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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, activities and timed toileting (bowel program).
  • Glycerin suppositories best choice for constipation in children and young adults (first choice).
  • Avoid harsh stimulants.
  • Loperamide may be used for diarrhea, however we would want to monitor electrolyte/fluid balances closely.
  • Use medications for the shortest time possible.

If no improvement (constipation or diarrhea) 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
  • Proper diet and fluids should encourage normal GI functioning (fiber, fruit, vegetables) This should be done prior to starting medication.
  • Cautious of dependency of laxatives (cathartic dependence - happens with longtime use)
  • Monitor antidiarrheal doses closely
  • Pregnancy/lactation safety not established - benefit outweighs risk
  • Mild stool softener may be used after delivery of baby.

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 (OTC laxative)
Castor Oil (“old school’ laxative)
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

*Encourage lifestyle changes before any medication (fluid and fiber and exercise)

  • Safety is a concern - more likely to develop adverse effects.
  • Older adults is at risk for constipation due to being less mobile and drinking less which may lead to dehydration which again leads to constipation.
  • Establishing a bowel regimen may help keeping eliminations regular.
  • Show caution with patients with hepatic/renal impairment whihc may alter metabolism and excretion of the drugs.
  • Start low go slow.
  • Psyllium agents best (need to drink proper fluid for this agent to work and to prevent adverse effects)
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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 patients/conditions would be a relative contraindication to treatment with Senna to a patient?

A

Acute abdominal disorder such as appendicitis, bowel obstruction, diverticulitis (inflammation of irregular bulging pouches in the wall of the large intestine) which may be worsened by the irritation caused by the chemical stimulant.

Senna is a Chemical stimulant

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8
Q

What conditions should we be cautions of when administering Castor Oil to a patient?

A

Heart block, Coronary Artery Disease &
Debilitation (serious weakening and loss of energy) due to this drug possibly causing electrolyte imbalances which may be dangerous to patients suffering from these conditons.

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 specifically blocks absorption of fats and
fat-soluble vitamins (A,D,E,K).

Drugs should be used for the shortest amount of time possible. The shorter the time used, the less side effects a patient will experience.

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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 conditions contraindicateds prescribing Polycarbophil to a patient?

A

Acute abdominal disorders because they may be exacerbated by this drug.

Polycarbophil 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
Sodium picosulfate w/ magnesium oxide

Lactulose

Polyethylene glycol

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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 (because we are trying to eliminate fecal matter in the intestine), intestinal obstruction (would be exacerbated) , acute abdominal distention ( we wouldn’t want to move what is causing the distention any further), 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 which increases the risk for seizure activity.

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

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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
Rectal irritation.

Sweating, palpitations, flushing, fainting

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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.

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26
Q

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

A

Because Osmotic Laxatives increase GI motility other oral medications given at the same time may not have time to absorbed properly.

If neuromuscular junction blockers are given with magnesium it may increase the effect of the neuromuscular junction blocker.

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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 feces of the intestinal
    tract which aids in excretion.
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28
Q

What are relative contraindications to Lubricants?

A

Acute abdominal disorders

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29
Q

What are some adverse effects of mineral oil?

A

Lubricants are not absorbed systemically so we tend to only see GI related adverse reactions such as : diarrhea, abdominal cramping, nausea; leakage and staining with mineral oil.

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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

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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

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32
Q

What does opioid antagonists do?

A

Binds to peripheral opioid receptors in the GI tract to block the opioid effect on the GI system - prevent opioid induced constipation.

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33
Q

Why would you give a patient Naloxegol?

A

Relieve opioid induced constipation

Naloxegol is an opioid antagonist.

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34
Q

What is a relative contraindication to opioid antagonists?

A

Bowel Obstruction

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35
Q

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

A

Hepatic/Renal Dysfunction due to impaired metabolism and excretion.

Naldemedine is an opioid antagonist.

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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 symptoms
GI: Abdominal pain, nausea, vomiting

38
Q

What assessment should be done prior to giving a patient any laxatives (includes all the drug categories for laxatives)?

A

History:
Allergy, pregnancy, lactation,
contraindications/cautions, level of activity - to determine other factors for constipation.

Physical:
Abdominal assessment - elimination patter, bowl sound, making sure abdomen is soft and not distended or tender (assess for fecal impaction and intestinal obstruction).

Skin assessment - signs of dehydration or sweating (adverse effect)

Cardiac assessment - due to potential for adverse effect.
Neurological assessment - Baseline since adverse effect may be dizziness and weakness.
Lab Values - Potentially electrolyte levels

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 due to risk for dependency.
  • 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 increases motility and secretions.

The parasympathetic response is often referred to as rest and digest.

43
Q

Why would you give Metoclopramide to a patient?

A

When rapid movement of GI content is desirable.

For Diabetic Gastroparesis (when the stomach doesn’t empty properly due to nerve damage from high blood sugar) especially.

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 (a drug induced involuntary movement disorder) - the drug can make this worse.

History of Seizures because Metoclopramide may increase the likelihood of a seizure.

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 due to parasympathetic effect.

Extrapyramidal effects / Tardive Dyskinesia -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: Base line abdominal assessment and cardiac including pulse and blood

49
Q

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

A

Diarrhea r/t drug effect
Impaired comfort r/t GI effect
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 to help things move along.
*Monitor blood pressure, pulse and HR 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 - avoid driving until they know effects of medication due to drowsiness effect.
*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

When would we give a patient Loperamide?

A

For acute or chronic diarrhea
Reduction of volume of discharge from ileostomies, especially if this is resulting in dehydration or electrolyte imbalance.
Also used for prevention of travelers diarrhea.

53
Q

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

A
  • History of GI obstruction - we don’t want risk of obstruction to happen again.
  • History of acute abdominal conditions.
  • Hepatic impairment - may affect metabolism.
  • Diarrhea due to poisonings - if movement is slowed down it can increase toxic effect

Loperamide is a Antidiarrheal drug.

54
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 ( an acute form of colonic distension. It is characterized by a very dilated colon)
  • Fatigue
  • Weakness
  • Dizziness

Bismuth Subsalicylate is an antidiarrheal

55
Q

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

A

History
* Allergy
* Acute abdominal conditions, poisoning, history of GI obstructions
* Hepatic impairment
Physical:
* Abdominal assessment including GI activity and elimination patterns
* Neurological status

56
Q

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

A

Constipation r/t to GI slowing by the antidiarrheal agent.
Altered GI motility
Impaired comfort
Knowledge deficit

Loperamide is an antidiarrheal drug.

57
Q

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

A

Administer the drug after each unformed
stool and to keep track of the exact amount given.

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

Provide appropriate safety and comfort
measures. (assistance with ambulation due to possible CNS effects) (easy access to bathroom and bedside commode)

Provide thorough patient teaching - Follow up with provider in 42 hrs. if no improvement.

Loperamide is an antidiarrheal

58
Q

Explain cathartic dependence

A

Cathartic dependence may happen after long term use of laxatives and it is the dependency of laxatives in order to initiate a bowel movement.

59
Q

To promote optimal GI function, what should the nurse teach the patient to include in the daily routine?

A

Appropriate fluid intake, fiber and exercise!

60
Q

Which drugs may block the absorption of fats and
fat-soluble vitamins (A,D,E,K)?

A

Castor Oil (chemical stimulant) & Mineral oil (Lubricant)

61
Q

Why is it important to separate the administration of other prescribed medications from chemical stimulants and bulk forming laxatives by at least 30 minutes in a patient taking these drugs?
A) To prevent additive CNS stimulation
B) To avoid increased absorption of other drugs
C) To prevent altered absorption of other drugs
D) To minimize risk of dehydration

A

C) To prevent altered absorption of other drugs

62
Q

The nurse administers psyllium to a client with constipation. What outcome best demonstrates therapeutic effects?

A

The bulk of the stool is increased.

63
Q

Which drug category works mainly by drawing more water into the GI tract?

A

Osmotic Laxatives

64
Q

Which drug is used prior to a bowel cleanse?

A

Osmotic Laxatives

65
Q

Why should we not give Lactulose to diabetic patients?

A

Because Lactulose is a sugar

66
Q

Which Osmotic Laxative lowers the seizure threshold and should not be given to patients who suffers from seizures?

A

Polyethylene glycol

67
Q

What is the reason that Osmotic laxatives may cause dehydration?

A

Because they draw water from the surrounding tissues into the GI tract and this may lead to dehydration if the patient isn’t drinking enough.

68
Q

Which drug may increase the effect of the neuromuscular junction blocker?

A

Magnesium.

69
Q

Which lubricant is administered as a suppository?

A

Glycerin.

70
Q

Which drug forms a slippery
coat on the feces of the intestinal
tract which aids in excretion?

A

Mineral oil.

71
Q

Which drug category is not absorbed systemically?

A

Lubricants.

72
Q

When doing a nursing assessment for laxatives, why is it important to get an understanding of the patients level of activity?

A

Because the level of activity may influence GI motility and inactivity may be a cause for constipation.

73
Q

Which drug should be used when we want rapid movement of GI content?

A

Metoclopramide which is a Gastrointestinal Stimulant.

74
Q

Which drug might make Tardive Dyskinesia worse?

A

Metoclopramide

75
Q

Which GI motility drug should not be taken with alcohol due to increased sedative effect?

A

Metoclopramide

76
Q

When it comes to diabetic patients, why may they need to have their diabetic medication dose altered when taking Metoclopramide?

A

Metoclopramide stimulates the bowels and makes things move quicker through the bowels so there is an increase of alteration in blood glucose as the absorption of nutrients have changed, so medication requirements may change due to change in blood glucose levels.

77
Q

What is rebound constipation? What drug may cause this?

A

Loperamide affects the bowels by depressing motility and this may cause rebound constipation.

78
Q

Which GI motility drugs may be used in children?

A

Loperamide for diarrhea (antidiarrheal drug) and glycerin suppositories for constipation (lubricants)

79
Q

Which GI motility drug is the best choice in older adults?

A

Psyllium (bulk forming laxative), however they must be encouraged to drink enough fluids with this drug for it to be effective and to prevent adverse reactions.

80
Q

What is diverticulitis?

A

Inflammation of irregular bulging pouches in the wall of the large intestine

81
Q

In which drug category could magnesium build up in the kidneys and lead to toxicity if the patient is suffering from renal insufficiency?

A

Osmotic laxatives - Magnesium drug classes.

82
Q

Which GI motility drug lowers the seizure threshold and which drug category does it belong to?

A

Polyethylene glycol which is an Osmotic laxative.

83
Q

Which GI motility drug category may cause rectal irritation?

A

Osmotic laxatives

84
Q

Which drug class may interfere with the neuromuscular junction?

A

Magnesiums

85
Q

Heart block, Coronary Artery Disease & Debilitation are some of the conditions that may be worsened by which drug category?

A

Chemical stimulant – this is due to the electrolyte imbalances these drugs may cause.

86
Q

What drug would we want to give for Diabetic Gastroparesis?

A

Metoclopramide

87
Q

Which GI motility agent should be administered 15 minutes AC?

A

Metoclopramide

88
Q

In what specific patient conditions would we not want to give Loperamide to stop diarrhea?

A

When the diarrhea is due to poisoning. We do not want to slow the movement of the poison which would give it more time to be absorbed in the GI tract. In this case we would not want to give the patients antidiarrheal drugs such as Loperamide.

89
Q

Which drug category should be administered after each unformed stool?

A

Antidiarrheal agents such as Loperamide or Bismuth Subsalicylate

Pharmacology Exam 2 (20 decks)

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