Drugs for Treating GI Disorders
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Transcript of Drugs for Treating GI Disorders
Drugs for Treating GI Disorders
Chapter 11
GI Disorders
Peptic Ulcer and Acid Reflux Disorders Laxatives and Cathartics Antidiarrheals Antiemetics
Vomiting
Drugs for Peptic Ulcer and Acid Reflux Disorders
Most of these drugs alter gastric acid and its effects on the mucosa of the upper GI tract
Many promote healing of lesions and prevent recurrence of lesions by decreasing cell destructive effects or increasing cell protective effects
Drug Classes
Antacids- Maalox, Mylanta Histamine-2 receptor antagonists-
cimetidine (Tagamet) Proton pump inhibitors- omeprazole
(Prilosec) Helicobacter pylori (H. pylori) agents-
antimicrobials- amoxicillin; bismuth subsalicylate (Pepto Bismol); combinations
Drug Selection
Proton pump inhibitors are drugs of first choice in most situations- heal more rapidly and may be combined with other drugs for treatment of H. pylori
H-2 antagonists are now over the counter
Antacids are still used to relieve heartburn and abdominal discomfort
Patient Teaching Guidelines
For Gastroesophageal reflux disease (GERD) - elevate head of bed, avoid stomach distention, sit upright for 1 to 2 hrs after eating, minimize acid-producing foods, avoid smoking, lose weight
Take drugs as directed These drugs may prevent absorption of
other drugs taken at the same time Histamine-2 antagonists may alter the
effects of several drugs
Lifespan Considerations
Children Antacids have been approved for use in
children- others have not but have been used in smaller doses
Elderly All these drugs may be used in the elderly Older adults have less gastric acid, so
smaller doses are indicated Monitor for adverse effects
Laxatives and Cathartics
Used to promote bowel elimination, such as in cases of constipation
Laxative implies mild effects Cathartic implies strong effects
Drug Classes
Bulk forming laxatives- methylcellulose (Citrucel)
Surfactant laxatives (stool softeners)- docusate sodium (Colace)
Saline cathartics- milk of magnesia, Fleet enema
Stimulant cathartics- bisacodyl (Dulcolax), castor oil
Lubricant laxatives- mineral oil
Indications for Use
Relief of constipation To prevent straining in patients with
cardiovascular disease (CVD), hypertension, stroke (CVA), and rectal conditions such as hemorrhoids
As a bowel prep To accelerate elimination of potentially
toxic substances
Patient Teaching Guidelines
Diet, exercise, fluid intake can prevent or treat constipation
Eat foods high in dietary fiber- fruits, vegetables, whole grain cereals and breads
Establish regular bowel habits Laxative use should be temporary Take as directed
Lifespan Considerations
Children Glycerin suppositories in younger children Stool softeners in older children Don’t use strong stimulant laxatives Don’t use saline laxatives if under 2 yrs of age
Elderly Constipation is a common problem Laxatives may be overused Strong stimulants should be avoided Metamucil is drug of choice for use on a regular
basis- take with a full glass of liquid
Antidiarrheals
Used to treat diarrhea Drugs may be given to relieve the
symptoms or treat the underlying cause of diarrhea
Drug Classes
Opiate-related drugs- paregoric; diphenoxylate with atropine (Lomotil)
Antibacterial agents- ciprofloxacin (Cipro); metronidazole (Flagyl)
Miscellaneous drugs- bismuth subsalicylate (Pepto Bismol)
Athlete/Patient Teaching Guidelines
Antidiarrheal meds are not always needed Drink plenty of fluids, avoid spicy foods and
fruits and vegetables until diarrhea stops Good handwashing, proper food storage can
prevent diarrhea Take drugs only as needed and as directed See health care provider if diarrhea is
accompanied by abdominal pain or fever
Lifespan Considerations
Children Appropriate fluid replacement is important
in conjunction with medications Elderly
Diarrhea is less common than constipation Excessive laxative use may cause diarrhea Watch for fluid volume deficits Most drugs can be given- watch for
constipation as a complication
Antiemetics
Used to prevent or treat nausea and vomiting from various causes
Drugs from many classes are used to treat nausea and vomiting
Drug Classes
Phenothiazines- promethazine (Phenergan)
Antihistamines- hydroxyzine (Vistaril) Prokinetic agent- metoclopramide
(Reglan) 5-HT3 (serotonin) receptor antagonists-
dolasetron (Anzemet) Miscellaneous- scopolamine (Transderm
scopolamine)
Drug Selection
Depends on cause of nausea and vomiting 5-HT3 receptor antagonists for
chemotherapy or post-op Anticholinergic and antihistamines for
motion sickness promethazine (Phergan)- antihistaminic,
antiemetic, and sedative effects Metoclopramide (Reglan) when non-
obstructive gastric retention
Athlete/Patient Teaching Guidelines
Take early- more effective than when nausea and vomiting have begun
Take fluids to prevent dehydration Lie down and rest to reduce nausea Be aware of safety precautions of drugs Take as directed
Lifespan Considerations
Children Use with caution- few studies have been
done May cause more adverse effects than in
adults Elderly
May cause excessive drowsiness Be aware of dehydration potential May also cause psychoactive effects