pyramid points chapter 56: gastrointestinal medications

PYRAMID POINTSPYRAMID POINTS

CHAPTER 56:CHAPTER 56:

GASTROINTESTINAL GASTROINTESTINAL MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH: Gastrointestinal Medications

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I. AntacidsI. Antacids DescriptionDescription

• Should be taken on regular schedule; some as prescribed Should be taken on regular schedule; some as prescribed taken 1 and 3 hours after each meal or at bedtimetaken 1 and 3 hours after each meal or at bedtime

• For maximum benefit treatment with antacid, elevate gastric pH For maximum benefit treatment with antacid, elevate gastric pH above 5above 5

• Tablets should be chewed thoroughly, followed with glass of Tablets should be chewed thoroughly, followed with glass of water or milkwater or milk

• Allow 1 hour between antacid administration, administration of Allow 1 hour between antacid administration, administration of other medicationsother medications

Aluminum hydroxide preparationsAluminum hydroxide preparations• Contain significant amounts of sodium; use with caution in Contain significant amounts of sodium; use with caution in

clients with hypertension, heart failureclients with hypertension, heart failure• Constipation most common side effect Constipation most common side effect • Can reduce effects of tetracyclines, warfarin sodium Can reduce effects of tetracyclines, warfarin sodium

(Coumadin), digoxin (Lanoxin); reduce phosphate absorption; (Coumadin), digoxin (Lanoxin); reduce phosphate absorption; can cause hypophosphatemiacan cause hypophosphatemia



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I. Antacids (continued) I. Antacids (continued) Calcium carbonate preparations rapid acting, can cause Calcium carbonate preparations rapid acting, can cause

constipationconstipation Magnesium hydroxide preparationsMagnesium hydroxide preparations

• Also saline laxative; most common side effect diarrheaAlso saline laxative; most common side effect diarrhea

• Contraindicated in clients with intestinal obstruction, Contraindicated in clients with intestinal obstruction, appendicitis, undiagnosed abdominal painappendicitis, undiagnosed abdominal pain

• In clients with renal impairment, magnesium can accumulate, In clients with renal impairment, magnesium can accumulate, leading to toxicityleading to toxicity

Sodium bicarbonateSodium bicarbonate• Can cause systemic alkalosis in clients with renal impairmentCan cause systemic alkalosis in clients with renal impairment

• Use with caution in clients with hypertension, heart failureUse with caution in clients with hypertension, heart failure



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II. Gastric ProtectantsII. Gastric Protectants Misoprostol (Cytotec)Misoprostol (Cytotec)

• Administer with mealsAdminister with meals

• Causes diarrhea, abdominal painCauses diarrhea, abdominal pain

Sucralfate (Carafate)Sucralfate (Carafate)• Administered orally on empty stomachAdministered orally on empty stomach

• May cause constipationMay cause constipation

• May impede absorption of warfarin sodium, phenytoin May impede absorption of warfarin sodium, phenytoin (Dilantin), theophylline, digoxin, some antibiotics(Dilantin), theophylline, digoxin, some antibiotics

Administer 2 hours apart from these medicationsAdminister 2 hours apart from these medications



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III. Histamine 2 Receptor AntagonistsIII. Histamine 2 Receptor Antagonists DescriptionDescription

• Suppress secretion of gastric acidSuppress secretion of gastric acid Should be used with caution in clients with impaired renal or Should be used with caution in clients with impaired renal or

hepatic failurehepatic failure Cimetidine (Tagamet)Cimetidine (Tagamet)

• Food reduces rate of absorptionFood reduces rate of absorption• If administered IV, 300-mg dose can be diluted in total volume If administered IV, 300-mg dose can be diluted in total volume

of 20 mL normal saline or 5% dextrose, injected slowly over not of 20 mL normal saline or 5% dextrose, injected slowly over not less than 2 minutes; also may be diluted in 100 mL, infused less than 2 minutes; also may be diluted in 100 mL, infused over 15 to 20 minutesover 15 to 20 minutes

• Administer 1 hour apart from antacids Administer 1 hour apart from antacids • Passes blood-brain barrier; central nervous system side effects Passes blood-brain barrier; central nervous system side effects

may occurmay occur



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III. Histamine 2 Receptor Antagonists (continued) III. Histamine 2 Receptor Antagonists (continued) Cimetidine (Tagamet) (continued) Cimetidine (Tagamet) (continued)

• Reduced dosage in clients with renal impairment necessaryReduced dosage in clients with renal impairment necessary

• IV administration can lead to hypotension, dysrhythmiasIV administration can lead to hypotension, dysrhythmias Ranitidine (Zantac)Ranitidine (Zantac)

• Side effects uncommonSide effects uncommon

• Does not penetrate blood-brain barrierDoes not penetrate blood-brain barrier

• For IV administration, dilute with 20 mL normal saline or 5% For IV administration, dilute with 20 mL normal saline or 5% dextrose; administer slowly over 5 minutes; may be diluted in dextrose; administer slowly over 5 minutes; may be diluted in 100 mL, administered over 15 to 20 minutes100 mL, administered over 15 to 20 minutes

Famotidine (Pepcid), nizatidine (Axid)Famotidine (Pepcid), nizatidine (Axid)• Do not need to be administered with foodDo not need to be administered with food



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IV. Proton Pump InhibitorsIV. Proton Pump Inhibitors Suppress gastric acid secretionSuppress gastric acid secretion Used to treat active ulcer disease, erosive Used to treat active ulcer disease, erosive

esophagitis, pathological hypersecretory esophagitis, pathological hypersecretory conditionsconditions

Contraindicated in hypersensitivityContraindicated in hypersensitivity Common side effects include headache, diarrhea, Common side effects include headache, diarrhea,

abdominal pain, nauseaabdominal pain, nausea



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V. Medication Regimens to Treat V. Medication Regimens to Treat Helicobacter pyloriHelicobacter pylori InfectionsInfections Antibacterial agent alone not effective in eradicating Antibacterial agent alone not effective in eradicating

bacteriumbacterium Dual, triple, quadruple therapy with variety of combinations Dual, triple, quadruple therapy with variety of combinations

usedused Combinations include antibacterial agents, proton pump Combinations include antibacterial agents, proton pump

inhibitors, histamine 2 receptor antagonists, antacidsinhibitors, histamine 2 receptor antagonists, antacids Common treatment protocol is triple therapy with two Common treatment protocol is triple therapy with two

antibacterial agents, one proton pump inhibitorantibacterial agents, one proton pump inhibitor If triple therapy fails, quadruple therapy recommended, with If triple therapy fails, quadruple therapy recommended, with

two antibiotics, one proton pump inhibitor, one bismuth or two antibiotics, one proton pump inhibitor, one bismuth or histamine 2 receptor antagonisthistamine 2 receptor antagonist



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VI. Gastrointestinal StimulantsVI. Gastrointestinal Stimulants Stimulate motility of upper gastrointestinal tract, increase Stimulate motility of upper gastrointestinal tract, increase

rate of gastric emptyingrate of gastric emptying Used to treat gastroesophageal reflux, paralytic ileusUsed to treat gastroesophageal reflux, paralytic ileus May cause restlessness, drowsiness, extrapyramidal May cause restlessness, drowsiness, extrapyramidal

reactions, insomnia, headachereactions, insomnia, headache Usually administered 30 minutes before meals or at bedtimeUsually administered 30 minutes before meals or at bedtime Contraindicated in clients with sensitivity, mechanical Contraindicated in clients with sensitivity, mechanical

obstruction, perforation, gastrointestinal hemorrhageobstruction, perforation, gastrointestinal hemorrhage



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VI. Gastrointestinal Stimulants (continued) VI. Gastrointestinal Stimulants (continued) Can precipitate hypertensive crisis in clients with Can precipitate hypertensive crisis in clients with

pheochromocytomapheochromocytoma Safety in pregnancy not establishedSafety in pregnancy not established Metoclopramide (Reglan) can cause parkinsonian Metoclopramide (Reglan) can cause parkinsonian

symptomssymptoms Anticholinergics, opioid analgesics antagonize Anticholinergics, opioid analgesics antagonize

effects of metoclopramideeffects of metoclopramide Alcohol, sedatives, cyclosporine (Sandimmune), Alcohol, sedatives, cyclosporine (Sandimmune),

tranquilizers produce additive effecttranquilizers produce additive effect



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VII. Bile Acid SequestrantsVII. Bile Acid Sequestrants DescriptionDescription Act by absorbing, combining with intestinal bile salts, which Act by absorbing, combining with intestinal bile salts, which

are then secreted in feces, preventing intestinal reabsorptionare then secreted in feces, preventing intestinal reabsorption Used to treat hypercholesterolemia, biliary obstruction, Used to treat hypercholesterolemia, biliary obstruction,

pruritus associated with biliary diseasepruritus associated with biliary disease Taste, palatability causes for noncomplianceTaste, palatability causes for noncompliance Should be used cautiously in clients with bowel obstruction, Should be used cautiously in clients with bowel obstruction,

severe constipationsevere constipation Side effects include nausea, bloating, constipationSide effects include nausea, bloating, constipation Stool softeners, other sources of fiber can be used to relieve Stool softeners, other sources of fiber can be used to relieve

side effectsside effects



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VIII. Medications to Treat Hepatic VIII. Medications to Treat Hepatic EncephalopathyEncephalopathy Lactulose (Cholac, Chronulac, Duphalac)Lactulose (Cholac, Chronulac, Duphalac)

• Reduces ammonia levelsReduces ammonia levels

• Administered orally or rectallyAdministered orally or rectally

NeomycinNeomycin• Administer orally or via nasogastric tubeAdminister orally or via nasogastric tube

• Used with caution in clients with renal impairmentUsed with caution in clients with renal impairment



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IX. Pancreatic Enzyme ReplacementsIX. Pancreatic Enzyme Replacements Used to supplement, replace pancreatic enzymesUsed to supplement, replace pancreatic enzymes Should be taken with meals or snackShould be taken with meals or snack High-fiber diet may increase efficacy of medicationHigh-fiber diet may increase efficacy of medication Side effects include abdominal cramps, pain, Side effects include abdominal cramps, pain,

nausea, diarrheanausea, diarrhea Products that contain calcium carbonate or Products that contain calcium carbonate or

magnesium hydroxide interfere with action of magnesium hydroxide interfere with action of enzyme replacementenzyme replacement



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X. Treatment of Inflammatory Bowel DiseaseX. Treatment of Inflammatory Bowel Disease AntimicrobialsAntimicrobials

• Prevent or treat secondary infectionsPrevent or treat secondary infections 5-Aminosalicylates (5-ASA)5-Aminosalicylates (5-ASA)

• Decrease inflammationDecrease inflammation CorticosteroidsCorticosteroids

• Decrease inflammationDecrease inflammation ImmunosuppressantsImmunosuppressants

• Suppress immune systemSuppress immune system ImmunomodulatorsImmunomodulators

• Reduce inflammationReduce inflammation



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XI. AntiemeticsXI. Antiemetics Control vomiting and motion sicknessControl vomiting and motion sickness Monitor for drowsinessMonitor for drowsiness Protect the client from injuryProtect the client from injury Monitor intake and outputMonitor intake and output



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XII. LaxativesXII. Laxatives Bulk-forming laxativesBulk-forming laxatives

• Increase bulk Increase bulk • Contraindicated in bowel obstructionContraindicated in bowel obstruction

Stimulant catharticsStimulant cathartics• Stimulate GI motilityStimulate GI motility

Saline (osmotic) catharticsSaline (osmotic) cathartics• Produce bulk; stimulate peristalsisProduce bulk; stimulate peristalsis

Stool softenersStool softeners• Soften fecesSoften feces

LubricantsLubricants• Mineral oil interferes with absorption of fat-soluble vitaminsMineral oil interferes with absorption of fat-soluble vitamins



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XIII. Medications to Control DiarrheaXIII. Medications to Control Diarrhea OpioidsOpioids

• Decrease intestinal motility, peristalsisDecrease intestinal motility, peristalsis

• When poisons, infections, bacterial toxins are cause of When poisons, infections, bacterial toxins are cause of diarrhea, opioids worsen conditiondiarrhea, opioids worsen condition

Other antidiarrhealsOther antidiarrheals• Monitor bowel movementsMonitor bowel movements

• Monitor fluid and electrolyte balanceMonitor fluid and electrolyte balance



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XIV. AntispasmodicsXIV. Antispasmodics DescriptionDescription

• Relax smooth muscle of GI tractRelax smooth muscle of GI tract

Side effectsSide effects• Constipation or diarrheaConstipation or diarrhea

• RashRash

• EuphoriaEuphoria

• DizzinessDizziness

• Nausea and vomitingNausea and vomiting

• WeaknessWeakness



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The client has been given a prescription for metoclopramide The client has been given a prescription for metoclopramide (Reglan) four times a day. The nurse determines that the client (Reglan) four times a day. The nurse determines that the client is taking the medication at optimal times if the client reports is taking the medication at optimal times if the client reports using the medication:using the medication:

1. One hour after each meal and at bedtime1. One hour after each meal and at bedtime

2. Every 6 hours, spaced evenly around the clock2. Every 6 hours, spaced evenly around the clock

3. 30 minutes before meals and at bedtime3. 30 minutes before meals and at bedtime

4. With each meal and at bedtime4. With each meal and at bedtime

pyramid points chapter 56: gastrointestinal medications

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