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