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1Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Chapter 18Chapter 18
Gastrointestinal Medications
2Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Chapter 18
Lesson 18.1
3Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Learning ObjectivesLearning Objectives
• Identify common uses for antacids and histamine H2-receptor antagonists
• Compare and contrast the actions of anticholinergic and antispasmodic medications on the gastrointestinal (GI) tract
• Compare the actions and adverse reactions of the five major classifications of laxatives
4Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Learning Objectives (cont.)Learning Objectives (cont.)
• Identify indications for the use of at least two common antidiarrheals, antiflatulents, digestive enzymes, and emetics
• Describe indications for disulfiram use and what is meant by "disulfiram reaction"
5Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Overview Overview
• Three major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colon
• Miscellaneous medications: antiflatulants, digestive enzymes, emetics, and medications to treat gallstones and alcoholism
6Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Digestive System Digestive System
• Functions
• Structures
• Protective factors
• Digestion variables
7Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Digestive SystemDigestive System
8Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors
• Stomach lining and acid production
• External factors that contribute to ulcer formation
• Protective medications
• Table 18-1
9Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Action and Uses• Antacids neutralize hydrochloric acid and
decrease gastric pH; inhibit pepsin• Histamine H2-receptor antagonists displace
histamine from the receptor site and prevent stimulation of the secretory cells (neutralize acid and promote healing of ulcers)
• Proton pump inhibitors irreversibly stop the acid secretory pump imbedded in the parietal cells
10Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Adverse Reactions• Antacids: weakness, anorexia, diarrhea, frequent
burping, bowel obstruction, constipation, hypermagnesemia
• H2-receptor antagonists: dizziness, headache, somnolence, mild/brief diarrhea, hematology changes, muscle pain
• Proton pump inhibitors: headache, diarrhea, abdominal pain, and nausea; rarely rash, vomiting, and dizziness
11Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Drug Interactions • Antacids prevent absorption of many drugs• Dicumarol absorbed 50% faster when taken
with antacids
12Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Antacids, H2-Receptor Antagonists, Proton Pump Inhibitors (cont.)
Nursing Implications and Patient Teaching• Assessment: interaction possibilities• Diagnosis: smoking/alcohol intake, stress• Planning: increase fluid intake• Implementation: forms and routes of administration vary• Evaluation: continued symptoms of GI distress• Patient and Family Teaching: administration times and
drug specificity, adverse reactions, drug storage and efficacy, medical follow-up, drug interactions
13Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Anticholinergics and Antispasmodics
Anticholinergics and Antispasmodics
• Motility
• Symptoms
• Classes of medications: anticholinergics, antispasmodics, antidiarrheals
• Table 18-2
14Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Anticholinergics and Antispasmodics (cont.)
Anticholinergics and Antispasmodics (cont.)
Action and Uses • Anticholinergic-antispasmodic preparations reduce GI
tract spasm and intestinal motility, acid production, and gastric motility, thus reducing pain– Use: peptic ulcer, pylorospasm, biliary colic, hypermotility,
irritable colon, and acute pancreatitis
• Antidiarrheals reduce the fluid content of the stool and decrease peristalsis and motility of the intestinal tract; increase smooth-muscle tone and diminish secretions– Use: treatment of nonspecific diarrhea or diarrhea caused by
antibiotics
15Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Anticholinergics and Antispasmodics (cont.)
Anticholinergics and Antispasmodics (cont.)
Adverse Reactions • Anticholinergics: due to high dosages• Antidiarrheals
16Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Anticholinergics and Antispasmodics (cont.)
Anticholinergics and Antispasmodics (cont.)
Drug Interactions • New GI stimulants, when combined with other
drugs that inhibit cytochrome P-450 4A4 systems, should be monitored for cardiac dysrhythmias
Nursing Implications and Patient Teaching • Assessment, diagnosis, planning,
implementation, and evaluation
17Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Laxatives Laxatives
• Aid in the elimination of stool from the rectum
• Bulk-forming agents• Fecal softeners• Hyperosmolar or saline solutions• Lubricants• Stimulant or irritant laxatives• Tables 18-3 and 18-4
18Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Laxatives (cont.)Laxatives (cont.)
Action and Uses • Bulk-forming laxatives absorb water and expand,
increasing the bulk and moisture content of the stool; peristalsis increases, and absorbed water softens the stool
• Fecal softeners lower the surface tension, which allows the fecal mass to be softened by intestinal fluids
• Hyperosmolar laxatives produce an osmotic effect by drawing water into the bowel, thereby promoting peristalsis and bowel movement
19Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Laxatives (cont.)Laxatives (cont.)
Action and Uses (cont.) • Lubricant laxatives create a barrier between
feces and the colon, preventing colon reabsorption and causing softening of the stool
• Stimulant or irritant laxatives work according to the agent
20Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Laxatives (cont.)Laxatives (cont.)
Adverse Reactions • Nausea and vomiting, obstruction,
hypersensitivity
• Cramping, diarrhea
• Electrolyte disturbances
21Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Laxatives (cont.)Laxatives (cont.)
Drug Interactions • Reduced effectiveness of antibiotics,
anticoagulants, digitalis, and salicylates when combined with laxatives
Nursing Implications and Patient Teaching • Assessment (CHF)
22Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Miscellaneous Gastrointestinal Drugs
Miscellaneous Gastrointestinal Drugs
• Antiflatulents
• Pancreatic digestive enzymes
• Emetics
• Disulfiram
• Table 18-5
23Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antiflatulents Antiflatulents
• Break up and prevent mucus-surrounded pockets of gas from forming in the intestine; reduce gastric pain
• Intended for short-term use
24Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Gallstone-Solubilizing Agents Gallstone-Solubilizing Agents
• Act on the liver to suppress cholesterol and cholic acid synthesis; biliary cholesterol desaturation is enhanced, and breakup occurs
• Used in selected patients with radiolucent stones in gallbladder
• Adverse reactions: dose related; diarrhea, anorexia, constipation, cramps, dyspepsia, epigastric distress, flatulence, heartburn, nausea, nonspecific abdominal pain, and vomiting
25Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Digestive Enzymes Digestive Enzymes
• Promote digestion by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking, not secreted, or not properly absorbed
26Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Disulfiram Disulfiram
• Used in the management of alcoholism
• Unpleasant reaction when combined with alcohol
27Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Emetics Emetics
• Used in emergencies to induce vomiting
• Poison Control Center
• Gastric lavage
• Syrup of ipecac
• Apomorphone
28Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Complementary and Alternative TherapiesComplementary and Alternative Therapies
• Common products
• Conditions
• Drug interactions
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