Chapter 19
Gastrointestinal Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Learning Objectives
 Identify common uses for antacids and histamine H2-receptor
antagonists
 Compare and contrast the actions of anticholinergic and
antispasmodic medications on the gastrointestinal (GI) tract
 Compare the actions and adverse reactions of the five major
classifications of laxatives
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists,
Proton Pump Inhibitors
Action and Uses
 Antacids neutralize hydrochloric acid which decreases gastric
pH; inhibit pepsin
 Histamine H2-receptor antagonists displace histamine from
the receptor site and prevent stimulation of the secretory
cells (neutralize acid and promote healing of ulcers)
 Proton pump inhibitors irreversibly stop the acid secretory
pump embedded in the parietal cells for the length of time
they are taken
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antacids, H2-Receptor Antagonists,
Proton Pump Inhibitors (cont.)
Nursing Implications and Patient Teaching
 Assessment: interaction possibilities
 Diagnosis: smoking/alcohol intake, stress
 Planning: increase fluid intake
 Implementation: forms and routes of administration vary
 Evaluation: continued symptoms of GI distress
 Patient and Family Teaching: administration times and drug specificity,
adverse reactions, drug storage and efficacy, medical follow-up, drug
interactions
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antacids
 Tums
 calcium carbonate
 Riospan
 magaldrate
 Milk of Magnesia
 magnesium hydroxide
 Mag Ox
 magnesium oxide
 Antacid combinations
 Maalox
 magnesium hydroxide &
aluminum hydroxide
 Gelusil
 aluminum hydroxide,
magnesium hydroxide &
simethicone
 Generics:
 aluminum carbonate
 sodium bicarbonate
**Aluminum tends to constipate a person.
H2 Receptor antagonists (-tidines)
 Tagamet
 cimetidine
 Pepcid
 famotidine
 Axid
 nizatidine
 Zantac
 ranitidine
Gastric medications
Treatment for H pylori
Miscellaneous
 Helidac/ Pylera
 Cytotec
 Bismuth subsalicylate,
 misprostol
metronidazole &
tetracycline
 Get 4 pills with each dose
QID
 Chew the bismuth and
swallow the Metro. &
tetra.
 acts to increase gastric
mucus layer/ protects
 Carafate
 sucralfate
 coats stomach wall/
protects ulcers so they can
heal
Proton Pump Inhibitors (PPIs)
 -prazoles
 Nexium
 esomeprazole
 Prevacid
 lansoprazole
 Prilosec
 omeprazole
 Protonix
 pantoprazole
 Aciphex
 rabeprazole
Anticholinergics and Antispasmodics
Action and Uses
 Anticholinergic-antispasmodic preparations reduce GI tract spasm
and intestinal motility, acid production, and gastric motility, thus
reducing pain
 Use: peptic ulcer, pylorospasm, biliary colic, hypermotility, irritable colon, and
acute pancreatitis
 Antidiarrheals reduce the fluid content of the stool and decrease
peristalsis and motility of the intestinal tract; increase smooth-muscle
tone and diminish secretions
 Use: treatment of nonspecific diarrhea or diarrhea caused by antibiotics
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Anticholinergics
Belladonna Alkaloids
Anticholinergics
 Sal-Tropine
 Librax
 atropine sulfate
 Scopace
 scopolamine
 clidinium
 Robinul
 glycopyrrolate
 Pro-Banthine
Anticholinergic combo drug
Donnatol
hyoscyamine, atropine,
scopolamine & phenobarbital
 propantheline
Gastrointestinal medications
antispasmodic
GI Stimulant
 Bentyl
 Reglan
 dicyclomine
 metaclopramide
 Increase speed at which the
stomach empties
Antidiarrheals
 Pepto-Bismol
 Bismuth subsalicylate (think ASA)
 Lomotil – ‘Lo motility’
 diphenoxylate and atropine sulfate
 Kaopectate
 kaolin & pectin
 Bacid / Lactinex
 lactobacillus
 Immodium
 loperamide
 Asacol – for ulcerative colitis
 mesalamine
 Azulfidine – for ulcerative colitis
 sulfasalazine
Question 1
Antidiarrheals act by:
1.
2.
3.
4.
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increasing the fluid content of the stool.
decreasing peristalsis in the intestinal tract.
increasing digestive secretions.
decreasing smooth muscle tone.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Laxatives
Action and Uses
 Bulk-forming laxatives absorb water and expand, increasing the
bulk and moisture content of the stool; peristalsis increases, and
absorbed water softens the stool
 Fecal softeners lower the surface tension, which allows the fecal
mass to be softened by intestinal fluids
 Hyperosmolar laxatives produce an osmotic effect by drawing
water into the bowel, thereby promoting peristalsis and bowel
movement
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Laxatives (cont.)
Action and Uses (cont.)
 Lubricant laxatives create a barrier between feces and the
colon, preventing colon reabsorption and causing softening
of the stool
 Stimulant or irritant laxatives work according to the agent
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Laxatives
Bulk forming
Fecal softener
 Citrucel
 Colace
 methylcellulose
 Metamucil / Fiberall
 psyllium seed
 docusate
Laxatives cont.
Saline / hyperosmolar
Lubricants
 Philips Milk of Magnesia
 Emulsoil
 magnesium
 Fleet’s enema
 sodium salts
 castor oil
Stimulant / Irritant
 Dulcolax / Correctol
 bisacodyl
 Cascara
 cascara sagrada
 Senekot / Ex-Lax
 senna
Antiflatulents
 Break up and prevent mucus-surrounded pockets of gas from
forming in the intestine; reduce gastric pain
 Intended for short-term use
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Miscellaneous GI Medications
 Antiflatulents
 activated charcoal (think liquid briquettes from the grill)
 Mylanta Gas Relief / Mylicon
 Simethicone – makes the bubbles smaller so they are easier to pass
 Emetics
 Syrup of Ipecac – ipecac (will clean out entire GI tract!!)
Gallstone-Solubilizing Agents
 Act on the liver to suppress cholesterol and cholic acid synthesis;
biliary cholesterol desaturation is enhanced, and breakup occurs
 Used in selected patients with radiolucent stones in gallbladder
 Adverse reactions: dose related; diarrhea, anorexia, constipation,
cramps, dyspepsia, epigastric distress, flatulence, heartburn,
nausea, nonspecific abdominal pain, and vomiting
 Gallstone Dissolvers – Actigall - ursodiol
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Digestive Enzymes
 Promote digestion by acting as replacement therapy when
the body’s natural pancreatic enzymes are lacking, not
secreted, or not properly absorbed
 Digestive enzymes
 Creon
 pancreatin
 Pancrease
 pancrelipase
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Disulfiram
 Used in the management of alcoholism
 Unpleasant reaction when combined with alcohol
 Anti-alcoholic product: Antabuse - disulfiram
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
 Questions?