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Ppt chapter 57
- 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drugs Affecting Gastrointestinal
Secretions
Chapter 57
- 2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Underlying Causes of GI Disorders
• Dietary Excess
• Stress
• Hiatal Hernia
• Esophageal Reflux
• Adverse Drug Effects
• Peptic Ulcer Disease
- 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Effect of Drugs on GI Secretions
• Decrease GI secretory activity
• Block the action of GI secretions
• Form protective coverings on the GI lining to prevent
erosion from GI secretions
• Replace missing GI enzymes that the GI tract or ancillary
glands and organs can no longer produce
- 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Peptic Ulcer Disease
• Definition
– Erosions in the lining of the stomach and adjacent
areas of the GI tract
• Symptoms
– Gnawing, burning pain, often occurring after meals
• Cause
– Bacterial infection by Helicobacter pylori bacteria
- 5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drugs Used in the Treatment of Ulcers
• Histamine-2 (H2
) Antagonists
– Block the release of hydrochloric acid in response to
gastrin
• Antacids
– Interact with acids at the chemical level to neutralize
them
• Proton Pump Inhibitors
– Suppress the secretion of hydrochloric acid into the
lumen of the stomach
- 6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drugs Used in the Treatment of Ulcers
(cont.)
• Antipeptic Agents
– Coat any injured area in the stomach to prevent
further injury from acid
• Prostaglandins
– Inhibit the secretion of gastrin and increase the
secretion of the mucous lining of the stomach,
providing a buffer
- 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sites of Actions of Drugs Affecting
Gastrointestinal Secretions
- 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Histamine-2 (H2
) Antagonists
• Actions
– Selectively block histamine-2 receptor sites
– This blocking leads to a reduction in gastric acid secretion
and reduction in overall pepsin production
• Indications
– Short-term treatment of active duodenal ulcer or benign
gastric ulcer
– Treatment of pathological hypersecretory conditions such
as Zollinger–Ellison syndrome
– Prophylaxis of stress-induced ulcers and acute upper GI
bleeding in critical patients
- 9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Histamine-2 (H2
) Antagonists (cont.)
• Indications (cont.)
– Treatment of erosive gastroesophageal reflux
– Relief of symptoms of heartburn, acid indigestion,
and sour stomach (OTC preparations)
• Pharmacokinetics
– Readily absorbed after oral administration
– Metabolized in the liver and excreted in urine
• Contraindications
– Known allergy
- 10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Histamine-2 (H2
) Antagonists (cont.)
• Caution
– Pregnancy or lactation
– Hepatic or renal dysfunction
• Adverse Effects
– GI effects
– CNS effects
– Cardiac arrhythmias and hypotension
• Drug-to-Drug Interactions
– Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine,
theophylline, chloroquine, benzodiazepines, nifedipine,
pentoxifylline, tricyclics, procainamide, and carbamazepine
- 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Drugs act in several ways on the secretions of the GI tract.
Which action affects the GI secretions least?
A. Decreases secretory activity
B. Blocks secretions
C. Replaces secretions
D. Prevents erosions
- 12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
C. Replaces secretions
Rationale: The effects of drugs on GI secretions: decrease
GI secretory activity; block the action of GI secretions;
form protective coverings on the GI lining to prevent
erosion from GI secretions; replace missing GI enzymes
that the GI tract or ancillary glands and organs can no
longer produce
- 13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antacids
• Actions
– Neutralize stomach acid by direct chemical reaction
• Indications
– Symptomatic relief of upset stomach associated with
hyperacidity, as well as hyperactivity
• Contraindications
– Allergy
• Caution
– Any condition that can be exacerbated by electrolyte
imbalance
– GI obstruction
- 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antacids (cont.)
• Adverse Effects
– Relate to their effects on acid-base levels and
electrolytes
– Rebound acidity
– Alkalosis
– Hypercalcemia
– Constipation or diarrhea
– Hypophosphatemia
• Drug-to-Drug Interactions
– Affect the absorption of many other drugs
- 15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Proton Pump Inhibitors
• Actions
– Act at specific secretory surface receptors to prevent the final
step of acid production and thereby decrease the level of acid in
the stomach
• Indications
– Short-term treatment of active duodenal ulcers, GERD, erosive
esophagitis, and benign active gastric disease
– Long-term treatment of pathological hypersecretory conditions
• Pharmacokinetics
– Acid labile, rapidly absorbed in the GI tract
– Metabolized in the liver and excreted in the urine
- 16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Proton Pump Inhibitors (cont.)
• Contraindications
– Allergy
• Caution
– Pregnancy or lactation
• Adverse Effects
– CNS effects
• Dizziness, headache, asthenia, vertigo, insomnia,
apathy
- 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Proton Pump Inhibitors (cont.)
• Adverse Effects (cont.)
– GI Effects
• Diarrhea, abdominal pain, and tongue atrophy
– Upper respiratory tract symptoms
• Cough, stuff nose, hoarseness, and epistaxis
– Other
• Rash, alopecia, pruritis, dry skin, back pain, and
fever
- 18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antipeptic Agent
• Actions
– Forms an ulcer-adherent complex at duodenal ulcer sites,
protecting the sites against acid, pepsin, and bile salts
• Indications
– Promote ulcer healing
• Pharmacokinetics
– Rapidly absorbed, metabolized in the liver, and excreted in
feces
• Contraindications
– Allergy
– Renal failure
- 19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antipeptic Agent (cont.)
• Caution
– Pregnancy or lactation
• Adverse Effects
– GI effects – Constipation, diarrhea, nausea,
indigestion, gastric discomfort, dry mouth
– Dizziness
– Sleepiness
– Vertigo
– Skin rash
– Back pain
- 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antipeptic Agent (cont.)
• Drug-to-Drug Interactions
– Aluminum salts
– Phenytoin, fluoroquinolone, or penicillamine
- 21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prostaglandin
• Actions
– Inhibits gastric acid secretion and increases bicarbonate
and mucous production in the stomach
• Indications
– Prevention of NSAID-induced gastric ulcers
– Treatment of duodenal ulcers
• Pharmacokinetics
– Rapidly absorbed from GI tract, metabolized in the liver,
and excreted in the urine
• Contraindications
– Pregnancy
- 22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prostaglandin (cont.)
• Caution
– Lactation
• Adverse Effects
– GI effects – Nausea, diarrhea, abdominal pain,
flatulence, vomiting, dyspepsia, and constipation
– GU effects – Miscarriages, excessive bleeding,
spotting, cramping, hypermenorrhea, dysmenorrhea,
and other menstrual disorders
- 23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Please answer the following statement as true or false.
There is a drug-drug interaction between the antipeptides
and penicillin.
- 24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
Rationale: Drug-to-drug interactions include aluminum
salts, phenytoin, fluoroquinolone, or penicillamine.
- 25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Patients Who May Require Digestive
Enzyme Supplements
• Saliva Supplements
– Stroke
– Salivary gland disorder
– Extreme surgery of the head and neck
• Pancreatic Enzyme Supplements
– Common duct problems
– Pancreatic disease
– Cystic fibrosis
- 26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Digestive Enzymes
• Actions
– Saliva substitute – Contains electrolytes and
carboxymethylcellulose to act as a thickening agent
in dry mouth conditions
– Pancreatic enzymes are replacement enzymes that
help the digestion and absorption of fats, proteins,
and carbohydrates
• Indications
– Replacement therapy
- 27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Digestive Enzymes (cont.)
• Contraindications
– Saliva – Allergy
– Pancreatic enzymes - Allergy
• Caution
– Saliva – CHF, hypertension, or renal failure
– Pancreatic enzyme – Pregnancy and lactation
- 28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Digestive Enzymes (cont.)
• Adverse Effects
– Saliva – Complications from abnormal electrolytes –
increased levels of magnesium, sodium, or potassium
– Pancreatic enzyme – GI irritation, nausea, abdominal
cramps, and diarrhea
- 29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Use of Agents Affecting Gastrointestinal
Secretions Across the Lifespan
- 30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Histamine-2 (H2
) Antagonists
- 31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Antacids
- 32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Proton Pump Inhibitors
- 33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Digestive Enzymes
- 34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
What H2 antagonist has been associated with
antiandrongenic effects?
A. Famotidine
B. Cimetidine
C. Nizatidine
D. Ranitidine
- 35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. Cimetidine
Rationale: Cimetidine was the first drug in this class to be
developed. It has been associated with antiandrongenic
effects, including gynecomastia and galactorrhea.
- 36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Histamine-2
(H2
) Antagonists
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 37. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Antacids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 38. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Proton Pump
Inhibitors
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 39. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Antipeptic
Agent
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 40. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Prostaglandin
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 41. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Digestive
Enzymes
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation