Gastrointestinal Disorders and Medication Management. Drugs for the Gastrointestinal Tract. Treatment for Vomiting. Nonprescription Antiemetics
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- Lewis Silvester Lewis
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1 Learning Unit 7: Handut Gastrintestinal Disrders and Medicatin Management Drugs fr the Gastrintestinal Tract Gastrintestinal disrders Vmiting Txic substance ingestin Diarrhea Cnstipatin Treatment fr Vmiting Nnpharmaclgic measures What ideas d yu have fr patients? Nnprescriptin antiemetics Prescriptin antiemetics Try t always determine the underlying cause first Nnprescriptin Antiemetics Cmmn ver the cunter (OTC ) Dimenhydrinate (Dramamine) Meclizine (Antivert) Use & Cnsideratins Mtin Sickness Take prir t travel Side Effects Similar t antichlinergics Drwsiness & Dizziness What side effects d yu expect? What will yu teach? Bismuth subsalicylate Pept Bisml Use & Cnsideratins Nausea, mild vmiting, diarrhea Cats gastric mucsa Acts as an adsrbent t txins Side Effects Temprary darkening f stls Prescriptin Antiemetics Prescriptive antihistamines Hydrxyzine (Vistaril) Antichlinergic Scplamine (Transderm-Scp) Page 1 f 9
2 Learning Unit 7: Handut Dpamine antagnists Phenthiazines Prchlperazine (Cmpazine) Prmethazine (Phenergan) Butyrphennes Drperidl (Inapsine) MISC Dpamine antagnist Metclpramide (Reglan) Benzdiazepines Lrazepam (Ativan) Sertnin receptr antagnist Ondansetrn (Zfran) Nursing Prcess in Vmiting Assessment Onset, duratin, frequency Health histry Questin Pssible factrs S / S infectin Check Vital signs Bwel sunds I/O Electrlytes Interventins Maintain gd ral hygiene Teach client alchl intensifies the sedative effect Teach client n driving / dangerus activities WARNING: Drugs are nt meant fr pregnancy related vmiting Emetic (Induce Vmiting) Activated Charcal Prmtes adsrptin (binding) Use & Cnsideratins Emergency antidte fr treatment f drug verdse r chemical pisnings Administratin = PO, NG Space 2 h apart frm ther ral meds Often used pst gastric lavage Vmiting & diarrhea Page 2 f 9
3 Learning Unit 7: Handut Causes f Diarrhea Fds Impactin Viruses r Bacteria Txins Drug Reactin Laxative Abuse Traveler s Diarrhea Escherichia cli Malabsrptin Syndrme Bwel Tumr Inflammatry Bwel Disease Ulcerative Clitis Chrhn s Disease Treating Diarrhea Nnpharmaclgic measures What ideas d yu have fr patients? IV fluid and electrlyte replacement Reduce risk f traveler s diarrhea Teach. Bttled water Washing fruits Cking vegetables Cmmn Antidiarrheals Opiates & Opiate-related agents Decrease peristalsis and abdminal cramping diphenxylate (Lmtil) Cmbined with atrpine lperamide (Imdium) OTC traveler s diarrhea Cnsideratins Mnitr fr CNS depressin Dependency ptential Cntraindicated in liver disease Smatstatin analg Suppress gastric enzymes Decreases smth muscle cntractin Used in severe diarrhea and lwer gastrintestinal hemrrhage Octretide (Sandstatin) Page 3 f 9
4 Learning Unit 7: Handut Adsrbents Cats GI tract & binds t txins Kapectate - OTC Pept Bisml OTC Nursing Prcess and Diarrhea Assessment Onset, duratin, frequency Health histry Questin Pssible factrs S / S infectin Check Vital signs Bwel sunds I/O Electrlytes Interventins Maintain gd skin hygiene and prtect frm irritatin Prmptly reprt acute abdminal pain and/r bleeding, duratin > 48 Teach client t avid sedatives and alchl Advise client - take as prescribed Medicatin can be habit frming Encurage fluids Cnstipatin Types f laxatives Osmtic (saline) Stimulant (cntact) Bulk-frming Emllient (stl sfteners) What are ptential causes and nnpharmaclgic treatment examples? Osmtic (Saline) Laxatives Actin Hypersmlar effect = pulls water int bwel using sdium, magnesium, ptassium salts stimulating peristalsis Lactulse (Enulse) Magnesium hydrxide (Milk f Magnesia) Magnesium xide (Mag-Ox) Sdium biphsphate (Fleet Phspha-Sda) Indicatin Diagnstic bwel prep Page 4 f 9
5 Learning Unit 7: Handut Electrlyte imbalances, hyptensin, weakness Cntraindicatin Cngestive Heart Failure Glytely preferred Stimulants (Cntact) Laxatives Actin Irritant Bisacdyl (Dulclax) Phenlphthalein (Ex-Lax) Indicatin Cnstipatin relief Adjunct t bwel diagnstic bwel prep Nausea, abdminal cramping, weakness, electrlyte imbalance with chrnic use, dependency & abuse Cntraindicatin Intestinal bstructin Bulk-Frming Laxatives Actin Nn-absrbable (fiber) causing water absrptin prmting bulk and increasing peristalsis Calcium plycarbphil (Fibercn) Indicatin Prmtes regularity & Increases fiber intake Intestinal bstructin with inadequate water intake Cntraindicatin Intestinal bstructin Emllients (Stl Sfteners) Actin Increase water retentin and act as a lubricant Ducsate Sdium (Clace) Periclace is ducsate sdium with casanthranl Mineral Oil Absrbs fat sluble vitamins! Indicatin Preventin, decrease straining, tx chrnic cnstipatin Page 5 f 9
6 Learning Unit 7: Handut Nausea, vmiting, abdminal cramping Mineral il absrbs fat sluble vitamins Cntraindicatin Inflammatry GI disrders Ulcerative clitis, Chrhns Appendicitis, Diverticulitis Bwel bstructin Nursing Prcess and Cnstipatin Assessment Bwel pattern, date f last BM Health histry Questin Pssible factrs Check Vital signs Bwel sunds GERD Interventins Teach client t reprt abdminal pain, N/V, rectal bleeding Teach client that veruse can cause dependency Teach client t increase fluids and activity as tlerated Advise client t time administratin t avid disruptin f sleep r activities Nnpharmaclgic Measures Avid tbacc Avid alchl Weight lss Individual intlerances May need t avid ht, spicy fds Avid high fat/greasy fds Take NSAIDs, aspirin, & gluccrticids with fd; dse if pssible Sit upright Dn t eat befre bedtime Wear lse-fitting clthing Pharmaclgic Measures Antiulcer drugs Tranquilizers Antichlinergic drugs Antacids Histamine 2 (H 2 )-blckers Page 6 f 9
7 Learning Unit 7: Handut Prtn pump inhibitrs Pepsin inhibitr Prstaglandin E 1 analg Antacids Actin Neutralize hydrchlric acid Systemic antacids Sdium bicarbnate = Alka-Seltzer Calcium carbnate = Tums Nn-systemic antacids Aluminum & magnesium prducts Amphjel r Maalx Systemic antacid side effects Sdium Bicarbnate Hypernatremia & water retentin Metablic alkalsis Calcium Carbnate Hypercalcemia Milk-alkali syndrme Bth cause rebund acid effect Nn-systemic antacid side effects Diarrhea with magnesium based prducts Cnstipatin with aluminum & calcium based prducts May cntain Simethicne, an anti-gas agent Dsing 1-3 hurs pc & hs Fllw with water Space antacids 1-2 hurs apart frm ther medicatins H2-Blckers Actin Cautius Use Electrlyte imbalance Renal insufficiency related t calcium/magnesium/aluminum Lng term use Blck gastric cells respnsible fr secretin f gastric acids Cmmn H2-blckers cimetidine (Tagamet ) ranitidine (Zantac ) famtidine (Pepcid ) Page 7 f 9
8 Learning Unit 7: Handut Dsing Space 1 hur befre and 2 hurs after antacids Cautin Renal & Hepatic Disease BUN, Creatinine, LFT s fr All! Prtn Pump Inhibitrs (PPIs) Actin Suppress gastric acid secretin by inhibiting the enzyme system in gastric cells blcking final step in acid prductin Cmmn Use Tx f GERDS, H. pylri, peptic ulcers, zllinger-ellisn syndrme Cmmn Prtn Pump Inhibitrs Omeprazle (Prilsec) Lansprazle (Prevacid) Rabeprazle (Aciphex) Pantprazle (Prtnix) Esmeprazle (Nexium) PPIs Dsing Daily Tx with reduced dsing fr maintenance/prphylaxsis Give befre fd (preferably breakfast) Cautius use Hepatic and renal insufficiency Pepsin Inhibitr Actin Inhibits secretin f pepsin Cats stmach mucsa Drug = Sucralfate (Carafate) Dsing = 1 gm ac & hs Administer antacids 1-2 hurs apart = cnstipatin Nursing Interventins fr Antiulcer Drugs Evaluate histry f discmfrt Obtain medicatin histry Assess clients, renal & liver functin; baseline stl guiac, and H & H Teach client nnpharmaclgic measures, even when medicatins must be prescribed Page 8 f 9
9 Learning Unit 7: Handut Instruct client nt t self-medicate withut advice frm physician Assure client receives apprpriate dsing instructins based n type f antiulcer drug prescribed Lri Bailey and Indian Hills Cmmunity Cllege Page 9 f 9
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