ULCERS

o Open sores in the mucous membranes, epithelial surface or mucosal linings of the
body.
o Occur frequently in the stomach and duodenum, where acid and pepsin activity are
greatest.

FACTORS CAUSING ULCERS

o Hyperacidity/hyperchlorhydria
o Emotional stress
o Smoking and alcohol intake
o Vagus nerve stimulation
o Use of NSAIDS and steroids
o ** 9/10 of cases of GI ulcer are caused by H. pylori bacteria.
Gastric ulcer: pain felt with food intake with frequent vomiting, periodic pain (dull, gnawing, =
burning), N&V, loss of appetite.
*50 y/o up are predisposed to gastric ulcer
Duodenal ulcer: usually but not always relieved by food, intense pain.
o Pain lasts 2-3 hrs pc
o Relieved by food
o (+) Melena
o Common in 30-60 y/o

GLRD
o Gastro- esophageal reflux disorder: characterized by a burning sensation behind the
sternum (retrosternal pain), or HEARTBURN.
o Occurs after meals, worsens when lying down, regurgitation of digestive juices into the
esophagus.
o The lower esophageal sphincter relaxes inappropriately causing gastric acid to reflux.

CONTENTS
I. ANTACIDS
II. GASTRIC STIMULANTS
III. HISTAMINE-2 BLOCKERS
IV. PROSTAGLANDINS
V. PROTON PUMP INHIBITORS
VI. ANTIEMETIC AGENTS
VII. EMETIC AGENTS
VIII. LAXATIVES
IX. ANTIDIARRHEALS

ANTACIDS
o Neutralizes acid as a one-time dose or a part of a treatment of more severe conditions
associated with hyperacidity.
o Brings gastric acid pH above 3.
o Presence of antacids in the stomach may impair absorption of many other drugs.
COMMON ANTACIDS
1. aluminum carbonate (BASALJEL)
2. aluminum hydroxide gel (AMPHOGEL)
3. aluminum/magnesium compounds (MAALOX)
4. aluminum and magnesium hydroxide (MAALOX II, MYLANTA II, NOVALUZID)
5. magnesium hydroxide (MILK OF MAGNESIA)
6. sodium bicarbonate
 7. calcium carbonate (TUMS)
8. sucralfate (CARAFATE)

GASTRIC STIMULANTS
o Stimulates peristalsis and gastric emptying.
o Induce contractions thus preventing reflux of acid into the esophagus.
o Indications: GERD, N&V due to chemotherapy.
COMMON GASTRIC STIMULANTS
o 1. metoclopramide (REGLAN, PLASIL)
o 2. cisapride (PROPULSID)

____ ACIDS
o Histamine 2 is a potent stimulator of gastric secretion, contained in mast cells along
the gastric mucosa.
o Mediate secretion of gastric acid and pepsin.
o Provides marked reduction in the production of gastric acids.
o Prevention of ulcers and treatment of GERD
o Know that these agents are for short-term treatment of up to 8 weeks only.
o Heals ulcers 60 to 80% in 4 weeks.
COMMON ANTACIDS
1. cimetidine (TAGAMET)
2. ranitidine (ZANTAC)
3. famotidine (PEPCID)
4. nizatidine (AXID)

_______MISC
• misoprostol (CYTOTEC): causes miscarriage.
MOA: replaces gastric prostaglandins and enhances natural local protective mechanisms
• bismuth (PEPTO-BISMUTH)
MOA: reduces GI motility and gastric secretions

PROTON PUMP INHIBITORS

• Inhibits hydrogen (Ht) and potassium (K+) ions within the parietal cells in the stomach,
which is responsible for gastric acid production.
• Short-term management of benign gastric ulcers, active duodenal ulcers, GERD.
• Helps eradicate H. pylori, promote ulcer healing, prevent ulcer recurrence
COMMON PP INHIBITORS
1. omeprazole (PRILOSEC, LOSEC)
2. lansoprazole (PREVACID)
3. esomeprazole (NEXIUM)
4. rabeprazole (ACIPHEX)

ANTIEMETIC AGENTS
o Inhibits vomiting.
o Reduces vomiting produced by highly emetogenic cancer therapy.
o May have anticholinergic and extrapyramidal symptoms effects.
COMMON ANTIEMETIC AGENTS
1. trimethobenzamide (TIGAN) -INJECTABLE FORMS CONTRAINDICATED IN
2. CHILDREN, NO SUPOSITORIES FOR NEWBORNS
3. prochlorperazine maleate (COMPAZINE) - DOC FOR SEVERE N&V OF ANY
CAUSE
1. metoclopramide (REGLAN, PLASIL)
2. ondasetron (ZOFRAN)
3. promethazine (PHENERGAN) (Pre-anesth, n&v)

EMETIC AGENTS
• Irritates the stomach to force the action of vomiting.
Bag
o Indications: Induction of vomiting when poisons have been ingested or drug overdose.
o NOT absorbed systemically.
o Vomiting occurs within 15-30 minutes and may persist for up to 30 minutes.
COMMON EMETIC AGENT
o SYRUP OF IPECAC
o oral dosing of 15 to 30 ml (5 ml for infants) should be followed with 200-300 ml of
water, vomiting should occur within 30 minutes.
o do not give carbonated beverage which may enhance absorption of ipecac.
o Call EMS, 911, paramedics, ER, or poison control first before administering іресас.

LAXATIVES
o Laxatives produce mild, gentle stimulus for defecation.
o Cathartics produce more intense action on the bowel.
o Both act directly on the intestines to alter stool formation.
o Indicated for management of constipation.

ACCEPTED CLINICAL USE OF LAXATIVES

• Relief of constipation from nonorganic abnormalities, including poor hygiene, voluntary
retention of feces, inadequate bulk food in the diet, emotional disturbances.
• Evacuation of bowel contents for medication with antihelmintics, bowel cleansing for
diagnostic examination or surgery.
• To prevent straining at stool to avoid rupture of hernia or hemorrhoidectomy.
• To prevent straining at stool for clients with MI.

BULK FORMING LAXATIVES

o High fiber.
o Absorbs water to increase bulk, distends bowel to initiate reflex bowel activity.
o The water absorbing ability of these agents makes them abre to control diarrhea.
o Onset: 12 hours to 3 days.
o Avoid use in clients with limited or restricted fluid intake or in dehydration.
COMMON BULK FORMING LAXATIVES
1. methylcellulose (CITRUCEL)
2. psylium (METAMUCIL)
3. polycarbophil (FIBERALL)
4. Fibrosine

LUBRICANTS
1. Coats surface of the feces and colon to ease passage of stools; also softens fecal
mass.
2. Onset: 6 to 8 hours.
3. DO NOT give within 2 hours of meals, it my reduce absorption of Vitamin A,D,E,K.
 4. NOT to be given in dysphagic and bedridden clients, aspiration of mineral oil may
cause lipid pneumonitis.
Mineral Oil (Fleet Mineral Oil):Does not stimulate peristalsis

HYPEROSMOTIC AGENTS
•Relieves constipation by increasing the water content of feces, resulting in distention,
peristalsis, and evacuation.
COMMON HYPEROSMOTIC AGENT
1. lactulose (DUPHALAC, CEPHULAC)
/ Hepatic encephalopathy Reduces ammonia levels in the blood by drawing ammonia from
blood to colon.
2. Oral glycerol (GLYCEROL); Rectal glycerol (FLEET BABYLAX)

STOOL SOFTENERS
• Incorporates water and lipids into the stool, producing an emollient action that reduces
surface tension.
• Used to prevent constipation or soften stool for conditions in which straining of stool is
contraindicated: Ml, geratic, anorectal conditions.
• docusate sodium: COLACE

SALINE LAXATIVES
• Are soluble inorganic salts that are powerful and rapid acting.
• Manipulates electrolyte levels, thus the client may experience increases in intestinal fluid
and electrolytes, thereby distending the colon.
• DOC to promotion of liquid stool evacuation without rupture of parasite egg capsules.
• CAUTION in clients receiving CNS depressants=seizure secondary to lowered calcium levels.
COMMON SALINE LAXATIVES
1, magnesium citrate CITRATE OF MAGNESIA)
2. magnesium hydroxide (MILK OF MAGNESIA, MOM)

ANTIDIARRHEALS
Locally acting or systemically administered preparations used to decrease the volume or
fluidity of bowel contents for both acute and chronic diarrhea.
OPIATES
o The most effective antidiarrheal agents.
o Has morphine as the main active constituent of most of these agents.
o Atropine is combined to some agents to discourage abuse.
o They slow intestinal motility and propulsion.
COMMON OPIATES
1. Ioperamide (IMODIUM)
2. diphenoxylate HCl with atropine S04 (LOMOTIL)
3. camphorated opium tincture (PAREGORIC)

ADSORBENTS
o Decreases fluid content in stool.
o May interfere with other drugs particularly digoxin, quinidine, and select antibiotics;
also with enzyme, nutrient and electrolyte absorption.
COMMON ADSORBENTS
1. activated attapulgite (DIATABS, OPECTATE)
2. bismuth subsalicylate (BISMATROL, PEPTO-BISMOL)
• CONTRAINDICATED IN CHILDREN RECOVERING FROM CHICKEN POX.

INTESTINAL FLORA MODIFIERS

• Promotes growth of e.coli, a normal bacterial fora of the bowels
o Restores gut flora depleted by antibiotic therapy.
o Aids in the breakdown and digestion of nutrients.
o Adjunct dietary regimen high in lactose and dextrose is also effective in the
recolonization of the colon. «Yoghurt, milk, and buttermilk>
o ; also with enzyme, nutrient and electrolyte absorption.
COMMON IFM
1. lactobacillus acidophilus
2. lactobacillus bulgaricus

Hormonal agents
o Increases absorption of fluids and electrolytes from the GIT.
o Suppresses diarrhea due to VIP (vasoactive intestinal peptide) tumors and AIDS.
COMMON HORMONAL AGENTS
1. octreotide acetate (SANDOSTATIN)
o CONTRAINDICATED IN CHOLELITHIASIS
o MONITOR CBG.

CNS STIMULANTS
o Stimulate a specific area of the brain or spinal cord. Mimic the effect of epinephrine
and nor epinephrine.
o These agents elevate mood, produce a sense of increased energy and alertness.
Decrease appetite and enhance the performance of task impaired by fatigue and
boredom.
INDICATIONS:
o Narcolepsy
o ADHD- Attention- Deficit/Hyperactivity Disorder
SIDE EFFECTS:
• Arrythmias, Seizure and laryngospasm
NURSING MANAGEMENT:
o The least possible amount of drug should be prescribed at one time to avoid
overdosage
o When used as an anorectic in obese client, have a weight reduction program
o Give 30-60 minutes a.c.
o Explain danger of abuse and dependence.
o Avoid caffeine
o Take 6 hours before bedtime to avoid insomnia
o Do not use together or within 14 days with MAO inhibitors

ANTIEPILEPTICS
o Epilepsy is a condition involving periodic seizure that may lead to motor convulsions.
Teratogenic.
o Seizure: abnormal electrical discharge of brain neurons that lead to alterations in the
behavior and muscle activity. May result temporary loss of consciousness.
o Convulsion: Spasmodic contraction of involuntary muscles
INDICATIONS:
o SIEZURE DISORDERS
o PREVENTION OF SEIZURE IN HIGH RISK FOR SEIZURE ACTIVITY: HEAD TRAUMA
NURSING MANAGEMENT:
o Manage reversible cause of seizure: infection or fever
o Ensure safety precautions
o Compliance to medication.
COMMON ANTIEPILEPTICS:
o phenytoin (Dilantin)
o carbamazepine (Tegretol)
o valproic acid (Depakene, Depakote)
o ethosuximide (Zarontin) - lowers episodes of seizures.

BARBITURATES
o The only limitation to using barbiturates in seizure management is their sedative effect
which increases as the dosage increases.
COMMON BARBITURATES:
o phenobarbital (Luminal)- control seizure in neonates, Therapeutic Level: 15-
40microgram/mililiter
o primidone (Mysoline)

BENZODIAZEPINES
o Usually classified as sedative hypnotic agents.
o Management of status epilepticus
o Treatment of seizure caused by alcohol widrawal
COMMON ANTIEPILEPTICS:
o diazepine (Valium) - not recommended recommended for maintenance of anti-seizure
effect
o clonazepam (Klonopin, Rivotri)
o lorazepam (Ativan)