GI Drugs Flashcards
common disorders with Upper GI
Heartburn, GERD, Peptic Ulcer Disease, Duodenal ulcer
Nursing Assessment for GI secretion drugs
baseline H&P including allergies and medications
focus: GI and abdominal assessment related to disorder and AE
Follow administration protocol
Nursing Education for GI secretion drugs
non-pharm interventions for disorder
proper administration
shortest duration to reduce risk for AE
Common AE for GI secretion drugs
nausea
vomiting
diarrhea
constipation
abdominal discomfort
rash
Sodium Bicarbonate class
antacids
Sodium Bicarbonate MoA
neutralize stomach acid by direct chemical reaction
Sodium Bicarbonate Indications
relief of upset stomach r/t hyperacidity
Sodium Bicarbonate Route
PO: rapid onset, short duration, give PRN to treat symptoms
also used IV for metabolic acidosis and cardiac emerg. (more severe AE profile and urgent nursing)
Sodium Bicarbonate AE
gastric acid rebound, belching, fluid retention, hypokalemia, metabolic alkalosis (headache, confusion, irritability, nausea, weakness, tetany) if overdosed
Sodium Bicarbonate nursing considerations
give other meds 1-2 hours after oral antacid; chew tab and give with 8 oz of water; do not take with milk; electrolyte disturbances; teach- not to take 2 wks; OTC
Cimetidine (Tagamet) class
Histamine 2 (H2) antagonists
Cimetidine (Tagamet) MoA
blocks histamine-2 receptor sites to reduce gastric acid secretion and pepsin production
Cimetidine (Tagamet) Indications
GI ulcers; GERD; hyper-secretory conditions; heartburn and acid indigestion
Cimetidine (Tagamet) AE
headache, dizziness; severe: cardiac arrhythmias
Cimetidine (Tagamet) Nursing
Teach: smoking diminishes effectiveness of med; extended duration (greater than 6 months) risk for vitamin B12 malabsorption; OTC
Omeprazole (Prilosec) class
proton pump inhibitors (PPI)
Omeprazole (Prilosec) MoA
blocks secretion hydrochloric acid in the stomach; ALL gastric acid secretion is temporarily blocked
Omeprazole (Prilosec) indications
GERD, GI ulcers; prevention ulcers in acute care
Omeprazole (Prilosec) cautions
long term use risk: atrophic gastritis (malabsorption of vitamin B 12- pernicious anemia), osteoporosis related fracture (decreased Ca absorption); associated with C diff.
Omeprazole (Prilosec) AE
headache, dizziness, upper respiratory infection (URI)
Omeprazole (Prilosec) nursing
administer on an empty stomach (30-60 min before a meal);
Teach- shortest duration, report s/s severe diarrhea; monitor h/h; OTC
Sucralfate (Carafate) class
gastrointestinal protectant
Sucralfate (Carafate) MoA
binds to base of ulcers and erosions forming protective barrier from pepsin
Sucralfate (Carafate) indications
GI ulcer; chronic renal failure/hyperphosphatemia
Sucralfate (Carafate) AE
constipation, dry mouth, dizziness
Sucralfate (Carafate) nursing considerations
administer med on an empty stomach, 1 hour before or 2 hours after meals and at bedtime; admin other meds at least 2 hours before (impairs absorption)
Assessment for Laxatives
baseline H&P including allergies and medications
focused assessment: bowel sounds, I&O, electrolytes
contraindicated in acute bowel disorders such as ileus, obstruction, ischemia, perforation
Monitoring for Laxatives
loose stools (diarrhea), nausea, vomiting, abdominal pain, dehydration, electrolyte imbalance
achievement of soft bowel movement within 24 hours of administration
implementation for laxatives
hold if loose stools
encourage 3 L of water daily, high fiber diet, increase activity
for multiple PRN softener/laxative orders (first use docusate if no results try bisacodyl or polyethylene glycol- may need multiple drugs for result
teaching for laxatives
teach not to take a laxative if experiencing nausea, vomiting, abdominal pain. contact provider if experiencing severe abdominal pain, muscle weakness, cramps, and or dizziness
long term use of laxatives results in decreased bowel tone and may lead to dependency; use for no more than 7 days.
Docusate (colace) class
lubricant/stool softener
Docusate (colace) MoA
promotes electrolyte and water absorption into colon, promotes incorporation of water into the stool (results in stool softening)
Docusate (colace) indications
relief and prevention of constipation, prevent straining
Docusate (colace) route
PO or suppository
Docusate (colace) AE
well tolerated, low risk for dehydration and electrolyte imbalance
Docusate (colace) nursing considerations
first-line pharmacologic therapy for prevention of constipation
bisacodyl (dulcolax) class
bowel chemical stimulant
bisacodyl (dulcolax) MoA
chemical irritant that directly stimulates GI tract motility
bisacodyl (dulcolax) indications
constipation, evacuate the bowel for diagnostic procedures
bisacodyl (dulcolax) route
PO or suppository
bisacodyl (dulcolax) AE
see nursing role
bisacodyl (dulcolax) nursing considerations
admin PO with water (interact milk, juice, antacids)
polyethylene glycol (Miralax) class
bulk stimulants; hyperosmotic laxative
polyethylene glycol (Miralax) MoA
increase water absorption into the colon and GI tract (water follows polyethylene glycol; which stays in the colon and GI tract)
polyethylene glycol (Miralax) indications
constipation, evaluate bowel for diagnostic procedure (high dose)
polyethylene glycol (Miralax) AE
see nursing role
polyethylene glycol (Miralax) nursing considerations
mix with 4-8 oz of water; acute care fall risk
antidiarrheal contraindications
diarrhea caused by poisoning or by bacterial toxins
acute abdominal disorders including GI obstructions
antidiarrheal assessment
baseline H&P including allergies and medications
I&Os and elimination patterns, electrolytes, hydration, bowel sounds and abdomen
TE: decrease number of bowel movements
antidiarrheal teaching
teach to take medications exactly as prescribes
notify HCP if symptoms persist after 2 days and or s/s dehydration
do not use for infectious diarrhea
keep hydrated 3L/day
loperamide (imodium) class
antidiarrheals
loperamide (imodium) MoA
slow the motility of GI tract through direct action on lining of GI tract
loperamide (imodium) indications
non-infectious diarrhea
loperamide (imodium) AE
constipation, abdominal distension, abdominal discomfort, nausea, dry mouth
loperamide (imodium) nursing considerations
admin drug after each loose stool; not to exceed recommended daily maximum dose.
antiemetic agent assessment
baseline H&P including allergies and medications
focus: GI, I&O, neuro/LOC
document emesis: output amount, color, frequency
s/s dehydration, electrolyte imbalance from vomiting
fall risk
drug-drug CNS depressants
antiemetic agent implementation
give PRN medication as appropriate
consider appropriate route, use least invasive
verify route-wrong route can be dangerous
Preventative therapy: admin 30-60 prior to chemotherapy dose or end of surgery
how patient situation affects antiemetic routes
oral preferred, but if vomiting, select alternate route (contact provider)
suppository often used in hospice care
antiemetic teaching
timing of administration
no heavy machinery
antiemetic evaluation
TE: absence of nausea and vomiting- document response
AE: drowsiness, dizziness, cardiovascular
lifespan older adults: poly-pharmacy, anticholinergic effects, CNS effects- falls
ondansetron (zofran) class
serotonin blockers
ondansetron (zofran) MoA
blocks serotonin peripherally, centrally and small intestine; blocks chemoreceptor trigger zone
ondansetron (zofran) indications
n/v (post op, chemotherapy, illness)
ondansetron (zofran) caution
cardiac arrhythmias, CNS depression
ondansetron (zofran) AE
drowsiness, dizziness, headache, diarrhea, prolonged QTc/dysrhythmias
ondansetron (zofran) nursing considerations
see general nursing
acute acetaminophen overdose
leads to acute liver failure: nausea, vomiting, jaundice, malaise, confusion
acute acetaminophen overdose treatment
acetylcysteine- use within 24 hours of toxicity
hepatic encephalopathy
liver cirrhosis, increased ammonia levels
hepatic encephalopathy treatment
lactulose- excretes ammonia in stool
loose stools are expected TE
lactulose (enulose) class
hyperosmotic laxative
lactulose (enulose) MoA
pulls fluid out of venous system and into lumen of small intestine; inhibits diffusion of ammonia back to blood, excreting more ammonia in stool
lactulose (enulose) indications
hepatic encephalopathy, constipation
lactulose (enulose) route
oral or enema
lactulose (enulose) AE
n/v/d; electrolyte imbalance
lactulose (enulose) nursing
titrate as directed (# of loose stools) or scheduled dose; monitor ammonia levels I&O, electrolytes, mental status, skin rectal area; use caution w/additional laxatives; teach: bad taste; compliance.