GI medications

Histamine 2 Antagonist

Block release of HCl acid in response to gastrin

end in -tidine

Short-term tx of ulcers & GERD
hypersecretory diseases

AE: heart arrhythmias, low BP

Don's use w/ warfarin, beta blockers, alcohol

Antacids

Directly interact with acid to neutralized them

calcium carbonate (Tums), milk of mag.

AE: electrolyte imbalance, affect absorption of other meds

easy to overuse/abuse

Proton Pump Inhibitors

Suppress secretion of HCl acid

end in -prazole

meant for SHORT term tx (4-8 wks.) of GERD, reflux

Long term use: gastric cancer, low Ca, Mag lvls, bone loss, HTN, increase chance of C. diff & PNA

Long term use should be under care of MD

GI protectant

Coat any injured area in the stomach

Sucralfate (Carafate)

AE: constipation, can cause aluminum toxicity
if taken w/ aluminum salts

Prostiglandin^

Inhibit secretion of gastrin
increase mucus secretion

misoprostol (Cytotec)

AE: abortive effect in pregnancy

Pt. ed: Female pts of child-bearing yrs: use contraception

For pts. who don't make enzymes: stroke, chemo,
salivary gland disorder, extreme head/neck surg.
cystic fibrosis, pancreas dysfunction

Saliva substitute (Mouth Kote, Salivart)
Pancrelipase (Creon, Pancrease)

Monitor: for dry mouth, pancreas labs

Phenothiazines

prochlorperazine

change responsiveness of CTZ

N/V from anesthesia, intractable hiccoughs

AE: Pink to red-brown urine
Photosensitivity

Nonphenothiazines

reduces responsiveness of nerve cells in CTZ

metoclopramide
(Reglan)

N/V from chemo, postop N/V

5-HT3 receptor blockers

block N/V receptors in CTZ and locally

ondansetron (Zofran)

N/V from chemo& radiation, postop N/V

AE: Prolonged QT interval

Substance P/Neurokinin 1 receptor antagonist

directly block N/V receptors in CNS

Highly emetogenic chemo (cisplatin)
Used in combo w/ dexamethasone

Don't use w/ warfarin PO contraception

promethazine (Phenergan)

H2 antihistamine

causes drowsiness

Risk of extravasation
DO NOT use hand vein

Nursing Considerations

Assess for dehydration

baseline CNS

Bowel sounds, activity, I&Os

oral care

Non pharm methods

Proper diet: high fiber, fresh fruits & veg
Promote healthy gut bacteria
Regular exercise, ambulation
Increase fluid intake
Don’t ignore urges

Chemical Stimulants

Chemically irritate the lining of the GI tract

Bisacodyl, senna

Caution: acute GI disorders, pregnancy

AE: cathartic dependence

Bulk Stimulants

Cause the fecal matter to increase in bulk

Methylcellulose (Citrucel)
Psyllium (Metamucil)

AE: constipation if not increased slowly &
used with lots of water

Osmotic Laxatives

Draw fluid into GI tract & stim GI motility

Lactulose (Constilac): hepatic encephalopathy
Polyethylene glycol (MiraLAX): daily laxative
Polyethylene glycol electrolyte solution (GoLYTELY): bowel prep for procedure. WILL cause diarrhea.

Subtopic

AE: cramping, bloating, dehydration

Lubricants

Help the intestinal contents move more smoothly

Docusate (Colace): stool softener

Can be used long term

Nursing considerations

Promote natural methods first

Encourage short-term use

Monitor for dehydration, encourage water intake

Monitor for electrolyte deficiencies

Pt. ed. about overuse, yo-yo use

Metoclopramide (Reglan)

Stimulate parasympathetic activity within the GI tract

AE: Reglan can cause tardive dyskinesia symptoms

if used more than 12 weeks, should
be done under care of MD

Loperamide (Imodium)

slows peristalsis, allows increased time for absorption

Caution: hx. of GI obstruction

AE: constipation

Box 58.4 on page 1028
Antibiotic that acts locally on the GI tract

Works against e. coli to tx. traveler's diarrhea

Used for hepatic encephalopathy
in conjunction with lactulose (which bind to ammonia)

GI bacteria causes ammonia
enceph. pts. can't filter ammonia