood
B. INDICATIONS reducing serum ammonia levels in
 Control and relieve symptoms of acute patients with liver dysfunction.
or chronic nonspecific diarrhea.  Saline cathartic laxatives: Draw water
C. CONTRAINDICATION & PRECAUTION into bowel, increasing the bulk of
 Contraindicated in patients with intestinal contents and stimulating
abdominal pain of unknown cause, peristalsis.
especially if accompanied by fever.  Stimulant laxatives: Stimulate
D. ADVERSE REACTION peristalsis and inhibit water and
 Constipation drowsiness (camphorated electrolyte reabsorption from intestine.
opium tincture, difenoxin, diphenoxylate,  Stool softeners: Allow more fluid and
and loperamide), nausea, abdominal fat to penetrate feces, producing softer
pain, pain at injection site, and fecal mass.
gallstones (octreotide). B. DRUG EXAMPLES
E. NURSING RESPONSIBILITIES
Bulk-forming Methylcellulose,
1. Assess skin turgor and monitor fluid and laxatives polycarbophil,
electrolyte balance for evidence of psyllium
dehydration resulting from diarrhea. Lubricant laxatives Mineral oil (Fleet
2. Assess for abdominal pain and Mineral Oil Enema)
distention, nausea and vomiting, and Hyperosmotic Lactulose
frank or occult bleeding; auscultate for laxatives
bowel sounds; and evaluate stools for Saline cathartic Magnesium Citrate,
frequency and consistency. laxatives sodium biphosphate
3. Know that high-dose, long-term use of Stimulant laxatives Bisacodyl (Dulcolax),
difenoxin or diphenoxylate may cause castor oil
dependence (atropine has been added to Stool softeners Docusate calcium,
these preparations to discourage abuse). docusate potassium,
4. Don't confuse camphorated opium docusate sodium
tincture with deodorized tincture of C. INDICATIONS
opium, which is 25 times more potent.  Treat or prevent constipation and prepare
5. Caution the patient to avoid activities bowel for radiologic or endoscopic
requiring alertness until drug response is procedures.
known; also instruct him to avoid alcohol  Manage chronic watery diarrhea
and CNS depressants when (methylcellulose and psyllium).
administering camphorated opium  Adjunctive treatment in managing hepatic
tincture, difenoxin, diphenoxylate, or encephalopathy (lactulose).
loperamide. D. CONTRAINDICATION & PRECAUTION
6. Instruct the patient to notify the  Contraindicated in patients with
practitioner if diarrhea persists or fever persistent or severe abdominal pain or
occurs.

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 unknown cause, especially when
accompanied by fever.
E. ADVERSE REACTION
 Nausea, vomiting, and abdominal
cramping
 Esophageal obstruction or intestinal
obstruction (bulk-forming laxatives)
 Lipid pneumonia and nutritional
deficiencies (lubricant laxatives)
 Cramps, distention, flatulence, and
belching (osmotic laxatives)
 Dehydration and electrolyte imbalances
(saline cathartic laxatives)
 Possible permanent loss of colonic
motility, laxative dependence, and
electrolyte imbalances with long-term
use or abuse of laxatives
F. NURSING RESPONSIBILITIES
1. Assess for abdominal pain and
distention, nausea and vomiting, and
frank or occult bleeding auscultate for
bowel sounds; and evaluate stools for
frequency and consistency.
2. Monitor for fluid and electrolyte
imbalances.
3. Mix bulk-forming laxatives in a full glass
of water or juice; give an additional glass
of fluid after administering.
4. Assess the patient's mental status,
including level of consciousness and
orientation when administering laxatives
as adjunctive drugs for hepatic
encephalopathy.
5. Dilute sodium phosphates with water
before giving, and monitor for electrolyte
disturbances.
6. Inform the patient that most laxatives are
for short-term use only and that long-term
use may cause electrolyte imbalances
and laxative dependence by causing a
permanent loss of colonic motility;
encourage use of other methods to
regulate bowel, such as increasing
dietary bulk and fluid intake and engaging
in exercise.