Interventions Medications for GI

Question 1

Names of Antacids

Answer 1

Aluminum or magnesium salts (Mylanta, Maalox)

Alginic acid and sodium bicarbonate (Gaviscon)

Question 2

purpose of Mylanta, Maalox

Answer 2

increase pH of gastric contents by deactivating pepsin

Question 3

purpose of Gaviscon

Answer 3

buffers acid in the stomach

Question 4

Nursing Interventions for Mylanta, Maalox

Answer 4

Give 1 hr before meals 2-3hr after meals, and at bedtime (Drugs work best on empty stomach, If given after meals, hydrogen ion load is high in food)

Use liquid rather than tables (Suspension are more effective than chewable tablets)

Observe for constipation or diarrhea (Aluminum products produce constipation, and magnesium products induce diarrhea)

Suggest use of combination or alternating use of aluminum and magnesium products ( Balancing their effects is important for patient adherence)

Do not give other drugs within 1-2 hr of antacids (Antacids interfere with absorption of other drugs)

Assess patients for a Hx of renal disease (Hypermagnesemia may result since antacids are high in magnesium which cannot be excreted by poorly functioning kidneys. Antacids have a high sodium content)

Question 5

Histamine Receptor Antagonists

examples

Answer 5

ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)

Question 6

Histamine Receptor Antagonists

purpose

Answer 6

decreases gastric acid secretions by blocking histamine receptors in parietal cells

Question 7

Histamine Receptor Antagonists

nursing interventions

Answer 7

Administer with meals and at bedtime (ranitidine and famotidine are more potent, longer acting drugs but produce fewer side effects)

Use cautiously and in reduced dosages in patients with renal disease (Patients need an adequate creatinine clearance to prevent drug toxicity)

Observe for dysrhythmias (Dysrhythmias are common adverts effects of the drug)

do not mix with tomato-based, mixed vegetable juice. Apple juice is the preferred choice (Nizatidine may be less potent when mixed with tomato based, mixed vegetable juices)

Question 8

Prokinetic drugs

example

Answer 8

metoclopramide (Reglan)

Question 9

Purpose of metoclopramide (Reglan)

Answer 9

Increases gastric emptying

Question 10

Nursing interventions for Reglan

Answer 10

Take drug before meals (this drug increases rate of gastric emptying)

Report any neurologic or psychotropic side effects, such as restlessness, anxiety, ataxia, hallucinations (Long term use produces adverse effects in up to one third of patients)

Question 11

Proton Pump Inhibitors

examples

Answer 11

omeprazole (Prilosec)

lansoprazole (Prevacid)

rabeprazole (Aciphex)

pantroprazole (Protonix)

esomeprazole (Nexium)

Question 12

Proton Pump Inhibitors

purpose

Answer 12

decreases gastric acid production

Suppresses H,K-ATPase enzyme system of gastric acid secretion

long acting

Question 13

Proton Pump Inhibitor

Nursing Interventions

Answer 13

Take drug before meals (Gastric acid suppression is greater than 90%)

Observe for typical side effects (abd cramping, diarrhea, headache (Action is prolonged, but GI effects are severe in some patients)

for the patient who has difficulty swallogin, or has NG tube, open capsule and mix granules in apple juice or apple sauce (for Prevacid, it is safe to administer by opening capsule)

Wear sunscreen if taking Aciphex (predisposes the patient to burns)

Protonix: Do not crush, break, or chew DR tablets. Do not give IV protonix with other IV drugs

Nexium: do not administer digoxin, rabeprazole, or iron salts. Do not crush, break, chew. Do not give IV with other IV drugs

Question 14

Aluminum hydroxide (Amphojel) - purpose of drug

Antacid

Answer 14

increases pH of gastric contents by deactivating pepsin

Question 15

Aluminum hydroxide (Amphoral) - nursing interventions

Answer 15

Give 1 hr after meals and at bedtime (Hydrogen ion load id high after ingestion of food)

Use liquid rather than tablets if palatable (Suspensions are more effective than chewable tablets)

Do not give other drugs within 1-2 hr of antacids (Antacids interfere with absorption of other drugs)

Observe patients for side effect of constipation. If constipation occurs, consider alternating with magnesium antacid (Aluminum causes constipation, and magnesium has a laxative effect)

Use for patients with renal failure (Aluminum binds with phosphates in the GI tract. This antacid does not contain magnesium)

Question 16

Mucosal Barrier Fortifiers

example

pg 1224

Answer 16

sucralfate (Carafate)

Question 17

Mucosal Barrier Fortifiers

purpose of drug

pg 1224

Answer 17

Binds with bile acids and pepsin to protect stomach mucosa

Question 18

Mucosal Barrier Fortifiers

nursing interventions

pg 1224

Answer 18

Give 1 hr before and 2 hr after meals and at bedtime (Food may interfere with drug’s adherence to mucosa)

Do not give within 30 minutes of giving antacids or other drugs (Antacids may interfere with effect)

Question 19

Prostaglandin analogs

example

pg 1224

Answer 19

misoprostol (Cytotec)

Question 20

Prostaglandin analogs

purpose of drug

pg 1224

Answer 20

Decreases gastric secretions and enhances resistance to mucosal injury when patient is taking NSAIDs

Question 21

Prostaglandin analogs

nursing interventions

pg 1224

Answer 21

Take with food (Drug protects against NSAID-induced ulcers)

Avoid magnesium-containing antacids (Both misoprostol and magnesium-containing antacids can cause diarrhea)

Question 22

Antimicrobials

examples

Answer 22

clarithromycin (Biaxin)

amoxicillin (Amoxil)

tetracycline

metronidazole (Flagyl)

pg 1224

Question 23

antimicrobials - purpose of drug

Answer 23

Treats Helicobacter pylori

Question 24

antimicrobials - nursing interventions

Answer 24

antimicrobials should be given as part of therapy to eradicate H. pylori infection

the selection of the specific drug depends on its effectiveness, side effects, and drug interactions