6. Antacids
Neutralize HCL
are the weak bases
For treatment of achlorhydria
Magnesium Hydroxide & Magneisum trisilicate
Sodium Bicarbonate
Alunium Hydroxide
7. Magnesium Hydroxide(MgOH)2 and
Magnesium trisilicate
Magnesium Hydroxide
In liquid called MILK OF MAGNESIA ( DUE
TO MILK LIKE APPEARANCE)
Interfares with absorption of folic acid and
IRON
9. Nursing Management
Shake Liquid before Pouring
Chew the tablet before swallowing
Avoid take with other drugs ( take after one hour of other
drugs) may interfare with absorbtion
Note Number , frequency and consistency of stool
Store durg in cool place and avoid freezing
10. Sodium Bicarbonate (NaHCO3)
Use for relief Heart burn and
acid indigestion
Uses
Hyperacidity
Peptic Ulcer
As urine alkalizer
Dose 1-5 gm
Side effect
Inscrease thirst
Stomach cramps
Gas
11. Aluminum Hydroxide
Neutralize the acidity associated with
indigestion .
forms insoluble salts chloride and phosphate
Al compound Protect the lining of
Stomach mucosa
Tablet 840 mg, gel (610 mg per 10 ml)
12. Dose
One tab x OD ( one hour
after meal and bed time )
Child 5 ml TID
Contraindications
Hypophosphatemia
Adverse effect
Constipation
Hemorrhoid
Fissure
Fecal Impaction
15. MOA
Inhibit the action of histamine
at the H2 receptors of parietal
cells
Reduce acid
secretion
Also reduce acid
stimulate by food,
insulin, histamine
caffine
17. Adverse Effects
Dizziness
Headace
Fatigue
Confusiton
Hyeper sensitivity and Rashes
Blood Disorders
Bradycardia after rapid IV Injection
18. Nursing Management
Administer IV push Slowly
If possible dilute drug with 20 ml distilled water, inject over 5 mins
Dose adjustment need for renal impairment patients
If taking single dose suggest to take at bed time
Tell pt completely swallow , not chew
23. Pantoprazole and Lansoprazole
PPI
MOA similar to Omeprazole
Pantaprazole 20mg, 40 mg tablets, 40 mg inj
Lansoprazole 15mg, 30 mg
24. Protective Reflex
Forceful propulsion of gastric contents out
of mouth
Emesis or Vomiting
25. Physiology of vomiting
Is coordinated by vomiting center ( Medulla oblongata of brain
stem)
The following area can stimulate the vomiting centre:
The Chemoreceptor Trigger Zone: This area is located in the floor
of the 4th ventricle of the brain.
26.
27. Triggers of CTZ
Histamines
Dopamine
Acetylcholine
Serotonin
These neurotransmitter are released
by virtue of various stimuli like drugs,
smell, taste, motion etc.
28. Drugs in Anti Emetics
Metaclpramide, Promethazine, Domperidome
Indications
Nausea, Vomiting
During treatment with cytotoxic
drugs or radiotherapy
Management of gastric stasis and
GERD
Persistent hiccup
Non ulcer dyspepsia
29. Metoclopramide
Mechanism of Action
Dopamine Receptor Blocker enhance ACH at muscarinic receptor on
Nerve Ending in gut
This cause
Inscrease tone of lower esophageal spinchter
Relaxation of pyloric antrum
Inscrease peristalalis and emptying of upper gut
30. Preparation 10 mg tablet, 5mg/5ml liquid,
5mg/ml in 2 ml solution
Doses
10 mg oral
i/m or slow i/v slowly
Contraindication
Recent GI surgery
Extra pyramidal symptoms
Epilepsy
Pheochromocytoma
35. Domperidone
Blocks dopamine d2 receptor in CTZ
Also inscrease tone in lower esophageal spincter
Enchances contraction os gastric antrum and relax pyloric
antrum
Poor crosses of BBB so less CNS toxicity
38. Anti Diarrheal Drugs
Drugs that make relief to diarrhea
Drugs
Kaolin-pectine
Codine and Diphenoxylate
Loperamide,
atropine
Diarrhea is not a disease, but a symptom of
some other problem
39. Kaolin -Pectin suspension
Most widely used preparation available
in powder dosage form
This product adsorbs bacterial toxins,
binds water and decreases mucus
secretion
40. Centrally acting agents
( MOA-Inhibit defecation reflex )
Codeine
Has limited use because it leads to tolerance and
addiction
Diphenoxylate
Opium-like drug with less addictive properties
Widely used combined with Atropine (an
Anticholinergic which decrease secretion of fluids)
41. Co-phenotrope
Diphenoxylate with atropine (100:1)
Opioid used exclusively as constipation agent
Most potent and cross BBB
Contra –indications
Children below 6 years
Obstructive jaundice
Diarrhea ass. With Pseudomembranous Colitis
Acute ulcerative colitis
42. Loperamide
Acts on m-opoid receptor in mysentric pleux or large intestine
Slow intestinal mobility
inhibition of the
peristaltic reflex
slowing the
passage of stools
through the
intestines
allow more time
for water and salts
in stool for
Absorbtion
43. Indications
Acute Non specific diarrhea
Chroinc diarrhea
Associated inflammatory bowel disease
Should not be used for diarrhea with infections
Dose
Acute 4 mg stat then 2mg after every stool
44. rehydration therapy
made from a special combination of salts and sugar
mixed with clean, safe water.
For preventing dehydrations
Designed to help the body replace fluids lost during
illness.
Most commonly used for diarrhea, especially with
children.
ORS, Ringer Lactate solution
ORT does not stop diarrhea, just prevents the body from drying up.
45. ORS
The composition of
different salts intended to
replenish the electrolyte
and water loss due to
diarrhea or other any
reasons.
WHO Composition
Sodium Chloride 2.6gm
Potassium choloride 1.5 gm
Sodium Citrate 2.9gm
Glucose 13.5 gm
Total 20.5 gm
46. Doses
Usual dose
200-400 ml after every loose stool motion
Children
100-200 ml after every loos stool
Infant
1-1.5 times usual feed volume
47. Ringer Lactate solution
Isotonic solutions with blood
IV administration
Advantages
Dissolve fasts and Works immediately
Prevents hypoglycemia
Multiple ion provider
Best isotioinc solution for rehydrations
Used as tranporter of medicien
49. Demerits
Not indicated for hypertensive pt
May have fever
Infectoin at the site of infections
Venous thromobis
Fluid overload
Cardia failure
Renal failure inscrease
51. Zinc therapy in diarrhea
Reduces duration of diarrhea episode by up to
25%
Decrease by about 25% the proportion of
episodes lasting more than seven days
It is associated with a 30% reduction in stool
volume
Conclusion: significant beneficial impact on
the clinical course of acute diarrhoea: reduces
both severity and duration
52. Role of Zinc
If Zinc deficiency
associated with an increased risk of gastrointestinal infections, adverse
effects on the structure and function of the gastrointestinal tract, and
impaired immune function
Supplementary zinc benefits
a vital micronutrient essential for protein synthesis,
cell growth and differentiation,
immune function, and
intestinal transport of water & electrolytes
53. Serotonin receptor blockers.
Block serotonin receptors in the gastrointestinal tract
Block serotonin receptors in the central nervous system
(emetic center)
Used often in surgical prophylaxis and when antineoplastic agents are
being given
Eg Ondansetron
55. Indications –
Short-term relief of constipation
– Prevent straining when it is clinically undesirable
– Evacuate the bowel for diagnostic procedures
– Removal of ingested poisons
– Adjunct in antihelmintic therapy
To relieve constipation caused by pregnancy or drugs
57. Drugs used are
Bisacodyl
Liquid paraffin
Magnesium Sulphate
Castor oil
58. Bisacodyl
Stimulant
Evaucaiton in 6-8 hs after PO
If Rectal Evacuation within 15 minutes
Acts on Large Bowel( osmotic)
5 mg tablet, suppository 5mg,10mg
Dose 5mg Hs
59. Liquid Paraffin
Act by lubricating fecese
Evacuation after 6-8 hrs
10-30 ml at night or when required
60. Magnesium Sulphate
Evacuation within 2-4 hrs
Is saline purgative
Dose
15 ml dissolve in 240 ml water
Child 5-10mg in 120 ml water
61. Caster Oil
Extracted from caster beans
Acts as stumatioing laxative for both large and small intestive
Lubricates bowels
Taken immediately after wakeup or before breakfast
Effective when taken in empty stomach
62. Adverse Effects
GI effects
Diarrhea, abdominal cramping, and nausea
CNS effects
Dizziness, headache, and weakness
CV effects
Sweating, palpitations, flushing, and fainting
63. Nursing managements of laxative
Dilute lactulose with water or fruit juice to minimize sweet taste
Don’t give move than one laxative at a time
Monitor frequency and consistency of stools
Shake suspension before administration
Prevent over use may cause dependence