Drugs used in gastrointestinal system for PCL

1. Drugs Used in
Gastrointestinal System
DR. SAROJ K. SUWAL
FOR PCL NURSING

2. Drugs
in
GI SYS.
Antiemetics
Antidiarrheal
laxatives
Gastric Acid
reducers
• Antacids
• PPI
• H2 antagonists
• Prostaglandins
Antibiotics

3. Gastrointestinal System
 Gastric Acid secretions

5. Cells in Stomach
 ECL  Enterochromaffin like cell

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

8.  MOA:
 Demulcent action  Protect Mucosa by forming coat (Mgcl2) React with
Bicarbonate Produce MgCO3 Eliminate in Feces ( so diarrheal Effect)
 Absorbs HCL
 Preparation
 Magnesium Hydroxide  Tablet 250 mg, Suspension 250mg/5ml
 Magnesium Trisilicate  Tablet 500mg, suspension 500mg/5ml
 Dose 250-500mg TDS
 Adverse Effect
 Diarrhea

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

13. Ulcer Healing Drugs
 H2 Antagonist
 Proton Pumb Inhibitor (PPI)

14. H2 receptor blockers
 50-60% acid is blocked
 E.g. Cimetidine , Famotidine , Ranitidine
 Indications:
 Peptic Ulcers ( GU,PU)
 Acid Indigestions and Heart Burns
 Gastritis
 GERD

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

16. Preparations and doses
 Ranitidine Tab 150 mg, 300mg @ HS for 4-8 weeks
 Cimetine
 Contraindications
 Pregnancy
 Lactation
 Hepatic Dysfunction

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

19. Proton Pump Inhibitors (PPI)
 Block gastric acid secretion inhibiting H+ /K+-ATPase
 95% acid is blocked
 Examples
 Omeprazole (20mg),
 pantoprazole (40mg),
 Esomeprazole (20mg)
 Rabeprazole

20. Used for
 Gastritis ( heart Burn)
 PU
 GERD or Reflux esophagitis
 NSAIDS induced Ulcer
 H.Pylori treatment

21. Omeprazole
 20 mg and 40 Mg Capsule, Inj 40 mg /vial
 Indications
 PU, GERD, NSAIDS induced Ulcer
 DU20 mg OD for 4 weeks
 GU 8 weeks
 Adverse effect
 Nausea Diarrhea, abdominal Colic, Skin rash, Headache, Joint pain,
Thrombocytopenia, Leucopenia

22. Nursing Mangement
 Don’t crush capsule
 Take before meal
 Watch for adverse effect

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.

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

31. Adverse Effect
Extrapyramidal
symptoms ( more
common in children)
Dyskinesia
Hyperprolactinemia
Nervousness
Drowsiness
Depression
diarrhoea

32. Promethazine (phenargan)
 Direct effect on medullary
Chemoreceptor trigger
zone(CTZ)Block Domapine
receptor (d2)
 Aslo act ast anti histamine( h1
receptor blockor

33. Indications
Post operative nausea and vomiting
Vomiting caused by toxins, radiation , cytotoxic drugs
Motion sickness

34. Adverse effect
 Dryness of mouth
 Blurred vision
 Dizziness
 Sedation
 Headache
 Fatigue
 Euphoria
 Tremor
 GI upset
 Blood Disorder(
thrombocytopenia, leucopenia
, agranulocytosis

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

36. Indications
 Functional Dyspepsia
 Nausea
 Vomiting in GI disorder
 Treatment with cytotoxic drugs, radiations

37.  Doses
 10 mg TDS,
 200-400 mcg /KG QID
 Adverse Effect
 Gynecomastia
 Galactorrhea ( milky nipple discharge)
 Rashes
 Dystonic reactions

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

48. Indications
 Diarrhea
 Surgery conditions
 Acute abdomen obstruction
 Pancreatitis
 Appendicitis
 Dehydration
 Hemorrhage

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

50. Composition
 Na 130 mol/L
 K+ 4m mol/L
 Cl109 mmol/L
 Lactate 28 mmol/L

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

54. Laxatives & Purgatives
 Laxatives are those which softens
stool
 Increase bowel movements

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

56. Contraindications –
 Acute abdominal disorders
 BOWEL OBSTRUCTIONS
 Chldren blow 3 years
 appedicitis
• Caution
 – Pregnancy or lactation

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

64.  Thanks