GI Disorder Flashcards
Constipation more frequent in
Older adults
Diagnosis requires at least two of the following symptoms.
for const
Two or fewer bowel movements per week
Lumpy or hard stools at least 25% of time
Straining to pass stools at least 25% of time
Feeling of incomplete evacuation at least 25% of time
Const causes
lack of fluid intake
Lack of dietary fiber
Immobility
Tx of Const nutriotinoal
Prune/prune juice
Increase fluid
Increase activity
Increase fibre
Increased fiber includes
Whole wheat, bran, oats, fruits and vegetables.
Will increase gas production initially but the effect decreases with time.
Pharmacotherapy w/ laxatives
Laxatives are drugs that promote evacuation of bowel
Classes of laxatives
Bulk-forming (ie psyillium)
Stool softeners (ie docusate)
Stimulants
Osmotics
Builk forming laxatives
Bulk-forming (ie psyillium)
Fibre that absorbs water, forming bulkier stool that passes more easily
Must be taken with lots of water
Stool softeners
Docusate
Surfactant that lowers surface tension of stool allowing more water to enter stool
Often given when constipation poses a risk
Stimulants laxatives
Irritate bowel, promoting peristalsis What do you think this can cause?
Osmotic laxatives
Draw water into GI tract
Can cause dehydration
Psyllium Mucilloid
Bulk forming lax
Metamucil, Psyllium
Occasional constipation
Reduction of blood cholesterol with longer use
Mechanism of action
Absorbs water in bowel forming a bulky stool
Bulky stool stimulates defecation reflex
AE
- safest laxitive if taken as directed with water
Mild. cramping or D
If not taken with adequate water, can cause obstruction of the esophagus or intestines
When giving laxatives ensure
Closeby commode or
Clear path to BR
How often must pts have BM in hospital
Pt must have BM EVERY 3 days
Diarrhea is
Increased fluidity of feces when colon does not reabsorb enough water
Often secondary to another condition
i.e.
GI infection
Drugs (antibiotics, NSAIDs, orlistat, digoxin)
Inflammation of bowel
Foods
Diseases of SI and pancreas, leading to malabsorption of food
Prolonged diarrhea
Indication for pharmacotherapy
Symptom of underlying disease
Prolonged diarrhea can cause:
1 Fluid deficit
2 acid–base imbalances
3 electrolyte abnormalities
Tx focus when dealing with diarrhea
to eliminate primary cause of diarrhea and to manage symptoms through pharmacotherapy
If infection is primary cause, then antibiotics will be most effective treatment.
Oral solutions would you reccomend for diarrhea
Gatorade, pediolyte
Diet for diarrhea
Decrease fiber
Decrease milk products
Avoid fatty foods
Avoid coffee & tea
Pharmacotherapy of diarrhea
Opioids (Most common)
- Codeine
Loperamide
Non opioid
- Pepto-Bismol
Psyllium - absorbs water to form bulk
Atropine
Used for: Mod-severe diarrhe
MoA: Binds to mu opioid receptors in GI tract reducing peristalsis
- Atropine blocks ACh receptors to reduce peristalsis
Combined, this combo provides time for water to be abosrombed from LI
Loperamide (Immodium)
Loperamide is an anti-diarrheal agent that provides symptomatic relief
also increases rectal tone,reducing daily fecal volume, and increasing the viscosity and bulk density of feces .It also increases the tone of the anal sphincter, thereby reducing incontinence and urgency.
Onset: 1 hour, can last for 3 days
Does not mediate significant analgesic activity at therapeutic
Assessment before Immodium
Obtain a complete health history including allergies and drug history
Obtain vital signs, ECG and electrolytes why?
Obtain and evaluate stool culture why?
Assess for presence of dehydration why?
Interventions for pts recieving antidiarrheal therapy
Monitor for anticholinergic effects including dry mouth
Initiate safety measures to reduce risk of falls
Vomiting controlled by
Controlled by the vomiting center of the brain that receives signals from digestive tract, inner ear, chemoreceptor trigger zone, cortex
Complications from chronic vomitingq
Dehydration
Electrolytes
WT loss
Metabolic alk
When foods and fluids cannot be tolerated, start with
Warm fluids, gatorade, bland fluid
Complentary alternative therapy for NV
Acupuncture
Herbs like ginger and peppermint
Breathing exercises
Pharm therapty of NV KNOW THIS
Anticholinergics
Antihistamines
Scopolamine
Class
Use
AE
Anticholinergics
Often given as a patch or SQ
Nausea due to Motion sickness or Post OP
AE-Dry mouth, Sleepines, Urinary retention, Agitation, Dilated pupils
Antihistimanines (Gravol)
Nausea due to motion sickness
Cause significant drowsiness
AE- Drowsiness. Dizziness, Blurred vision,Dry mouth, nose, and throat, Constipation
Serotonin Receptor antiagonists
Ondansetron - zofran
Chemotherapy-induced nausea and vomiting
AE- Blurred vision, bradycardia, anxiety, agitation, shivering
Phenothiazines
H2 receptor antagonists; ie prochlorperazine)
Antineoplastic therapy
- NV
Cannabinoids (Marinol-dronabinol)
Used to treat NV caused by Antineoplastic (Chemo) therapy
Stimulate appetite (CAN be a benefit)
AE- seizures, tachycardia, mood changes
Corticosteroids used for
Tx of NV in Antineoplastic therapy (Cancer tx)
Post-surgical nausea and vomiting
Haldol
classified as an antipsychotic but also helps control nausea and vomiting by blocking dopamine receptors in the brain.
1st Line therapy for preventing post op vomiting
Can be given PO
AE: Anxiety, tiredness, neuroleptic malignant sundrome (Life threatening)
Metoclopramide (Maxeran)
Tx of severe NV
Blocks D2 receptors in brain, preventing signaling to the vomiting centre
AE: Drowsiness, Extrapyramidal effects (Smack lips, lick lips, twisting neck etc/)
In both Crohn’s and ulcerative colitis, malnutrition can result. Why do you think this is?
Crohns - Affects the small intestine
First response to IBD exacerbation
NPO
Pharmacotherapy of IBD (1 of 2)
5 ASA
Corticosteriods
Immunosuppressants
IBS Tx
Pancreatis
Digestive enzymes remain in the pancreas rather than being released into duodenum
Acute pancreatitis
More common in middle-aged adults
Associated with gallstones in females, alcoholism in males
Chronic pancreatitis
Associated with alcoholism
Causes of pancreatitis
Alcoholism
Infections
Genetic (cystic fibrosis)
Pancrelipase
Use: Replacement therapy for patients with insufficient pancreatic exocrine secretions
Panceatisi
MoA- Facilitates digestion
lipids into glycerol and fatty acids
starches into dextrin and sugars
proteins into peptides
Protevyion from acid secretion in stomach
Goblet cells produce mucous which protects the lining of the stomach
Pancreas secretes bicarbonate ions into duodenum to neutralize acid to protect mucosa
Most peptic ulcer dx caused by
H pylori
Duodenum ulcers relieved by
Food
Gastric ulcers
More common in those over 60, not relieved by food
GERD
Chronic condition
Nutritional therapy for GERD
Consume small meals and consume liquids bw meals
Limit foods or substances increasing gastric acid (Coffee and alcohol)
(Choclate fried food)
Avoid lying down after eating or eating right before bed. Meals should be consumed at least 3 hours before bed.
Avoid wearing tight garments or bending over.
Avoid cigarette smoking which relaxes the sphincter.
Avoid using NSAIDS. Which can damage esophageal mucosa.
Ranitidine (Zantac)
Uses:
Duodenal ulcers, gastric ulcers
Hypersecretory conditions (ie ZES)
Heartburn, GERD
Used off-label to counter medications that promote development of peptic ulcers
MoA:
Blocks H2 receptors on the parietal cells in the stomach to decrease acid production
Administered once daily
AE of Ranitidine
Adverse effects
Uncommon and transient
Serious adverse effects, reduction in;
1 Platlets
2 RBC
3 WBC
Proton Pump Inhibitors
PPIs block the enzyme (H+/K+ pump )on parietal cells, reducing acid secretion in the therapy of PUD and GERD
Should be taken about 30 minutes before meals
Omeprazole
PPI
Uses: By prescription, approved for short-term, 4- to 8-week therapy of active peptic ulcers
OTC, indicated for relief of heartburn
MoA: Reduces acid secretion in stomach by irreversibly binding to the H+/K+ pump
AE: Headache, nausea, diarrhea, rash, abdominal pain
SHOWN to cause cancer long term (In animals)
Main downside of taking antacids
Can reduce absorptionof OTHER Drugsthat require acidic environment
Neutralize the stomach acid
Adverse effects of hydroxide
Constipation
At high doses, aluminum products bind with phosphate in GI tract, and long-term use can result in phosphate depletion
