Drugs Used to Treat Gastrointestinal Conditions

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Drugs Used to Treat Gastrointestinal Conditions
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• Slide 4 Digestive System Animation

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Figure 27-1 The digestive system.
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Digestive System Animation
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Liver

• Center of metabolic activity in body
• Detoxifies blood and secretes bile

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Peptic Ulcers

• Caused by hyperacidity and excessive pepsin
  activity
• Alcohol, caffeine, and smoking have been linked
  to peptic ulcers
• Many cases of gastric ulcers or gastritis are due
  to Helicobacter pylori

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Table 27-1 Drugs Commonly Used in Peptic Ulcer
Disease
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Table 27-1 (continued) Drugs Commonly Used in
Peptic Ulcer Disease
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Table 27-1 (continued) Drugs Commonly Used in
Peptic Ulcer Disease
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Antacids Uses

• Alkaline compounds that neutralize hydrochloric
  acid
• Most common types contain aluminum hydroxide and
  magnesium carbonate.

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Antacids Adverse Effects

• Common diarrhea or constipation, anorexia,
  weakness, bone pain, tremors
• Hypermagnesemia may produce nausea, vomiting,
  confusion, renal calculi, metabolic alkalosis,
  and headache

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Antacids Contraindications

• Contraindicated in patients with hypercalcemia,
  hyperparathyroidism, vitamin D-overdosage, and
  decalcifying tumors (depending on type of
  antacid)
• Cautious use in patients with impaired kidney
  function or dialysis, and in lactation

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Antacids Patient Information

• Instruct patients to take antacids 1 to 3 hours
  after meals and at bedtime, and not within 1 to 2
  hours of taking other oral medications.
• Advise patients to increase fluid intake to
  prevent kidney stones.
• Patients with cardiovascular disease should avoid
  antacids that are high in sodium.

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Tums Use by Older Adults

• Calcium carbonate (Tums) should be used with
  caution in older adults. This is because of their
  likelihood of having the following disorders
• Renal disease or calculi
• Ventricular fibrillation
• Cardiovascular disease

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H2-receptor Antagonists Uses

• H2-receptor antagonists reduce secretion of
  gastric acid by blocking H2-receptors
• Used in short-term treatment of active duodenal
  ulcers and prevention of ulcer recurrence
• Also used for heartburn

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H2-receptor Antagonists Adverse Effects

• Common GI disturbances, headache, drowsiness,
  confusion, agitation, hallucinations, and
  reversible impotence
• Serious cardiac arrhythmias and cardiac arrest
  after IV bolus dose

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H2-receptor Antagonists Contraindications

• The agents are contraindicated in
• Pregnancy and lactation
• Children younger than 16 years of age

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H2-receptor Antagonists Patient Information

• Warn patients to avoid smoking and drinking
  alcohol.

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Proton Pump Inhibitors Uses

• Act by blocking hydrochloric acid production
• Used to heal stomach and duodenal ulcers and
  relieve symptoms of GERD and esophagitis

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Proton Pump Inhibitors Adverse Effects

• Common headache, dizziness, fatigue, diarrhea,
  abdominal pain, nausea
• Rare hematuria

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Proton Pump Inhibitors Contraindications

• Long-term use is contraindicated.
• Should not be used in children younger than 18
  years

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Proton Pump Inhibitors Patient Information

• Advise patients that treatment is for short term
  only (48 weeks).

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OTC Gastric Medications in Children

• Omeprazole (Prilosec and Zegerid) has not been
  significantly tested in children.
• Do not use in children younger than 18.

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Prostaglandins Uses

• Affect GI motility and gastric acid secretion
• Used to prevent complications of gastric ulcers
  that result from NSAID use

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Prostaglandins Adverse Effects and
Contraindications

• Common adverse effects are diarrhea and
  menorrhagia (in women)
• Contraindicated in pregnancy and lactation

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Prostaglandins Patient Information

• Advise women to immediately report pregnancy.
• Advise patients that diarrhea may occur but will
  disappear after the first month of therapy.

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Table 27-2 Classifications of Antidiarrheal
Drugs
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Table 27-3 The Most Common Antidiarrheals
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Opioids Uses

• Narcotic analgesics act as stimulants on opioid
  receptors in the GI tract to increase mixing
  movements of the gut and decrease peristatic
  movements
• Used to treat diarrhea

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Opioids Adverse Effects

• Constipation
• Nausea and vomiting
• Agitation
• Drowsiness
• Tachycardia
• Numbness of hands and feet

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Opioids Contraindications

• Contraindicated in intestinal obstruction and in
  children younger than 6 years
• Not recommended for treatment of chronic diarrhea.

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Opioids Patient Information

• Encourage patients to keep a record of bowel
  movements to determine effectiveness or possible
  constipation.
• Advise patients to drink clear fluids for a few
  days.

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Opioids in Elderly Patients

• Monitor opioid use in elderly patients carefully
  because opioids can cause respiratory depression
  and decreased blood pressure in this population.

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Absorbents

• Absorb toxins in GI tract that might be causing
  diarrhea
• Adverse effects constipation
• Contraindications bowel obstruction, colitis,
  fever, pregnancy, lactation
• Patient education Instruct patients to report
  diarrhea that is not controlled within 48 hours.

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Table 27-4 Categories of Laxatives
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Table 27-4 (continued) Categories of Laxatives
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Osmotic Laxatives Uses

• Sodium and magnesium ions attract water into
  bowel causing a more liquid stool.
• Used for short-term treatment of occasional
  constipation

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Osmotic Laxatives Adverse Effects

• Common nausea, vomiting, abdominal cramps,
  diarrhea, weakness, lethargy, electrolyte
  imbalances
• Serious hypotension, bradycardia, mental
  depression, coma

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Osmotic Laxatives Contraindications

• Contraindicated in renal impairment and
  hypertension

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Osmotic Laxatives Patient Education

• Instruct patients that 24 to 48 hours are needed
  for effect to occur.
• Women should not breast feed while taking these
  drugs.

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Laxative Abuse

• Evaluate laxative use in patients suspected of
  having bulimia or anorexia.
• Elderly patients may perceive constipation and
  overuse laxatives. Be alert for volume depletion
  in older adults.

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Stool Softeners

• Uses to ease bowel movements in constipated
  patients
• Adverse effects mild abdominal cramps, diarrhea,
  nausea
• Contraindications Atonic constipation, abdominal
  pain, intestinal obstruction, heart failure,
  edema, diabetes

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Stool Softeners

• Patient education Instruct patients to drink
  lots of fluids and not use these drugs for a long
  period.

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Laxative Stimulants

• Uses temporary relief of constipation
• Adverse effects anorexia, nausea, gripping,
  rebound constipation, melanosis
• Contraindications abdominal pain, fecal
  impaction, GI bleeding, ulcerations, pregnancy,
  heart failure

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Laxative Stimulants

• Patient education Advise patients that prolonged
  use disrupts normal colon function.

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Bulk-forming Laxatives

• Work by absorbing free water in intestinal tract
  use in atonic or spastic constipation
• Adverse effects nausea, vomiting, diarrhea,
  abdominal cramps
• Contraindications esophageal and intestinal
  obstruction, fecal impaction, children younger
  than 2 years

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Bulk-forming Laxatives

• Patient education Advise patients with diabetes
  that these drugs contain sugar.

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Emetics

• Use to induce vomiting (emergency)
• Adverse effects stiff muscles, myopathy,
  convulsions, coma, arrhythmias, fatal myocarditis
• Contraindications shock, seizures, impaired
  cardiac function, sedation
• Patient education Advise patients not to use
  before calling poison control center.

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Table 27-5 The Most Commonly Used Antiemetics
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Table 27-5 (continued) The Most Commonly Used
Antiemetics
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Antiemetics

• Uses to prevent or treat nausea and vomiting
• Adverse effects drowsiness, dry mouth,
  confusion, hypotension, blurred vision
• Contraindications coma, CNS depression,
  pregnancy, and lactation
• Patient education Advise patients to avoid
  driving and alcohol.