DRUGS AFFECTING THE GI

SYSTEM
Ma. Concepcion A. Maico-Bacus, EdD, MAN, RN
Clinical Instructor
H2-Receptor Antagonists (H2RA)
Types Actions
• Cimetidine (Tagamet), • H2-receptor antagonists
ranitidine (Zantac), famotidine (H2RA) inhibit histamine
(Pepcid), nizatidine (Axid). action on H2-receptors, which
Note the “tidine” ending in all are found on the gastric
the generic names. parietal cells. This action
reduces the secretion of
gastric acid, as well as
hydrogen ion concentration.
Uses Contraindications and
• Prevention and treatment of Precautions
gastric and duodenal ulcers • Caution with hepatic and renal
• Heartburn, acid indigestion, and dysfunction
gastroesophageal reflux disease • Caution in older adult patients
• Antacids can decrease
absorption, especially with
cimetidine
• Cimetidine has many drug
interactions, which limit its use
Side Effects • Cimetidine: May bind with
• Diarrhea, constipation androgens to cause
gynecomastia and impotence;
• Older adults: confusion, effects reverse after
agitation medication is withdrawn;
• Decrease in stomach acid when given IV bolus may
may increase growth of cause hypotension and
Candida and bacteria in dysrhythmias
stomach, resulting in
increased risk for pneumonia
Nursing Implications
• Oral medications may be taken without regard to meals.
• At least 1 hour should separate the administration of antacids
and cimetidine.
• Teach patient to avoid alcohol.
• Smoking may decrease effectiveness.
• Teach patient the signs of gastric bleeding (black tarry stools,
“coffee-grounds” vomitus) and to notify health care provider if
any occur.
• Teach patient to notify health care provider for any indication of
respiratory problems.
• Teach patient that 5 to 6 small meals a day may be preferable
to 3 large meals a day.
Psyllium (Metamucil)
Classification
• Bulk-forming laxative
Actions
• Acts similar to dietary fiber. This medication is not digested or
absorbed. After ingestion, it will swell to form a viscous solution
or gel, softening the fecal mass and increasing the bulk. A fecal
mass stretches the intestinal wall to stimulate peristalsis and
passage of a soft-formed stool in 1 to 3 days.
Uses
• Treats constipation; preferred agent for temporary treatment of
constipation
• Prevents constipation and straining after myocardial infarction
or rectal surgery
Contraindications
• Fecal impaction or any condition leading to narrowing of the
intestinal lumen
• Bowel obstruction or undiagnosed acute abdominal pain
Precautions
• Esophageal obstruction can occur if medication is swallowed
without sufficient fluid
• Intestinal adhesions, ulcers, narrowing of intestinal lumen
Side Effects
• Abdominal discomfort, bloating
• Impaction and obstruction if not given with adequate liquids
Nursing Implications
• Mix medication with at least 8 ounces of water; mix at the
bedside immediately before administration.
• Instruct patient to drink at least 8 ounces of water after each
dose and drink at least 6 to 8 glasses of water each day to
facilitate peristalsis and to prevent obstruction.
• Bowel movement should occur in 12 to 36 hours.
• Administer at least 2 hours before or after medications.
Proton Pump Inhibitors
Examples
• Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole
(Prevacid), pantoprazole (Protonix).
• Note the “prazole” ending in all the generic names.
Actions
• Suppress the secretion of gastric acid by combining with an
enzyme on the gastric parietal cells; block the final common
pathway for gastric acid formation; decrease hydrogen ion
transport into the gastric lumen.
Uses
• Short-term (4 to 8 weeks): duodenal ulcers associated with
Helicobacter pylori, gastric ulcers, erosive gastritis, and
gastroesophageal reflux disease
• Long-term: hypersecretory conditions (Zollinger-Ellison syndrome)
Contraindications and Precautions
• Long-term use may predispose patient to the risk of developing C.
difficile and GI infections (e.g., salmonella), especially in hospitalized
patients.
• Long-term therapy may predispose patient to the risk of osteoporosis
and fractures.
• Use with caution in hepatic impairment.
Nursing Implications
• Instruct patient to avoid opening, chewing, or crushing
capsules.
• Instruct patient to return for follow-up if symptoms are
unresolved after 4 to 8 weeks of therapy.
• Teach patient to take medication before meals.
• Encourage patient to maintain adequate intake of calcium and
vitamin D.
• Teach patient to report any symptoms of hypomagnesemia
(tremor, muscle cramps, seizures, dysrhythmias).
Magnesium Hydroxide (Milk of Magnesia)
Classification
• Osmotic laxative, magnesium compound (antacid)
Actions
• Draws water into the intestine by osmotic action on the
surrounding tissue. The increase in fluid in the intestine will
dilute the stool, stretch the bowel, and increase peristalsis.
Rapid-acting antacid with high acid-neutralizing capacity and
long-lasting effects.
Uses
• Constipation
• Cleanse the gastrointestinal tract
• Flush ingested toxins out the gastrointestinal tract
• Antacid
Contraindications
• Undiagnosed abdominal pain
• Renal impairment
Precautions
• Rectal bleeding
• Bowel obstructions
• Colostomy or ileostomy
Side Effects
• Abdominal cramping, diarrhea, dehydration
• Hypermagnesemia—magnesium toxicity (CNS depression) can
occur in patient with renal impairment
Nursing Implications
• Give with at least 8 ounces of water.
• Will generally act within 6 to 12 hours.
• Monitor bowel movement, hydration status, and electrolyte
levels.
• Laxative abuse (laxative taken every day) decreases the
defecatory reflex, leading to laxative dependence.
• Teach patient to eat foods high in fiber (brans, fruits) and
increase fluid intake.
• For antacid use, it is commonly given with aluminum hydroxide
to alleviate common symptoms of diarrhea.
Aluminum Hydroxide
Classification
• Phosphate-binding antacid, aluminum compound
Actions
• Reduces acid concentration and pepsin activity by raising pH of
gastric secretions. Binds with phosphate and helps prevent
hyperphosphatemia. Decrease in serum phosphorous level may
precipitate an increase in serum calcium level.
Uses
• Relieves hyperacidity related to gastritis and reflux
• Treats gastric and duodenal ulcers
• May be used to treat hyperphosphatemia in renal insufficiency
• Is most frequently used in combination with magnesium
hydroxide
Contraindications and Precautions
• Dehydration or fluid restriction or both
• Renal disease or cardiac disease or both
• Undiagnosed abdominal pain, intestinal obstruction, chronic
constipation, diarrhea
• Binds to tetracyclines, warfarin, and digoxin and may reduce
their effect
Side Effects
• Constipation, abdominal cramps, hypophosphatemia
Nursing Implications
• Monitor serum calcium, phosphate, magnesium, and sodium
levels.
• Do not administer antacids to patients with a cardiac
presentation who complain of dyspepsia; discomfort may be
referred anginal pain.
• Teach patient to shake suspensions thoroughly before use and
to thoroughly chew tablets before swallowing.
• Teach patient to take medication before meals, when stomach
acidity is highest.
Antidiarrheals
Examples
• Loperamide (Imodium), diphenoxylate (Lomotil) with atropine
Actions
• Direct effect on intestinal motility; slows intestinal transient and
allows for increased absorption of water and fluids.
Diphenoxylate is an opioid and is combined with atropine to
discourage the abuse of taking high doses to experience opioid
euphoria. Loperamide is an analog of meperidine and has little
or no potential for abuse.
Uses
• Symptomatic relief of acute nonspecific diarrhea
• Chronic diarrhea associated with inflammatory bowel disease
Side Effects
• Drowsiness, dizziness, abdominal discomfort
Contraindications and Precautions
• Hepatic or renal disease (Lomotil)
• Dehydration with electrolyte depletion
• Diarrhea from colitis or from infectious organism (slowing
peristalsis may delay the removal of the infecting organism,
which may prolong the infection)
• Imodium and Lomotil are not used in children younger than 2
years of age
• Undiagnosed abdominal pain
Lactulose
Classification
• Hyperosmotic laxative and ammonia detoxicant
Actions
• Pulls ammonia into the colon from the intestines; promotes
increased peristalsis, bowel evacuation (expelling ammonia
from colon); decreases serum ammonia concentration in the
body.
Uses
• Treats portal systemic (hepatic) encephalopathy
• Treats constipation not responding to bulk laxatives
Contraindications
• Undiagnosed abdominal pain, nausea and vomiting
Precautions
• Diabetes mellitus
• Dehydration
Side Effects
• Abdominal cramping, flatulence, nausea, vomiting
• Frequent loose stools may be desirable in excretion of
ammonia; may be a side effect if used for constipation
Nursing Implications
• Encourage increased fluid intake and high-fiber diet.
• Monitor bowel activity; may receive dose even with loose stools.
• Monitor serum ammonia and electrolyte levels.
• May be given by mouth (PO) or by enema:
• PO: Mix with fruit juice, water, or milk to improve flavor.
• Rectally: Use rectal balloon catheter; patient needs to retain enema for
30 to 60 minutes.
• Teach patient that bowel movement occurs within 1 to 3 days of
initial dose.