Chapter 46

DRUGS FOR GASTROINTESTINAL TRACT DISORDERS

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Drugs for the Gastrointestinal Tract

Gastrointestinal disorders

Vomiting Toxic substance ingestion Diarrhea Constipation

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Vomiting

Cerebral centers affecting vomiting

The chemoreceptor trigger zone and vomiting center.

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Antiemetics

Nonpharmacologic measures

Weak tea Gatorade Crackers Toast

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Antiemetics (contd)

Nonprescription antiemetics

Antihistamines Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl) Side effects (similar to anticholinergics)

Drowsiness, dry mouth, constipation

Bismuth subsalicylate (Pepto-Bismol) Action

Acts directly on gastric mucosa to suppress vomiting

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Antiemetics (contd)

Prescriptive antihistamines

Hydroxyzine (Vistaril) Promethazine (Phenergan) Acts on VC, decreases stimulation of CTZ Scopolamine (Transderm-Scop) Acts on VC, decreases stimulation of CTZ

Anticholinergic

Dopamine antagonists

Phenothiazines Promethazine (Phenergan)

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Antiemetics (contd)

Promethazine (Phenergan)

Action Inhibit CTZ, blocks H1 receptor sites Side effects Drowsiness, dry mouth, blurred vision, tachycardia,
constipation, urinary retention, photosensitivity, EPS (tardive dyskinesia, acute dystonia, akathisia)

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Antiemetics (contd)

Dopamine antagonists

Butyrophenones Haloperidol (Haldol), Droperidol (Inapsine) Action

Blocks dopamine (D2) receptors in CTZ EPS, hypotension

Side effects

Metoclopramide (Reglan) Action

Blocks D2 receptors in CTZ

Sedation, diarrhea, EPS
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Side effects

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Antiemetics (contd)

Benzodiazepines

Lorazepam (Ativan) Use

Used in combination with a glucocorticoid and
serotonin 5-HT3 receptor antagonist

Cancer chemotherapy

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Antiemetics (contd)

Serotonin receptor antagonist

Ondansetron (Zofran) Action

Use

Blocks serotonin receptors in CTZ and afferent vagal nerve terminals in UGI Cancer chemotherapy Headache, diarrhea, dizziness, fatigue

Side effects

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Antiemetics (contd)

Glucocorticoids

Dexamethasone (Decadron) Methylprednisolone (Solu-Medrol) Use: cancer chemotherapy Dronabinol (Marinol) Side effects

Cannabinoids

Drowsiness, dizziness, dry mouth, impaired thinking, euphoria, mood changes, headaches, confusion, depersonalization, nightmares, incoordination, memory lapse, anxiety

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Antiemetics (contd)

Miscellaneous

Diphenidol (Vontrol) Trimethobenzamide (Tigan) Action

Side effects

Suppress impulses to CTZ Drowsiness, dry mouth, tachycardia, urine retention, constipation, diarrhea, blurred vision, hypotension, EPS

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Antiemetics (contd)

Nursing interventions

Provide mouth care Monitor vital signs, bowel sounds Monitor for dehydration Warn not to consume alcohol when taking an antiemetic Warn pregnant females to avoid antiemetics Avoid driving motor vehicles

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Emetics

Ipecac (OTC)

Action Stimulates CTZ & acts directly on gastric mucosa Use Induces vomiting after toxic substance Caution Avoid vomiting if substance is caustic or petroleum If vomiting contraindicated, activated charcoal is
given

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Emetics (contd)

Ipecac

Administration Use ipecac syrup, not ipecac fluid extract Take with a glass of water or fluid, not with milk or
carbonated beverage Vomiting occurs in 15 to 30 minutes If vomiting does not occur, give activated charcoal Gastric lavage may be needed if vomiting does not occur

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Diarrhea

Causes

Spicy or spoiled foods Bacteria (Escherichia coli), virus, toxins Drug reactions Fecal impaction, laxative abuse Malabsorption disorders, bowel tumor, inflammatory bowel disease Stress, anxiety

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Antidiarrheals

Purpose

Decrease hypermotility Should not be used for more than 2 days or if fever is present Opiates and opiate-related agents Somatostatin analog Adsorbents

Caution

Types

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Antidiarrheals (contd)

Opiates and opiate-related agents

Paregoric (camporated opium tincture) Diphenoxylate with atropine (Lomotil) Loperamide (Imodium) Opiates decrease GI motility Opiates may cause respiratory depression
May cause physical dependence Atropine contraindicated in glaucoma

Especially children and elderly

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Antidiarrheals (contd)

Somatostatin analog

Octreotide (Sandostatin) Use: for severe diarrhea from cancer

Adsorbents

Bismuth salts (Pepto-Bismol) Kaolin-pectin (Kaopectate) Action: coats GI tract, absorbs bacteria or toxins Parepectolin (paregoric, Kaolin-pectin)

Combination agents

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Antidiarrheals (contd)

Nursing interventions

Monitor BP, R Report more than 10-15 mmHg decrease in BP Monitor frequency of bowel movements and bowel sounds Assess for evidence of dehydration Monitor electrolytes Avoid fried foods, milk, and sedatives If diarrhea persists after 48 hrs, notify MD

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Constipation

Causes

Bowel obstruction, fecal impaction Chronic laxative use, ignoring urge to defecate Neurologic disorders Side effect of drugs Lack of exercise, fiber, water

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Constipation (contd)

Laxatives

Laxatives: promote soft stool Cathartics: soft to watery stool with cramping Purgatives: watery stool with cramping Osmotic (saline) Stimulant (irritants) Bulk-forming Emollient (stool softeners)

Types of laxatives

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Osmotic (Saline) Laxatives

Polyethylene glycol (GoLYTELY) Lactulose (Chronulac) Action

Hyperosmolar salts pull water into colon, increase water in feces to increase bulk, which stimulates peristalsis Fluid and electrolyte imbalances, hypotension, weakness

Side effects

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Stimulant (Irritant) Laxatives

Phenolphthalein (Ex-Lax, Correctol) Bisacodyl (Dulcolax) Action

Increase peristalsis by irritating sensory nerve endings in intestinal mucosa

Results: orally 6-12 hrs, supp 15-60 min Side effects

Abdominal cramps, weakness, reddish brown urine, diarrhea

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Bulk-Forming Laxatives

Psyllium hydrophilic mucilloid (Metamucil) Calcium polycarbophil (Fiber-Con)

Action Absorb water into intestines, increase bulk and

peristalsis

Results
8-12 hrs

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Bulk-Forming Laxatives

Administration

Mix in glass of water or juice, stir, drink immediately, follow with 1 glass water Abdominal cramps Excess laxative Nausea,vomiting, gas, diarrhea

Side effects

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Emollients (Stool Softeners)

Docusate (Colace) Action

Lowers surface tension Promotes water accumulation in intestine Emulsifies and lubricates feces for easier passage

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Emollients (Stool Softeners) (contd)

Use

Prevents constipation Reduces straining post surgery or myocardial infarction Abdominal cramping, nausea, vomiting, diarrhea

Side effects

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Laxatives

Contraindications

Undiagnosed abdominal pain Inflammatory disorders of the GI tract Appendicitis, diverticulitis, ulcerative colitis Spastic colon Bowel obstruction

Pregnancy

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Case Study
A client who is taking chemotherapy for cancer of the right kidney is extremely nauseated and vomiting.

Critical Thinking Which types of antiemetic are appropriate for cancer chemotherapy?

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Practice Question #1
Ondansetron (Zofran) has been ordered for the client who is taking cancer chemotherapy to control the severe nausea and vomiting. What side effects are possible?
Headache, dizziness, and fatigue Constipation, anxiety, and fever Abdominal cramping and irritability D. Psychosis and middle ear disturbances
A. B. C.

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Practice Question #1 (contd)

Answer: A. Rationale: Side effects of ondansetron (Zofran) include headache, dizziness, and fatigue. Constipation, anxiety, fever, abdominal cramping, irritability, psychosis, and middle ear disturbances are not side effects/adverse effects of ondansetron.

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