Laoag City, Ilocos Norte

Pharmacology

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DRUGS ACTING ON THE GASTROINTESTINAL

SYSTEM

Objectives
◆ Discuss the different drugs acting on the
gastrointestinal system as to action,
therapeutic/desired effect, side effects/adverse
reactions, preparations and dosages, drug
interactions and nursing responsibilities.
◆ Name examples of drugs per classification.
◆ Formulate a drug study.

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The gastrointestinal system (tract), comprising the alimentary

canal and the digestive tract begins at the oral cavity and ends at
the anus. The main functions of this system are digestion of food
particles and absorption of the digestive contents (nutrients,
electrolytes, minerals and fluids) into the circulatory system for
cellular use. But in some instances, GI problems can be
encountered which frequently require drug intervention. This
module will be tackling about drugs for gastrointestinal disorders.
As a start up, I want you to search for words related to the topic
below.

A N T I D I A R R H E A L A
O A H N I W P A N A W Q V N
Q N E D A A R Q B N Q W O T
I T R V R M I O D T S E M I
T R A O R L L P F I D R I U
I S W M H A E L T E G T T L
N U E Y E X A M Y M J Y I C
G I D T A A S N H E K I N E
F P O I L T N G J T P M G R
C O N S T I P A T I O N O N
T A A L W V R E U C O O K L
U L C E R E D R U G S I T O
P O I S O N I N G I T E W V
E V N M V O E M E T I C L O
V O M I T I N G L X A T V E

VOMITING ULCER DIARRHEA

EMETIC ANTIEMETIC CONSTIPATION

ANTIDIARRHEAL LAXATIVE ANTIULCER

POISONING

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WORDS TO SEARCH:

1. With the words you have searched above, write down 2 words which are
connected with each other, then explain briefly how are they are related. (e.g.,
diarrhea-antidiarrheal)
(1 item, 2 words)
a. ____________________________________________________
_____________________________________________________
_____________________________________________________
____________________________________________________
b. ____________________________________________________
_____________________________________________________
_____________________________________________________
____________________________________________________
c. ____________________________________________________
_____________________________________________________
_____________________________________________________
____________________________________________________
d. ____________________________________________________
_____________________________________________________
_____________________________________________________
____________________________________________________
e. ____________________________________________________
_____________________________________________________
_____________________________________________________
____________________________________________________

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This is the discussion part of the drugs

affecting the gastrointestinal system.

DRUGS ACTING ON THE GASTROINTESTINAL SYSTEM

A. ANTI-EMETIC/ANTI-VOMITING AGENTS
● Help relieve nausea and vomiting.

VOMITING (EMESIS)
➢ Expulsion of gastric contents.

CAUSES
⚫ Motion sickness
⚫ Viral and bacterial infection
⚫ Surgery
⚫ Pain
⚫ Pregnancy
⚫ Effects of antineoplastics
⚫ Radiation
⚫ Disturbances of the middle ear that affect equilibrium (vertigo)

2 MAJOR CEREBRAL CENTERS

a. The chemoreceptor trigger zone (CTZ) that lies near the medulla
b. The vomiting center in the medulla- odor, smell, taste and gastric
mucosal irritation transmitted directly

✓ When these 2 are stimulated, vomiting occurs.

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CLASSIFICATIONS

1. NON PRESCRIPTION ANTIEMETICS

● can be purchased as over-the-counter (OTC) drugs.
● Have minimal effect on controlling severe vomiting resulting from anti-
cancer agents, radiation and toxins.

a. Antihistamine Antiemetics
● Can be purchased OTC to prevent nausea, vomiting,
and dizziness caused by motion.
● These drugs inhibit vertibular stimulation in the middle
ear.
● Should be taken 30 mins before travel, not effective if
taken after vomiting has occurred.

Examples
● Dimenhydrinate (Dramamine)
● Cyclizine HCl (MAREZINE)
● Meclizine HCl (Antivert)
● Diphenhydramine HCl (Benadryl)

SIDE EFFECTS
● drowsiness
● Dryness of the mouth
● Constipation

b. Bismuth Subsalicylate (pepto-Bismol)

● Act directly on the gastric mucosa to suppress vomiting.
● Marketed in liquid and chewable tablet forms

c. Phosphorated carbohydrate solution (Emetrol)

⚫ A hyperosmolar CHO, decreases nausea and vomiting by changing the
gastric pH.

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⚫ May also decrease smooth muscle contraction of the

stomach.
⚫ Patients with DM should avoid this drug because of
its high sugar content.

2. PRESCRIPTION ANTIEMETICS

a. ANTIHISTAMINES & ANTICHOLINERGICS

● Act primarily on the vomiting center
● Also act by decreasing stimulation of the CTZ and vestibular pathways.

Examples
● Hydroxyzine (Vistaril) - presc. antihistamine
● Scopolamine (Transderm-Scop) - for motion sickness, 1 patch behind
ear @ least 4 hours before Antiemetic effect is required.
● Hyoscine, Dicyclomine

SIDE EFFECTS
● Drowsiness- major problem
● Dry mouth
● Blurred vision- pupillary dilation (mydriasis)
● Tachycardia
● Constipation

b. DOPAMINE ANTAGONISTS
● these agents suppress emesis by blocking dopamine2 receptors in the
CTZ.

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CATEGORIES

b. 1 Phenothiazines
● Used to treat nausea and vomiting resulting from surgery, anesthetics,
chemotherapy, and radiation sickness.
● They act by inhibiting the CTZ.
● When used in patients with cancer- given the night before treatment, the
day of the treatment and for 24 hours after the treatment.

Examples
● Chlorpromazine (Thorazine)
● Prochlorperazine (Compazine)
● Perphenazine (Trilafon)
● Fluphenazine (Prolixin)
● Promethazine (Phenergan)- has a sedative effect

PK: Promethazine is readily absorbed in the GIT. It has

93% protein binding sites. Metabolized by the liver and
excreted in the urine and feces.

PD: Onset- oral and IM- 20 minutes, duration--4 to 6 hours

IV- onset 3 to 5 mins, duration of action is the same as for the oral prep

DRUG INTERACTIONS
● CNS depression increases when promethazine is taken with alcohol,
narcotics, sedative-hypnotics and general anesthetics
● Anticholinergic effects increase when promethazine is combined with
antihistamines, atropine and other phenothiazines.

SIDE EFFECTS AND ADVERSE REACTIONS

● Moderate sedation
● Hypotension
● EPS (Extrapyramidal Symptoms)
○ Akathisia- feeling of restlessness (tapping your finger, rocking,
crossing and uncrossing legs)
○ Parkinsonism- tremor, slower movements, rigid muscles, slower
thought processes
○ Tardive dyskinesia- uncontrollable facial movements such as
sucking or chewing, lip smacking, sticking tongue out, blinking
eyes repeated
○ Dystonia- muscle involuntarily contract and contort (twist)
● CNS effects- restlessness, weakness, dystonic reactions, agitation
● Mild anticholinergic symptoms

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○ Since the dose is lower for vomiting than for psychosis,

side effects are not as severe.

b. 2 BUTYROPHENONES
● Used to treat postoperative nausea and vomiting and emesis associated
with toxins, cancer chemotherapy and radiation therapy.
● Anti emetic doses are smaller than those
required for antipsychotic effects.
Examples
● Haloperidol (Haldol)
● Droperidol (Inapsine)

SIDE EFFECTS
● Hypotension - BP should be monitored
● EPS (Extrapyramidal symptoms) if used for
extended period of time

c.BENZODIAZEPINES
● indirectly control nausea and vomiting that may
occur with cancer chemotherapy.
● LORAZEPAM (Ativan) - effectively provides
emesis control, sedation, anxiety reduction.

d. SEROTONIN 5 HYDROXYTRYPTAMINE3 (5-HT3)

RECEPTOR ANTAGONISTS
● Suppress n/v by blocking the receptors (5-HT3)
in the CTZ and the afferent vagal nerve
terminals in the upper GIT.
● Can be administered orally and IV
● Also effective in preventing n/v before and after surgery.
●
Examples

● Ondansetron (Zofran)
● Granisetron (Kytril)
● Dolasetron ( Anzemet)
● Palonosetron (Aloxi)

Side Effects
⚫ Headache
⚫ Diarrhea
⚫ Diziness
⚫ Fatigue

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E. GLUCOCORTICOIDS
● Effective in suppressing emesis associated with cancer chemotherapy.
● Administered IV for only a short period of time.
Examples
● Dexamethasone (Decadron)
● Methylprednisolone (SoluMedrol)

F. CANNABINOIDS
● agents that are prescribed for clients receiving chemotherapy who do not
respond to or unable to take other anti emetics.
● Active ingredients in marijuana, were approved for clinical use in 1985.
● Contraindicated for patients with psychiatric disorders.

Examples
● Dronabinol
● Nabilone

SIDE EFFECTS
● mood changes
● euphoria
● Drowsiness
● Dizziness
● Headaches
● Nightmares
● Confusion
● memory lapse
● dry mouth
● Orthostatic hypotension
● Tachycardia

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G. MISCELLANEOUS ANTIEMETICS.
● suppress the impulses to the CTZ
● also prevents vertigo by inhibiting impulses to the vestibular
area.

Examples
● Metoclopramide HCl (Reglan)
● Diphenol
● Trimethobenzamide (Tigan)

SIDE EFFECTS
● drowsiness
● Anticholinergic symptoms (dry mouth, increased HR, urine
retention, constipation, blurred vision)

NURSING RESPONSIBILITIES

a. Monitor v/s. If vomiting is severe, dehydration may

occur.
b. Monitor bowel sounds for hypoactivity or
hyperactivity.
c. Provide mouth care after vomiting.
d. Advise client to avoid driving and operating
hazardous machinery or instruments because
Drowsiness is common with anti-emetics.
e. Instruct the client not to consume alcohol while
taking anti emetics. Alcohol can intensify the sedative
effect.
f. Suggest non pharmacologic methods of alleviating
nausea and vomiting such as weak tea, crackers and
dry toast.

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B. EMETICS
● Drugs to induce vomiting in order to expel the substance before
absorption occurs.

1. IPECAC SYRUP
● induces vomiting by stimulating the CTZ in the
medulla and acting directly on the gastric mucosa.
● Available in liquid form and should be taken with a
glass of water or other fluid except milk or
carbonated beverages.
● Vomiting should occur within 15 to 30 minutes.
● When vomiting is not induced within this time
frame- patient should be treated with an adsorbent
activated charcoal or do gastric lavage
● Appropriate in isolated cases for the patient who is
ALERT and if administered within 60 minutes of
poisoning.

NURSING RESPONSIBILITIES
a. Call the poison control center to report the toxic
ingestion and for instructions
b. Offer sufficient fluids with IPECAC. Should be taken
with a glass of water- do not give with mild or
carbonated beverages.
c. Do not offer IPECAC and fluids to a semi conscious or
unconscious person because of the danger of
aspiration.
d. Do not induce vomiting if the toxic substance is a
caustic such as ammonia, chlorine bleach, toilet
cleaners or battery acid or a petroleum distillate like
gasoline, kerosene, paint thinners or lighter fluids.
Regurgitating these substances can cause additional
injury to the esophagus.

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C. ANTIDIARRHEALS
⚫ Use to treat and decreasing hypermotility (increased peristalsis).

DIARRHEA - frequent liquid stool is a symptom of an intestinal disorder.

CAUSES
● Food- spicy, spoiled
● Fecal impaction
● Bacteria (E. coli, Salmonella); virus (Rotavirus)
● Toxins
● Drug reaction
● Laxative abuse
● Malabsorption syndrome- caused by lack of digestive enzymes
● Stress and anxiety
● Bowel tumor
● Inflammatory bowel disease

CLASSIFICATIONS

1. OPIATES
● decrease intestinal motility thus decreasing peristalsis.
● Duration of action: app 2 hours

Examples
● Opium tincture
● Paregoric
● Codeine

SIDE EFFECT: constipation

● Can cause CNS depression when taken with alcohol, sedatives or

tranquilizers

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2. OPIATE RELATED AGENTS

● they decrease intestinal motility and are taken for
“travelers diarrhea or acute diarrhea”.
● Less potential for causing dependence

Examples
● Diphenoxylate with atropine (Lomotil)
● Loperamide (Imodium)

SIDE EFFECTS
● n/v
● Drowsiness
● Abdominal distention
● Tachycardia
● Paralytic ileus
● Urinary retention
● Decreased secretions
● Physical dependence

DRUG INTERACTIONS
● If taken with alcohol, narcotics or
sedative hypnotics, CNS depression
can occur.

3. ADSORBENTS
● act by coating the wall of the GIT and adsorbing bacteria or toxins that
cause diarrhea.

Examples
● Kaolin-pectin
● Bismuth subsalicylate (Pepto-Bismol)
NURSING RESPONSIBILITIES
a. Monitor v/s. Opiate and opiate related drugs can cause CNS
depression- monitor respirations.
b. Monitor bowel frequency and bowel sounds. Notify the physician if
intestinal hypoactivity occurs when taking diphenoxylate or
loperamide.
c. Check for s/sy of dehydration due to persistent diarrhea. Flid
replacement may be necessary and check the serum electrolytes.
d. Recognize that Anti diarrheals may need to be withheld if diarrhea
continues beyond 48 hours or acute abdominal pain develops.
e. Advise the client not to ingest fried foods or milk products until after
diarrhea has stopped.
f. Encourage to drink clear liquids.
Pharmacology g. Teach patient that constipation can result from overuse of anti
diarrheals.
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This portion is the continuation of the discussion on the different

gastrointestinal agents.

D. LAXATIVES
● Used to eliminate fecal matter.
● Treat constipation.

CONSTIPATION
● Accumulation of hard fecal material in the large intestine.

Causes:
● Insufficient water intake
● Poor dietary habits
● Fecal impaction
● Bowel obstruction
● Neurologic disorders
● Ignoring the urge to defecate
● Lack of exercise

FOUR TYPES OF LAXATIVES

1.OSMOTIC(SALINE)/ HYPEROSMOLAR LAXATIVES

● include salts or saline products, lactulose and glycerin.

Examples
● Magnesium citrate (Citroma)
● Magnesium Hydroxide (Milk of magnesia)
● Magnesium Oxide (Mag-Ox)
● Sodium biphosphate (Fleet Phospho-Soda)
✓ High doses of these drugs are used for bowel preparation for
diagnostic and surgical procedures.
✓ These are saline products- consists of Na and Mg- serum
electrolytes should be monitored to avoid electrolyte imbance.
● Lactulose (Cephulac) - draws water into the intestines and promotes
water and electrolyte retention.
✓ This drug alsodecreases ammonia level and is useful in liver
diseases such as cirrhosis.

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● Glycerin- increases water in the feces in the large intestine.

SIDE EFFECTS
● Hypermagnesemia-if continuous use- pt with renal failure should avoid
magnesium salts
S/sy: Drowsiness, weakness, paralysis, hypotension, flush and
respiratory depression

Lactulose S/Es (if used in excess)

● Flatulence
● Diarrhea
● Abdominal cramps
● N/v
✓ Pts. Who have DM should avoid lactulose because it contains
glucose and fructose.

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2. STIMULANT (CONTACT/IRRITANT) LAXATIVES

● Increases peristalsis by irritating sensory nerve endings in the intestinal
mucosa.

Examples
● Bisacodyl (Dulcolax) -most frequently used and abused laxative, also
used to empty the bowel before diagnostic tests.
● Senna (Senokot)
● Castor oil- acts on the small bowel and produces a watery stool.
○ Action is quick- w/in 2-6

hours, it should not be taken at

bedtime.

PK: Bisacodyl is minimally absorbed from the GIT. It is excreted in feces, a

portion is excreted in the urine
PD: Promotes defecation by irritating the colon.
Onset of action--6 to 8 hours (oral), 15- 60 minutes (rectal
administration)

SIDE EFFECTS
● nausea
● Abdominal cramps
● Weakness
● Fluid and electrolyte imbalances- with excessive and chronic use

● Castor oil should not be should in early pregnancy because it

Stimulates uterine contraction.
● Prolonged use of senna can damage nerves--results to loss of
intestinal muscular tone

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4. BULK FORMING LAXATIVES

● natural fibrous substances that promote large, soft stools by absorbing
water into the intestine, increasing fecal bulk and peristalsis.
● These agents are non absorbable.
● Defecation usually occurs within 8 to 24 hours
● Powdered form should be mixed in a glass of water or juice, stirred,
drunk immediately, and followed by a half to a full glass of water.
Insufficient fluid intake can cause the drug to solidify in the GIT which
can result intestinal obstruction.

Examples
● Polycarbophil (FiberCon) - patients with Hypercalcemia should avoid
this because of the significant amount of Ca in the drug.
● Polyethylene glycol (Miralax)
● Methylcellulose (Citrucel)
● Psyllium (Metamucil)

PK: Metamucil is a non digestible and non absorbent substance that, when
mixed with water, becomes a vicious solution.
Excreted in the feces

PD: Onset- 12 to 72 hours, Peak- 1 to 3 days duration is unknown

SIDE EFFECTS
● nausea
● Vomiting
● Flatus
● Diarrhea
● Abdominal cramps- if the drug is used in dry form

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5. EMOLLIENT/STOOL SOFTENERS
● are lubricants and stool softeners(surface-
acting or wetting drugs) used to prevent
constipation.
● These drugs decrease straining during
defecation.

Emollient Lubricant- increase water retention in the

stool.

Example:Mineral oil- absorbs essential fat soluble

vitamins (ADEK)

Emollient stool softeners--work by lowering surface tension and promote water

accumulation in the intestine and stool.
● They are frequently prescribed for patients after MI or surgery.

Examples

● Docusate calcium (Surfak)

● Docusate sodium (Colace)
● Docusate sodium with senna (Peri-colace)

SIDE EFFECTS

Mineral oil- n/v, diarrhea, abdominal cramping

✓ Not indicated for children, older adults or patients w/ debilitating
diseases because they might aspirate the mineral oil resulting in
lipid pneumonia.
Docusate- mild cramping

CONTRAINDICATIONS
● Inflammatory disorder of the GIT
● Pregnancy
● Spastic colon
● Bowel obstruction

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6. CHLORIDE CHANNEL ACTIVATORS

● activate chloride channels in the lining of the small intestine, leading to
an increase in intestinal fluid secretion and motility.
● Used to treat idiopathic constipation in adults.

Example
● Lubiprostone- first drug in this category
- FDA approved in January 2006
- Contraindicated for patients with a history of mechanical GI
obstruction, diverticulitis, severe
diarrhea

SIDE EFFECTS
● diarrhea
● Headache
● Nausea
● Abdominal distention
● Flatulence

NURSING RESPONSIBILITIES
a. Monitor fluid intake and output.
b. Encourage patient to increase water intake(if not
contraindicated) and increase fiber in the diet such
as grains and fruits.
c. Advise patient to avoid overuse of laxatives which
can lead to fluid and electrolyte imbalances and
drug dependence.
d. Warn patient that drug is not for long term use,
bowel tone may be lost.

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E. ANTIULCER DRUGS

1. TRANQUILIZERS
● have minimal effect in preventing and treating ulcers, however, they
reduce vagal stimulation and decrease anxiety.

Example: Librax- a reformulated product of the

anxiolytic chlordiazepoxide (librium) and the anti
cholinergic Clinidium bromide

ADVERSE EFFECTS
● Edema
● Ataxia- lack of voluntary corrdination of muscle
movement
● Confusion
● Extra pyramidal syndrome (EPS)
● Aggranulocytosis- reduction of white blood cells.

2. ANTICHOLINERGICS
● They act by inhibiting acetylcholine and blocking histamine and
hydrochloric acid.
● They also delay gastric emptying time.
● Should be taken before meals to decrease the acid secretion that occurs
with eating.
● Should be used as adjunctive therapy and not as the only anti ulcer drug.

Examples
● Propantheline Bromine (Pro-Banthine)
● Glycopyrrolate (Robinol)
● Clinidium Bromide

SIDE EFFECTS
● dry mouth
● Decreased secretions
● Headache
● Blurred vision
● Drowsiness
● Dizziness
● Lethargy

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● Palpitations
● Urinary retention
● Constipation
● Brady/tachycardia

3. ANTACIDS
● promote ulcer healing by neutralizing hydrochloric acid and reducing
pepsin activity.
● They do not coat the ulcer.

Examples

2 TYPES
a. SYSTEMIC
● Sodium bicarbonate (Alka-Seltzer)
● Calcium carbonate (Tums) - can lead to hypercalcemia
✓ 1/3 to 1/2 of the drug can be systemically absorbed and can cause
acid rebound.

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b. NON SYSTEMIC

✓ Composed of alkali salts

✓ Small degree of systemic absorption

● Aluminum hydroxide (Amphojel)

● Megaldrate (Riopan)
● Calcium carbonate and Mg Hydroxide (Rolaids, Mylanta, Tums)
● Mg Hydroxide & Aluminum Hydroxide (Maalox, Mylanta
Ultimate Strength)
● Mg hydroxide and Al Hydroxide with Simethicone (Mylanta,
Maalox, Gelusil)
● Mg Trisilicate with Al Hydroxide (Gaviscon)

✓ Magnesium compounds can cause diarrhea,

aluminum compounds can cause constipation.
✓ So when Mg and Al are combined, they neutralize
which causing severe diarrhea and constipation.

PK: only a very small amount of Amphojel and Maalox is

absorbed from the GIT
● They are bound to phosphate and excreted in feces and portion
is excreted in the urine

PD: onset of action is fairly rapid, but the duration of action varies,
depending on whether the antacid is taken with or without food.
● If the antacid is taken after a meal, the duration of action may
be up to 3 hours.
● The ideal dosing interval for antacids is 1 to 3 hours (maximum acid
secretion occurs after eating) after meals and at bedtime.
● Chewable tablets should be followed by water
● Liquid antacids should also be taken with water(2-4 oz) to assure that
the drug reaches the stomach.
● Antacids contain Mg salts and are contraindicated in clients with
impaired renal function because of the risk of hypermagnesemia.

SIDE EFFECTS
● Diarrhea
● Constipation
● Hypophosphatemia- if prolonged use

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4. HISTAMINE BLOCKERS/H2 RECEPTOR ANTAGONISTS

● Popular drugs used in the treatment of gastric and duodenal ulcers.
● Prevent acid reflux in the esophagus - reflux esophagitis
● These drugs block the H2 receptors of the parietal cells in
the stomach thus reducing gastric acid secretion and
concentration.

Examples
● Cimetidine (Tagamet) - short t 1/2, short DOA; blocks about
70% of acid secretion for 4 hours.
● Famotidine (Pepcid)
● Nizatidine(Axid) - can relieve nocturnal gastric acid
secretion for 12 hours
● Ranitidine (Zantac) - most frequent prescribed

PK:
Ranitidine is
5 to 12 x
more potent
than
Cimetidine
but less
potent than
Famotidine.
● It is rapidly absorbed and reaches its peak of concentration after a
spindle dose in 1 to 3 hours.
● Has low protein binding power and a short half life
● About 50% is excreted unchanged in the urine.

PD: ranitidine has a longet onset of action and duration of action of up to 12

hours.
Cimetidine- duration of action 4-5 hours, frequently given 3 to 4 times a day.

SIDE EFFECTS
● headache
● Dizziness
● Constipation
● Pruritus
● Skin rash
● Gynecomastia
● Decreased libido
● Impotence

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5. PROTON PUMP INHIBITORS/GASTRIC ACID SECRETION

INHIBITORS/GASTRIC ACID PUMP INHIBITORS
● Suppress gastric acid secretion by inhibiting the hydrogen/potassium
adenosine triphosphate (ATPase) enzyme system located in the gastric
parietal cells.
● They inhibit gastric acid secretion up to 90% greater than the H2
Blockers.
● These agents block the final step of acid production.
● Take PPI 30 mins before meal-best time or an empty stomach at the time
when one notices the discomfort.
● Used to treat peptic ulcers and GERD.

Examples
● Esomeprazole Mg (Nexium)
● Lansoprazole (Prevacid)
● Omeprazole (Prilosec)
● Pantoprazole (Protonix)
● Rabeprazole (AcidHep)
● Dexlansoprazole (Dexilant)

PK and PD: The duration of action for Esomeprazole is 24 hours.

● These drugs have short half life and are highly protein bound (97%).
● Caution: pts w/ hepatic impairment- liver enzymes should be monitored.

SIDE EFFECTS
● headache
● Dizziness
● Diarrhea
● Abdominal pain
● Rash

DRUG INTERACTIONS
● PPIs can enhance the action of digoxin, oral anticoagulants, certain
benzodiazepines, and phenytoin.

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6.PEPSIN INHIBITOR (MUCOSAL PROTECTIVE DRUG)

● SUCRALFATE (CARAFATE)
○ a complex of sulfate sucrose and aluminum hydroxide.
○ It is nonabsorbable and combines with Chon to form a viscous
substance that covers the ulcer and protects it from acid and
pepsin.
○ Does not neutralize acid or decrease acid secretions.
○ The dose is 1 gram 4x a day before meals and at bedtime.

PK: less than 5% of SUCRALFATE is absorbed by the GIT.

● It has a t ½ of 6-20 hours
● 90% is excreted in the feces

PD: Onset of action--30 minutes, duration is 5 hours.

SIDE EFFECTS
● dizziness
● Nausea
● Constupation
● Dry mouth
● Rash
● Pruritus

DRUG INTERACTIONS
● Decreases the absorption of tetracycline, phenytoin, fat soluble vitamins
and other antibacterial agents.
● Antacids decrease the effects of sucralfate.

7. PROSTAGLANDIN ANALOGUE
● MISOPROSTOL
○ a drug used to prevent and treat peptic ulcer.
○ It suppresses gastric acid secretion and increase cytoprotective
mucus in the GIT.
○ Contraindicated during pregnancy and for women of childbearing
age.

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NURSING RESPONSIBILITIES
a. Advise client to avoid foods and liquids that can cause gastric irritation
such as caffeine containing beverages, soda, alcohol, fatty foods and
spices.
● ANTACIDS
○ Avoid administering antacids with other oral drugs since antacids
can delay drug absorption. Should be given 1-2 hours after other
medications.
○ Do not take antacids at meal time, they slow gastric emptying time
causing increased GI activity and gastric secretion.
○ Advise the client not to take antacids without notifying the
physician.
○ Teach patient hot to take antacids correctly. Chewable tablets
must be thoroughly chewed and followed with water. With liquid
antacid, patient should follow antacid with 2 to 4 ounces of water.
● ANTI-CHOLINERGICS
○ to avoid constipation--increase fluids, bulk food and physical
exercise.
○ Report tachycardia or urinary retention.
● H2 BLOCKERS
○ advise to avoid smoking which can hamper the effectiveness of
the drug.
○ Given before meals or at bedtime to decrease food induced acid
secretion.
○ Educate in the use of relaxation techniques to decrease anxiety.
● PEPSIN INHIBITORS
○ Administer drug on an empty stomach.
○ Advise patient to take drug exactly as ordered. Therapy usually
requires 4 to 8 weeks for optimal ulcer healing.
○ Increase fluids, dietary bulk and exercise to relieve constipation.

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 Laoag City, Ilocos Norte

1. CHECKPOINTS: Assessment in the form of a long quiz on the

different drugs affecting the GIT. Be sure to check updates
daily. Memorize all the actions, side effects/adverse effects,
drug interactions and nursing responsibilities especially the
NAMES of the drugs per classification.

2. Choose one (1) drug among the drugs affecting the

gastrointestinal system and make a DRUG STUDY. Use your
drug handbook or any pharmacology book as your reference.
With regard to the brand name and D,R,F, just choose one
(1) in your drug handbook.

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