Gastrointestinal Agents

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Gastrointestinal Agents Antiulcer Drugs

• Joan M. Pino-Talbot
• RN MSN APN CS

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Drugs for the Gastrointestinal Tract

• Gastrointestinal disorders
• Vomiting
• Toxic substance ingestion
• Diarrhea
• Constipation

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Cerebral Centers Affecting Vomiting
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Vomiting (contd)

• Nonpharmacologic measure
• Nonprescription antiemetics
• Antihistamines
• Bismuth subsalicylate
• Phosphorylated carbohydrate solution

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Prescription Antiemetics

• Prescriptive antihistamines
• Anticholinergic
• Dopamine antagonists
• Phenothiazines
• Butyrophenones
• Metoclopramide

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Prescription Antiemetics (contd)

• Benzodiazepines
• Serotonin receptor antagonist
• Glucocorticoids
• Cannabinoids
• Miscellaneous
• Diphenidol, droperidol, trimethobenzamide

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Emetics

• Ipecac is an OTC drug
• Administration
• Take with a glass of water or fluid, not with
  milk or carbonated beverage
• Vomiting occurs in 20 to 30 minutes and if not,
  repeat dose
• Gastric lavage may be needed if vomiting does not
  occur
• Caution avoid vomiting if substance is caustic
  or petroleum

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Diarrhea

• Causes of diarrhea
• Nonpharmacologic measures
• Travelers diarrhea
• Frequent cause Escherichia coli
• Preventive measures

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Antidiarrheals

• Purpose of antidiarrheals
• Types of antidiarrheals
• Opiates and opiate-related agents
• Diphenoxylate with atropine
• Somatostatin analog, octreotide (Sandostatin) for
  severe diarrhea
• Adsorbents Kaopectate
• Antidiarrheal combinations

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Constipation

• Causes
• Nonpharmacologic measures
• Laxatives
• Laxatives vs. cathartics vs. purgatives
• Types of laxatives
• Osmotic (saline)
• Stimulant (contact)
• Bulk-forming
• Emollient (stool softeners)

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Osmotic (Saline) Laxatives

• Types and action
• Side effect electrolyte imbalances, hypotension,
  weakness, etc.
• Stimulants ( contact) laxatives
• Types and action
• Side effects abdominal cramps, electrolyte
  imbalances

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Bulk-Forming Laxatives

• Type and action
• Administration of bulk-forming laxatives
• Adverse effects intestinal obstruction without
  sufficient amount of water
• Stool softeners
• Types and action

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Bulk-Forming Laxatives (contd)

• Contraindications
• Inflammatory disorders of the GI tract
• Appendicitis
• Diverticulitis
• Ulcerative colitis
• Spastic colon
• Bowel obstruction
• Pregnancy

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Case Study

• A client who is taking chemotherapy for cancer of
  the right kidney is extremely nauseated and
  vomiting.
• Critical Thinking
• Which type of antiemetic are appropriate for
  cancer chemotherapy?

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Practice Question

• Ondansetron (Zofran) has been ordered for the
  client who is taking cancer chemotherapy to
  control the severe nausea and vomiting. What side
  effects are possible?
• A. Headache, dizziness, and fatigue
• B. Constipation, anxiety, and fever
• C. Abdominal cramping, and irritability
• D. Psychosis and middle ear disturbances

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Practice Question (contd)

• Answer A
• Rationale Side effects of Zofran include
  headache, dizziness, and fatigue. Constipation,
  anxiety, fever, abdominal cramping, irritability,
  psychosis, and middle ear disturbances are not
  side effects/adverse effects of Zofran

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Antiulcer DrugsPeptic Ulcers

• Peptic Unclers

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Peptic Ulcers

• Gastric secretions
• Gastric mucosal barrier (GMB)
• Peptic ulcers
• Esophageal ulcer
• Duodenal ulcer
• Stress ulcer
• Predisposing factors in peptic ulcers disease
  see Table 46-1
• Helicobacter pylori (H. pylori)
• Gastroesophageal reflux disease (GERD)

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Nonpharmacologic Measures

• Avoid tobacco
• Avoid alcohol
• Weight loss
• Avoid hot, spicy, and greasy foods
• Take any NSAIDs including aspirin and oral
  glucocorticoids with food or in deceased dosage
• Sit upright
• Do not eat before bed
• Ware loose-fitting clothing

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Pharmacologic Measures

• Antiulcer drugs
• Tranquilizers
• Anticholinergic drugs
• Antacids
• Histamine2 (H2)-blockers
• Proton Pump Inhibitors
• Pepsin inhibitors
• Prostaglandin E1 analog

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Antacids

• Functions
• Types of antacids
• Systemic antacids
• Sodium bicarbonate
• Calcium carbonate
• Side effects
• Hypernatremia
• Water retention
• Hypercalcemia

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Antacids (contd)

• Nonsystemic antacids
• Aluminum hydroxide (Amphojel)
• Dihyroxyalumium sodium (Rolaids)
• Calcium carbonate (Tums)
• Magaldrate (Riopan)
• Magnesium hydroxide and aluminum hydroxide
  (Maalox, Mylanta, Gelusil)
• Side effects
• Diarrhea
• Constipation

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H2-Blockers

• Actions
• Types of H2-blockers
• Cimetidine (Tagamet)
• Lab effects increases BUN, creatinine, and
  alkaline phosphatase (ALP)
• Drug interactions
• Ranitidine (Zantac)
• Avoid taking with antacids

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H2-blockers (contd)

• Types of H2-blockers
• Famotidine (Pepcid)
• More potent the cimetidine and ranitidine
• Nixadtidine (Axid)
• OTC H2-blockers

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Proton Pump Inhibitors (PPIs)

• Functions
• Types of PPIs
• Omeprazole (Prilosec)
• Drug interactions
• Lansoprazole (Aciphex)
• Raberprazole (Protonix)
• Esomeprazole (Nexium)

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Proton Pump Inhibitors (PPIs) (contd)

• Treatment for
• Peptic ulcers
• GERD
• H.pylori
• Caution hepatic impairment

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Prostaglandin Analog

• Misoprostol (Cytotec)
• Action
• Uses
• Contraindications

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Case Study

• A client has peptic ulcer disease due to
  H.pylori. An antibiotic and proton pump inhibitor
  have been ordered.
• Critical thinking
• Explain the importance and use of a dual, triple,
  or quadruple drug therapy program in the
  eradication of this bacterial infection.

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Practice Question

• Which of the following are most likely to be
  included in a dual drug therapy program for
  peptic ulcer disease due to H.pylori?
• A. Omeprazole and clarithromycin
• B. Tetracycline and metronidazole
• C. Ranitidine and amoxicillin
• D. Ciprofloxacin and sucralfate

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Answer to Practice Question

• Answer A
• Rationale Omeprazole and clarithromycin are
  commonly included in a dual drug therapy program
  for peptic ulcer disease due to H.pylori.

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Pepsin Inhibitor

• Sucralfate (Carafate)
• Action
• Administration schedule
• Storage