Pharmacology In Nursing
GI Medications

Drugs To Tx Peptic Ulcer Disease

Antacids

Helicobacter Pylori Agents

Histamine-2 Receptor Antagonists

Proton Pump Inhibitors

Prostaglandins

Sucralfate

Antacids: General

Neutralize acid

Prevent/tx PUD, GERD, Esophagitis, heartburn, gastritis, GI Bleeding and stress ulcers.

Separate administration from other drugs by 1 to 2 hours

For tx of PUD, 1 &3 hours after meals and @ bedtime

Magnesium Hydroxide/Aluminum (Maalox)

Tx of PUD pain and to promote healing

Neutralizes gastric acid and inactivating pepsin

Contraindicated with impaired renal function

Amphogel

Choice for clients with chronic renal failure

Aluminum does not accumulate

Neutralizes gastric acid and inactivates pepsin

Drug-Interactions
p 753

Chelation

Altered stomach pH

Altered urinary pH

Antiflatulent Agent
Simethicone (Mylecon)

May be mixed in antacid formulation or given alone

Causes gas bubbles to coalesce

Aids in the passage of gas through the GI

Give after meal and @ HS

Shake liquid preparations thoroughly

Patient Teaching: Antacids

Magnesium may cause diarrhea

Calcium or aluminum may cause constipation

Renal patients should not take products containing Magnesium

Take 1-2 hours ā or after other medications

1 & 3 hours PC and HS

Histamine Receptor Antagonists

Inhibit secretion of gastric acid

Prevention & tx of PUD, Esophagitis, GI bleeding, stress ulcers, and Zollinger-Ellison Syndrome

May alter the effects of other drugs

Famotidine (Pepcid)

With or without food

Preferred over cimetidine

Does not inhibit the cytochrome p450 system

Renal impairment monitor creatinine

Teaching: Histamine Receptor Antagonists

OTC, do not take longer than 2 weeks

Take with or without food

Do not take an antacid for approx 1 hour before or after taking one of these drugs

Proton Pump Inhibitors

Strong inhibitors of gastric acid secretion

Bind to the gastric proton pump and prevent "pumping" or release of gastric acid (24 hr action)

Indicated in PUD, Gastritis, GERD, & Zollinder-Ellison syndrome

Faster relief and healing than H2RA’s

Teaching: Proton Pump Inhibitors

Take the medication for the full course prescribed (4-8 weeks)

Do not crush the tablet

Pantoprazole (Protonix)

4 weeks tx (duodenal) to 8 weeks (gastric)

Few effects on other drugs

Most frequently reported side effects N&V, diarrhea, and HA

Consequences unknown for long term suppression of gastric acid

Sulcrafate (Carafate)
Table 47-7

Can be used to prevent & tx PUD

Adheres to the ulcer site, forming a barrier

It requires an acid Ph to activate

May bind with other drugs and interfere with absorption

Teaching: Sulcrafate

Give approximately 2 hours before or after other drugs

Take on an empty stomach before meals and @ HS

Misoprostol (Cytotec)
Prostaglandin

Do not give to women of childbearing years unless a reliable method of birth control can be DOCUMENTED

 

See box on 759

Diarrhea

Def on pg 766

Usually self-limiting

INDICATIONS for tx

Diarrhea >2-3 d

Severe diarrhea in elderly and children

Chronic inflammatory disease

HIV/AIDS

When specific cause has been determined

Diphenoxylate (Lomotil)
Antidiarrheal

Schedule V

Overdose is tx’d with Naloxone (Narcan)

Contraindicated in severe liver disease, glaucoma, children<2

Decreases GI motility

 

Contraindications for Antidiarrheals

Diarrhea caused by:

Toxic materials

Microorganisms (shigella, salmonella, e-coli)

Antibiotic associated colitis

 

 

Teaching: Antidiarrheal

Drink 2-3 qts of fluid/d

Avoid spiced foods

Consult HCP if diarrhea accompanied by severe abd pain, fever, or blood/mucus appears in stool

May cause Drowsiness!

Laxatives & Cathartics
Assessment

Diet?

Drug therapy?

Hemorrhoids?

Elderly?

Box 48-2

Usage

Removal of intestinal parasites

Reduce ammonia

Tx drug-induced constipation

Post Ob

Poor physical activity

Bowel prep

Fig 48-1

Docusate Sodium (Colace)
Emollient

Used to prevent straining at stool

"stool softener" by incorporating water into the stool

Psyllium (Metamucil)
Fiber/Bulk Forming Laxative

Largely unabsorbed

Swell and become gel-like

Stimulate peristalsis and defecation

Long term use or for those clients who cannot or will not adjust diet

Biscodyl (Dulcolax)
Irritant/Stimulant Cathartic

Among the strongest and most abused

Irritate the GI mucosa and pull H2O into the lumen

Can be given PO or Rect

Suppository s/b inserted the length of the index finger

Do not chew tablets

Mineral Oil
Lubricant

Only lubricant used clinically

Exact mechanism of action is unknown

Useful as a retention enema

Lactulose
Hyperosmolar

Not absorbed by the GI

Pulls H2O from intestine

Tx of constipation and encephalopathy

Reduces the amount of ammonia production in the intestine (etoh liver disease)

Contraindications to Laxative/Cathartic Use

Never give in the presence of undiagnosed abdominal pain

Obstruction

Fecal Impaction

Teaching: Laxatives & Cathartics

Fiber and exercise

Laxative use should be temporary

No laxatives while abd pain or N&V are present

 

Antiemetic

p 782

Promethazine (Phenergan)Antiemetics

PO, IM, Rec, IV

Inhibits the CTZ in the medulla, Fig 49-2

Give 30-60 minutes ā radiation, chemo…etc

Will cause drowsiness

Syrup of Ipecac
Emetic

Use in emergency to induce vomiting

Do not give to unconscious victim

Give 1 dose if vomiting does not occur, may give second dose but no more

Do not give if ingestion of petroleum based products has occurred

Activated Charcoal
Absorbent Agent

Used in emergency tx of certain poisons

If told to give both this and ipecac syrup to treat the poisoning, do not give this medicine until after vomiting and the vomiting has stopped. This usually takes about 30 minutes.

Activated charcoal will cause stool to turn black

Test Question

Sulcrafate (Carafate) is ordered. The MAR reads to administer at 0900, 1300, 1800, & 2200. What should the nurse do?

Call the MD

Give as written

Change the times

Hold the medication

C

Change the times because those are all after meal times!

Test # 2

For which client diagnosis would Aluminum Hydroxide (Amphogel) be ordered ordered?

a. Hepatic Impairment

b. Renal impairment

c. Constipation

d. Sinusitus

A

Clients with liver impairment should not be ingesting additional magnesium

Test #3

A nursing assessment finds the client is difficult to awaken. The MAR shows that Diphenoxylate (Lomotil) was given 3 times last night. What order should the nurse expect the MD to write first?

Draw a peak drug level

Naloxone (Narcan) Stat

Nalbuphine (Nubain) QID

D/C Diphenoxylate (Lomotil)

B

Although Atropine has been added to the medication to discourage abuse, you cannot rule out the possibility of this scenerio