DRUGS AFFECTING THE GI TRACT

MYLA M . GUADIZ , R.N., M.A.N.

Introduction
Vomiting(Emesis)- the expulsion of gastric contents. Causes: Motion sickness Infection Food intolerance Pain Shock

 Pregnancy Surgery Drugs

TWO MAJOR VOMITING CENTER The CTZ- Drugs and toxins and dopamine Vomiting Center- motion sickness.

Antiemetics
NON PRESCRIPTION: Can be purchased over the counter without prescription. Usually used for motion sickness. Should be taken 30 minutes before traveling. Not effective if vomiting has already occurred.

 Drug: Meclizine hydrochloride- BONAMINE

Bonamine
Antiemetic and antivertigo Indication: To prevent or treat vertigo and to treat motion sickness. Blocks the transmission of impulse to the vomiting center of the brain.blocks the cholinergic synapse.

 CONTRAINDICATION: Hypersensitivity to the drug. Adverse reactions: Dizziness and drowsiness Hypotension Blurred vision Diplopia Drymouth Tinnitus Urinary frequency associated with hesitancy

 Bronchospasm Jaundice NURSING CONSIDERATIONS: 1. Used cautiously to patients with asthma. 2. May result to ototoxicity. 3. Inform patient to take drug before traveling. 4. Avoid alcohol when taking the drug. 5. Eye examination maybe recommended.

Prescription
Classification: Antihistamine Anticholinergic Dopamine antagonists Benzodiazepines Serotonin antagonists cannabinoids

Metoclopromide
Antiemetic and upper GI stimulants INDICATIONS: to treat gastroesophageal reflux disease and to prevent postoperative vomiting. ACTION: Antagonizes dopamine effect in the GI tract stimulating it to contract. Also blocks the dopaminergic receptor in the CTZ.

 CONTRAINDICATION: GI hemorrhage Hypersensitivity Seizure disorders ADVERSE REACTION: Fluid retention Constipation Diarrhea Menstrual irregularities agranulocytosis

Restless leg Rash Parkinsonism Tardive dyskinesia Motor restlessness

NURSING CONSIDERATIONS
Use cautiously to patients with hypertension. Use cautiously to elderly patients Assess patients for signs and symptoms of intestinal obstruction. Notify physician if parkinsonisms takes place. Keep drug away from light. Avoid alcohol.

EMETICS
Are drugs used to induce vomiting. Indicated to expel unwanted substance within the GI tract. Contraindicated if this substances are ingested: ammonia, bleach dye, chlorine, toilet cleaners, and battery acid. Activated charcoal is given if emetics or emesis is contraindicated.

IPECAC
EMETIC INDICATION: To induce vomiting. ACTION: Irritating the gastric mucosa and stimulating the CTZ in the CNS.

CONTRAINDICATION
Loss of gag reflex Poisoning with strong acids. Seizures Semiconsciousness and unconsciousness. shock

Adverse Reaction
Depression Drowsiness Aspiration Coughing Indigestion

Consideration
Give the drug only to conscious patients Vomiting will occur 20 to 30 minutes after administration of the drug. After ingestion of the drug increase fluid intake. Used the syrup form.

DIARRHEA- frequent liquid stool. CAUSES: Foods Fecal impaction Bacteria Toxins Laxative abuse Anxiety Inflammatory bowel disease.

ANTIDIARRHEALS
Opiates ( Lomotil) > Decreasing GI motility Somatostatin analogue (Sandostatin) > Inhibit GI fluid secretion Adsorbents (Kaopectate) > Coats the GI tract adsorbing the bacteria causing the diarrhea.

Nursing Consideration
Monitor the frequency of bowel movement. Check for signs and symptoms of dehydration. Use cautiously to pregnant women. Withhold the drug if diarrhea persist after 48 hours. Encoursge the patient to drink clear liquids.

CONSTIPATION
Accumulation of hard fecal material. CAUSES: Fecal impaction Obstruction Decreased fluid intake Hormonal Ignoring the urge to defecate

 Lack of exercise.

LAXATIVES
Stool softener TYPES: Osmotic Stimulants Bulk forming emolients

OSMOTIC
Increase concentration of solutes within the intestine thus promoting the pulling of water towards the intestine. Sodium salts , magnesium salts and potassium salts are included.

LACTULOSE
Laxative INDICATION: To treat constipation also used to prevent hepatic encephalopathy. ACTION: breaks down in the stomach and acidifying the fecal contents. Makes intestinal contents more acidic than the blood. Trapped ammonia is converted into ammonia ions.

Contraindications: Hypersensitivity Adverse Reactions: Abdominal cramps Distention Diarrhea Hyperglycemia Hypernatremia Hypokalemia hypovolemia

Nursing Considerations
Check for serum electrolytes. Monitor blood ammonia Monitor for signs of dehydration Monitor blood glucose level Replace fluid lost cc per cc basis Take the drug with food. Do not take other laxatives when taking the drug.

STIMULANTS
Irritating sensory nerve endings DULCOLAX: Indication: Short term treatment for constipation Contraindication: fecal impaction, intestinal or biliary obstruction, appendicitis.

Nursing Consideration
Encourage the patient to increase fluid intake Advise the client to avoid overuse of laxatives Instruct client not to chew tablets Increase intake of food rich in fiber

BULK FORMING
Natural fibrous substances that promotes large, soft stool. Absorbs water towards the intestine. Increase fecal bulk.

PSYLLIUM
Indication: to control chronic constipation Contraindication: Fecal impaction, abdominal pain, intestinal obstruction. Side effect: Anorexia, nausea vomiting, cramps, diarrhea, bronchospasm.

Nursing Consideration
Monitor fluid intake of the patient. Monitor bowel sounds. Mixed the preparation with water before use. Instruct the patient to avoid inhaling psyllium dust.

EMOLIENTS
Stool softeners and lubricants Decrease straining when defecating. Promotes water accumulation in the intestine. Mineral Oil. Colace, Pericolace, and dialose Not indicated for children.

Contraindications
Use of other laxatives. Appendicitis Ulcerative colitis Pregnancy Bowel obstruction

Adverse Reaction
Nausea Vomiting Abdominal cramping

Nursing Consideration
Like other laxatives Not given to children