pharm 4 GI
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Disorders of the upper GI?
- 1. GERD
- 2. PUD
- 3. H. Pylori Infection
- 4. NV
4 s/s of GERD?
- 1. heartburn
- 2. regurgitation
- 3. dysphagia
- 4. waterbrush
salivary gland secretes salty/sour secretion due to reflux
4 Tx options for GERD?
- 1. antacids
- 2. promotility agents
- 3. antisecretory agents
- 4. mucosal protective agents
H. Pylor Tx?
Legacy triple therapy: 2 ABX and a proton pump inhibitor (PPI)
4 ABX that may be used in legacy triple therapy for H. pylori?
- 1. clarithromycin
- 2. amoxicillin
- 3. metronidazole
- 4. tetracycline
Proton pump inhibitors end with ____.
Action of PPI?
blocks the final step of gastric acid production
Why are PPI's enteric coated?
so can get passed gastric acid to work
Route of PPI?
nexium & protonix can be given IV
Dosing of PPI?
once per day
Which stomach med is a preg. cat. X?
Effect of PPI besides decreasing acid?
have some antimicrobial affect against H. pylori
Most common AE of PPI?
Other AE that may occur?
HA & diarrhea
- 1. dizziness
- 2. constipation
- 3. abd pain
- 4. NV
- 5. URI
- 6. pneumonia
Serious AE of PPI?
Why may these occur?
- 1. URI- upper resp infection
- 2. pneumonia
decreased gastric acid can cause increased bacteria in GI & resp tracts
When should PPI be taken?
1 hour before meals
3 nursing considerations with PPI?
- 1. cannot crush - enteric coated
- 2. may need Ca supplement b/c PPI decreases absorption of Ca
- 3. antacids can be taken for additional management
3 uses for PPI?
- 1. peptic ulcers resulting from H. pylori
- 2. GERD
- 3. erosive esophagitis
- 4. hypersecretory conditions (Zollinger-Ellison Syndrome)
Peptic Ulcer Disease is usually caused by?
6 factors that can make PUD worse?
- 1. NSAIDS
- 2. ASA
- 3. glucocorticosteroids
- 4. stress
- 5. caffeine
- 6. smoking
- 7. alcohol
3 Tx of PUD?
- 1. PPI
- 2. histamine-2 receptor antagonists
- 3. antacids
Histamine-2 receptor antagonists end with ____.
Prototype H-2 blocker?
Action of H-2 blockers?
inhibit all phases of gastric acid secretion
H-2 blockers used to Tx what 5 conditions?
- 1. s/s of active duodenal ulcers
- 2. benign gastric ulcers
- 3. GERD
- 4. hypersecretory conditions
- 5. erosive esophagitis
2 routes for H-2 blockers?
Drug interactions with H-2 blockers?
cimetidine/Tagamet interacts with multiple meds
Tarry stools is an indication of what?
What may this be caused by?
upper GI bleed
Admin of IV ranitidine/Zantac?
admin slowly to prevent hypotension & cardiac arrhythmias
Why is it important for pt to take oral H-2 blockers u.t.?
s/s disappear before the ulcer will totally heal
Taking antacids with H-2 blockers?
give at least 2 hours apart from antacids
Antacid drug interactions?
antacids interact with a lot of meds - decrease effects of most meds
Taking OTC stomach med with H-2 blockers?
should not substitute or add OTC b/c risk for interaction
If a pt has arthritis they will be taking a lot of ____.
What drug will they take to prevent ulcers?
1. prevent NSAID- induced gastric ulcers in high risk pt
2. therapeutic abortions
Action of cytotec?
increases the production of protective mucous and decreases the secretion of gastric acid
also causes uterine contractions
Consideration for interactions with any GI med?
many GI meds mess with other med abortion
What is required prior to the admin of cytotec?
negative pregnancy test
When will cytotec therapy be begun?
on 2nd or 3rd day of mentrual period
2 things to teach cytotec pt?
- 1. use contraception throughout therapy (in women)
- 2. take with food
Most common AE of cytotec?
Uses for sucralfate/Carafate?
Tx duodenal ulcers & accelerate ulcer healing
also prevention & long-term Tx of ulcers
What is sucralfate?
aluminum salt with anti-peptic activity
Action of sucralfate?
non-abosrobent paste forms & adheres to ulcer lesions
AE of sucralfate?
When should sucralfate be taken?
1 h before meals & 1 h before or after other meds - can affect absorption of other meds
4 bases for antacids?
- 1. aluminum
- 2. magnesium
- 3. calcium
- 4. sodium
AE of aluminum based antacids?
aluminum - constipation
together - none
Magnesium & aluminum based antacids in kidney failure/ESRD?
magnesium cannot be excreted and will build up
aluminum can help with phosphorous excretion
What needs to be monitored when pt is taking antacids?
When should antacids be taken?
2 h after other drugs and 1 h after meals
Why should pt not substitute antacid for Rx meds to treat peptic ulcer?
can affect absorption of other meds or mess up electrolytes
Do not take max dose of antacid for more than _____.
What should pt report to MD of taking antacids?
- 1. constipation/diarrhea
- 2. abd pain
- 3. black tarry stools/coffee ground emesis
Prototype prokinetic agent?
What is metoclopramide?
4 uses for metoclopramide?
- 1. delayed gastric emptying
- 2. GERD
- 3. NV
- 4. diabetic gastroparesis
How does metoclopramide help with NV?
increases the effect of Ach on GI system
4 AE of metoclopramide?
- 1. extrapyramidal reactions
- 2. depression
- 3. parkinson-like s/s
- 4. decreases seizure threshold
4 s/s of extrapyramidal reaction?
- 1. muscle rigidity
- 2. tremor
- 3. bradykinesia
- 4. tardive dyskinesia
Who may receive metoclopramide for NV?
What GI med may be given to MI pt to prevent vagal response?
When should metoclopramide be given?
30 minutes before meals or chemo
IV admin of metoclopramide?
give slow IV push to prevent exgtrapyramidal effects
Pt teaching for metoclopramide?
s/s of AE
Why may metoclopramide be given to pt getting a GI procedure/exam?
b/c they get GoLytely & it makes them nauseated
Prototype digestive enzyme med?
pancrelipase - synthetic pancreatic enzymes
What condition requires the use of pancrelipase?
3 AE of pancrelipase?
- 1. N
- 2. abd cramps
- 3. diarrhea
When should pancrelipase be taken?
before or with meals
Pt teaching for pancrelipase?
- 1. do not crush or chew tablets
- 2. avoid breathing powder & skin contact
Why should pt avoid breathing powder & skin contact with pancrelipase powder?
can cause asthma attack
Contraindications with pancrelipase?
hypersensitivity to pork
Prototype med for weight management?
AE of xenical?
- 1. oily spotting
- 2. flatus with stool
- 3. fecal urgency
Contraindications for xenical?
Pt education with xenical?
- 1. limit dietary fat to 30% of calories
- 2. may need multivitamin for fat soluble vitamins
3 classifications of anti-emetics?
- 1. selective serotonin receptor antagonists
- 2. antidopaminergic
- 3. anticholinergic
Prototype selective serotonin receptro antagonist?
3 common AE of zofran?
- 1. HA
- 2. constipation
- 3. malaise
3 serious AE of zofran?
- 1. arrhythmias
- 2. hypotension
- 3. extrapyramidal effects
When should zofran be admin?
15 to 30 min. before chemo repeating q 8 h for 1 to 2 days post chemo or radiation
prior to anesthesia for post-op NV
Pt teaching with zofran/
possible AE to notify
4 meds used for lower GI probs?
- 1. antidiarrheals
- 2. IBS
- 3. IBD
- 4. laxatives
Important consideration with lomotil?
it is similar to demerol - schedule V med
has no pain effects
atropine is in it to prevent its abuse
Action of lomotil?
reduces intestinal motility and slows peristalsis
Use for lomotil?
treats diarrhea not responsive to symptomatic supportive TX
Contraindication for lomotil?
diarrhea ass. with organisms that penetrate intestinal mucosa
Common AE of lomotil?
- 1. drowsiness
- 2. dizziness
- 3. dry mouth
2 serious AE of lomotil?
- 1. atropine overdose
- 2. toxic megacolon
3 nursing considerations with lomotil?
- 1. decrease dose when diarrhea becomes less frequent
- 2. monitor for s/s of atropine overdose
- 3. do not exceeed the prescribed dose
Teaching for lomotil?
- 1. don't drive until know effects
- 2. don't take too much med
Why is it important not to take too much lomotil?
- 1. can form dependence on it
- 2. can get atropine overdose
6 major groups of laxatives?
- 1. saline
- 2. hyperosmotic
- 3. stimulant/irritant
- 4. bulk-forming
- 5. stool softeners/surfactants
- 6. emollient
Prototype saline laxative?
magnesium hydroxide/Milk of Magnesia
Action of saline laxatives
retain water in the intestinal lumen - stimulates peristalsis
Why should magnesium hydroxide only be used short-term?
can form physial dependene with all laxatives except bulk-forming
Common AE of magnesium hydroxide?
- 1. overactive GI activity
- 2. dependence
Serious AE with magnesium hydroxide?
fluid and electrolyte imbalances
Pt teaching for magnesium hydroxide?
- 1. take with a full glass of water
- 2. avoid long-term use
Prototype hyperosmotic laxative?
Action of hyperosmotic laxatives like lactulose?
pulls water and ammonia into the stool for evacuation
Uses for hyperosmotic laxatives like lactulose?
- 1. constipation
- 2. hepatic coma
- 3. hepatic encephalopathy
Why are hyperosmotic laxatives like lactulose used for hepatic coma & hepatic encephalopathy?
ammonia levels built up in these conditions and these laxatives help excrete it
2 routes of admin for lactulose?
PO & enema
Prototype stimulant/irritant laxative?
Action of stimulant/irritant laxatives?
increases peristalsis via nerve stimulation in the colon
Contraindication for use of stimulant/irritant laxatives?
2 routes of admin for stimulant/irritant laxatives?
PO & suppository
Teaching for stimulant/irritant laxatives?
can't use too much - can cause loss of bowel function & dependency
Prototype bulk-forming laxative?
Action of bulk-forming laxatives?
fiber pulls water to lg & sm int. to form soft bulky stool increasing peristalsis
can also help pull out cholesterol
Bulk-forming laxatives should be used with caution in what pt?
pt with HTN, CHF, or edema b/c some contain Na & have to increase fluids with admin
Pt teaching with bulk-forming laxatives?
must increase fluid intake
Prototype stool softener?
Action of stool softeners?
coats surface of feces and colon to ease passage of stool
Use for stool softeners?
prophylactically to prevent constipation
4 pt that may be using stool softeners?
- 1. elderly
- 2. post-op]
- 3. MI
- 4. opiate use
Prototype emollient laxative?
Action of emollient laxatives?
lubricates the intestine
AE of mineral oil?
decreased absorption of fat-soluble vitamins
Drug interaction with mineral oil?
pt on coumadin would have increased med effects because of decreased vitamin K
Contraindications for all laxatives?
- 1. s/s of acute abd prob: abd pain, nausea, cramps
- 2. diverticulitis
- 3. IBD
- 4. bowel obstruction
- 5. fecal impaction except colace
Which laxatives are safest and only one recommended for long-term use?
Nursing consideration for admin of bulk laxative?
full glass of water or juice with admin
Long term use of laxatives (except bulk) can lead to ______ ______.
______ based laxatives are contraindicated with renal dysfunction.
______ based laxatives are contraindicated with CHF, HTN, & edema
Med used for IBS diarrhea type?
Action of lotronex/
decreases bowel motility, secretions, and abd pain
Lotronex common AE?
Lotromex serious AE?
ischemic colitis & severe constipation
Education with lotromex?
- 1. possible AE of constipation & to report to MD
- 2. s/s of ischemic colitis
S/S of ischemic colitis?
- 1. rectal bleeding
- 2. blood diarrhea
- 3. new or worsening abd pain
IBS drug for constipation type?
Action of zelnorm?
stimulates the peristaltic reflex & decreases visceral sensitivity (decreases pain & bloating)
CI for zelnorm?
- severe renal impairment
- hepatic impairment
- Hx of bowel obstruction
- gallbladder disease
Education about zelnorm?
diarrhea that does not resolve or is accompanied by severe cramping abd pain or dizziness should notify MD
IBS med used to Tx bowel spasms?
Action of Bentyl?
anticholinergic agent, antispasmotic
Bentyl is contraindicated in what conditions?
- 1. obstructive uropathy
- 2. myasthenia gravis
- 3. glaucoma
- 4. bowel obsturction
- 5. paralytic ileus
- 6. toxic megacolon
- anticholinergic effects:
- 1. sedation
- 2. constipation
- 3. urinary retention
- 4. tachycardia
- 5. dry mouth
- 6. blurred vision
- 7. dizziness
Education for Bentyl?
can cause sedation.....
When should Bentyl be taken?
before meals to alleviate pain ass. with ingestion of food
2 types of IBD?
- 1. ulcerative colitis
- 2. crohn's disease
What type of med may be used to Tx IBD?
Action of aminosalicylates?
dcreases prostaglandins & leukotrienes
Route of asacol>
CI for asacol?
salicylates and sulfite sensitivity
children r/t Reye syndrome
Serious AE of asacol?
- 1. blood dyscrasias
- 2. exacerbation of colitis
- 3. pericarditis
- 4. renal impairment
- 5. hepatotoxicity
Teaching for asacol>
- 1. swallow oral med whole
- 2. contact MD if rash or fever occurs
Important consideration with pepto-bismol?
can cause Reye syndrome in CH
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