UNIT IX: DRUGS THAT AFFECT THE GASTRO  Avoid other medicines that lowers gastric

INTESTINAL TRACT pH or increases hyperacidity such as

caffeine, aspirin
 Used to treat peptic ulcer disease and gastric  Take 1- 3 hours after eating & do not take
hyperacidity other medicines within 1-2 hours of taking
antacid; not at mealtime = slow gastric
PEPTIC ULCER DISEASE- Break or emptying time = increase GI activity &
ulcerations in the protective mucosal lining of gastric secretions
the lower esophagus, stomach or duodenum  Drink 2-4 oz of water after antacid
 Shake liquid preparations well and
Non- Pharmacologic Measures: followed with water
 Avoid tobacco and alcohol  Instruct to inquire about interactions with
 Wt loss any new medication & OTC
 Avoid hot, spicy, greasy foods and  Inform clients that they may experience
caffeine containing beverages better relief from liquids than tablets
 Drugs like NSAIDs (ASA) /  Monitor for constipation or diarrhea;
corticosteroids = taken with food medication or dose may be changed
decrease dosage  Do not give milk products and vitamin D
 Raise head of bed, do not eat before with calcium carbonate = milk alkali
bedtime, wear loose- fitting clothing syndrome (alkalosis, hypercalcemia,
crystalluria, renal failure)
ANTACIDS
MOA: neutralizes gastric acid secretions and
HISTAMINE- 2 RECEPTOR ANTAGONISTS
raises the gastric pH of the stomach
MOA: block the H2 receptors of the parietal cells
of the stomach, thus reducing gastric acid
USES :reflux indigestion – esophageal irritation
secretion and concentration
and inflammation resulting from reflux of the
stomach contents into the esophagus
USES: treatment ulcer, prevention of stress ulcer,
: PUD, ulcer prevention
hyperacidity, patients on prolonged NPO / pre
operative, GI bleed
DI: + digoxin / antibiotics = decrease absorption
DI: + digoxin / anticoagulants = increases their
SE:rebound hyperacidity (excessive amount of
action
acid in the stomach),
+ antacid = decrease effectiveness
GI disturbances ( constipation / diarrhea)
SE: HA, confusion, nausea, diarrhea, abdominal
Electrolyte imbalances
pain, anemia, severe bradycardia (IV
Hypermagnesemia( hypotension, N/V, ECG
administration), constipation
changes)
Hypophosphatemia (anorexia, malaise,
EXAMPLE:
muscle weakness)
cimetidine (Tagamet) famotidine (Pepcid)
Hypernatremia = water retention
ranitidine (Zantac) nizatidine (Axid)
Systemic alkalosis

NURSING INTERVENTIONS:
EXAMPLE: (systemic & non- systemic acting)
 Administer before meals
- aluminum hydroxide (Mylanta, Amphogel,
 Reduced doses of drug are needed by
Novaluzid)
older adults
- magnesium hydroxide ( Milk of Magnesia,
 Administer IV drug in 20 – 100mL solution
simeco)
 Do not administer at the same time with
- calcium carbonate ( Alka – Mints, Tums)**
antacids, give an hour before or 2 hours
- sodium bicarbonate ( Alka – seltzer)**
after
- aluminum – magnesium complex (Maalox)
 Avoid smoking because it hampers the
- magnesium hydroxide + aluminum hydroxide
effectiveness of the drug
with simethicone (Maalox TC, Mylanta II)
 Drug induced impotence and
gynecomastia – reversible
Nursing Interventions:
 Relaxation technique
 Assess effectiveness of medication
 Eat foods rich in Vit B12 to prevent
deficiency as a result of drug therapy

1
 ANTICHOLINERGIC AGENTS NURSING INTERVENTIONS:
AKA: anti – spasmodics  Take before meals; as prescribed (4-8
weeks)
MOA: decreases acetylcholine by blocking the  Take one hour apart from antacid
cholinergic receptors Digoxin: administer sucralfate at least 2 hours
: reduces gastric acid secretion, decreases apart
smooth muscle motility and delays gastric
emptying time PROSTAGLANDIN ANALOGUE
**** stimulate gastric secretions = ulcerations MOA: decrease vagal activity
: inhibits gastric acid secretion & protects the
USES: adjunct therapy for PUD mucosa
: spasms and cramping associated with : promotes secretion of sodium bicarbonate
irritable bowel syndrome and cytoprotection mucus
SE: tachycardia, urinary retention, dry mouth, HA, USE: PUD
constipation SE: diarrhea, abdominal pain
EXAMPLE: misoprostol (Cytotec)
EXAMPLE: Atropine sulfate, belladonna aklaliods,
hyoscyaminesulfate NURSING RESPONSIBILITIES:
 Take with food
NURSING RESPONSIBILITIES  No alcohol, NSAIDs, aspirin, smoking
 Monitor bowel elimination **** can cause uterine contractions
 Take before meals
 Give antacids 2 hours after anticholinergic
ANTI- FLATULENTS
MOA: aids in breaking up gas bubbles trapped in
PROTON PUMP INHIBITOR
the intestines; increases gastric emptying
MOA: suppresses the final step of gastric acid
USES: post operative patients, children with colic
production by inhibiting hydrogen - potassium
SE: constipation, LBM (domperidone), dry mouth,
ATPase enzyme
abdominal cramps
Inhibit up to 90% than H2 blockers
USES: short term treatment of erosive
EXAMPLE:
esophagitis
simethicone (Kremil-S, Simeco)
: omeprazole – long term treatment of
domperidone (Motilium)
duodenal ulcer
: treatment of H. pylori, active benign gastric
NURSING INTERVENTIONS:
ulcers
 Increase oral fluid intake
INTERACTIONS: may increase concentration o
 Manage constipation: high fiber (bran,
oral anticoagulants, diazepam, phenytoin if with
grain, fruits), ambulation
omeprazole
 Auscultate bowel sounds
SE: headache, abdominal discomfort, dizziness,
 Avoid gas forming foods (apples, brocolli,
flatulence, diarrhea
cabbage, coconuts, egg plant, milk,
EXAMPLE: omeprazole (Losec), pantoprazole
radish, onions)
(Pantoloc), esomeprazole (Nexium), lanzoprazole
 Manage diarrhea
(Prevacid)
ANTI- EMETICS
NURSING INTERVENTIONS:
MOA: used to control vomiting
 Take before meals
SPECIFICALLY:
 Regular medical check – up
1. phenothiazines decrease the response to
CRYOPROTECTIVE chemoreceptor trigger zone (CTZ) by inhibiting
AKA: Pepsin inhibitor / Mucosal Protective Drug the dopaminergic receptors
MOA: forms a barrier / coating at the ulcer site chlorpromazine (Thorazine)
EXAMPLE: sucralfate (Iselpin), rebamipide prochlorperazine maleate (Compazine)
(Mucosta) promethazine
SE: constipation ( not systemically absorb)
DI: may impede absorption of warfarin, phenytoin, 2. anti- histamines block the action of
theophylline acetylcholine in the brain to decrease nausea and
vomiting
dimenhydramine (Dramamine)
2
 cyclizine HCL (Marezine)
meclizine HCL ( Bonamine)
hydroxyzinepamoate (Vistaril)
diphenhydramine HCL (Benadryl)
promethazine (Phenergan)
3. Anti – cholinergics prevent motion sickness
by decreasing the GI motility and secretions
scopolamine (Triptone)
4. cannabinoids (active ingredients of marijuana)
dronabinol
nabilone
5. Others : increases gastric emptying
metoclopramide HCL (Plasil)
trimethobenzamide HCL (Tigan)
USES: severe nausea, vomiting, before & after
chemotherapy, motion sickness
SE/ AE:
- anticholinergic effects
- drowsiness (anti histamines)
- orthostatic hypotension
- extrapyramidal findings (phenothiazines):
parkinson’s disease symptoms – tremors, muscle
rigidity, bradykinesia
- Hypersensitivity, photosensitivity
NURSING INTERVENTIONS
 Motion sickness: take 30 min- 1 hour
before the activity that causes nausea
 Caution the patient about sedative effects,
implement safety measures
 Give vistaril via Z- track route / deep IM
 Avoid alcohol
 Avoid use in pregnant women during 1st
trimester
 Increase OFI to prevent dehydration
EMETICS
MOA: irritates the stomach and stimulates the
CTZ and vomiting center in the medulla
USES: overdose ; accidental poisoning
SE: toxicity, CNS depression (decrease RR and
BP), may be abused by bulimic patients,
nausea, diarrhea, GI upset
EXAMPLE: ipecac syrup, apomorphine HCL
NURSING INTERVENTIONS
 Have ipecac at home in case of
accidental poisoning, note expiration date
 Never administer to comatose or semi –
comatose patients
or accidentally ingest caustic substances
(ammonia, chlorine bleach, toilet cleaners or
battery acid)
 Can be very messy and may be
difficult for a child to ingest
 Administer 10 mL of ipecac followed
by a glass of water in children < 1 y.o.;
15 mL for children > 1 y.o.; 15-30 mL
followed by several glasses of water
for adults
 May repeat ipecac dose in 30 min if
the first dose does not produce
emesis
 Never give with or after activated
charcoal. If needed, give before the
activated charcoal, activated charcoal
is given via lavage if emetics are
ineffective
 Monitor VS especially RR because
apomorphine can cause respiratory
depression and hypotension
LAXATIVES / CATHARTICS
 To eliminate fecal matter
Laxatives: promote soft stools
Cathartics: promote soft watery stool with some
cramping
GROUPS:
1. Osmotic laxatives: pull water into the colon
and increases water in the feces to increase bulk
which stimulates peristalsis
Hyperosmolar salts
Saline products ( composed of sodium or
magnesium)
cephulac (Lactulose)
Glycerin
Sodium biphosphate
2.Contact laxatives/ stimulants/ irritants:
increase peristalsis by irritating the nerve endings
in the intestinal mucosa
senna (Senokot)
Bisacodyl (Dulcolax)
Castor oil
3. Bulk forming: natural fibrous substance that
promote large, soft stools by absorbing water into
the intestine, increasing fecal bulk and peristalsis;
non absorbable agents
psyllium (Metamucil)
4. Emollients/ stool softeners: lubricants to
prevent constipation, decrease straining during
defecation
= lower surface tension and promotes water
accumulation in the intestine and stool
docusate sodium (Colace)
5.lubricants: lessen irritation to hemorrhoids,
cause lipid pneumonia if accidentally aspirated
Mineral oil
3
SE: dehydration, electrolyte imbalance
(hypokalemia), abdominal cramps
NURSING INTERVENTIONS:
 Monitor for misuse of these drugs, can be
a habit forming, short term use (tone of
bowel)
 Take drug within one hour of any other
drug
 Monitor serum electrolytes
 Assess bowel elimination pattern:
discontinue if diarrhea persists, rectal
bleeding, cramping
 Do not give if obstruction is suspected
( abdominal pain with fever, nausea and
vomiting)
 Teach exercise and high fiber diet to
promote elimination
 Clients who should avoid straining may
benefit from a lubricant laxative
 Mineral oil enemas work well without
causing severe strain in clients who had a
recent heart attack and fecal impaction
 Mineral oil enemas also work well if saline
is contraindicated
 Bulk forming laxatives which come in
flavored and sugar free forms would be
mixed in 8- 10 oz of water or juice and
drink immediately followed by a full glass
of water
 Take on an empty stomach
ANTI- DIARRHEALS
GROUPS:
1. adsorbents: removes toxins by binding with
them and forms a coating over the mucosa
bismuth subsalicylate (Pepto- Bismol)
Activated charcoal
Kaolin
Pectin
2. opiates: decrease intestinal motility
paregoric (camphorated opium tincture)
codeine
diphenoxylate HCL + atropine sulfate (Lomotil)
loperamide (Imodium)
3. Anticholinergic
Alcohol+ kaolin+ pectin+ paregoric =
parapectolin
Scopolamine hydrobromide (Donnagel)
USES: short term diarrhea, irritable bowel
syndrome, overdose
SE: constipation; dizziness; OPIATES=abuse
potential, urinary retention, dry mouth, flushing
NURSING INTERVENTIONS:
 Know how to administer properly.
 Encourage clear liquids avoid fried foods
or milk products
 Instruct: relieve symptoms not cure the
disease
 Notify physician if diarrhea persists longer
than 48 hours or if abdominal pain occurs
 Assess elimination, dehydration
 Activated charcoal is a powder that must
be mixed with water during administration
 Monitor VS ( opiates causes CNS
depression)
GASTROINTESTINAL STIMULANTS
MOA: stimulates motility of the upper GI tract and
increase the rate of gastric emptying without
stimulating gastric, biliary or pancreatic
secretions
USES: gastroesophageal reflux, treat urinary
retention & abdominal distention
CI: mechanical obstruction, perforation, GI
hemmorhage
SE/ AE: restlessness, drowsiness, dizziness,
insomia, HA, N/V, salivation, decrease CR, BP,
increase lung secretion & LBM
EXAMPLE:
bethanecol chloride ( Urecholine)
metoclopramide (Plasil)
domperidone (motilium)
NURSING INTERVENTIONS:
 Administer 30 minutes before meal and at
bedtime
 Monitor pulse, BP when large doses are
taken because of the risk of hypotension
 Monitor I & O