GASTROINTESTINAL DRUGS
DRUGS:
Digestion
 Foods we eat needs to be converted into
simplest form
o Carbs -> glucose
o Lipids -> fatty acids
o Proteins -> amino acids
 Digestion needs help from enzymes EX
amylase breaks down starches to
monosaccharides
 Mechanical digestion pushes food to stomach
 More chemical digestion happens in the
stomach
STOMACH
 Secretes mucus, pepsinogen, and HCl acid.
 pH ranges from 2-4 (lower = acidic; higher =
basic/alkalinic)
 EX of pH:
o Urine = 6 (slightly acidic)
o Blood = 7.35-7.45 (slightly alkalinic)
o S. intestine mucus = 8 (basic/alkaline)
o 7 = neutral
 Stomach wall is lined with mucus which
protects stomach from acidity of HCl acid.
Acid Indigestion “Heartburn”
 Excessive acid that goes to esophagus
 Gastroesophageal / cardiac sphincter is
normally closed to prevent reflux or backflow
of stomach contents back to esophagus
 Pts with heartburn – this sphincter remains
open (due to wear and tear, excessive
production)
 Esophagus does not have mucus lining = reflux
of acid burns the lining of esophagus
 They are AKA cardiac due to anatomical
location, almost same as heart location and
sometimes mistaken as chest pain.
 ULCER occurs when stomach linings are
damaged
PEPTIC ULCER DISEASE
 Caused by many factors.
o Not eating
o H. pylori – lives in acidic environment
 Mucus lining of stomach in an area is
THINNING and eventually nawawala then
creates a wound
 2 types:
o gastric
o duodenal
ANTACIDS
 neutralizes stomach acid
 available in OTC, pts self-treat
 indication:
o hyperacidity
o hyperphosphatemia (CKD pts) and
prevent formation of stones
o treats calcium deficiency
o stress ulcers – by glucocorticoid that
increases glucose and GI secretions
o constipation
 adverse effects
o Magnesium – diarrhea
o Aluminum – constipation
 Kremil-S combination of both
o Aluminum – attracts phosphates if
taken for an extended period of time
o Carbonate – bloating and flatulence
 Nx consideration:
o Administer apart from other meds pls
o Ensure therapeutic levels
o Diagnostic testing
o Prevent imbalances – acid base or
electrolyte imbalance
o Bowel program – diarrhea and
constipation
o Adequate nutrition – fluid and
electrolytes r/t diarrhea
o Support
o Education
 ALGINATES AND ANTIFOAMING AGENTS
o Combined with antacids
o Floats on stomach CONTENTS to form
a neutralizing layer
o Helps prevent acid reflux
o Gaviscon
o Simethicone – prevents formation of
gases and flatulence (by carbonates)
HISTAMINE-2 ANTAGONISTS
 Antihistamine – histamine 2 stimulates HCl
production
 Decrease HCl acid production
 Selectively blocks H2 receptors on the parietal
cells
 Blocks production of HCl acid
 Indications:
o Short-term for ulcers
o Zollinger-Ellison syndrome
o Stress induced ulcers
o Erosive GERD
o Heartburn, acid indigestion, sour
stomach
  “-tidine”
 Adverse Effects:
o Dizziness confusion
o Cardiac arrhythmias, cardiac arrest
o Diarrhea
o Impotence
o Rashes
 Nx cons:
o Administer with or before meals at
bedtime
o Monitor pts if given IV doses – cardiac
arrhythmias
o Provide comfort, bathroom privileges,
assist c ambulation
o Reorient if CNS effects occur
o Support – answer questions and
educate

PROTON PUMP INHIBITORS

 Stops secretion/production of HCl acids
 Blocks the final step of acid production as long
as you’re taking the drug
 Gives time for stomach ulcers to heal
 Indications:
o Esophagitis, heartburn, GERD
 Advere effects
o Headache, dizziness, vertigo
o Diarrhea, abd pain, n/v
o URTI, cough

GI PROTECTANT (CYTOPROTECTIVE)
 Coats any injured area in the stomach
 Less contact to acid = healing
 Sucralfate (Carafate) only GI protectant
available
 Creates a viscuous substance – will act as
barrier

PROSTAGLANDINS
 Protects stomach lining
 By increasing mucus production
 Misoprostol (Cytotec) – prostaglandin E
analogue
 Misprostol – check for allergies/allergic
reactions
 Contraindicated during pregnancy –
abortifacient (triggers/stimulates uterine
contraction)