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Pharmacology Exam #2 > GI Motility > Flashcards

GI Motility Flashcards

1
Q

Lifespan considerations for
Laxatives and Antidiarrheal agents
In children

A

Before using meds try:
* proper diet with fluids and fiber
* exercise
* timed toileting

While using meds:
* Monitor electrolytes closely
* Use meds for shortest time possible
* Follow up with provider for underlying conditions and nutritional deficiencies

For constipation:
🟢 USE gylcerin suppositories
🚫 AVOID harsh stimulants

For diarrhea:
🟢 USE Loperamide

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2
Q

Actions of Drugs used to affect Motor Activity of the GI Tract

A

1) Speed up or improve movement of intestinal contents (constipation)
2) Increase the tone of the GI tract and stimulate motility throughout the system
3) Decrease the movement along the GI tract when rapid movement decreases absorption of nutrients (diarrhea)

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3
Q

Lifespan considerations for
Laxatives and Antidiarrheal agents
In Adults

A
  • Caution not to become dependent on laxatives –> cathartic dependence
  • Encourage proper diet, exercise, fluids, fiber
  • Safety during pregnancy/lactation not established
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4
Q

Lifespan considerations for
Laxatives and Antidiarrheal agents
In Older Adults

A
  • Increased likelihood of constipation (more dehydrated, less active)
  • Hepatic and renal impairment
  • Use a bowel regimen
  • Start low, go slow
  • Psyllium agents are BEST (but must drink LOTS of fluids with this)
  • Encourage lifestyle changes: exercise, fluids, fiber
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5
Q

Chemical Stimulants
Mechanism of Action

A

Directly stimulates nerve plexus in the intestinal wall resulting in ⬆️ increasing movement

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6
Q

Chemical Stimulants
Drug Names

A
  • Bisacodyl (Dulcolax)
  • Castor Oil
  • Senna (Ex-lax)
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7
Q

Chemical Stimulants
Contraindications

A

Absolute:
* Allergy

Relative:
* Acute abdominal disorders (appendicitis, colitis, diverticulitis, etc)

Cautions:
* Heart Block
* Coronary Artery Disease (CAD)
* Debilitation (because of decreased absorption ➡️ electrolyte imbalance)

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8
Q

Chemical Stimulants
Adverse Effects

A

💩 GI: diarrhea, abdominal cramping, nausea
🧠 CNS: dizziness, headache, weakness
💓 Cardiac: Sweating, palpitations, flushing, fainting
* Cathartic dependence

Castor Oil:
* Blocks absorption of fats and fat-soluble vitamins (A, D, E, K)

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9
Q

Chemical Stimulants
Drug Interactions

A
  • Other prescribed medications (separate by at least 30 minutes)
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10
Q

Bulk Forming Laxatives
Mechanism of Action

A

⬆️ SIZE of fecal matter
⬆️ fluid in the GI tract
⬆️ stretch on GI tract, stimulating local stretch receptors
⬆️ GI activity/motility

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11
Q

Bulk Forming Laxatives
Indication

A

Constipation

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12
Q

Bulk Forming Laxatives
Drug Names

A
  • Methylcellulose (Citrucel)
  • Polycarbophil (Fiber Lax)
  • Psyllium (Metamucil)
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13
Q

Bulk Forming Laxatives
Contraindications

A

Absolute:
* Allergy

Relative:
* Acute abdominal disorders (appendicitis, colitis, diverticulitis, etc.)

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14
Q

Bulk Forming Laxatives
Adverse Effects

A

💩 GI: diarrhea, abdominal cramping, nausea
🧠CNS: dizziness, headache, weakness
💓CV: sweating, palpitations, flushing, fainting

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15
Q

Bulk Forming Laxatives
Drug Interactions

A
  • Other prescribed medications (take 30 minutes apart due to absorption effect)
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16
Q

Osmotic Laxatives
Mechanism of Action

A

💦 Draws more water into the GI tract ➡️ stimulates increased GI motility

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17
Q

Osmotic Laxatives
Indications

A
  • Constipation
  • Bowel cleanse before surgery
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18
Q

Osmotic Laxatives
Drug Names

A
  • Magnesium (Magnesium sulfate, Magnesium citrate, Magnesium hydroxide)
  • Lactulose
  • Polyethylene glycol
  • Sodium picosulfate with magnesium oxide
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19
Q

Osmotic Laxatives
Contraindications

A

Relative:
* Acute abdominal conditions (fecal impaction, intestinal obstruction, acute abdominal distention, appendicitis)

Caution:
* Lactulose: Diabetes (lactulose is a sugar)
* Magnesium: Renal insufficiency
* Polyethylene glycol: seizures (lowers the seizure threshold)

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20
Q

Osmotic Laxatives
Adverse Effects

A

💩 GI: diarrhea, abdominal cramping, bloating, nausea, dehydration, dry mouth
🧠 CNS: dizziness, lightheadedness, headache, weakness
💓 CV: sweating, palpitations, flushing, fainting
* Rectal irritation

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21
Q

Osmotic Laxatives
Drug Interactions

A
  • Other oral medications
  • Magnesium: neuromuscular junction blockers (increased toxic effect)
22
Q

Lubricants
Mechanisms of Action

A
  • Docusate (Colace)
    Stool Softener
  • Glycerin suppository
    hyperosmolar laxative used to gently evacuate the rectum with minimal systemic effects
  • Mineral Oil
    Forms a slippery coat on the contents of the intestinal tract
23
Q

Lubricants
Indication

A

When straining to have a bowel movement is contraindicated
(ie. hemorrhoids)

24
Q

Lubricants
Contraindications

A

Absolute:
* Allergy

Relative:
* Acute abdominal disorders

25
Q

Lubricants
Adverse Effects

A

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

not absorbed systemically

26
Q

Lubricants
Drug Interactions

A

Frequent use of mineral oil can interfere with absorption of fat soluble vitamins (A, D, E, K)

27
Q

Opioid Antagonist
Mechanism of Action

A

Binds to peripheral opioid receptors to BLOCK the opioid effect on the GI tract

28
Q

Opioid Antagonist
Indication

A

Relieve OPIOID induced constipation

29
Q

Opioid Antagonist
Drug Names

A
  • Methylnaltrexone
  • Naldemedine
  • Naloxegol

“nal” somewhere in name

30
Q

Opioid Antagonist
Contraindications

A

Absolute:
* Allergy
* Bowel Obstruction

Caution:
* Hepatic dysfunction
* Renal dysfunction

31
Q

Opioid Antagonist
Drug Interactions

A

Other opioid antagonists

32
Q

Opioid Antagonist
Adverse Effects

A

💩 GI: Abdominal pain, nausea, vomiting
* Opioid withdrawal symptoms

33
Q

Laxatives
Assessment

A

History:
* Allergy, pregnancy, lactation
* level of activity
* cautions/contraindications

Physical:
* Abdominal assessment
* Skin assessment
* Cardiac assessment
* Neurological assessment

Labs:
* Electrolyte baselines

34
Q

Laxatives
Nursing Conclusions

A
  • Impaired Comfort
  • Diarrhea
  • Knowledge deficit
35
Q

Laxatives
Implementation/Patient Teaching

A
  • Use as a temporary measure
  • Appropriate dietary measures, exercise, environmental controls
  • Administer oral form with FULL glass of water
  • DO NOT chew tablets
  • Adminster bulk laxatives with PLENTY of water
  • Insert rectal suppositories high into rectum, encourage pt. to retain enema or rectal solution (squeeze those butt cheeks!)
36
Q

Gastrointestinal Stimulants
Mechanism of Action

A
  • Stimulate parasympathetic nervous system (rest & digest) activty in GI tract
  • ⬆️ Increase GI secretions and motility
37
Q

Gastrointestinal Stimulants
Indications

A
  • Rapid movement of GI contents
  • Diabetic gastroparesis (paralyzed stomach)
38
Q

Gastrointestinal Stimulants
Drug Name

A

Metoclopramide

39
Q

Gastrointestinal Stimulants
Contraindications

A

Absolute:
* Allergy

Relative:
* GI obstruction

Caution:
* History of tardive dyskinesia
* History of seizures

40
Q

Gastrointestinal Stimulants
Adverse Effects

A

💩 GI: Nausea, vomiting, diarrhea, intestinal spasms, cramping
💓 CV: ⬇️ decreased blood pressure and ⬇️ heart rate
🧠 CNS: Extrapyramidal effects, weakness, fatigue

41
Q

Gastrointestinal Stimulants
Drug Interactions

A
  • Alcohol (increased sedative effect)
  • Antipsychotics (inc. risk of extrapyramidal effects)
42
Q

Gastrointestinal Stimulants
Assessment

A

History:
* Allergy, pregnancy, lactation
* GI obstruction, tardive dyskinesia, seizures

Physical:
* Abdominal assessment
* Cardiac assessment: BP and heartrate

43
Q

Gastrointestinal Stimulants
Nursing Conclusions

A
  • Diarrhea
  • Impaired comfort
  • Fall risk
  • Knowledge deficit
44
Q

Gastrointestinal Stimulants
Implementation/Patient Teaching

A
  • Administer at least 15 min. before each meal and at bedtime
  • Monitor BP carefully if giving via IV
  • Monitor for extrapyramidal effects, seizures, and sedation
  • Monitor diabetic pts for altered glucose levels
45
Q

Antidiarrheal Drugs
Mechanism of Action

A

Slow the motility of the GI tract through direct action on the lining of the GI tract

46
Q

Antidiarrheal Drugs
Indications

A
  • Acute or chronic diarrhea
  • Reduction of volume of discharge from ileostomies
  • Prevention and treatment of traveler’s diarrhea
47
Q

Antidiarrheal Drugs
Drug Names

A
  • Bismuth Subsalicylate (Pepto Bismo)
  • Loperamide (Immodium)
48
Q

Antidiarrheal Drugs
Contraindications

A

Absolute:
* Allergy

Caution:
* History of GI obstruction
* History of acute abdominal conditions
* Hepatic impairment
* Diarrhea due to posioning

49
Q

Antidiarrheal Drugs
Adverse Effects

A

💩 GI: constipation, abdominal distention, abdominal discomfort, nausea & vomiting, dry mouth, toxic megacolon (rare but serious complication)
🧠 CNS: fatigue, weakness, dizziness

50
Q

Antidiarrheal Drugs
Assessment

A

History:
* Allergy
* Acute abdominal conditions, poisoning, GI obstructions
* Hepatic impairment

Physical:
* Abdominal assessment including GI activity and elimination patterns
* Neurological status (due to CNS effects)

51
Q

Antidiarrheal Drugs
Nursing Conclusions

A
  • Constipation
  • Altered GI motility
  • Impaired Comfort
  • Knowledge Deficit
52
Q

Antidiarrheal Drugs
Implementation/Patient Teaching

A
  • Administer the drug after each unformed stool
  • Keep track of the exact amount given
  • Easy access to bathroom
  • Monitor reponse carefully; note frequency and consistency of stool
  • Follow up with provider if no relief in 48 hours

Pharmacology Exam #2 (14 decks)

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