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Pharmacology Exam 2 > Drugs Affecting GI Motility > Flashcards

Drugs Affecting GI Motility Flashcards

1
Q

What Are The Actions of Drugs Used to Affect GI Motility?

A

Speed up or improve movement of
intestinal contents when movement
becomes slow or sluggish (constipation)

Increase the tone of the GI tract and
stimulate motility throughout the
system

Decrease movement along the GI tract
when rapid movement decreases
the time for absorption of
nutrients (diarrhea)

Speed up or slow down!

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2
Q

What are some considerations that should be taken into account when giving drugs that affect the GI motility in children?

A

Prior to medicating try diet rich in fiber and plenty of fluids.
Exercise
Timed toileting.

Glycerin suppositories best choice for constipation in children and young adults (first choice)

Avoid harsh stimulants

Loperamide may be used for diarrhea

Monitor electrolyte/fluid balances closely

Use medications for the shortest time possible

If no improvement follow up with provider to rule out underlying symptoms and nutritional deficiencies.

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3
Q

What are some considerations that should be taken into account when giving drugs that affect the GI motility in adults?

A

Cautious of dependency (cathartic dependence - happens with longtime use)

Proper diet and fluids should encourage normal GI functioning.

Monitor antidiarrheal doses closely

Pregnancy/lactation safety not established - benefit outweighs risk

Mild stool softener used after delivery

May enter breastmilk and may affect GI of neonate - use caution.

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4
Q

What suffix(es)/Drug names and potential outliers should we remember for the drug category Chemical stimulants?

A

Bisacodyl
Castor Oil
Senna

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5
Q

What are some considerations that should be taken into account when giving drugs that affect the GI motility in older adults?

A

Safety is a concern - more likely to develop adverse effects.

Older adults is at risk for constipation.

Establish a bowel regimen.

Show caution with patients with hepatic/renal impairment.

Start low go slow.

Psyllium agents best (need to drink proper fluid for this agent to work)

Encourage lifestyle changes.

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6
Q

How does Chemical Stimulants work?

A

Work at the beginning of the small intestine and increase motility throughout the rest of the GI tract by irritating the nerve plexus in the intestinal wall. This result in increasing
movement.

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7
Q

What is a relative contraindication when thinking about prescribing Senna to a patient?

A

Acute abdominal disorder such as appendicitis, bowel obstruction, diverticulitis which may be worsened by the irritation.

Senna is a Chemical stimulant

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8
Q

What are some cautions to remember when administering Castor Oil to a patient?

A

Heart block, Coronary Artery Disease &
Debilitation due to this drug possibly causing electrolyte imbalances.

Castor oil is a chemical stimulant

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9
Q

What are some adverse effects to monitor for when giving a patient chemical stimulants?

A

GI: diarrhea, abdominal cramping,
nausea - risk for cathartic dependance with long term use.

CNS: dizziness, headache, weakness

Cardiac: Sweating, palpitations, flushing, fainting

Castor oil: blocks absorption of fats and
fat-soluble vitamins

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10
Q

What are some drug-drug interactions to be aware of in a patient taking chemical stimulants?

A

Other prescribed medications should be separated by at least 30 minutes because the chemical laxatives may alter absorption of other drugs.

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11
Q

What suffix(es)/Drug names and potential outliers should we remember for the drug category Bulk Forming Laxatives?

A

Methylcellulose
Polycarbophil
Psyllium

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12
Q

What does Bulk Forming Laxatives do?

A

They increase motility by increasing size
of fecal material, this draws more fluid
into the GI tract which causes more stretch on GI tract which activate more GI activity/peristalsis

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13
Q

Why would you give a patient bulk forming laxatives?

A

For constipation.

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14
Q

What is a relative contraindication to giving a patient Bisacodyl?

A

Acute abdominal disorders

Bisacodyl is a bulk forming laxative

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15
Q

What are some adverse reactions that may happen when a patient is given Psyllium?

A

GI: diarrhea, abdominal cramping, nausea
CNS: dizziness, headache, weakness
Sweating, palpitations, flushing,
fainting

Psyllium is a bulk laxative

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16
Q

What drug-drug interactions do we need to be mindful of when administering Senna?

A

Other prescribed medications. Give 30 min apart due to interreference of absorption of other medications.

Senna is a bulk laxative.

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17
Q

What suffix(es)/Drug names and potential outliers should we remember for the drug category Osmotic Laxatives?

A

“Magnesium”

Magnesium sulfate
Magnesium citrate
Magnesium hydroxide

Lactulose

Polyethylene glycol

Sodium picosulfate with magnesium oxide

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18
Q

How does Osmotic Laxatives work?

A

They draw more water into the GI tract which makes it easier for the feces to move along the tract and get excreted. Increases motility in GI tract.

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19
Q

Why would osmotic laxatives be given to a patient?

A

To treat constipation and cleanse bowl prior to surgery.

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20
Q

What would be some relevant contraindications to prescribing osmotic laxatives to a patient?

A

Acute abdominal conditions

Fecal impaction, intestinal obstruction,
acute abdominal distention, appendicitis

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21
Q

What should we be cautious of when giving Lactulose to a patient?

A

Diabetes because Lactulose is a sugar.

Lactulose is an Osmotic Laxative but this caution applies only to Lactulose.

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22
Q

What should we be cautious of when giving Magnesium to a patient?

A

Renal Insufficiency because magnesium is excreted by the kidneys. So if kidneys aren’t working properly magnesium could build up leading to toxicity.

Magnesium in an Osmotic Laxative but this caution applies only to Magnesium.

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23
Q

What should we be cautious of when giving Polyethylene glycol to a patient?

A

Seizures because Polyethylene glycol lowers the seizure threshold.

Polyethylene glycol is an osmotic laxative but this caution applies only to Polyethylene glycol.

24
Q

What are some adverse reactions to osmotic laxatives?

A

GI: diarrhea, abdominal cramping,
abdominal bloating, nausea;
dehydration: dry mouth (osmotic laxatives draw fluid into the GI tract and therefore can cause dehydration)

CNS: dizziness, lightheadedness, headache, weakness

Sweating, palpitations, flushing, fainting

25
Q

What are some drug drug interactions to keep in mind when giving a patient Magnesium?

A

neuromuscular junction
blockers - may see increased effect.

Magnesium is an osmotic laxative but this drug-drug interaction only applies to magnesium.

26
Q

What drug-drug interaction do we need to be mindful of when prescribing any of the osmotic laxatives?

A

Other oral medications may not have time to absorbed due to increased GI motility.

27
Q

What suffix(es)/Drug names and potential outliers should we remember for the drug category Lubricants?

A

Docusate - stool softener

Glycerin - Hyperosmolar laxative used to
gently evacuate the rectum without
systemic effects higher in the GI tract.
Administered as a suppository

Mineral Oil - Forms a slippery
coat on the contents of the intestinal
tract

Mineral Oil

28
Q

What is a relative contraindication to Lubricants?

A

Acute abdominal disorders

29
Q

What are some adverse effects of mineral oil?

A

GI : diarrhea, abdominal cramping,
nausea; leakage and staining with mineral oil.

Drugs are not absorbed systemically so few reactions outside GI tract.

Mineral oil is a lubricants.

30
Q

What are some adverse drug-drug interactions of mineral oil?

A

Frequent use of mineral oil can interfere
with absorption of the fat-soluble
vitamins A, D, E, & K

31
Q

What suffix(es)/Drug names and potential outliers should we remember for the drug category Opioid Antagonists?

A

All have “nal” in the name:

Methylnaltrexone

Naloxegol

Naldemedine

32
Q

What does opioid antagonists do?

A

Binds to peripheral opioid
receptors to block the opioid
effect on the GI tract.

33
Q

Why would you give a patient Naloxegol?

A

Relieve opioid induced constipation

Naloxegol is an opioid antagonist.

34
Q

What is a relative contraindication to opioid antagonists?

A

Bowel Obstruction

35
Q

What are some cautions to keep in mind when prescribing a patient Naldemedine?

A

Hepatic/Renal Dysfunction

Naldemedine is an opioid antagonist.

36
Q

What are some drug- drug interactions to be mindful of when prescribing Methylnaltrexone to a patient?

A

Other opioid antagonists because it increases the risk of opium withdrawal.

Methylnaltrexone is an opioid antagonist.

37
Q

What are some adverse reactions that you may see in a patient that have been given Opioid Antagonists?

A

Opioid Withdrawal
GI: Abdominal pain, nausea, vomiting

38
Q

What assessment should be done prior to giving a patient laxatives?

A

History
Allergy, pregnancy, lactation,
contraindications/cautions, level of activity - to determine other factors for Constipation
Physical
Abdominal assessment
Skin assessment - signs of dehydration or sweating (adverse effect)
Cardiac assessment
Neurological assessment
Lab Values

Baseline physical is to determine that reaction wasn’t already there before drug was given.

39
Q

What nursing conclusion can be made with all laxatives?

A

Impaired comfort
Diarrhea
Knowledge deficit

40
Q

What implementations should be expected with all laxatives?

A
  • Administer a laxative only as a temporary measure
  • Arrange for appropriate dietary measures, exercise, and environmental controls
  • Administer the oral form with a full glass of water and caution the patient not to chew tablets
  • Administer bulk laxatives with plenty of water
  • Insert rectal suppositories high into the rectum; encourage patients to retain enemas as long as possible.
  • Monitor bowel function
  • Provide comfort and safety measures
  • Provide thorough patient teaching
41
Q

What suffix(es)/Drug names and potential outliers should we remember for the drug category Gastrointestinal Stimulants?

A

Metoclopramide

42
Q

What does Metoclopramide do?

A

Stimulates Parasympathetic activity within the GI tract and secretions,

Increase GI secretions and motility.

43
Q

Why would you give Metoclopramide to a patient?

A

When rapid movement of GI content is desirable.

For diabetic Gastroparesis especially. Some diabetic patients have issues with nerves that impacts stomach movement.

44
Q

What is a relative contraindication when giving a patient Gastrointestinal Stimulants?

A

GI obstruction - wouldn’t allow passage of stool so we would avoid stimulating the stomach.

45
Q

What are some cautions to be mindful of when giving a patient Metoclopramide?

A

History of Tardive Dyskinesia - the drug can make this worse.

History of Seizures.

Metoclopramide is a Gastrointestinal Stimulant.

46
Q

What are some adverse effects that may be seen when a patient is taking Metoclopramide?

A

GI effects : Nausea, vomiting, diarrhea, intestinal spasms, cramping

CV effects :decreased blood pressure and heart rate

Extrapyramidal effects -prolonged use.

Weakness and fatigue

Metoclopramide is a Gastrointestinal Stimulant.

47
Q

What are some adverse drug-drug interactions that may be seen with Metoclopramide use?

A

Alcohol - increase sedative effect
Antipsychotics - increase risk of tardive dyskinesias

Metoclopramide is a Gastrointestinal Stimulant

48
Q

What should you assess for prior to giving the patient Gastrointestinal Stimulants?

A

History : Allergy, pregnancy, lactation
GI obstruction, tardive dyskinesia,
seizures
Physical: Abdominal assessment
Cardiac including pulse and blood

49
Q

What nursing diagnosis can be made prior to giving a patient Metoclopramide ?

A

Diarrhea
Impaired comfort
Fall risk
Knowledge deficit

Metoclopramide is a Gastrointestinal Stimulant.

50
Q

What implementations should be made when giving a patient Gastrointestinal Stimulants?

A

Administer at least 15 minutes before each meal and at bedtime
*Monitor blood pressure carefully if giving the drug IV
*Monitor for extrapyramidal symptoms, seizures, and sedation
*Monitor diabetic patients - increase of alteration in blood glucose so medication requirements may change.
*Comfort and safety measures
*Provide thorough patient teaching

51
Q

What are the drug classes we need to know for the category of Antidiarrheal drugs?

A

Bismuth Subsalicylate

Loperamide

52
Q

What should we be cautious of when giving a patient Loperamide?

A

History of GI obstruction
History of acute abdominal
conditions
Hepatic impairment
Diarrhea due to poisonings - if movement is slowed down it can increase toxic effect

Increased discharge

Loperamide is a Antidiarrheal drug.

53
Q

What adverse effects should we keep an eye out for when giving a patient Bismuth Subsalicylate?

A
  • Constipation
  • Abdominal distension
  • Abdominal discomfort
  • Nausea/vomiting
  • Dry mouth
  • Toxic megacolon
  • Fatigue
  • Weakness
  • Dizziness

Bismuth Subsalicylate is an antidiarrheal

54
Q

What should we assess for prior to giving a patient antidiarrheal drugs?

A

History
* Allergy
* Acute abdominal conditions, poisoning, GI obstructions
* Hepatic impairment
Physical
* Abdominal assessment including GI activity and elimination patterns
* Neurological status - to monitor for CI effects.

55
Q

What nursing conclusion can be made before giving a patient Loperamide?

A

Constipation
Altered GI motility
Impaired comfort
Knowledge deficit

Loperamide is an antidiarrheal drug.

56
Q

What implementations should we do when a patient is being given Loperamide?

A

Administer the drug after each unformed
stool
Keep track of the exact amount given

Monitor the response carefully; note the
frequency and characteristics of the stool

Provide appropriate safety and comfort
measures

Provide thorough patient teaching

Loperamide is an antidiarrheal

Pharmacology Exam 2 (10 decks)

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