CHAPTER 7 CRITERIA
7.1 cite the classifications and actions of gastrointestinal system drugs
7.2 give examples of when, how and to whom gastrointestinal system drugs may be
administered (textbook)
7.3 identify the side effects and special considerations associated with gastrointestinal system
drug therapy
7.4 identify considerations and implications of using gastrointestinal system medications across
the life span
7.5 apply evidence-based concepts when using the nursing process
7.6 identify indications, side effects and potential drug interactions associated with the use of
herbal supplements
7.7 identify and interpret related laboratory tests
CHAPTER 7 LEARNING OBJECTIVES
ANTI-ULCER MEDICATIONS
Parietal Cells:
Chief Cells:
Surface Epithelium Cells:
Intrinsic factor:
GERD:
Peptic Ulcer Disease:
Nursing considerations:
Assessment:
Implementation:
Evaluation:
7.e Recognize the different types of hyperacidity medications
Antacids
 Indications: To relieve heartburn, acid indigestion and upset stomach.
 Mechanism of Action: Neutralizes gastric acidity and elevate the pH of the stomach.
Elevated pH also inactivates pepsin, a digestive enzyme.
 Specific Administration Considerations: Comes in a variety of formations. Chew the
entire tablet, then drink a full glass of water (after tablet or capsule). If a liquid form, be
sure to shake well. Do not administer calcium carbonate within 1-2hours as it may
decrease the effectiveness of other medicines. Calcium carbonate may be contraindicated
in patients with preexisting kidney disease because it may cause hypercalcemia.
 Side Effects: Constipation and rebound hyperacidity when discontinued.
 Patient Teaching: Take Over the Counter (OTC) meds appropriately. Teach about
decreasing the risk factors for GERD – smoking cessation and avoiding food and
beverages that increase acidity.
 Calcium Carbonate (TUMS)
H2- receptor antagonists  2 – Receptor Antagonist – the “dines”
 Indications: Used to treat GERD, peptic ulcer disease, erosive esophagitis and
hypersecretory conditions or as an adjunct treatment for the control of upper GI bleeding.
OTC famontidine is also used to treat heartburn or sour stomach
 Mechanism of Action: H2-receptors antagonists block the histamine’s actions at the H2
receptor of parietal cell. This reduces the hydrochloric acid production.
 Specific Administration Considerations: Take 15 to 60 minutes prior to eating food
and drinking drinks that cause heartburn. Patients with liver and kidney disease may
require adjustment dosing.  safe for pediatric and geriatric patients
 Side Effects: Constipation.
 Patient Teaching: Encourage fluids and high fiber to decrease the risk of constipation.
Smoking cessation is important as is interferes with histamine antagonists.
 Famotidine, ranitidine, cimetidine.
Proton Pump Inhibitors  Proton Pump Inhibitors – “azole”
-More powerful than antacids and H2-receptor antagonists
 Indications: Treat damage from GERD (5 years +) by allowing the esophagus to heal
and prevent further damage; used when the stomach creates too much acid (ZollingerEllison syndrome) and in combination with antibiotics to treat H. Pylori infections
(common cause of duodenal ulcers).
 Mechanism of Action: Binds to the hydrogen-potassium ATPase enzyme system of the
parietal cell. Inhibits the secretion of the hydrochloric acid and the anti-secretory effect
lasts longer that 24 hours.
 Specific Administration Considerations: Delayed release granules must be mixed with
applesauce or given with apple juice or given through a feeding tube. Review
medications with concurrent use to avoid interactions. Watch for a zinc deficiency and
low magnesium.
 Patient Teaching: Avoid use of alcohol, NSAIDS and foods that cause GI irritation.
 Pantoprazole, esomeprazole, lansoprazole, omeprazole.
Mucosal Protectants  Sucralfate
 Indications: Treatment of ulcers. Used to cover and protect GI ulcers.
 Mechanism of Action: Locally covers the ulcer site of the GI tract; protects it against
further attack of acid, pepsin and bile salts. Minimally absorbed by the GI tract.
 Specific Administration Considerations: Administer on an empty stomach, 1 hour
before a meal or 2 hours after. Use cautiously with renal disease or on dialysis.
 Side Effects: Constipation and rebound hyperacidity.
 Patient Teaching: Notify health care provider if their condition does not improve or gets
worse.
 Sucralfate
ANTIDIARRHEAL MEDICATIONS + LAXATIVES
3 classes of antidiarrheal medications:
 Adsorbents  help eliminate the toxin or bacteria from the GI tract
 Antimotility  slow peristalsis
 Probiotics  help restore the normal bacteria found in the lower intestine
Oral rehydration may be used to help relace fluid and electrolyte loss, but not treat diarrhea
Antibacterial agents may also be used to treat diarrhea caused by specific infections, such as
campylobacter or giardia, but they are not routinely needed
Constipation:
Diarrhea:
Nursing considerations:
Assessment:
Implementation:
Evaluation:
ADSORBENTS
Bismuth subsalicylate (pepto bismol)
ANTIMOTILITY
1: Anticholinergics
hyoscyamine
2: opiate-like medication
Loperamide
PROBIOTICS
Lactobacillus
LAXATIVES
Constipation:
Causes:
Medication:
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Antacids that contain aluminum and calcium
Anticholinergics
Anticonvulsants
Calcium channel blockers
Diuretics
Iron supplements
Medicines used to treat Parkinson’s disease
Narcotic pain medications
Some medicines to treat depression
Health and Nutrition Problems:
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Not eating enough fiber
Not drinking enough liquids or dehydration
Not getting enough physical activity
Celiac disease
Disorders that affect the bran and spine
Diabetes
Hypothyroidism
Inflammation linked to diverticular disease or proctitis
Intestinal obstructions, including anorectal blockage and tumors
Daily Routine Changes:
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Pregnancy
Aging
Traveling
Ignoring the urge to have a bowel movement
Medication changes
Change in diet
Nursing Considerations:
Assessment:
Implementation:
Evaluation:
Laxative classes:
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fiber supplements
stool softeners
osmotic agents
lubricants
stimulants
LAXATIVES
Fiber supplements: Psyllium
Stool Softeners: Docusate
Osmotic agents: Milk of Magnesia, polyethylene glycol
Lubricants: Mineral oil enema
Stimulants: Bisacodyl
7.c Discuss the various categories of laxative medications
Fiber supplements  Fiber Supplements-psyllium(Metamucil)
 Indications: Constipation.
 Mechanism of Action: Psyllium adds bulk to stool to facilitate bowel movements.
 Specific Administration Considerations: Add dose to an 8- ounce glass of water. Stir
briskly and drink. Usually causes a bowel movement within 12-72 hours.
 Patient Teaching: Start with 1 dose and gradually increase to 3 doses every 24 hours.
Stool Softeners  Stool Softeners – docusate (Colace)
 Indications: Constipation.
 Mechanism of Action: Facilitates movement of water and fats into stool to make it soft
and easier to pass the bowel movement.
 Specific Administration Considerations: It may cause stomach cramping. Usually
causes a bowel movement within 12-72 hours.
Osmotic Agents  Osmotic Agents – Milk of Magnesia and polyethylene glycol 3350 (Miralax)
 Indications: Constipation.
 Mechanism of Action: Osmotic agents hold the water within the stool – increasing the
number of bowel movements and making then easier to pass.
 Specific Administration Considerations: Polyethylene glycol 3350 has a bottle top that
can be used as a measuring cap to contain 17 grams of powder when filled to the
indicated line. Fill to top of clear section in cap, which is marked to indicate the correct
dose (17 g); stir and dissolve in any 4 to 8 ounces of beverage (cold, hot or room
temperature), and then administer.
 Patient Teaching: Usually produces a BM in 1-3 days. May cause loose watery stools.
Lubricants  Lubricants – Fleet’s enema
 Indications: Constipation.
 Mechanism of Action: Mineral oil coats the stool to help seal in water.
 Specific Administration Considerations: Read drug label for children as some brands
can be used in children aged 2 or older, whereas others are not intended for children.
 Patient Teaching: Usually produces a bowel movement in 2 to 15 minutes. It may cause
stomach cramps, bloating, upset stomach, or diarrhea.
Stimulants  Stimulants - bisacodyl
 Indications: Constipation.
 Mechanism of Action: Causes the intestines to contract moving the stool throughout the
colon.
 Specific Administration Considerations: Oral dosage or rectal suppositories are
available.
 Patient Teaching: Instruct to hold the suppository in rectally for 15- 20 minutes. BM’s
occur usually within 15 minutes.
7.d Discuss the various categories of antidiarrheal medications
Adsorbents  Bismuth subsalicylate
 Indications: Treatment of gas and diarrhea.
 Mechanism of Action: Works by coating the walls of the GI tract and binding the
causative bacteria or toxin for elimination from the GI tract through the stool. Decreases
the flow of fluids and electrolytes into the bowel, which decreases inflammation from the
bowel.
 Specific Administration Considerations: Bismuth subsalicylate has salicylate in it. Be
aware of any salicylate allergies. Children who have or recovering from chicken pox or
flu-like symptoms should not use this product.
 Patient Teaching: Take medication as advised. Discontinue if tinnitus occurs. Be aware
of potential color changes to stool that may occur due to the medication contains aspirin.
 watch for blood (GI bleed)
Anticholinergics
Antimotility
 Indications: Treatment of gas and its symptoms – painful pressure; fullness and bloating
 Mechanism of Action: Works by altering the elastically of the mucous-covered gas
bottles, which decreases the size of the gas bubbles and decreases the pain and helps pass
them.
 Specific Administration Considerations: Administer four times a day, after meals and
at bedtime. If a liquid product, make sure to shake.
 Patient Teaching: Avoid straws, decrease intake of beans and cruciferous vegetables’
increase ambulation and changing positions.
(Anticholinergics, Opioid-Like Medications)
Anticholinergics - hyoscyamine
 Indications: Treatment of diarrhea.
 Mechanism of Action- Works on the smooth muscle of the GI tract to stop propulsive
motility and decreases gastric acid section.
 Specific Administration Considerations: Read drug label for all contraindications
including but not limited to glaucoma, myasthenia gravis and paralytic ileus. Be aware of
a partial bowel obstruction as this drug would be harmful and inappropriate.
 Patient Teaching: Patients should receive instruction that these medications may cause
dizziness and drowsiness. If patients experience dry mouth, frequent oral hygiene may
alleviate discomfort.
Anticholinergics - loperamide
 Indications: Treatment of diarrhea. Less CNS effects.
 Mechanism of Action: Decreases the flow of fluids and electrolytes into the bowel and
slowing down the movement of the bowel to decrease the number of bowel movements.
 Specific Administration Considerations: Do not give to a child younger than two years
of age. Taking more than the prescribed dose can cause a serious abnormal heart rhythm.
Be sure to read the drug label for interactions.
 Patient Teaching: Patients should receive instruction that these medications may cause
dizziness and drowsiness. If patients experience dry mouth, frequent oral hygiene may
alleviate discomfort.
Antiflatulent – simethicone
 Indications: Treatment of gas and its symptoms – painful pressure; fullness and bloating
 Mechanism of Action: Works by altering the elasticity of the mucous-covered gas
bubbles, which decreases the size of the gas bubbles and decreases the pain and helps
pass them.
 Specific Administration Considerations: Administer four times a day, after meals and
at bedtime. If a liquid product, make sure to shake.
 Patient Teaching: Avoid straws, decrease intake of beans and cruciferous vegetables,
increase ambulation and changing positions.
ANTIEMETICS
7.g Discuss the different types of antiemetic medications
 Nausea and vomiting are common conditions. Nausea is the unpleasant sensation of
having the urge to vomit, and vomiting (emesis) is the forceful expulsion of gastric
contents.
Anticholinergics - scopolamine
 Indications: Treatment of motion sickness or nausea and vomiting related to surgical
anesthesia and/or opiate anesthesia.
 Mechanism of Action: Blocks the Ach receptors in the vestibular center and within the
brain to prevent nausea-inducing stimuli. Also, dry GI sections and reduce smooth
muscle spasms.
 Specific Administration Considerations: Apply to dry intact skin to behind the ear. Do
not use with a patient who has glaucoma. Remove before having an MRI.
 Patient Teaching: Do not drive, operate machinery or participate in underwater sports
until they know how the Transderm Scop affects them.
Antihistamines – meclizine
 Indications: Treatment of motion sickness.
 Mechanism of Action: Blocks the H1 receptors in the vestibular center and may block
acetylcholine (ACh).
 Specific Administration Considerations: Do not administer to a patient with glaucoma
or an enlarged prostate. Dosage should be given one hour prior to travel beginning.
 Patient Teaching: Do not drive a motor vehicle or operate machinery. Avoid alcoholic
drinks, sedatives and tranquilizers.
Dopamine Antagonists – prochlorperazine
 Indications: Treatment of nausea and vomiting. May be used as an antipsychotic
medication.
 Mechanism of Action: Blocks dopamine in the Chemoreceptor Trigger Zone (CTZ).
Calms the Central Nervous System (CNS) and block acetylcholine.
 Specific Administration Considerations: Do not administer to a patient less than 2
years old and less than 20 pounds.
 Patient Teaching: Avoid alcoholic drinks, sedatives and tranquilizers. May experience
photosensitivity and extreme temperatures should be avoided.
Prokinetics – Metoclopramide
 Indications: Used to promote peristalsis to empty the GI tract and reduce nausea.
 Mechanism of Action: Blocks the dopamine and sensitizes tissue to ACh.
 Specific Administration Considerations: Effects of the med last 1-2 hours.
Metoclopramide should not be used whenever stimulation of gastrointestinal motility
might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical
obstruction, or perforation).
 Patient Teaching: notify HCP if they experience any new feelings of depression or
abnormal muscle movements.
Serotonin Antagonists – ondansetron
 Indications: Used to treat nausea and vomiting associated with chemotherapy,
postoperative nausea and vomiting and hyperemesis.
 Mechanism of Action: Blocks the serotonin receptors in the GI tract, the Chemoreceptor
trigger zone and vomiting center.
 Specific Administration Considerations: Available as an oral agent or injectable for IV
administration for those too nauseated to take anything orally.
 Patient Teaching: notify HCP if they experience a change in their heart rate,
lightheadedness or feel faint or any hypersensitivity reactions.
Neurokinin Receptor Antagonists - aprepitant
 Indications: Used to treat nausea and vomiting associated with chemotherapy, post
operative nausea and vomiting.
 Mechanism of Action: Stops the substance-P neurokinin in the brainstem.
 Specific Administration Considerations: Administered with dexamethasone and
ondansetron. Can be given orally or intravenously.
 Patient Teaching: Monitor INR levels as med may interfere with warfarin. May reduce
the effectiveness of oral contraceptives, so use a back up birth control measure.
Tetrahydrocannaboids (THC)- Dronabinol or medical marijuana
 Indications: Used to treat nausea and vomiting associated with cancer or AIDS.
 Mechanism of Action: Inhibits the effects of the cerebral cortex causing an alteration of
mood and body’s perception of its surroundings. This may decrease the nausea and
vomiting and stimulate their appetite.
 Specific Administration Considerations: It is a controlled substance and may become
addictive.
 Patient Teaching: Do not drive, operate machinery or engage in any hazardous activity.
Keep out of reach of children and pets.
7.h Explain the nursing process as it relates to clients with gastrointestinal disorders
Nursing Process for Hyperacidity Medications
 Assessment: Abdominal assessment and documentation of bowel patterns.
 Implementation: Review the medication and follow administration for other
medications and foods.
 Evaluation: Improvement should occur within the defined time period.
Nursing Process for Antidiarrheal Medications.
 Assessment: Abdominal assessment, frequency of bowel movements and stool
characteristics, skin assessment of anal and surrounding areas.
 Implementation: Teach the client not to exceed dosages for OTC medications. Teach
about other nonpharmacological interventions – fluids: water, sports drinks and non
caffeinated beverages. Bland and soft diet.
 Evaluation: Improvement should occur within a 48-hour time period. The health care
provider should be notified of increased bleeding in patients taking salicylates and
abnormal heart rhythms in patients taking loperamide.
Nursing Process for Antiemetics Medications.
 Assessment: The cause of nausea and vomiting, so the treatment can correctly target the
cause.
 Implementation: Advocate for the most effective route of administration if the patient is
vomiting.
 Evaluation: An improvement of nausea and vomiting. Monitor for dehydration.
7.b Describe the therapeutic effects and side effects of the most commonly used classifications of
gastrointestinal medications
Antibacterial
7.i Explain the use of herbal and vitamin supplements with gastrointestinal medications
 Ginger is used in traditional Indian and Chinese medicine as an antiemetic.
 Vitamin B6 (Pyridoxine) recommended for pregnant women with nausea and vomiting.
7.j Discuss common laboratory considerations with gastrointestinal medications
Which of the following types of cells are responsible for secreting
hydrochloric acid within the stomach to maintain the environmental pH?
Surface epithelium cells
Chief cells
Enteroendocrine cells
Parietal cells
Please fill in the sentence with the correct terms.
Peptic ulcer disease is caused when gastric or duodenal ulcers are caused by the
breakdown of GI mucosa by PEPSIN in combination with HYDROCHLORIC ACID.
Peptic ulcer disease is a relatively harmless hyperacidity disease
process that is easily treated with over the counter antacids.
T/F
Antacid chewable tablets exhibit maximum effectiveness when
swallowed whole.
T/F
Oral famotidine should be consumed 15 to 60 minutes before eating for maximum
effectiveness.
SUCRALFATE is a mucosal protectant used to cover and protect gastrointestinal
ulcers.
Sucralfate should be taken with food for maximum effectiveness. T/F
Many hyperacidity medications should be used cautiously in patients
with chronic kidney disease due to issues with impaired excretion and
risk of hypercalcemia. T/F
Proton pump inhibitors are more powerful than antacids and H2 receptor
antagonists. T/F
CHAPTER 9 CRITERIA
9.1 cite the classifications and actions of endocrine system drugs
9.2 give examples of when, how and to whom endocrine system drugs may be administered
9.3 identify the side effects and special considerations associated with endocrine system drug
therapy
9.4 identify the considerations and implications of using endocrine system medications across
the life span
9.5 apply evidence-based concepts when using the nursing process
9.6 identify indications, side effects and potential drug interactions associated with the use of
herbal supplements
9.7 identify and interpret related laboratory tests
CHAPTER 9 LEARNING OBJECTIVES
9.a Review the pathophysiology of the endocrine system
The endocrine system uses hormones for chemical signaling.
They are sent by the endocrine organs and transported by through the bloodstream to the target
cells and making a specific response.
9.b Identify the most common endocrine disorders
9.c Describe the endocrine negative feedback system
9.d Describe the various classifications of medications used for the treatment of endocrine
disorders
9.e Explain the differences between the medication treatment for Type I and Type II diabetes
9.f Describe the classifications of sex hormones
9.g Explain the nursing process as it relates to clients with endocrine disorders
9.h Identify common laboratory considerations related to endocrine medications
9.i Explain the treatment of hypoglycemia and hyperglycemia
9.j Describe endocrine disorders considerations across the lifespan
9.k Describe herbal and vitamin supplement considerations with endocrine medications