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NurseReview.Org - Pharmacology Git Drugs

  1. 1. Pharmacology of the GIT system
  2. 2. LECTURE Outline <ul><li>REVIEW the Anatomy of the GIT </li></ul><ul><li>REVIEW the Physiology of the GIT </li></ul><ul><li>Review common GI drugs in the following categories: </li></ul><ul><ul><li>1. Drugs affecting GI secretions </li></ul></ul><ul><ul><li>2. Laxatives </li></ul></ul><ul><ul><li>3. Anti-diarrheals </li></ul></ul><ul><ul><li>4. Emetics and anti-emetics </li></ul></ul>
  3. 3. Fig. 16.1
  4. 4. Fig. 16.10a
  5. 5. Fig. 16.10b
  6. 6. Fig. 16.11a
  7. 7. Fig. 16.11b
  8. 8. Fig. 16.12
  9. 9. Drugs affecting GI secretions <ul><li>There are five types of drugs that affect gastric acid secretions and are useful for the treatment of peptic ulcer. </li></ul><ul><li>Histamine (H2) receptor antagonist/blockers </li></ul><ul><li>Antacids </li></ul><ul><li>Proton pump inhibitors </li></ul><ul><li>Mucosal protectants </li></ul><ul><li>Prostaglandin analogs </li></ul>
  10. 10. Drugs affecting secretions: anti ulcer Misoprostol Prostaglandin analog Sucralfate Mucosal protectants Omeprazole Proton pump inhibitors AlOH and MgOH Antacids Cimetidine Histamine (H2) receptor antagonist/blockers Prototype Anti-ulcer drugs
  11. 11. General indication of the drugs affecting gastric acid secretion <ul><li>Peptic ulcer </li></ul><ul><li>Gastritis </li></ul><ul><li>Patient on NPO to prevent stress ulcer </li></ul>
  12. 12. General time of administration of the drugs affecting gastric acid secretion Misoprostol WITH MEALS Prostaglandin analog Sucralfate BEFORE MEALS Mucosal protectants Omeprazole BEFORE MEALS Proton pump inhibitors AlOH and MgOH Usually after meals Antacids Cimetidine With FOOD or ONE hour after ANTACID Histamine (H2) receptor antagonist/blockers Prototype Best time to give Anti-ulcer drugs
  13. 13. Pharmacodynamics <ul><li>Histamine (H2) receptor blockers </li></ul><ul><li>These drugs BLOCK the release of hydrochloric acid in the stomach in response to gastrin </li></ul>
  14. 14. Drugs affecting GI secretions <ul><li>Antacids </li></ul><ul><li>These drugs interact with the gastric acids at the chemical level to neutralize them </li></ul>
  15. 15. Drugs affecting GI secretions <ul><li>Proton pump inhibitors </li></ul><ul><li>These drugs suppress the secretion of hydrochloric acid into the lumen of the stomach </li></ul>
  16. 16. Drugs affecting GI secretions <ul><li>Mucosal protectants </li></ul><ul><li>These are agents that coat any injured area in the stomach to prevent further injury from acid </li></ul>
  17. 17. Drugs affecting GI secretions <ul><li>Prostaglandin analogs </li></ul><ul><li>These are agents that inhibit the secretion of gastrin and </li></ul><ul><li>increase the secretion of mucus lining of the stomach, providing a buffer. </li></ul>
  18. 18. Histamine 2 receptor blockers
  19. 19. The H2 Blockers- “tidines” <ul><li>Prototype: Cimetidine </li></ul><ul><li>1. Ranitidine </li></ul><ul><li>2. Famotidine </li></ul><ul><li>3. Nizatidine </li></ul>
  20. 20. The H2 Blockers- “tidines” <ul><li>Pharmacodynamics: Drug Action </li></ul><ul><li>The H2 blockers are antagonists at the receptors in the parietal cells of the stomach. </li></ul><ul><li>The blockage results to inhibition of the hormone gastrin. </li></ul><ul><li>There will be decreased production of gastric acid from the parietal cells. </li></ul><ul><li>Also, the chief cells will secrete less pepsinogen. </li></ul>
  21. 21. The H2 Blockers- “tidines” <ul><li>Therapeutic use of the H2 blockers </li></ul><ul><li>Short-term treatment of active duodenal ulcer or benign gastric ulcer </li></ul><ul><li>Treatment of hypersecretory conditions like the Zollinger-Ellison syndrome </li></ul><ul><li>Prevention of stress-induced ulcers and acute GI bleeding </li></ul><ul><li>Treatment of erosive GERD (reflux disease) </li></ul><ul><li>Relief of Symptoms of heart burn and acid indigestion </li></ul>
  22. 22. The H2 Blockers- “tidines” <ul><li>Precautions and Contraindications </li></ul><ul><li>Any known allergy is a clear contraindication to the use of the agents. </li></ul><ul><li>Conditions such as pregnancy, lactation, renal dysfunction and hepatic dysfunction should warrant cautious use. </li></ul><ul><li>Nizatidine can be used in hepatic dysfunction. </li></ul>
  23. 23. The H2 Blockers- “tidines” <ul><li>Dynamics- Side effects/adverse effects </li></ul><ul><li>GIT= diarrhea or constipation </li></ul><ul><li>CNS= Dizziness, headache, drowsiness, confusion and hallucinations </li></ul><ul><li>Cardio= arrhythmias, HYPOTENSION (related to H2 receptor blockage in the heart) </li></ul><ul><li>Cimetidine= Gynecomastia and impotence in males </li></ul>
  24. 24. The H2 Blockers- “tidines” <ul><li>Drug-drug Interactions </li></ul><ul><li>Cimetidine, Famotidine, Ranitidine are metabolized in the liver- they can cause slowing of excretion of other drugs leading to their increased concentration . </li></ul>
  25. 25. The H2 Blockers- “tidines” <ul><li>Drug-drug Interactions </li></ul><ul><li>These drugs can interact with CIMETIDINE </li></ul><ul><li>Anticoagulants </li></ul><ul><li>Phenytoin, </li></ul><ul><li>Alcohol </li></ul><ul><li>Antidepressants. </li></ul>
  26. 26. The H2 Blockers- “tidines” <ul><li>Nursing considerations: </li></ul><ul><li>Administer the drug WITH meals at BEDTIME to ensure therapeutic level </li></ul><ul><li>One hour after Antacids </li></ul><ul><li>Stress the importance of the continued use for the length of time prescribed </li></ul>
  27. 27. The H2 Blockers- “tidines” <ul><li>Nursing considerations </li></ul><ul><li>Monitor the cardiovascular status especially if the drugs are given IV </li></ul><ul><li>Warn patient of the potential problems of increased drug concentration if the H2 blockers are used with other drugs or OTC drugs. Advise consultation first! </li></ul>
  28. 28. The H2 Blockers- “tidines” <ul><li>Nursing considerations: </li></ul><ul><li>Provide comfort measures like analgesics for headache, assistance with ambulation and safety measures because of confusion </li></ul><ul><li>Warn the patients taking cimetidine that drowsiness may pose a hazard if driving or operating delicate machines. </li></ul>
  29. 29. The H2 Blockers- “tidines” <ul><li>Nursing considerations: </li></ul><ul><li>Provide health teaching as to the dose, frequency, comfort measures to initiate when side-effects are intolerable </li></ul><ul><li>Evaluate the effectiveness </li></ul><ul><li>Relief of symptoms of ulcer, heart burn and GERD </li></ul>
  30. 30. Antacids
  31. 31. The Antacids <ul><li>These are drugs or inorganic chemicals that have been used for years to neutralize acid in the stomach </li></ul>
  32. 32. The Antacids <ul><li>The following are the common antacids that can be bought OTC: </li></ul><ul><li>Aluminum salts (hydroxide) </li></ul><ul><li>Calcium salts (carbonate) </li></ul><ul><li>Magnesium salts (milk of magnesia) </li></ul><ul><li>Sodium bicarbonate </li></ul><ul><li>Magaldrate (aluminum and magnesium combination) </li></ul>
  33. 33. The Antacids <ul><li>Pharmacodynamics: drug action </li></ul><ul><li>These agents act to neutralize the acidic pH in the stomach. </li></ul><ul><li>They do not affect the rate of gastric acid secretion. </li></ul>
  34. 34. The Antacids <ul><li>Pharmacodynamics: drug action </li></ul><ul><li>The administration of antacid may cause an acid rebound. </li></ul><ul><li>Neutralizing the stomach content to an alkaline level stimulates gastrin production to cause an increase in acid production and return the stomach to its normal acidic state. </li></ul>
  35. 35. The Antacids <ul><li>Therapeutic Indications </li></ul><ul><li>Symptomatic relief of upset stomach associated with hyperacidity </li></ul><ul><li>Hyperacidic conditions like peptic ulcer, gastritis, esophagitis and hiatal hernia </li></ul><ul><li>Special use of AMPHOGEL (aluminum hydroxide): to BIND phosphate </li></ul>
  36. 36. The Antacids <ul><li>Precautions of Antacid Use </li></ul><ul><li>Known allergy is a clear contraindication </li></ul><ul><li>Caution should be instituted if used in electrolyte imbalances, GI obstruction and renal dysfunction. </li></ul><ul><li>Sodium bicarbonate is rarely used because of potential systemic absorption  metabolic alkalosis!!! </li></ul>
  37. 37. The Antacids <ul><li>Pharmacokinetics </li></ul><ul><li>These agents are taken orally and act locally in the stomach </li></ul>
  38. 38. The Antacids <ul><li>Pharmacodynamics: Effects of drugs </li></ul><ul><li>GIT= rebound acidity; alkalosis may occur. </li></ul><ul><li>Calcium salts may lead to hypercalcemia </li></ul><ul><li>Magnesium salts can cause DIARRHEA </li></ul><ul><li>Aluminum salts may cause CONSTIPATION and Hypophosphatemia by binding with phosphates in the GIT. </li></ul><ul><li>2. Fluid retention due to the high sodium content of the antacids. </li></ul>
  39. 39. The Antacids <ul><li>Nursing Considerations: </li></ul><ul><li>Administer the antacids apart from any other medications by ONE hour before or TWO hours after- to ensure adequate absorption of the other medications </li></ul><ul><li>Tell the patient to CHEW the tablet thoroughly before swallowing. Follow it with one glass of water </li></ul><ul><li>Regularly monitor for manifestations of acid-base imbalances as well as electrolyte imbalances </li></ul>
  40. 40. The Antacids <ul><li>Nursing Considerations: </li></ul><ul><li>Provide comfort measures to alleviate constipation associated with aluminum and diarrhea associated with magnesium salts. </li></ul><ul><li>Monitor for the side-effects, effectiveness of the comfort measures, patient’s response to the medication and the effectiveness of the health teachings </li></ul>
  41. 41. The Antacids <ul><li>Nursing Considerations </li></ul><ul><li>Evaluate for effectiveness: </li></ul><ul><li>Decreased symptoms of ulcer and pyrosis </li></ul><ul><li>Decreased Phosphate level (Amphogel) in patients with chronic renal failure </li></ul>
  42. 42. proton-pump inhibitors
  43. 43. The PPI <ul><li>These are the newer agents for ulcer treatment </li></ul><ul><li>The “prazoles” </li></ul><ul><li>Prototype: Ome prazole </li></ul><ul><li>Laniso prazole </li></ul><ul><li>Esome prazole </li></ul><ul><li>Panto prazole </li></ul>
  44. 44. The PPI <ul><li>Pharmacodynamics: drug action </li></ul><ul><li>They act at specific secretory surface receptors to prevent the final step of acid production and thus decrease the level of acid in the stomach. </li></ul><ul><li>The “pump” in the parietal cell is the H-K ATPase enzyme system on the secretory surface of the gastric parietal cells </li></ul>
  45. 45. The PPI <ul><li>Clinical use of the PPIs </li></ul><ul><li>Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis and benign gastric ulcer </li></ul><ul><li>Long-term- maintenance therapy for healing of erosive disorders. </li></ul>
  46. 46. The PPI <ul><li>Precautions with the use of the PPIs </li></ul><ul><li>Known allergy is a clear contraindication </li></ul><ul><li>Caution if patient is pregnant </li></ul>
  47. 47. The PPI <ul><li>Pharmacodynamics: Adverse effects </li></ul><ul><li>CNS- dizziness , headache, asthenia (loss of strength), vertigo , insomnia, apathy </li></ul><ul><li>GIT- diarrhea, abdominal pain, nausea, vomiting, dry mouth and tongue atrophy </li></ul><ul><li>Respi- cough, stuffy nose, hoarseness and epistaxis. </li></ul>
  48. 48. The PPI <ul><li>Nursing considerations: </li></ul><ul><li>Administer the drug BEFORE meals. Ensure that patient does not open, chew or crush the drug. </li></ul><ul><li>Provide safety measures if CNS dysfunction happens. </li></ul><ul><li>Arrange for a medical follow-up if symptoms are NOT resolved after 4-8 weeks of therapy. </li></ul>
  49. 49. The PPI <ul><li>Nursing considerations: </li></ul><ul><li>Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. </li></ul><ul><li>Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ </li></ul>
  50. 50. The PPI <ul><li>Nursing considerations: </li></ul><ul><li>Evaluate for effectiveness of the drug </li></ul><ul><li>Healing of peptic ulcer </li></ul><ul><li>Decreased symptoms of ulcer </li></ul>
  51. 51. Mucosal protectants
  52. 52. The Mucosal Protectant <ul><li>Sucralfate (Caralfate/ Iselpin) </li></ul><ul><li>This is given to protect the eroded ulcer sites in the GIT from further damage by acid and digestive enzymes </li></ul>
  53. 53. Sucralfate <ul><li>Pharmacodynamics: Action of drug </li></ul><ul><li>It forms an ulcer-adherent complex at duodenal ulcer sites, protecting the sites against acid, pepsin and bile. </li></ul><ul><li>This action prevents further breakdown of proteins in the area and promotes healing. </li></ul>
  54. 54. Sucralfate <ul><li>Clinical use of sucralfate </li></ul><ul><li>Short and long term management of duodenal ulcer. </li></ul><ul><li>NSAIDs induced gastritis </li></ul><ul><li>Prevention of stress ulcer </li></ul><ul><li>Treatment of oral and esophageal ulcers due to radiation, chemotherapy or sclerotherapy. </li></ul>
  55. 55. Sucralfate <ul><li>Precautions on the use of Sucralfate </li></ul><ul><li>This agent should NOT be given to any person with known allergy to the drug, and to those patients with renal failure/dialysis because of build-up of aluminum may occur if used with aluminum containing products. </li></ul>
  56. 56. The Mucosal Protectant <ul><li>Pharmacodynamics: Side-effects & adverse reactions </li></ul><ul><li>Primarily GIT= CONSTIPATION, occasionally diarrhea, nausea, indigestion, gastric discomfort, and dry mouth may also occur </li></ul><ul><li>CNS= dizziness, drowsiness, vertigo </li></ul><ul><li>Others= rash and back pain </li></ul>
  57. 57. The Mucosal Protectant <ul><li>Drug-drug interactions </li></ul><ul><li>If used with aluminum salts= high risk of accumulation of aluminum and toxicity . </li></ul><ul><li>If used with phenytoin, fluoroquinolones and penicillamines- decreased levels of these drugs when taken with sucralfate </li></ul>
  58. 58. The Mucosal Protectant <ul><li>Nursing Considerations </li></ul><ul><li>Administer drug ON AN EMPTY stomach , 1 hour before meals , or 2 hour after meals and at BEDTIME </li></ul><ul><li>Monitor for side-effects like constipation and GI upset </li></ul><ul><li>Encourage intake of high-fiber foods and increased fluid intake </li></ul><ul><li>Administer antacids BETWEEN doses of sucralfate, NOT WITHIN 30 minutes of sucralfate dose </li></ul>
  59. 59. The Mucosal Protectant <ul><li>Nursing Considerations </li></ul><ul><li>Provide comfort measures if CNS effects occur </li></ul><ul><li>Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. </li></ul><ul><li>Monitor patient response to the drug, the effectiveness of the teaching plan and the measures employed </li></ul>
  60. 60. The Mucosal Protectant <ul><li>Nursing Considerations </li></ul><ul><li>Evaluate effectiveness of therapy </li></ul><ul><li>Healing of ulcer </li></ul><ul><li>No formation of ulcer </li></ul>
  61. 61. Prostaglandin analogue
  62. 62. Prostaglandin analogue <ul><li>Misoprostol </li></ul><ul><li>This agent is a synthetic prostaglandin E1 analog that is employed to protect the lining of the mucosa of the stomach </li></ul>
  63. 63. Prostaglandin analogue <ul><li>Misoprostol: Pharmacodynamics </li></ul><ul><li>Being a prostaglandin analog, it inhibits gastric acid secretion to some degree </li></ul><ul><li>It INCREASES mucus production in the stomach lining. </li></ul>
  64. 64. Prostaglandin analogue <ul><li>Misoprostol: Clinical use </li></ul><ul><li>NSAIDs-induced gastric ulcers </li></ul><ul><li>Duodenal ulcers unresponsive to H2 antagonists </li></ul>
  65. 65. Prostaglandin analogue <ul><li>Precautions of Misoprostol Use </li></ul><ul><li>This drug is CONTRAINDICATED during pregnancy because it is an abortifacient. </li></ul><ul><li>Women should be advised to have a negative pregnancy test within 2 weeks of beginning therapy and should begin the drug on the second or third day of the next menstrual cycle. </li></ul><ul><li>They should be instructed in the use of contraceptives during therapy. </li></ul>
  66. 66. Prostaglandin analogue <ul><li>Pharmacodynamic effects: drug reactions </li></ul><ul><li>GIT= Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia </li></ul><ul><li>GU effects= miscarriages, excessive uterine CRAMPING and bleeding , spotting, hyper-menorrhea and menstrual disorders. </li></ul>
  67. 67. Prostaglandin analogue <ul><li>Nursing Considerations </li></ul><ul><li>Administer to patients at risk for NSAIDs-induced ulcers during the full course of NSAIDs therapy </li></ul><ul><li>Administer four times daily with meals and at bedtime </li></ul><ul><li>Obtain pregnancy test within 2 weeks of beginning therapy. </li></ul><ul><li>Begin the therapy on second or third day of menstrual period to ensure that the woman is not pregnant </li></ul>
  68. 68. Prostaglandin analogue <ul><li>Nursing Considerations </li></ul><ul><li>Provide patient with both written and oral information regarding the associated risks of pregnancy </li></ul><ul><li>Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. </li></ul><ul><li>Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ </li></ul>
  69. 69. laxatives
  70. 70. Laxatives <ul><li>Generally used to INCREASE the passage of the colonic contents </li></ul><ul><li>The general classifications is as follows: </li></ul><ul><li>1. Chemical stimulants- irritants </li></ul><ul><li>2. Mechanical stimulants- hyperosmotic agents and saline cathartics </li></ul><ul><li>3. Lubricants and stool softeners </li></ul>
  71. 71. Laxatives <ul><li>They promote bowel evacuation for various purposes </li></ul><ul><li>They are classified into their mode of action </li></ul>
  72. 72. Laxatives Lubricating the intestinal material to promote passage through the GIT Docusate Mineral oil Lubricants Increased fluid content of the fecal material causing stimulation of the local reflex Lactulose Mechanical (bulk) stimulants Direct stimulation of the GIT nerves Irritant laxatives Bisacodyl (Dulcolax) Chemical stimulants Action Prototype Type
  73. 73. Therapeutic Indications of the Laxatives <ul><li>SHORT term relief of Constipation </li></ul><ul><li>Prevention of straining in conditions like CHF, post-MI, post partum, post-op </li></ul><ul><li>Preparation for diagnostic examination </li></ul><ul><li>Removal of poison or toxins </li></ul><ul><li>Adjunct in anti-helminthic therapy </li></ul><ul><li>To remove AMMONIA by use of lactulose </li></ul>
  74. 74. Contraindications in Laxative use <ul><li>ACUTE abdominal disorders </li></ul><ul><ul><li>Appendicitis </li></ul></ul><ul><ul><li>Diverticulitis </li></ul></ul><ul><ul><li>Ulcerative colitis </li></ul></ul>
  75. 75. Chemical Stimulant Cathartics <ul><li>Prototype: Bisacodyl </li></ul><ul><li>Irritant laxatives: </li></ul><ul><li>1. Castor oil </li></ul><ul><li>2. Senna </li></ul><ul><li>3. Cascara </li></ul><ul><li>4. Phenolphthalein </li></ul>
  76. 76. Chemical Stimulant Cathartics <ul><li>Pharmacodynamics </li></ul><ul><li>These agents DIRECTLY stimulate the nerve plexus in the intestinal wall </li></ul><ul><li>The result is INCREASED movement or motility of the colon </li></ul>
  77. 77. Mechanical Stimulant Cathartics <ul><li>Prototype: LACTULOSE (Cephulac) </li></ul><ul><li>Bulk-forming laxatives </li></ul><ul><li>1. Magnesium ( citrate , hydroxide, sulfate)- saline cathatic </li></ul><ul><li>2. Psyllium </li></ul><ul><li>3. Polycarbophil </li></ul>
  78. 78. Mechanical Stimulant Cathartics <ul><li>Pharmacodynamics </li></ul><ul><li>These agents are rapid-acting laxatives that INCREASE the GI motility by </li></ul><ul><ul><li>Increasing the fluids in the colonic material </li></ul></ul><ul><ul><li>Stimulating the local stretch receptors </li></ul></ul><ul><ul><li>Activating local defection reflex </li></ul></ul>
  79. 79. Lubricants-Stool softener <ul><li>Prototype: Docusate </li></ul><ul><li>1. Glycerin </li></ul><ul><li>2. Mineral oil </li></ul>
  80. 80. Lubricants-stool softeners <ul><li>Pharmacodynamics </li></ul><ul><li>Docusate increases the admixture of fat and water producing a softer stool </li></ul><ul><li>Glycerin and Mineral oil form a slippery coat on the colonic contents </li></ul>
  81. 81. Pharmacokinetics: Common Side-effects of the Laxatives <ul><li>Diarrhea </li></ul><ul><li>Abdominal cramping </li></ul><ul><li>Nausea </li></ul><ul><li>Fluid and electrolyte imbalance </li></ul><ul><li>Sympathetic reactions- sweating, palpitations, flushing and fainting </li></ul><ul><li>CATHARTIC dependence </li></ul>
  82. 82. The Nursing Process and Laxative <ul><li>ASSESSMENT </li></ul><ul><li>Nursing History- elicit allergy to any laxatives, elicit history of conditions like diverticulitis and ulcerative colitis </li></ul><ul><li>Physical Examination- abdominal assessment </li></ul><ul><li>Laboratory Test: fecalysis, electrolyte levels </li></ul>
  83. 83. The Nursing Process and Laxative <ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Alteration in bowel pattern </li></ul><ul><li>Alteration in comfort: pain </li></ul><ul><li>Knowledge deficit </li></ul>
  84. 84. The Nursing Process and Laxative <ul><li>IMPLEMENTATION </li></ul><ul><li>Emphasize that it is use on a SHORT term basis </li></ul><ul><li>Provide comfort and safety measures like ready access to the bathroom, side-rails </li></ul><ul><li>Administer with a full glass of water </li></ul>
  85. 85. The Nursing Process and Laxative <ul><li>IMPLEMENTATION </li></ul><ul><li>4. Encourage fluid intake, high fiber diet and daily exercise </li></ul><ul><li>5. DO NOT administer if acute abdominal condition like appendicitis is present </li></ul><ul><li>6. Advise to change position slowly and avoid hazardous activities because of potential dizziness </li></ul>
  86. 86. The Nursing Process and Laxative <ul><li>IMPLEMENTATION </li></ul><ul><li>7. Record intake and output to assess fluid alteration </li></ul><ul><li>8. If possible, observe the character of stools </li></ul><ul><li>9. Caution the patient that chronic use may promote dependence and use during pregnancy may cause uterine cramping and Vitamin deficiency </li></ul>
  87. 87. The Nursing Process and Laxative <ul><li>EVALUATION of drug effectiveness </li></ul><ul><li>Evaluate relief of GI symptoms, absence of staining and increased evacuation of GI tract </li></ul><ul><li>For Lactulose: decreased ammonia </li></ul><ul><li>Nomal bowel fucntion is restored </li></ul>
  88. 88. The Anti-diarrheals <ul><li>These are agents used to calm the irritation of the GIT for the symptomatic relief of diarrhea </li></ul><ul><li>General Classifications </li></ul><ul><li>1. Local anti-motility </li></ul><ul><li>2. Local reflex inhibition </li></ul><ul><li>3. Central action on the CNS </li></ul>
  89. 89. The Anti-diarrheals Stops GIT spasm by CNS action Opium derivatives (paregoric) Central acting agent Directly inhibits the intestinal muscle activity to SLOW peristalsis Loperamide Local anti-motility Locally coats the lining of the GIT to soothe irritation Bismuth subsalicylate Local reflex inhibitor Action Prototype Type
  90. 90. Clinical Indications of drug use <ul><li>Relief of symptoms of acute and chronic diarrhea </li></ul><ul><li>Reduction of fecal volume discharges from ileostomies </li></ul><ul><li>Prevention and treatment of traveler's diarrhea </li></ul>
  91. 91. Contraindications of anti-diarrheal Use <ul><li>Poisoning </li></ul><ul><li>Drug allergy </li></ul><ul><li>GI obstruction </li></ul><ul><li>Acute abdominal conditions </li></ul>
  92. 92. Pharmacokinetics: Side effects <ul><li>Constipation </li></ul><ul><li>Nausea, vomiting </li></ul><ul><li>Abdominal distention and discomfort </li></ul><ul><li>TOXIC MEGACOLON </li></ul>
  93. 93. Nursing process and anti-diarrheals <ul><li>ASSESSMENT </li></ul><ul><li>Nursing History – Elicit history of drug allergy, conditions like poisoning, GI obstruction and acute abdominal conditions </li></ul><ul><li>Physical Examination- Abdominal examination </li></ul><ul><li>Laboratory test- electrolyte levels </li></ul>
  94. 94. Nursing process and anti-diarrheals <ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Alteration in bowel pattern </li></ul><ul><li>Alteration in comfort: pain </li></ul>
  95. 95. Nursing process and anti-diarrheals <ul><li>IMPLEMENTATION </li></ul><ul><li>Monitor patient response within 48 hours. Discontinue drug use if no effect </li></ul><ul><li>Provide comfort measures for pain </li></ul><ul><li>Provide teaching regarding its short term use only </li></ul>
  96. 96. Nursing process and anti-diarrheals <ul><li>EVALUATION </li></ul><ul><li>Monitor effectiveness of drug- RELIEF of diarrhea </li></ul><ul><li>Monitor adverse effects, effectiveness of pain measures and effectiveness of teaching plan </li></ul>
  97. 97. Emetic and anti-emetics
  98. 98. Emetics and Anti-emetics <ul><li>Emetic Agent </li></ul><ul><li>Syrup of Ipecac </li></ul><ul><li>Anti-emetics </li></ul><ul><li>1. Phenothiazines </li></ul><ul><li>2. Non-phenothiazines </li></ul><ul><li>3. Anticholinergics/Antihistamines </li></ul><ul><li>4. Serotonin receptor Blockers </li></ul><ul><li>5. Miscellaneous </li></ul>
  99. 99. EMETIC <ul><li>Prototype: Ipecac Syrup </li></ul>
  100. 100. EMETIC <ul><li>Pharmacodynamics </li></ul><ul><li>Ipecac syrup irritates the GI mucosa locally, resulting to stimulation of the vomiting center </li></ul><ul><li>It acts within 20 minutes </li></ul>
  101. 101. EMETIC <ul><li>Clinical Use of ipecac </li></ul><ul><li>To induce vomiting as a treatment for drug overdose and certain poisonings </li></ul>
  102. 102. EMETIC <ul><li>Contraindications of Ipecac use </li></ul><ul><li>Ingestion of CORROSIVE chemicals </li></ul><ul><li>Ingestion of petroleum products </li></ul><ul><li>Unconscious and convulsing patient </li></ul>
  103. 103. EMETIC <ul><li>Pharmacokinetics: side effects of Ipecac </li></ul><ul><li>Nausea </li></ul><ul><li>Diarrhea </li></ul><ul><li>GI upset </li></ul><ul><li>Mild CNS depression </li></ul><ul><li>CARDIOTOXICITY if large amounts are absorbed in the body </li></ul>
  104. 104. Nursing process and the EMETIC <ul><li>ASSESSMENT </li></ul><ul><li>Nursing History- elicit the exact nature of poisoning </li></ul><ul><li>Physical Examination- CNS status and abdominal exam </li></ul>
  105. 105. Nursing process and the EMETIC <ul><li>IMPLEMENTATION </li></ul><ul><li>Administer to conscious patient only </li></ul><ul><li>Administer ipecac as soon as possible </li></ul><ul><li>Administer with a large amount of water </li></ul><ul><li>Vomiting should occur within 20 minutes of the first dose . Repeat the dose and expect vomiting to occur with 20 minutes </li></ul>
  106. 106. Nursing process and the EMETIC <ul><li>IMPLEMENTATION </li></ul><ul><li>5. Provide comfort measures like ready access to bathroom, assistance with ambulation </li></ul><ul><li>6. Offer support </li></ul>
  107. 107. Nursing process and the EMETIC <ul><li>EVALUATION </li></ul><ul><li>Evaluate patient response within 20 minutes of drug ingestion </li></ul><ul><li>Monitor for adverse effects </li></ul><ul><li>Evaluate effectiveness of comfort measures and teaching plan </li></ul>
  108. 108. Anti-Emetics
  109. 109. ANTI-EMETICS <ul><li>These are agents used to manage nausea and vomiting </li></ul><ul><li>They act either locally or centrally </li></ul><ul><li>In general, they may inhibit the chemoreceptor trigger zone in the medulla by blocking DOPAMINE receptor </li></ul><ul><li>Others act by decreasing the sensitivity of the vestibular apparatus </li></ul>
  110. 110. ANTIEMETICS Dronabinol, hydroxyzine Miscellaneous “ setron”- dolasetron Serotonin Receptor blockers Meclizine, buclizine Anticholinergics and Antihistaminics Metoclopramide Non-phenothiazines Prochlorperazine, Promethazine Phenothiazines Common examples Anti-emetic types
  111. 111. ANTIEMETICS Act in the CNS , either in the medulla or in the cortex Miscellaneous Centrally and locally inhibits the serotonin receptors Serotonin receptor blockers Block the transmission of the impulses to the medulla Anticholinergics Reduces the responsiveness of the nerve cell in the medulla; also blocks the dopamine receptors Non-phenothiazine Centrally block the vomiting center in the medulla Phenothiazines Pharmacodynamics Types
  112. 112. ANTIEMETICS N/V associated with chemotherapy Miscellaneous N/V associated with chemotherapy Serotonin-receptor Blockers N/V associated with motion sickness Anticholinergics N/V associated with chemical stimulation Non-phenothiazine N/V associated with anesthesia, intractable hiccups Phenothiazines Clinical Use Types
  113. 113. ANTIEMETICS <ul><li>Indications </li></ul><ul><li>1. Prevention and treatment of vomiting </li></ul><ul><li>2. Motion sickness </li></ul>
  114. 114. ANTIEMETICS <ul><li>Contraindications </li></ul><ul><li>1. Severe CNS depression </li></ul><ul><li>2. Severe liver dysfunction </li></ul>
  115. 115. ANTIEMETICS <ul><li>Pharmacokinetics: </li></ul><ul><li>Oral absorption is good if vomiting is not present </li></ul><ul><li>IV drugs can be given if vomiting is active </li></ul><ul><li>Most drugs are metabolized in the liver excreted in the kidneys </li></ul>
  116. 116. ANTIEMETICS <ul><li>Pharmacokinetics: Side-effects </li></ul><ul><li>1. PHOTHOSENSITIVITY </li></ul><ul><li>2. Drowsiness, dizziness, weakness and tremors and DEHYDRATON </li></ul><ul><li>3. Phenothiazines = autonomic anti-cholinergic effects like dry mouth, nasal congestion and urinary retention </li></ul><ul><li>Metoclopramide= EPS due to dopamine receptor blockage </li></ul>
  117. 117. Nursing Process and the ANTIEMETICS <ul><li>ASSESSMENT </li></ul><ul><li>Nursing History- elicit allergy, impaired hepatic function and CNS depression </li></ul><ul><li>Physical Examination- CNS status and abdominal examination </li></ul><ul><li>Laboratory test- Liver function studies </li></ul>
  118. 118. Nursing Process and the ANTIEMETICS <ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Alteration in comfort: pain </li></ul><ul><li>High risk for injury </li></ul><ul><li>Knowledge deficit </li></ul>
  119. 119. Nursing Process and the ANTIEMETICS <ul><li>IMPLEMENTATION </li></ul><ul><li>Assess patient’s intake of other drugs that may cause dangerous drug interaction </li></ul><ul><li>Emphasize that this is given on a short term basis </li></ul>
  120. 120. Nursing Process and the ANTIEMETICS <ul><li>IMPLEMENTATION </li></ul><ul><li>3. Provide comfort and safety measures </li></ul><ul><ul><li>Advise to change position slowly </li></ul></ul><ul><ul><li>Avoid hazardous activities </li></ul></ul><ul><ul><li>Provide mouth care and ice chips </li></ul></ul><ul><ul><li>Monitor for dehydration and offer fluids if it occurs </li></ul></ul>
  121. 121. Nursing Process and the ANTIEMETICS <ul><li>IMPLEMENTATION </li></ul><ul><li>4. Protect from sun exposure </li></ul><ul><ul><li>Sunscreens </li></ul></ul><ul><ul><li>Protective covering </li></ul></ul><ul><li>5. Provide health teaching </li></ul>
  122. 122. Nursing Process and the ANTIEMETICS <ul><li>EVALUATION </li></ul><ul><li>1. Monitor for the drug effectiveness </li></ul><ul><ul><li>Relief of nausea and vomiting </li></ul></ul><ul><li>2. Monitor for adverse effects </li></ul><ul><li>3. Evaluate effectiveness of comfort measures and teaching plan </li></ul>
  123. 123. End