git drugs

Drugs Acting on the

Gastrointestinal System

Prepared by:BSN 2 – Group

5Co, Rizza Yvonne

Dalida, Martin ElginDel Moro, Zyra

CharlayneNuguit, Katrina

Oreta, Chela MarieSante, Charisse

JaneTolete, Sandra

Vendiola, Carla

Drugs Acting on the Gastrointestinal System

Review of the Gastrointestinal System

The Gastrointestinal System, comprising the alimentary canal and the digestive tracts, begins at the oral cavity of the mouth and ends at the anus.


Major structures are • Oral cavity (mouth,

tongue and pharynx)

• Esophagus• Stomach• Small intestine

(duodenum, jejunum and ileum)

• Large intestine (cecum, colon and rectum)

• Anus


Accessory organs and glands are

• Salivary glands• Pancreas• Gallbladder• Liver


MAIN FUNCTION OF GI SYSTEM: • Digestion of food particles and

absorption of the digestive contents (nutrients, electrolytes, minerals, and fluids) into the circulatory system for cellular use.

• Digestion and absorption take place in the small intestine and lesser extent in the stomach. Undigested materials passes the lower intestinal tract thru peristalsis to the anus/rectum and excreted as feces or stool.


Drugs Acting on theGastrointestinal System

A. ANTI-EMETICSB. EMETICSC. DIGESTIVE DRUGSD. ANTI-DIARRHEALSE. LAXATIVESF. ANTI-FLATULENTSG. ANTI-ULCERS


VOMITING • Vomiting(emesis), the

expulsion of gastric contents, has a multitude of cause, including motion sickness, viral and bacterial infection, food intolerance, surgery, pregnancy, pain, shock, effects of selected drugs (e.g., antineoplastics), radiation, and disturbances of the middle ear that affect equilibrium.


VOMITING• Nausea, a queasy sensation, may or

may not precede the expulsion.• The cause of the vomiting must be

identified.• Antiemetics can mask the underlying

cause of vomiting and should not be used until the cause has been determined unless the vomiting is so severe as to cause dehydration and electrolyte imbalance.


Drug Acting on Vomiting:

ANTI-EMETICSAnti-emetics has 3 CATEGORIES:a. Antihistaminesb. Phenothiazinesc. Serotonin 5-HT3

Receptor Antagonists


Anti-emetics: 1. Antihistamines

MECLIZINE HYDROCHLORIDE

Brand Name:•Bonamine

Classification:•Antiemetics specifically Antihistamine - used for nausea and vomiting caused by inner ear stimulation.


Mechanism of Action:•Reduces ob of the labyrinthine apparatus; probably acts at least partly by blocking cholinergic synapses in the vomiting center, which receives input from the CTZ and from peripheral nerve pathways; peripheral anticholinergica effects may contribute to efficacy.

Indication:•Prevention and treatment of nausea, vomiting, motion sickness•Possibly effective for the management of vertigo, associated with diseases affecting vestibular system


Dosage and Route:•Motion sickness- 25- 50 mg PO 1hr before travel. May repeat dose every 24 hr for the duration of the journey.•Vertigo- 25- 100 mg PO daily in divided doses


Available Forms:•Tablets•chewable tablets•capsules


Side Effects:•Dizziness•Sedation•Drowsiness•Epigastric pain•Diarrhea or constipation•Dry mouth•Dryness of nasal mucosa


Adverse Effects:•CNS- drowsiness, confusion, europhia, nervousness, restlessness, insomnia, excitement, seizures, vertigo, tinnitus, blurred vision, diplopia, auditory and visual hallucinations•CV- hypotension, palpitations, tachycardia •DERMATOLOGIC- urticaria, rash•GI- dry mouth, anorexia, nausea and vomiting, diarrhea and constipation•GU- urinary frequency, difficulty urination, urine retention•RESPIRATORY- respiratory depression, death (due to overdose, especially in young children), dry nose and mouth


Nursing Responsibilities:•Independent:Take as prescribe. Avoid excessive dosage. If you are using chewable tablets, chew them Carefully before swallowing. Instruct to avoid alcohol because serious sedation can occur.•Collaboration:Report to the physician if she/he experience difficulty in breathing, hallucinations, tremors, loss of coordination, visual disturbance, and irregular heart beat.


Anti-emetics: 2. Phenothiazines

PROCHLORPERAZINE MALEATE

Brand Name:Compazine

Classification:Antiemetic specifically Phenothiazines


Mechanism of Action:Acts on the chemoreceptor trigger zone to inhibit nausea and vomiting; in larger doses, it partially depresses vomiting center


Dosage and Route:• Psychotic disturbance- initially, 5-10 mg

PO TID or QID. Gradually increased dosage every 2-3 days as needed up to 50-75 mg per day for mild or moderate disturbance, 100-150 mg per day for more severe disturbance

• Antiemetic- for control of severe nausea and vomiting, 5-10 mg PO TID-QID.


Available Forms:• Tablets• capsules

Side Effects:• Sore throat• Fever unusual bleeding or brushing• Rash • Weakness• Tremors• Impaired vision• Dark- urine• Pale stools• Yellowing of the skin or eyes

Adverse Effects:• AUTONOMIC: dry mouth, salivation, nasal

congestion, nausea and vomiting, anorexia, fever, pallor, flushed faces, sweating, constipation, urinary retention, incontinence, polyuria, enuresis, ejaculation inhabitation, male impotence

• CNS: drowsiness, dizziness, insomia, vertigo, headache, weakness, tremors, ataxia, slurring, cerebral edema, seizure

• CV: hypotension, orthostatic hypotension, hypertension, tachycardia, bradycardia, cardiac arrest, heart failure, cardiomegaly, refractory arrhythmias, pulmonary edema

• EENT: glaucoma, photophobia, blurred vision, miosis, mydriasis, deposits in the cornea and lens (opacities),pigmentary retinopathy

• HEMATOLOGIC: transient leucopenia, adgranulocytosis

• HEPATIC: cholestatic jaundice• SKIN: mild photosensitivity, allergic reaction,

exfoliative dermatitis• OTHER: gynecomastia, hyperprolactinenia

Nursing Responsibilities:•Independent:Do not allow patient to crush or chew SR capsulesTake drug exactly as prescribe to avoid over-dose

because to not develop a substance abuse problem.Instruct the patient to avoid driving or engaging in other dangerous activities if dizziness, drowsiness or vision changes occur for the patient’s safety.•Collaboration:Report to the physician about dosage reduction.


Anti-emetics: 3. Serotonin 5-HT3 Receptor Antagonists

ONDANSTERON HYDROCHLORIDEBrand Name:

Zofran Zofran ODTClassification: Anti emetics especially Serotonin 5-HT3 receptor antagonists- block serotonin stimulation centrally in the chemoreceptor trigger zone and peripherally in the vagal nerve terminals, both of which stimulate vomiting.


Mechanism of Action:Block specific receptor sites (5-HT3), which are associated with nausea and vomiting in the chemoreceptor trigger zone, centrally and at specific sites peripherally. It is know whether its antiemetic actions are from actions are from actions at the central, peripheral, or combined sites


Dosage and Route:• Parenteral Prevention of chemotherapy-induced nausea and vomiting. Three 0.15

mg/kg doses. IV; first dose is given over 15 min. beginning 30 min. before chemotherapy; subsequent doses are given at 4 and 8 hrs, or a single 32 mg dose is infused over 15 min. beginning 30 min. before the start of the chemotherapy.

• Oral Prevention of nausea and vomiting associated with cancer

chemotherapy; 8 mg PO 30min. prior to chemotherapy, the 8 mg 8 hr later; give 8mg every 12 hr for 1-2 days after the completion of the chemotherapy, give 24 mg PO 30 min. before starting the chemotherapy.

Prevention of nausea and vomiting associated with radiotherapy: 8mg PO TID. For total-body radiotherapy; administered 1-2 hr before radiation each day. For single high- dose radiotherapy to abdomen, give 1-2 hr before radiotherapy, then 8hr for 1-2 days after completion of therapy. For daily fractionated radiotherapy to abdomen, give 1-2 hr before therapy, then 8hr for each day therapy is given.


• Parenteral and Oral Prevention of postoperative nausea and vomiting:

4mg undiluted IV, preferably over 2-5 min, or as a single IM dose immediately before induction of anesthesia of 16mg PO 1hr before anesthesia

Prevention of chemotherapy-induced nausea and vomiting

Parenteral 6 months-18 yr:three doses of 0.15mg/kg. IV over 15

min given 30 min before the start of the chemotherapy, then 4 and 8 hr later.

• Oral 12 years old and older: same as adult


4-11 yr: 4mg PO 30 min before the start of chemotherapy, 4mg at 4 and 8 hr, then 4mg PO TID for 1-2 days after completion of chemotherapy

Younger than 4: safety and efficacy not established Prevention of postoperative nausea and vomiting: 1

month-12 yr: 0.1 mg/kg IV if patient weighs less than 40 kg or a single dose of 40kg, preferably given 2- 5 min before or following induction of anesthesia. Infuse over at least 30 sec.


Available Form:• Tablets- orally disintegrating• Tablets- oral solution Injection


Indication:• Parenteral and oral- prevention of nausea and

vomiting associated with emetogenic cancer chemotherapy in patients older than 6months.

• Prevention of postoperative nausea and vomiting- to prevent further episodes, or when postoperative nausea and vomiting must be avoided (oral), prophylactically (parenterel) in patients older than 1 month

• Prevention of nausea and vomiting associated with radiotherapy

• Unlabeled uses: treatment of nausea and vomiting associated with acetaminophen poisoning, prostacyclin therapy


Side Effects:• Weakness• Dizziness (change position slowly to avoid injury)• Drowsiness

Adverse Reactions:• CNS- headache, dizziness, drowsiness, shivers,

malaise, fatigue, weakness, myalagia• CV- chest pain, hypotension• DERMATOLOGIC- pruritus• GI- abdominal pain, constipation, liver impaired,

diarrhea• GU- urinary retention• LOCAL- pain at injection site

Nursing Responsibilities:• Independent:Ensure that the timing of drug doses

correspond to that of the chemotherapy or radiation

Administered oral drug for 1-2 days following completion of chemotherapy or radiation

Instruct patient to immediately report difficulty breathing after drug administration.


EMETICS

Emetics include:

• Ipecac Syrup

Emetics- used to induce vomiting in a person who has ingested toxic substances.


Emetics: IPECAC SYRUP

Brand Names:• Generic only. No brands available

Classification:• Antidote


Mechanism of Action:• To induce vomiting after poisoning.• Irritates the gastric mucosa and stimulates the medullary chemoreceptor trigger zone to induce vomiting.

Indications:• Ipecac should be considered only in an alertconscious patient who has ingested a potentiallytoxic amount of poison.• As the effect of ipecac diminishes with time and asclinical studies have demonstrated no benefit fromits use, it should be considered only if it can beadministered within 60 minutes of the ingestion.• Even then clinical benefit has not been confirmed


Dosage and Route:

Adults • PO 15 to 30 mL followed by 3 to 4glasses of water. May repeat dose within 20min if vomiting does not occur.Children younger than 1 yr of age • PO 5 to 10mL followed by 1/ 2 glass of water.Children 1 to 12 yr of age • PO 15 mL followed by 1 to 2 glasses of water.


Available Forms:Syrup


Side Effects:• Signs of potential side effects, especially cardiac and muscle disorders related to emetine toxicity (with chronic abuse).Adverse EffectsCardiovascular• Heart conduction disturbances; atrial fibrillation; fatal myocarditis.CNS• Depression.GI• Diarrhea.Neuromuscular & skeletal• Myopathy


Nursing responsibilities:Independent: Explain to the patient that Ipecac should be given with

sufficient fluids, not milk or carbonated beverages. Do not give ipecac syrup to an unconscious or drowsy

child. Because vomited material may enter lungs and cause

pneumonia. Have patient sit upright with head forward before

administering dose and for 30 min or more after administration.


To prevent aspiration of the patient.Advise parents that drug has shelf life of 1

yr and should be replaced yearly. Instruct parents to check expiration date

before purchasing product.Prepare for forceful vomiting; have a large

basin ready, and move clothing to protective area.

To prevent waste of time in cleaning the room.


•Collaborative:Consult poison control center before administering.To report the toxic ingestions and for instructions.Teach parents to repeat dose if child does not vomit within 20 min and then to take child to emergency room.Because gastric lavage may be necessary.Instruct parents to always consult health care provider or poison control center before administration.


DIGESTIVE DRUGS(Digestants)

Digestive Drugs includes a. Pancreatinb. Pancrelipase

Digestive drugs (digestants) aids digestion in the patient who’s missing enzymes or other substances needed to digest food. Digestants that function in the GI tract, liver, and pancreas.


Digestants: 1.

PANCREATINBrand Names:* Pankreoflat

Classification:* Digestants especially Pancreatic Enzyme


Mechanism of Action:* Replaces endogenous exocrine pancreatic enzymes and aids digestion of starches, fats and proteins.Route Onset Peak DurationP.O. Unknown Unknown 1-2 hr

Indications:* Exocrine pancreatic secretion insufficiency; digestive aid in diseases related to deficiency of pancreatic enzymes, such as cystic fibrosis.


Dosage and Route:* Adult & Children:Dosage varies with condition treated. Usual first dose is 8,000 to 24,000 units of lipase activity PO before or with each meal or snack. Total daily dose also may be given in divided doses every 1-2 hours throughout.


Available Forms:TabletsCapsule


Side Effects:NauseaVomitingDiarrheaMouth and Skin IrritationAllergic ReactionsHigh Doses: causes problems such as high blood levels of a substance called uric acid, as well as colon damage.

Adverse Effects* GI: nausea, diarrhea with high doses* Skin: perianal irritation* Other: allergic reactions


Nursing Responsibilities:•*Independent:Instruct patient to take drug before or with meals and snacks.~ Because food slows absorption of medication and may interfere with complete absorption into the body.Warn patient not to inhale powder form or powder from capsules.~ It may irritate skin and mucous membranes.Instruct the client not to hold the tablets or capsule contents in mouth. ~The medication may irritate the inside of mouth.Do not crush or let patient chew the enteric-coated capsules.~ The drug will not survive acid environment of the stomach.Tell patient to store drug in airtight container at room temperature.~To protect the drug from moisture or heat.


• Collaborative: Report joint pain, swelling, soreness; difficulty of breathing; GI upset.~To watch out for unwanted reactions to the drug. Instruct patient not to change brands without consulting prescriber.~Because some brands are interchangeable and some are not. Tell the doctor and pharmacist what prescription and nonprescription

medications, vitamins, nutritional supplements, and herbal products the patient is taking. Be sure to mention iron products.

~The doctor may need to change the doses of the medications or monitor the patient carefully for side effects.

Consult the doctor or pharmacist for more information about what foods/liquids to avoid.

~To avoid mixing of foods. Instruct the client to watch out for the change in one’s own health

condition.~To determine if it is better, worse or the same.


Digestants: 2.

PANCRELIPASE

Brand Names:Zenpep

Classification: Digestive Enzyme


• Mechanism of Action: Replacement of pancreatic enzymes: Helps to digest and absorb fat, proteins, and carbohydrates.Route Onset Peak DurationP.O. Variable Variable Variable

• Indications: Replacement therapy in patients with deficient exocrine pancreatic secretions, cystic fibrosis, chronic pancreatitis, postpancreatectomy, ductal obstructions, pancreatic insufficiency, steatorrhea or malabsorption syndrome, and postgastrectomy.* Presumptive test for pancreatic function.


Dosage and Route:* AdultsCapsules and Tablets4,000-2,000 units PO with each meal and with snacks, usually 1-3 capsules or tablets before or with meals and snacks. May be increased to 8 capsules or tablets in severe cases. 500 units/kg/meal to maximum of 2,500 units/kg/meal. Patients with pancreatectomy or obstruction, 8,000-16,000 units PO lipase at 2-hr intervals, may be increased to 64,000-88,000 units.


• Powder0.7g PO with mealsPediatric Patients 7-12 yr4,000-12,000 units PO lipase with each meal and with snacks.Pediatric Patients 4 yr to younger than 12 yr500 units/kg/meal to maximum of 2,500 units/kg/mealPediatric Patients 1-6 yr4,000-8,000 units PO lipase with each meal and 4,000 units with snacksPediatric Patients 1 to younger than 4 yr1,000 unit/kg/meal to maximum of 2,500 units/kg/mealPediatric Patients 6 mo-1 yr2,000 units lipase PO per meal; 2,000-4,000 units per feeding


• Side Effects:* Dizziness; gas; headache; stomach pain.* Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); painful, swollen joints; severe or persistent loose stools, diarrhea, or constipation; severe or unusual nausea, vomiting, or stomach pain.

•Adverse Effects* GI: Nausea, abdominal cramps, diarrhea* GU: Hyperuricosuria, hyperuricemia with extremely high doses* Hypersensitivity: Asthma with inhalation of fine–powder concentrates in sensitized individuals


Nursing Responsibilities:•* Independent:Instruct patient to take drug before or with meals and snacks.Follow the doctor’s instruction on how the drug is taken.Tell patient not to crush or chew enteric-coated forms. Capsules containing enteric-coated capsules may be opened and sprinkled on a small quantity of cool, soft food.For the convenience of the patient’s swallowing.Warn patient not to inhale powder form or powder from capsules.It may irritate skin or mucous membranes.Tell patient to store drug in an airtight container at room temperature.To protect from moist, heat and light.Do not hold the pankreoflat tablet in your mouth. The medication may irritate the inside of your mouth.


BACK

•Collaborative:Instruct patient not to change brands without consulting prescriber.~Some brands of pancreatin are interchangeable while others are not. Ask your pharmacist which brands or generic forms can be substituted for another.Tell the client the importance of takingpancreatin regularly to get the most benefit. ~Get your prescription refilled before you run out of medicine completely.Do not change brands of pancreatin without first talking to the physician or pharmacist. ~Some brands of pancreatin are interchangeable while others are not.It is very important to follow the diet plan created for your patient by the doctor or nutrition counselor. ~He should become very familiar with the list of foods he should eat or avoid to help control his condition.


DIARRHEA• Diarrhea (frequent liquid

stool) is a symptom of an intestinal disorder.

• Causes include: Foods (spicy, spoiled) Fecal impaction Bacteria (Escherichia

coli, Salmonella) or virus (parvovirus, rotavirus)

Toxins Drug reaction Laxative abuse

Malabsorption syndrome caused by lack of digestive enzymes

Stress and anxiety Bowel tumor Inflammatory bowel

disease, such as ulcerative colitis or Crohn’s disease.


DIARRHEA

• Diarrhea can be mild to severe.

• Antidiarrheals are not to be used for more than 2 days and should not be used if fever is present.


Drug Acting on Diarrhea:

ANTI-DIARRHEALSAnti-diarrheals has 4 MAIN CATEGORIES:a. Opioid-Related Drugsb. 5-HT3 Receptor Antagonistsc. Adsorbentsd. Somatostatin Analog


Anti-diarrheals: 1. Opioid-Related Drugs

LOPERAMIDEBrand Names:ImmodiumClassification:Antidiarrheals specifically Opioid related drugs - decrease peristalsis (involuntary, progressive, wavelike, intestinal movement that pushes fecal matter along) in the intestine.


Mechanism of Action:* > Slows intestinal motility and affects water and electrolyte movement through the bowel by inhibiting peristalsis through direct effects on the circular and longitudinal muscles of the intestinal walls.Indications:• Control and asymptomatic relief of acute non

specific and chronic diarrhea associated with inflammatory bowel disease.

• Reduction of volume of discharge from ileostomies.

• OTC use, control of diarrhea, including travellers’ diarrhea.


Dosage and Route:• Acute diarrhea:* Initial dose of 4mg PO followed by 2mg after each unformed stool. *donot exceed 16mg/day unless prescribed by a doctor.• Chronic diarrhea: Initial dose of 4mg PO followed

by 2mg after each unformed stool.*average daily maintenance is 4 to 8 mg. Travellers’ diarrhea: 4mg PO after 1st loose stool,

after 2mg after each subsequent stool. *donot exceed 16mg/day.

Pediatric patient: avoid use in children below 2yo, donot use OTC product with children.


Contraindications: patients with allergy to loperamide Patients who must avoid constipation, diarrhea Use cautiously with hepatic impairment, acute ulcerative

colitis pregnancy and lactation

Side Effects: The most common side effects associated with Imodium are

mild dizziness, drowsiness, dry mouth, mild stomach pain and tiredness. In relieving diarrhea, the medication also can cause constipation.

Serious but rare Imodium side effects call for immediate medical attention. These include severe stomach pain, worsening diarrhea and vomiting.


Adverse Effects• CNS: tiredness, drowsiness, dizziness • GI: toxic megacolon, (in pt with ulcerative colitis)

abdominal pain, distention or discomfort, constipation, dry mouth, nausea,

• vomiting • Hematologic: myelosuppression • Hypersensitivity: rash • Respiratory: pulmonary (infiltrates and fibrosis)


Nursing Responsibilities:• * Independent: monitor input /output MIO= to make sure the patient

does not end up dehydrated monitor for the medicine reaction/response = to take

other options if otherwise make sure the patient does not take prohibited foods

= this might further aggravate his condition. make the patient comfortable = so that the he will

relax, and avoid further complications. e. give drug after each unformed stool, keep track of amount given = to avoid excessive amount.


Collaborative: take drug as prescribed, donot

exceed prescribed dosage. This might cause drug overdose. drink clear fluids To avoid

dehydration. do not be shocked upon

experiencing common side effects as this will pass…

d. report abdominal pain and distention, for immediate health action


Anti-diarrheals: 2. 5-HT3 Receptor Antagonists

ALOSETRONBrand Name: Lotronex Classification: Antidiarrheals specifically 5 HT3 Receptor Antagonists- used for short-term treatment of women with irritable bowel syndrome (IBS)


Mechanism of Action:Selectively inhibits 5- HT3 receptors in the GI tract, which blocks neuronal depolarization, resulting in less visceral pain, colonic transit and GI secretions.


Indications:Treatment of severe diarrhea predominant IBS in women who have chronic IBS (longer than 6 months), have no anatomic or biochemical abnormalities of the GI tract, and who have failed to respond to conventional therapy.


Dosage and Route:• Individualize dosage; increase dosage gradually to

avoid adverse effects; decrease dosage gradually (no more than 0.5 mg q 3 days) when discontinuing drug.

Adults:• Anxiety disorders: Initially, 0.25-0.5 mg PO TID;

adjust to maximum daily dose 4 mg/ day in divided doses at intervals of 3-4 days or extended- release form once per day in the AM once dosage is established (immediate release, intensol solution).


• Panic Disorder: Initially, 0.5 mg PO TID; increase dose at 3-4 day intervals in increments of no more than 1 mg/ day; ranges of 1-10 mg/ day have been needed. ER tablets- initially, 0.5- 1 mg/day; dosage range, 3-6 mg/day.

• Geriatric patients/ Patients with hepatic disease: Initially, 0.25 mg bid-tid PO; gradually increase if needed and tolerated; ER tablets—0.5 mg PO once each day; gradually increase if needed and tolerated.


Available Forms:• Tablets • ER tablets • Oral solution• Rapidly disintegrating tablets


Side Effects:• Headache• Nausea• Vomiting• Constipation• Ischemic colitis

Adverse Effects:• CNS: Anxiety, tremors, dreams, headache• Dermatologic: sweating, urticaria• GI: Abdominal pain, nausea, constipation,

Ischemic colitis• Other: Malaise, fatigue, pain


Nursing Responsibilities:• Independent: Advise patient that drug may be taken with or

without food as the drug is safe to take even without eating meals.

Inform patient not to share drug with other people having similar symptoms. This drug hasn’t been shown to be safe or effective for men.

In order to prevent complications or adverse reaction to the patient.

Tell patient to notify the prescriber immediately if she becomes pregnant as the drug crosses the placenta; during lactation drug is secreted in breast milk and serious adverse effects could occur during pregnancy.


• Collaborative: Report to doctor when constipation, signs of

ischemic colitis occurs --- worsening abdominal pain, bloody diarrhea, blood in the stool; continuation of IBS symptoms without relief.

To give immediate treatment or medication, as well as medical attention.


Anti-diarrheals: 3. Adsorbents

BISMUTH SALICYLATEBrand Names:BismatrolBismatrol Extra Strenght Classification:Anti-diarrheals specifically Adsorbents – are prescribe as antidotes for the ingestion of toxins, substances that can lead to poisoning or overdose.


Mechanism of Action:> May have antisecretory, antimicrobial, and anti inflammatory effects. Probabaly increases smooth muscle tonne, in GI

tract, inhibits motility and propulsion and diminishes secretions.

Indications:Bismuth subsalicylate is a medication that relieves diarrhea or loose stools as well as heartburn, indigestion, and stomach upset.


Dosage and Route: > Mild Non Specific Diarrhea

ages 12 and older: 30ml or 2 tablets PO q30mins -1hr up to max of 8 doses and for no longer than 2 days.> ages 9 to 12: 15ml or 1 tab PO q30mins to 1 hr> ages 6 to 9: 10ml PO q 30 minsto 1 hr

> ages 3 to 6: 5ml PO q30 mins

Travellers diarrhea: > 2 tabs PO qid before meals and hs for up to 3

weeks when traveling.


Contraindications:Patients hypersensitive to salicylatesuse cautiously in patients taking aspirinStop, if tinnius occursuse cautiously in children and in patients with bleeding disorders

Side Effects:Approximately 12 percent of bismuth subsalicylate users report nausea, making this the most common side effect of the drug. Around 6 percent of patients actually report increases in diarrhea and abdominal pain while taking the drug. Black, tarry stools are also common, occurring in at least 3 percent of users. More than 2 percent of people who take bismuth subsalicylate experience an increased incidence of upper respiratory infections


Danger Side Effects:Bismuth subsalicylate also has the potential to cause a number of other annoying, but not dangerous, side effects. Additional gastrointestinal side effects of the drug include constipation, loss of appetite, vomiting, discoloration of your tongue, changes in taste, flatulence and itching or soreness around your anus. Some patients experience neurological side effects while taking bismuth subsalicylate, such as dizziness, headaches, weakness, insomnia and tingling in the extremities. Body pains, ringing in your ears and sinus infections are also possible side effects of bismuth subsalicylate. Adverse EffectsTemporary darkening of tongue and stools salicylism with high dose


Nursing Responsibilities: • Independent: monitor fluid and electrolyte balance to avoid dehydration. correct fluid and electrolyte balance before starting drug, to

administer the proper medications. • Collaborative: advise patient that bismuth subsalicylate contains salicylate, instruct patients to shake liquid before measuring

dose( forcomplete medicine contents) and chew the tablet well for easy absorbent.


Anti-diarrheals: 4. Somatostatin Analog

OCTREOTIDEBrand Name: Sandostatin

Clasification:Anti diarheal specifically Somatostatin Analog - prescribed to inhibit gastric acid, pepsinogen, gastrin, cholecystokinin, and serotonin secretions and intestinal fluid.


Mechanism of Action:Mimics the natural hormone somatostatin; suppresses secretion of serotonin; gastrin vasoactive intestinal peptide, insulin, glucagon, secretin, motilin and pancreatic polypeptide; also suppreses growth hormone and decreases splanchnic blood flow.


Indications:• Symptomatic treatment of patients with

metastatic carcinoid tumors to suppress or inhibit the associated severe diarrhea and flushing episodes

• Treatment of the profuse watery diarrhea associated with vasoactive intestinal polypeptide tumors (VIPomas)


Dosage and Route: Adults• Subcutaneous injection is the route of choice. Initial

dose is 50 mcg subcutaneously 2-3 times daily; the number of injections is increased based on the response,usually BID- TID. IV bolus injections have been used in emergency situations --- not recommended. Depot injection: Do not administer IV or subcutaneously; inject intragluteally at 4-week intervals.

• Carcinoid Tumors: First 2week of therapy: 100-600 mcg/ day subcutaneously in 2-4 divided doses (mean daily dosage, 300 mcg)


• VIPomas: 200- 300 mcg subcutaneously in 2-4 divided doses during initial 2 wk of therapy to control symptoms. Range, 150-750 mcg subcutaneously; doses above 450 mcg are usually not required. Depot injection: 20 mg IM every 4 wk.

• Acromegaly: 50 mcg TID subcutaneously, adjusted up to 100- 500 mcg TID. Withdraw for 4 wk once yearly. Depot injection: 20 mg IM intragluteally once every 4 wk; after 2-3 mos., re-evaluate patient to adjust dosage as needed.

• Geriatric patients/ patients with renal impairment: Half- life may be prolonged; adjust dosage.


Available forms:• Injection • Depot injection


Side- effects:• Headache • Dizziness• Light- headedness• Fatigue• Nausea• Diarrhea• Abdominal pain• Flushing• Dry skin• Flaking of skin• Pain at injection site


Adverse Effects:• CNS: Anxiety, headache, dizziness, light-headedness,

fatigue, seizures, depression, drowsiness, vertigo, irritability, forgetfulness, malaise, nervousness, visual changes.

• CV:Shortness of breath, hypertension, thrombophlebitis, hearft failure, palpitations, bradycardia

• Dermatologic: Flushing, edema, hair loss, thinning of skin, bruising, rash, pruritus, skin flaking


• Endocrine: Hyperglycemia, galactorrhea, hyperthyroidism

• GI: nausea, vomiting, diarrhea, abdominal pain, loose stools, constipation, flatulence, hepatitis, GI bleeding, heartburn, dry mouth, burning mouth

• Local: Injection site pain• Muscoloskeletal: weakness, leg cramps, muscle pain,

joint pain• Respiratory: Rhinorrhea


BACK

Nursing Responsibilities:• Independent: Monitor patient regularly for gallbladder disease. Therapy may

be related to the development of cholelithiasis because of its effect on gallbladder motility or fat absorption.

Monitor patient closely for signs and symptoms of glucose imbalance. Patients with type I DM and those receiving oral antidiabetics may need dosage adjustments during therapy, Monitor glucose level because it may induce hypoglycemia or hyperglycemia.

Store ampules in the refrigerator, may be at room temperature on the day of use to do not reduce its effectiveness.

Monitor patients closely for endocrine reactions especially alterations on growth hormone level as the drug suppresses the growth hormone


CONSTIPATION• Constipation (accumulation of hard fecal material

in the large intestine) is a relatively common complaint and a major problem for older adults.

• Insufficient water intake and poor dietary habits are contributing factors.

• Other causes include:Fecal impactionBowel obstructionChronic laxative useNeurologic disorders (paraplegia) Ignoring the urge to defecateLack of exerciseSelected drugs, such as anticholinergics,

narcotics, and certain antacids


Drug Acting on Constipation:

LAXATIVESLaxatives has 4 MAIN CATEGORIES:a. Hyperosmolar

(Osmolar/Saline)Laxatives b. Dietary Fiber & Bulk-

Forming Laxativesc. Emollient Laxativesd. Stimulant Laxatives


Laxatives: 1. Hyperosmolar Laxatives

LACTULOSEBrand Names:Lilac Classification:Hyperosmolar laxatives- work by drawing water into the intestine, thereby promoting bowel distention and peristalsis.


Mechanism of Action:The drug passes unchanged into the colon where bacteria break it down to organic acids that increase the osmotic pressure in the colon and slightly acidify the colonic content, resulting in an increase in stool water content, stool softening, laxative action. This also results in migration of blood ammonia into the colon contents with subsequent trapping and expulsion in the feces.


Dosage and Route:• Adults Laxative: 15-30 mL/day PO; may be increased to 60

mL/day as needed OralPortal-systemic encephalopathy: 30-45 mL tid or qid. Adjust dosage every 1-2 days to produce two or three soft stools/day. 30-45 mL/hr may be used if needed. Return to standard dose as soon as possible. Rectal Portal-systemic encephalopathy: 300 mL lactulose mixed with 700 mL water or physiologic saline as retention enema, retained for 30-60 min. may be repeated every 4-6 hr. start oral drug as sonn as feasible and before stopping enemas


• Pediatric patients Laxative: safety and efficacy not established. OralPortal-systemic encephalopathy: standards not clearly established. Initial dose of 2.5-10 mL/day in divided dose for small children or 40-90 mL/day for older children is suggested. Attempt to produce two or three soft stools daily.


Indications:Treatment of constipationPrevention and treatment of portal-systemic encephalopathy


Available forms:Syrup, solution


Side Effects:• Abdominal fullness • Flatulence• Belching Adverse Effects• GI: Transient flatulence, distention, intestinal

cramps, belching, diarrhea, nausea• Other: Acid-base imbalances, electrolyte

imbalance


Nursing Responsibilities: • Independent: Encourage increased fluid intake to prevent dehydration Sufficient

fluid intake is necessary for the bowel to absorb sufficient amounts of liquid to promote proper stool consistency.

Instruct patient to eat a high fiber diet. Fiber is an important element in promoting healthy digestion. It enhances easy defecation. Your diet should include fiber-rich foods such as fruits, vegetables and whole grains.

Determine stool color, consistency, frequency and amount. Assist in identifying causative or contributing factors and appropriate interventions.

Tell the patient that the drug can be mixed in water, juice, or milk.To make it more tolerable to take.

Instruct patient not to take other laxatives during lactulose therapy to prevent diarrhea


• Collaborative: Seek emergency medical attention if you think you have used

too much of this medicine. Overdose symptoms may include diarrhea, stomach pain, hot and dry skin, confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, and muscle weakness or limp feeling.

Consult with dietitian to provide well balanced diet high in fiber, fiber resists enzymatic digestion and absorbs liquids in its passage along intestinal tract and thereby produces bulk, which act as a stimulant in defecation

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include diarrhea, stomach pain, hot and dry skin, confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, and muscle weakness or limp feeling.


Laxatives: 2. Dietary Fiber & Bulk-Forming Laxatives

CALCIUM POLYCARBOPHIL

Brand Names:Equalactin, Fiberall, FiberCon, Fiber-Lax, Phillips’ Fibercaps

Classification:Laxative specifically Bulk – Forming LaxativesAntidiarrheal


Mechanism of Action:Acts as a bulk laxative by keeping water within the bowel lumen. The increased bulk encourages peristalsis and bowel movement. As an antidiarrheal by taking on water within the bowel lumen to create a formed stool. Normalization of bowel water content while adding bulk, treating both diarrhea and constipation.


Dosage and Route:• AdultsPO: 1 G 1-4 x daily or PRN, not to exceed 6 g/24 hr.• Children 6-12 yrPO: 500 mg 1-3 x daily or PRN, not to exceed 3 g/24 hr.Children 2-6 yrPO: 500 mg 1-2 x daily, or PRN, not to exceed 1.5 g/24 hr.


Available Forms:• Tablets• Tablets (chewable)

Indications:Treatment of constipation or diarrhea

Side Effects:• Vomiting• Chest pain• DOB• Difficulty of swallowing after taking the

medication.


Adverse EffectsGI: abdominal fullness and increased flatus, intestinal obstructionOther: laxative dependence with long term or excessive use.Nursing Responsibilities: Independent:Determine stool color, consistency, frequency and amount. Assist in identifying causative or contributing factors and appropriate interventions. b. advise patient to chew Equalactin tablets thoroughly before swallowing and to drink an 8 ounce glass of water with each dose. When drug is used as an antidiarrheal, tell patient not to drink the glass of water. The polycarbophil tablet may expand in your throat and cause you to choke if you do not use enough liquid to help swallow the pill. Always take polycarbophil with plenty of fluids. Insufficient fluid may cause the fiber to swell and cause choking or even rupture of the esophagus. Do not use polycarbophil if you have difficulty swallowing.


Laxatives: 3. Emollient Laxatives

DOCUSATE CALCIUM

Brand Names:Surfak Classification:Stimulant laxative: Stool softener


Mechanism of Action:Stool softener that reduces surface tension of interfacing liquid contents of the bowel. This detergent activity promotes incorporation of additional liquid into stools, thus forming a softer mass. Also promotes electrolyte and water secretion into colon.


Dosage and Route:• Adults and children older than 1250- 500 mg docusate calcium or sodium P.O daily until bowel movements are normal. Or, give enema. Dilute 1:24 with sterile water before use, and give 100 to 150 ml retention enema, 300 to 500 ml evacuation enema, or 0.5 to 1.5 L Flushing enema. PR.• Higher dosage is used for initial therapy. Adjust

dosage to individual response.


Available forms:•Capsules (soft gels)


Indications:relieves occasional constipation (irregularity)generally produces a bowel movement in 12 to 72 hours Side Effects:• Hypersensitivity to drug• stomach pain• nausea• vomiting• Intestinal obstruction Adverse Effects• GI: bitter taste, mild abdominal cramping, diarrhea• EENT: throat irritation• Skin: rash


Nursing Responsibilities: • Independent: Before giving drug, determine whether patient has adequate

fluid intake, because the colon needs water to do its job, thus dehydration can be a major cause of constipation. Exercise, because the movement of the body typically triggers the guts to undulate more, thus pushing the stool towards the rectum and increasing the "urge" to go. Diet, because constipation is usually caused by a combination of a high fat and low fiber diet.

Tell patient about dietary sources of food including bran and other cereals, fresh fruits and vegetables. These are rich in fiber that can help the stools form.


Instruct patient to use drug only occasionally and not for longer than 1 week without prescriber’s knowledge. It may lead to laxative dependence.

Tell patient to stop drug and notify prescriber if severe cramping occurs to treat underlying causes.

Notify patient that it will take 1- 3 days to soften stools.• Collaborative: Report if stomach pain/cramping, nausea and vomiting

occur.


Laxatives: 4. Stimulant Laxatives

BISACODYLBrand Names:Dulcolax Classification:Stimulant Laxatives


Mechanism of Action:Stimulant laxative that increases peristalsis, probably by direct effect on smooth muscles of the intestine, by irritating the muscles or stimulating the colonic intramural plexus. Drug also promotes fluid accumulation in colon and small intestines. Dosage and Route:• Adults and children age 12 and older: 10 to 15 mg P.O in

evening or before breakfast. Up to 30 mg P.O, prn. Or, 10mg PR. For evacuation before examination or surgery.

• Children ages 6- 11: 5mg P.O or P.R H.S or before breakfast. Oral dose isn’t recommended if child can’t swallow tablet whole.


Available forms:• Enema• Powder for rectal solution (bisacodyl tannex)• Suppositories• Tablets


Indications:Chronic constipation, preparation for childbirth, surgery, rectal or bowel examination Side Effects:• Hypersensitivity to drug• Nausea and vomiting• Abdominal cramps• faintness


Adverse Effects• CNS: muscle weakness with excessive use, dizziness,

faintness• GI: nausea, vomiting, abdominal cramps, diarrhea

with high doses, burning sensation in rectum with suppositories, laxative dependence with long term or excessive use, protein-losing enteropathy with excessive use.

• Metabolic: alkalosis, hypokalemia, fluis and electrolyte imbalance.

• Musciloskeletal: Tetany


Nursing Responsibilities: • Independent:• Suppository; Give drug at times that don’t interfere with scheduled activities

or sleep. Soft, formed stools are usually produced 15- 60 minutes after rectal use.

Before giving for constipation, determine whether patient has adequate fluid intake, exercise, and diet.

Tablets and suppositories are used together to clean the colon before and after surgery and before barium enema.

Insert suppository as high as possible into the rectum, and try to position suppository against the rectal wall. Avoid embedding within fecal material because doing so may delay onset of action.


BACK

• Oral Advice patient to swallow enteric-coated tablet whole to

avoid GI irritation. Instruct him not to take within 1 hour of milk or antacid.

Tell patient that drug is for 1 week treatment only because it is often abuse.

Teach patient about dietary sources of bulk, including bran and other cereals, fresh fruits, and vegetables.

Tell patient to take drug with a full glass of water or juice.• Collaborative:Advise patient to report adverse effects to prescriber to prevent complications.


FLATULENCE• Flatulence is the state of having

excessive stomach or intestinal gas. This can result in uncomfortable feelings of bloating, as well as increased belching (burping) or passing of gas from the rectum.

• Flatulence is the expulsion through the rectum of a mixture of gases that are byproducts of the digestion process

• The gases are expelled from the rectum in a process uncommmonly referred to as "passing gas", "breaking wind" or "farting".


FLATULENCE• Flatus is brought to the rectum by

the same peristaltic process which causes feces to descend from the large intestine.

• The noises commonly associated with flatulence are caused by the vibration of the anal sphincter, and occasionally by the closed buttocks.


Drug Acting on FLATULENCE:

ANTI-FLATULENTSAnti-Flatulent:

SIMETHICONEBrand Name:• Disflatyl

Classification• Antiflatulents- disperse gas pockets in the GI tract.

They’re available alone or in combination with antacids.


Mechanism of Action• Defoaming action disperses and prevents the

formation of mucus-surrounded gas pockets in the GI tract;

• Changes the surface tension of gas bubbles in the stomach and small intestine, enabling the bubbles to coalesce, allowing gas to be more easily freed by belching per flatus.

• Pharmacokinetics: not absorbed systematically; excreted unchanged in feces


Dosage and Route• Adults Capsules: 125 mg PO qid, after each meal and

at bedtime Tablets: 40-125 mg PO qid, after each meal

and at bedtime Drops: 40-80 mg PO qid up to 500 mg/day,

after each meal and at bedtime• Pediatric patients 2-12yr 40 mg PO qid after each meal and at bedtime• Pediatric patients younger than 2 yr 20 mg PO qid after each meal and at bedtime;

up to 240 mg/day


Available forms:• Chewable tablets• Tablets • Capsules• Drops


Indications• Relief of symptoms of

pressure, bloating, and fullness from excess gas in the digestive tract;

• Postoperative gaseous distention and pain, use in endoscopic examination; air swallowing; functional dyspepsia; spastic or irritable colon; diverticulosis


Side Effects • Increased belching• Passing of flatus as gas disperses

Adverse Effects• GI: nausea, vomiting, diarrhea,

constipation, belching, passing of flatus


Nursing Responsibilities• Independent

Take drug after each meal and at bedtime to reduce the impact of acidity.

taking the chewable tablet form of this medicine it is important that you chew the tablets thoroughly before you swallow them. This is to allow the medicine to work faster and more completely.

Advise patient that changing positions often and walking will help pass flatus.

Avoid foods that seem to increase gas, to reduce air swallowing by avoiding fizzy, carbonated drinks.

Shake well before use, because the medicine could be a heterogeneous mixture, and part of it had settled out. Shake it, and it should mix together again


BACK

• Collaborative Report extreme abdominal pain, worsening of condition being

treated, vomiting to relief the symptoms of pressure, bloating.

Do not use this medication without medical advice if you are breast-feeding a baby. It is not known whether simethicone passes into breast milk or if it could harm a nursing baby.

Never use simethicone if you have allergy because it is contraindicated with allergy to components of the products.

The liquid form may contain phenylalanine. Talk to your doctor before using this form of simethicone if you have phenylketonuria (PKU).

Do not change to another brand without checking with your doctor. The number of capsules or tablets that you take depends on the brand and strength of the medicine. If you refill your medicine and it looks different, check with your pharmacist.


ULCERS

• Peptic ulcer is a broad term for an ulcer occurring in the esophagus, stomach or duodenum within the upper gastrointestinal (GI) tract.


ULCERS• The ulcers are more specifically named according to the site of

involvement: esophageal, gastric, and duodenal ulcers. Duodenal ulcers occur 10 times more frequently than gastric and esophageal ulcers. The release of HCl from the parietal cells of the stomach is influenced by – Histamine - The release of histamine is the most important

positive regulation mechanism of the secretion of gastric acid in the stomach. Its release is stimulated by gastrin and acetylcholine.

– Gastrin - peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and aids in gastric motility. Gastrin acts on parietal cells directly and indirectly too, by stimulating the release of histamine.

– Acetylcholine - a neurotransmitter that acts on both direct on parietal cells and mediated through the secretion of gastrin from G cells and histamine.


ULCERS• Peptic ulcers

occurs when there is a hypersecretion of HCl and pepsin (a digestive enzymes), which erode the GI mucosal lining.


Drug Acting on Ulcers:

ANTI-ULCERSAntiulcer drugs are a class of drugs, exclusive of the

antibacterial agents, used to treat ulcers in the stomach and the upper part of the small intestine.

Anti-ulcers has 5 CATEGORIES:a. Systemic Antibioticsb. Antacidsc. Histamine-2 (H2) Receptor Antagonistsd. Proton Pump Inhibitors (PPIs)e. Pepsin Inhibitor


Anti-Ulcers: 1. Systemic Antibiotics

CLARITHROMYCIN

•Brand Names:

Biaxin, biaxin XL

Brand Names:Biaxin, biaxin XL

Classification:Antiulcerants specifically Systemic antibiotics - eradication of bacteria helps to heal ulcers and decrease their recurrence.


Mechanism of Action:• Inhibits protein synthesis

in susceptible bacteria, causing cell death.

• Pharmacokinetics Metabolism: hepatic

t1/2:3-7 hr Distribution: crosses

placenta; enters breast milk

Excretion: urine


Dosage and Route:• Adults- 250, 500 mg PO every 12 hr

for 7-14 days• Pediatric patients- 15 mg/kg/day PO

divided every 12 hr for 10 days• Geriatric patients pr patients with

impaired renal function- decrease dosage or prolong intervals as appropriate.


Available Forms:• Tablets• Granules For Suspension• ER Tablets


Indications:• Treatment of URIs• Treatment of lower respiratory infections• Treatment of skin and skin structure infections• Treatment and prevention of disseminated

mycobacterial infections • Treatment of active duodenal, ulcer associated

with H. pylori in combination with proton pump inhibitor

• Treatment of acute otitis media, acute maxillary sinusitis

• Treatment of mild to moderate community- acquired pneumonia

Side Effects:• Stomach cramping• Discomfort• Diarrhea• Fatigue• Headache• Additional infection

in the mouth or vagina

Adverse Effects:• CNS: dizziness,

headache, vertigo, somnolence, fatigue

• GI: diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomambranous colitis, abnormal taste

• Other: superinfeclions, increased PT, decrease WBC count


Nursing Responsibilities:• Independent

Take drug with food if GI effects occur, because taking them with food may help avoid GI side effects like nausea that you might experience if you take the medication on an empty stomach.

Shake suspension before use, because the medicine could be a heterogeneous mixture, and part of it had settled out. Shake it, and it should mix together again.

Inform patient that drug may be taken with or without food because it does not reduce the impact of acidity.

Do not refrigerate because it will change its texture and its taste, it will get worse. You should keep this suspension at room temperature.

Swallow the tablets and capsules whole; do not split, chew, or crush them because it can lessen the efectiveness of the drug.


• Collaborative Report severe or watery diarrhea, severe nausea and

vomiting to have early treatment

Advise patient to report persistent adverse reaction so that we can see if that drug is compatible or not

Take clarithromycin exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended because overdose symptoms may include severe stomach pain, nausea, vomiting, or diarrhea.

tell your doctor if you are pregnant or plan to become pregnant while using this medication because it is not known whether clarithromycin will harm an unborn baby. Before you take clarithromycin.

tell your doctor if you have or have ever had kidney or liver disease to inhibit protein synthesis in susceptible bacteria, causing cell death


Anti-Ulcers: 2. Antacids

ALUMINUM HYDROXIDE

Brand Name:Amphojel

ClassificationAntiulcerants specifically Antacids - are over-the counter (OTC) medication that are used as adjunct therapy to treat peptic ulcers.


Mechanism of Action• Neutralizes or reduces gastric acidity, resulting in

an increase in the pH of the stomach and duodenal bulb and inhibiting the proteolytic activity of pepsin, which protects the lining of the stomach and duodenum.

• Lowering phosphate in hyperphosphatemia and chronic renal failure; may cause hyposphatemia in other states.

• Pharmacokinetics Metabolism: hepatic Distribution: long-term use, small amounts

maybe absorbed systematically and cross the placenta and enter breast milk

Excretion: feces


Dosage and Route:• AdultsTablets and capsules: 500- 1500 mg 3-6 times/day PO between meals and bedtimeLiquid: 5-10 mL between meals and bedtime, or as directed.• Pediatric patients – 5-15 mL PO every 3-

6 hr or 1-3 hr after meals and at bedtime


Available Forms• Tablets• Capsules • Suspension • Liquid


Indication• Symptomatic relief of upset stomach

associated with hyperacidity• Hyperacidity associated with uncomplicated

peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, hiatal hernia

• Unabled uses: prophylaxis of GI bleeding, stress ulcer, reduction of phosphate absorption in hyperphosphaternia in patients with chronic renal failure; suspected GERD laryngitis (adults).


Side Effects• constipation• loss of appetite• confusion• unusual tiredness or discomfort• muscle weakness

Adverse Effects• GI: constipation; intestinal obstruction;

decreased absorption of fluoride; accumulation of aluminum in serum, bone, and CNS; rebound hyperacidity

• Musculoskeletal: osteomalacia and chronic phosphate deficiency with bone pain, malaise, muscular weakness


Nursing Responsibilities• Independent

Avoid taking other medications at the same time you take aluminum hydroxide, because antacids can make it harder for your body to absorb certain other drugs.

Shake well before use, because the medicine could be a heterogeneous mixture, and part of it had settled out. Shake it, and it should mix together again.

Do not use the maximum dosage of this product for more than two weeks, because excessive doses, or normal doses in patients with low phosphate diets may lead to phosphate depletion accompanied by increased reabsorption and urinary excretion of calcium with the risk of osteomalacia.

measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon, so that you wil get a correct dose.

If tablets are being used, chew thoroughly before swallowing, and follow with a glass of water, because tablets are bitter so when we take it we need to drink water for as not to taste the bitterness of it.


• Collaborative Report constipation; bone pain, muscle weakness, coffee

ground vomitus, black tarry stools; no relief from symptoms being treated because constipation is the most common adverse effect so that we can prevent to have a severely gastric acidity.

Consult with your heath care provider before using other drug because it make harder for your body to absorb certain other drugs.

Instruct pregnant patient to seek medical advice before taking drug because it may be harmful to unknown baby and may pass into breast milk and could harm a nursing baby.

Urge patient to notify prescriber about signs and symptoms of GI bleeding, such as tarry stool or coffee-ground vomitus, because bloody stools often are a sign of an injury or disorder in the digestive tract


Anti-Ulcers: 3. H2 Receptor Antagonists

RANITIDINE HYDROCHLORIDEBRAND NAMES:

• ZantacCLASSIFICATION:• Antiulcerants specifically Histamine-2 (H2)

antagonist - Block histamine-2 receptors of the parietal cells in the stomach, thus reducing gastric acid and concentration from stimulating the acid-secreting parietal cells of the stomach.


Mechanism of Action:• Competitively inhibits the action of histamine

at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic-agonists, gastrin and pentagastrin.

• Pharmacokinetics: Metabolism: Hepatic; T1/2: 2-3 hr Distribution: Crosses the placenta; enters

breast milk Excretion: Urine


Dosages and Route:• Adults:

Active duodenal ulcer: 150 mg bid PO for 4-8 wk. Alternatively, 300 mg PO once daily at bedtime or 50 mg IM or every 6-8 hr or by intermittent IV infusion, diluted to 100 mL and infused over 15-20 min. Do not exceed 400 mg/day.

Maintenance therapy, duodenal ulcer: 150 mg PO at bedtime. Maintenance therapy, gastric ulcer: 150 mg PO at bedtime. Active gastric ulcer: 150 mg bid PO or 50 mg IM or IV every 6-8 hr. Pathologic hypersecretory syndrome: 150 mg bid PO. Individualize

the dose with patient’s response. Do not exceed 6g/day. GERD, esophagitis, benign gastric ulcer: 150 mg bid PO. Treatment of heartburn, acid ingestion: 75 mg PO as needed.


• Pediatric Patients 1 mo-16yr Injection: 2-4 mg/kg/day IV or IM every 6-8 hr to

a maximum of 50 mg every 6-8 hr.• Geriatric patients or patients with impaired renal

function For creatinine clearance less than 50mL/min,

accumulation may occur, use lowest dose possible, 150 mg every 24 hr PO or 50 mg IM or IV every 18-24 hr. Dosing may be increased to every 12 hr if pt. tolerates it & blood levels are monitored.


Available forms:• Tablets• Capsules • Syrup• Injection


Indications:• Short term treatment of active duodenal ulcer• Maintenance therapy for duodenal ulcer at

reduced dosage• Short term treatment and maintenance

therapy of active, benign gastric ulcer• Short term treatment of GERD• Pathologic hypersecretory conditions (eg.

Zollinger-Ellison syndrome – adults only)• Treatment of erosive esophagitis• Treatment of heartburn, acid ingestion, sour

stomach.


Side Effects:• Constipation• Nausea and vomiting• Enlargement of breasts• Impotence or decreased libido• Headache


Adverse Effects• CNS: Headache, malaise, dizziness, somnolence,

insomnia, vertigo• CV: Tachycardia, bradycardia, PVCs (rapid IV

administration)• Dermatologic: Rash, alopecia• GI: Constipation, diarrhea, nausea, vomiting,

abdominal pain, hepatitis, increased ALT levels.• GU: Gynecomastia, impotence or decreased

libido• Hematologic: Leukopenia, granulocytopenia,

thrombocytopenia, pancytopenia• Local: Pain at IM site, local burning or itching at

IV site• Other: Arthralgias


Nursing Responsibilities: • Independent: Administer oral drugs with meals because to

decrease chances of nausea and vomiting and at bed-time for best results and to promote compliance.

Anticipate decreasing doses in renal and liver failure to not worsen condition.

Provide concurrent antacid therapy to relieve pain. But ensure that the pt. takes it exactly as prescribed, being careful of the times of administration to be effective. But administer antacids at least 1 hour before or after H2 receptor antagonists as antacids can decrease drug absorption.


Arrange for follow-up, including blood tests, to evaluate the side effects.

Adjust lights and temperature and avoid noise to reduce headache when pt experiences it.

Teach them to have regular medical follow-up care to evaluate their response

Urge patient to avoid cigarette smoking because this may increase gastric acid secretion and worsen disease.

Teach client to eat foods rich in vitamin B12 to avoid deficiency as a result of drug therapy.

• Collaborative: Report if sore throat, fever, unusual bruising or

bleeding, tarry stools, confusion, hallucinations, dizziness, severe headache, muscle or joint pain to evaluate the patient’s reaction to drug.


Anti-Ulcers: 4. Proton Pump Inhibitors

OMEPRAZOLEBrand Names:Prilosec, Prilosec OTC and Zegerid (with Sodium Bicarbonate) Classification:Antiulcerants specifically Proton Pump Inhibitor; Antisecretory drug - Disrupts chemical binding in stomach cells to reduce acid production, lessening irritation and allowing peptic ulcers to better heal. It blocks the last step in the secretion of gastric acid by the combining with hydrogen, potassium and ATP in the parietal cells of the stomach.


• Mechanism of Action:Gastric acid-pump inhibitor: Suppresses gastric secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.• Pharmacokinetics:

Metabolism: Hepatic; T1/2: 0.5-1 hr Distribution: Crosses the placenta;

may enter breast milk Excretion: Bile, urine


Indications:•Short term treatment of active duodenal ulcer•Treatment of heartburn or symptoms of GERD•Short treatment of active benign gastric ulcer•GERD; severe erosive esophagitis, poorly responsive symptomatic GERD•Long-term therapy: Treatment of pathological conditions (Zollinger-Ellison’s syndrome, multiple adenomas, systemic mastocytosis)•Eradication of Helicobacter pylori with amoxicillin or metronidazole and clarithromycinUnlabeled use: Posterior laryngitis


Available forms:• Capsules• Tablets• Powder for oral

suspension



Active duodenal ulcer: 20 mg PO for 2-8 wk. Should not be Maintenance therapy, duodenal ulcer: 150 mg PO at bedtime.

Active gastric ulcer: 40 mg PO daily for 4-8 wk. Severe erosive esophagitis or poorly responsive GERD: 20 mg PO

daily for 4-8 week. Do not use as a maintenance therapy. An additional 4-8 week course can be considered if needed.

Pathologic hypersecretory syndrome: In individualize dosage. Initial dose is 60 mg PO daily. Doses up to 120 mg tid have been used. Administer daily amounts greater than 80 mg in divided doses.

Frequent heartburn (2 or more days per week): 20 mg PO once daily before eating in the morning for 14 days. May repeat the 14 –day course every 4 mo. (Prilosec OTC)

Upper GI bleeding in critically ill patients: 40 mg PO followed by 40 mg PO in 6-8 hr on day 1; then 40 mg/day for up to 14 days (Zegerid).


• Pediatric Patients 2 yr and older GERD or other acid-related disorder: 10 mg if

patient weighs less than 20 kg, 20 mg if 20 kg or more.

• Pediatric Patients younger than 2 yr. Safety and efficacy not established


Side Effects:• Dizziness• Headache• Nausea, vomiting, diarrhea• Symptoms of URI• Cough Adverse Effects• CNS: Headache, dizziness, asthenia, vertigo, insomnia,

apathy, anxiety, paresthesias, dream abnormalities• Dermatologic: Rash, inflammation, urticaria, pruritus,

alopecia, dry skin• GI: Diarrhea, abdominal pain, nausea, vomiting,

constipation, dry mouth, tongue atrophy • Respiratory: URI symptoms, cough, epistaxis• Other: Cancer in preclinical studies, back pain, fever


Nursing Responsibilities: • Independent:

Administer before meals, about 30 minutes to increase its effectiveness

Caution patient to swallow capsules whole- not to open, chew, or crush them. These are delayed-release and long acting; opening crushing or chewing them destroys the drug’s effects.

Arrange for further evaluation of patient after 8 wk of therapy for GERD as it is not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies.

Administer antacids with omeprazole, if needed. Tell and caution patient to avoid hazardous activity if he gets dizzy

as this is a side effect of the drug.• Collaborative:

Report severe headache, worsening of symptoms, fever, chills and severe diarrhea

Advise patient to have regular medical follow-up visits to monitor closely his condition.


Anti-Ulcers: 5. Pepsin Inhibitor

SUCRALFATEBrand Names:Iselpin, Carafate Classification:Antiulcerants specifically Pepsin Inhibitor - A mucosal protective drug. It is nonabsorbable and combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin. It does not neutralize acid or decrease acid secretion.


Mechanism of Action:• Forms an ulcer-adherent

complex at duodenal ulcer sites, protecting the ulcer against acid, pepsin, and bile salts, thereby promoting ulcer healing; also inhibits pepsin activity in gastric juices.

• Pharmacokinetics: minimal systemic absorption


Indications:• Short term treatment of duodenal ulcers, up

to 8 wk• Maintenance therapy for duodenal ulcer at

reduced dosage after healing.• Treatment of oral and esophageal ulcers due

to radiation, chemotherapy and sclerotherapy.• Unlabeled uses: Accelerates healing of gastric

ulcers, long term treatments of gastric ulcers, treatment of reflux and peptic esophagitis, treatment of NSAID or aspirin-induced GI symptoms and GI damage, prevention of stress in critically ill patients.


Available forms:• Tablet



Active duodenal ulcer: 1 gg PO qid on an empty stomach (1 hr before meals and at bedtime. Continue treatment for 4-8 week.

Maintainance: 1 g PO Pediatric Patients Safety and efficacy not established

Side Effects:• Dizziness• Vertigo• Indigestion• Nausea• Dry mouth• constipation


Adverse Effects• CNS: dizziness, sleeplessness,

vertigo• Dermatologic: Rash, pruritus, • GI: constipation, diarrhea,

nausea, indigestion, gastric discomfort, dry mouth

• Other: back pain


Nursing Responsibilities: • Independent: Give drug on empty stomach, 1 hr before or 2 hr after

meals to enable binding of sucralfate to the gastric and duodenal mucosa to increase its effectiveness; and at bedtime for best results and to promote compliance.

Monitor pain; use antacids to relieve pain. Administer antacids bet. doses of sucralfate, not within 30 min before or after sucralfate doses as it may decrease binding of drug to gastroduodenal mucosa, impairing effectiveness.

Urge patient to avoid cigarette smoking, which may increase gastric acid secretion and worsen disease.

Advise patient to increase fluids, dietary bulk, and exercise to relieve constipation.


Teach client to avoid foods and liquids that can cause gastric irritation, such as caffeine-containing beverages, alcohol and spices.

Instruct patient to continue prescribed regimen to ensure complete healing. Pain and other ulcer signs and symptoms may subside within first few weeks of therapy.

• Collaborative: Report severe gastric pain for proper treatment.

BACK


thank

YOU

git drugs

Documents

chemoreceptor trigger zone

uneven heart rate

pathologic hypersecretory syndrome

adequate fluid intake

causing cell death

avoid cigarette smoking

ht3 receptor antagonists

critically ill patients