GI Medications Flashcards
Antacids
- Work by neutralizing stomach acid & increasing gastric pH
- Given between meals and before bedtime
- Reducing acidity can promote healing of ulcers, reduce ulcers, or treat hyperacidity
- Does nothing to reduce the underlying cause of hyperacidity
- Contain Calcium, aluminum, and magnesium
Antacids
-Interactions
Changes the pH of the stomach and can effect the absorption of medications
- Decreases effectiveness of anti-infectives, and H2 blockers
- Increases effectiveness of diazepam, enteric coated drugs
Antacids and Anti-infectives
- Antaids decrease effectiveness of anti-infectives, and H2 blockers
Antacids and Diazepam
Antacids increase effectiveness of diazepam & enteric coated drugs
Antacids
-Pt teaching
- Don’t take w/in 2 hrs of other meds
2. Watch for electrolyte changes
H2 Blockers
- Used to treat ulcers and gastroesophageal reflux
- Works by blocking H2 (histamine) in the parietal cells
- SHORT term fix for hyperacidity
H2 Blockers
-Examples
- Cimetidine
- Famotidine**
- Ranitidine
H2 Blockers
-Adverse Effects
- Diarrhea
- Dizziness
- Mental confusion
Proton Pump Inhibitors
-Action
- Gastric anti secretory agent, works by inhibiting the proton pumps, not allowing the secreting of HCL most likely irreversible
Proton Pump Inhibitors
-Used For
- Used for ulcers
- GERD
- Hypersecretory conditions
Proton Pump Inhibitors
-Examples
- Lansoprazole (Prevacid)
2. Pantoprazole (Protonix)
Proton Pump Inhibitors
-Adverse effects
- Abdominal upset
- Headache
- Dizziness
- Well TOlerated
Proton Pump Inhibitors
-Drug Interactions
- H2-blockers
- Warfarin (increases effectiveness)
- Antibiotics
Proton Pump Inhibitors
-Teaching points
- do NOT crush or chew sustained release tablets or capsules
- Long term, regular use can cause Vitamin B12 deficiency
- leads to anemia - Take on empty stomach - 30 minutes prior to meal
- Teach pt ways to reduce gastric acidity or irritation
Mucosal Protectant
-Action
- Works by reacting w/ the HCL and proteins to form a paste at the ulcer site
- Used in duodenal (and gastric) ulcers
Mucosal Protectant
-sucralfate (Carafate)
- Used for the treatment of duodenal ulcers
Mucosal Protectant
-Adverse Effects
- Constipation **
- GI upset and drowsiness
Also, 90% of the aluminum from carafate is not absorbed, but watch pt’s w/ renal disease when the remaining aluminum cannot be removed via kidneys
Mucosal Protectant
-Teaching and Nursing Implications
- Administer on an empty stomach, 1 hr before or 2 hrs after food or other meds
- Watch for renal failure pt’s
- Make sure you flush the NG or feeding tube before and after giving it, if giving through tubes
Prostaglandins
-Action
- Works by increasing prostaglandins, which decrease gastric acid, protecting the mucosa
Prostaglandins
-Example
- Misoprostol (Cytotec)
Prostaglandins
-Indication
- Given when Pt’s are chronically taking NSAIDs, will also produce cervical softening and uterine contractions
Prostaglandins
-Adverse Effects
- Commonly diarrhea and abd pain
2. Contraindicated w/ pregnancy
Prostaglandins (Cytotec)
-Pt teaching
- Take w/ meals and bedtime
2. Discuss contraceptives w/ women on this medication
Antiemetics & Emetics
-Examples
- Prokinetic Agent (Reglan)
- Phenothiazine
- Seotonin Antagonist
Antiemetics
-Action
- Antiemetics treat N/V. Also can treat gastric motility disorders
- (prokinetic such as metoclopramide (reglan)
Antiemetics
-2 Groups
- Phenothiazine (Dopamine Blocker)
- Serotonin Blocker
Work to decrease activating the CTZ (vomiting center)
Antiemetics (dopamine blockers)
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
Adverse Effects
- Drowsiness
- Hypotension
- Anticholinergic
- Extrapyramidal symptoms
Antiemetics (dopamine blockers)
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
Implication and teaching
- Watch for adverse effects
- hypotension, EPS, drowsiness - ID and treat underlying cause of nausea
Antiemetics (serotonin blockers)
-Ondansetron (Zofran)
Action
- Blocks Serotonin, reducing triggering the vomit center via CTZ
Antiemetics (serotonin blockers)
-Ondansetron (Zofran)
Adverse Effects
- Generally well tolerated
- Headache
- Diarrhea
- Dizziness
Antiemetics (serotonin blockers)
-Ondansetron (Zofran)
Pt teaching and implications
- Watch for liver damage (Increased AST, ALT)
2. Monitor I&O and BP
Laxatives
-Different types
- Stimulant Laxative
- Bulk-forming Laxative
- Lubricant Laxative
- Hyperosmotic Laxative
- Stool softener
Laxatives
-Different kinds
- The best laxative i snot a medication
- Water, fiber, activity - Next best is bulk
- Stimulant laxatives can become addicting
- Saline enemas are used infrequently and as last resort
- Hyperosmotic is used for quick acting laxative, when medical tests are ordered
Best Laxative
- Water, fiber, and activity
Saline enemas
- Used infrequently and as last resort
Hypoosmotic laxatives
- Used for quick acting laxative when medical tests are ordered.
Cytotec (misoprostol)
-Prostaglandins
Adverse Effects
- Abdominal pain
- Diarrhea
- Constipation
Cytotec (misoprostol)
-Prostaglandins
Pregnancy
- Misoprostol will cause spontaneous abortion
- Women of childbearing age must be informed of this effect through verbal and written info and must use contraception throughout therapy
Lifestyle changes for GERD and Ulcers?
- Avoid aspirin and similar pain meds
- avoid alcohol & Caffeine
- avoid tobacco
- avoid oily and spicy meals
- Avoid acidic fruits & sweets
H1 Histamine receptor
-Location
- Found on smooth muscle, endothelium, and CNS
- Causes bronchoconstriction (lungs)
- Primary receptors involved in allergic rhinitis
H2 Histamine Receptors
-Location
- Located on Parietal cells and Vascular Smooth muscle cells
- Primarily involved in Vasodilation
- Also STIMULATE GASTRIC ACID SECRETION
Bulk-forming laxatives
- Preferred drugs for the treatment and prevention of chronic constipation
- May be taken on a regular basis w/out ill effects
- Slow onset
- not used when rapid and complete bowel evacuation is needed
Stool Softeners
- Used to Prevent Constipation
- used especially in patient who have undergone recent surgery
Stimulant Laxative
- Rapid acting
- Cause diarrhea and cramping
- Only use occasionally because they may cause laxative dependence and depletion of electrolytes
Hyperosmotic Laxative
- Can produce a bowel movement very quickly
2. DO NOT use on a regular basis because of the possibility of fluid and electrolyte depletion
Lubricant Laxative
- includes mineral oil, which lubricates stool and colon mucosa
- Mineral oil should be discouraged
- it may interfere w/ the absorption of fat-soluble vitamins - Serious adverse effects
H2 Blockers vs. PPI’s
- PPI’s are the most effective
- PPI’s
- inhibit proton pumps, not allowing the secreting of HCL most likely irreversible - H2 blockers:
- works by blocking H2 (histamine in the parietal cells)
sucralfate (Carafate)
-Administration
- Administer on an empty stomach 1 hr before or 2 hours after food or other medications
- Flush the NG or feeding tube before and after giving it, if giving through these tubes
Constipation
-Causes
- Inadequate water and fiber intake
- Inadequate activity
- Resisting urge to have bowel movement
- Overuse of laxatives
- Hypothyroidism
- Medications
Constipation
-Treatment
- A high-fiber diet
- Adequate fluid intake
- Regular exercise
- Don’t ignore urge for BM’s
Antacids
-w/ other medications
- Don’t take antacids w/in two hours of other medications
Vitamin B12 and Intrinsic Factor
- Intrinsic factor is release by parietal cells (stomach surface)
- W/out intrinsic factor the body can only absorb 1% of ingested vitamin B12.
- Pernicious anemia can result from B-12 deficiency
Vitamin B-12 Deficiency
-S/S
- Fatigue & weakness
- Rapid HR and breathing
- Pale skin & sore tongue
- Easy bruising or bleeding, including bleeding gums
- Nerve damage that affects cognitive and muscle function
Extrapyramidal symptoms (EPS)
- Can be an adverse effect of Compazine
- EPS include:
- Muscular rigidity, tremor, bradykinesia and difficulty walking
- induced by neuroleptic meds; drug-induced parkinsonism
