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AGENTS USED TO TREAT GASTROINTESTINAL
DISORDERS
ANTACIDSANTACIDS
HYDROCHLORIC ACID
is constantly secreted by the parietal cells in
the lining of the stomach.
The rate of acid secretion in the
stomach may vary widely throughout the day, but it is generally at its highest level just before or during the ingestion of a meal
ANTACIDS
-are alkaline chemical agents used for relief
of symptoms associated with hyperacidity and
peptic ulcer disease
-primary goal is for relief of pain
The pain-reducing effect of antacids is believed to be due to their:
acid neutralizing capacity
inhibition of the protein-digesting ability of pepsin
action to increase the resistance of the stomach lining
The pain-reducing effect of antacids is believed to be due to their:
Ability to increase the tone of the lower esophageal sphincter
-this is why antacids are effective in reducing pain associated with GERD
SELECTION OF ANTACIDS
An ideal antacid product:
effectively neutralizes large volumes of acid with a reasonably small dose
avoids causing “acid rebound”
has a prolonged action
does not interfere with the digestion or absorption of nutrients or drugs
SELECTION OF ANTACIDS
An ideal antacid product:
does not cause constipation or diarrhea
does not release carbon dioxide gas in the stomach
SELECTION OF ANTACIDS
An ideal antacid product:
does not interfere with electrolyte and acid base balance at usual therapeutic doses
is palatable
is inexpensive
CLASSIFICATION
SYSTEMIC ANTACIDS
NON-SYSTEMIC ANTACIDS
SYSTEMIC ANTACIDS
- are highly soluble in gastric fluids; once dissolved, they are absorbed
readily-agents this category (sodium
bicarbonate) have a rapid onset and a short duration of action
SYSTEMIC ANTACIDS
- most likely to cause acid-base and electrolyte disturbances
- May cause rebound hyperacidity
NONSYSTEMIC ANTACIDS
- most useful agents for long-term therapy
- although a small proportion of the antacid may be absorbed, most of the
dose remains in the GI tract and will not alter systemic acid base balance or
electrolyte levels
NONSYSTEMIC ANTACIDS
- caution must be used in administering magnesium-containing antacids to clients with impaired renal function
-as magnesium may accumulate and cause toxicity in such clients
NONSYSTEMIC ANTACIDS
- Most non-systemic antacids will cause either constipation or diarrhea
EXAMPLE OF NONSYSTEMIC ANTACIDS
Aluminum carbonate gel (Basaljel)Aluminum hydroxide gel (Amphogel,
Alternagel)Aluminum phosphate gel (Phosphaljel)
Calcium carbonate (Tums, Chooz)Dihydroxy-aluminum sodium carbonate
(Rolaids Antacid)
EXAMPLE OF NONSYSTEMIC ANTACIDS
Magaldrate (Riopan)Magnesium Hydroxide (Milk of
Magnesia, MOM)Magnesium Oxide
EXAMPLE OF SYSTEMIC ANTACIDS
Sodium Bicarbonate (Baking Soda, Soda Mint)
NURSING IMPLICATIONSNURSING IMPLICATIONS
Administration with other drugs or food may reduce the absorption of these
agents
Do not take other oral drugs within 1-2 hours of antacid administration
Monitor quality and consistency of stool during antacid therapy
NURSING IMPLICATIONSNURSING IMPLICATIONS
Shake liquid antacid products well prior to use
Follow administration of antacid with a small amount of water or milk to facilitate passage into stomach
Do not administer within 1-2 hours of any enteric coated products
NURSING IMPLICATIONSNURSING IMPLICATIONS
Assess the client’s response to antacid use
OTHER AGENTS OTHER AGENTS AFFECTING AFFECTING
GASTROINTESTINAL GASTROINTESTINAL FUNCTIONFUNCTION
LAXATIVES
CONSTIPATION is a condition in which passage of feces through the lower GI
tract is slow or nonexistent
This results in a reduction in the frequency and an increase in difficulty
of fecal evacuation
FACTORS THAT CONTRIBUTE TO CONSTIPATION
Ignoring the defecation urge
Environmental changes
Ingestion of a low-residue diet
Decreased physical activity
Emotional stress
FACTORS THAT CONTRIBUTE TO CONSTIPATION
Ingestion of constipating foods (e.g. dairy products)
Use of constipating drugs (e.g. calcium-and/or aluminum-containing antacids, anticholinergics, opiates)
FACTORS THAT CONTRIBUTE TO CONSTIPATION
Chronic misuse or overuse of stimulant laxatives
Decreased fluid intake
LAXATIVES
are drugs intended to facilitate the passage and elimination of feces from
the colon and rectum
USES OF LAXATIVES
Prepare clients for a lower GI x-ray series or surgery
Reduce the strain of defecation in clients with cardiovascular disease or in
post-operative clients
Diagnose and treat parasitic infestations of the GI tract
USES OF LAXATIVES
Help remove unabsorbed poisons from the GI tract when oral poisonous
substances have been consumed
Prevent or treat constipation
STIMULANT LAXATIVES
-increase the motility of the GI tract by chemical irritation of the intestinal
mucosa
-it may also act by increasing the secretion of water into both the small
and large intestines
They tend to produce a watery, often diarrheal, stool
EXAMPLE OF STIMULANT LAXATIVES
Bisacodyl (Dulcolax, Bisacolax)Cascara Sagrada
Castor OilPhenolphthalein (Alophen)
Senna (Senokot)
NURSING IMPLICATIONS
Contraindicated for use in clients with abdominal pain, nausea, vomiting, or
rectal fissuresShould only be used for short-term
treatmentEvaluate effectiveness of laxative
SALINE LAXATIVES
-draw water through the intestinal wall by osmotic action and thereby increase
the fluidity of the stool and stimulate greater intestinal motility
Saline laxatives are only employed in the rapid evacuation of the bowel (in
preparing a client for endoscopic examination)
EXAMPLE OF SALINE LAXATIVES
Magnesium CitrateMagnesium Hydroxide
Magnesium Sulfate, epsom saltsSodium Phosphate (Fleet enema)
NURSING IMPLICATIONS
Should only be used for short-term treatment
Contraindicated for use in clients with abdominal pain, nausea, vomiting, or
other symptoms of appendicitisEvaluate the effectiveness of laxative
BULK-FORMING LAXATIVES
-among the safest laxatives available. They are natural or semisynthetic
compounds that absorb fluid and swell in the intestine, thereby stimulating
peristaltic action
-tend to produce normally formed stool
EXAMPLE OF SALINE LAXATIVES
Barley Malt extract (Maltsupex)Methylcellulose (Citrucel)
PolycarbophilPsyllium (Metamucil, Novo-Mucilax)
NURSING IMPLICATIONS
Laxative effect may not be evident for up to 3 days
Contraindicated for use in clients with abdominal pain, nausea, vomiting or
other symptoms of appendicitisEvaluate effectiveness of laxative
LUBRICANT LAXATIVES
-this are oils that act as lubricants to facilitate the passage of the fecal mass
through the intestine
EXAMPLE: Liquid Petrolatum (Fleet Oil Retention Enema)
Oral form should be administered on an empty stomach because of the drugs ability to impair the absorption of fat-soluble drugs and nutrients
STOOL SOFTENERS
-this are detergent-like drugs that permit easier penetration and mixing of
fats and fluids with the fecal mass
-this agent does not irritate the intestine or stimulate peristaltic action
EXAMPLE OF SALINE LAXATIVES
Docusate calcium (Calax, Surfak)Docusate potassium (Dialose)
Docusate sodium (Colace, Selax)
NURSING IMPLICATIONS
Liquid dosage form may be given in milk, fruit juice, or formula to mask tasteAction may not be evident for up to 3
daysPrevents development of constipation.
It is not used to treat existing constipation
NURSING IMPLICATIONS
Avoid use for longer than 1 weekEvaluate client for the effectiveness of
these agents
ANTIDIARRHEAL AGENTS
DIARRHEA is defined as the abnormally frequent passage of watery
stools.
It is generally caused by the failure of the small and large colon to adequately absorb fluid from the intestinal contents
POSSIBLE CAUSES OF DIARRHEA
Allergy
Amebic dysentery
Antibiotics
Cancer of the GI Tract
Food poisoning
POSSIBLE CAUSES OF DIARRHEA
Lactose intolerance
Medication
Radiation
Regional enteritis
Ulcerative colitis
DRUG THERAPY
is generally aimed at REDUCING the MOTILITY of the GI Tract,
thereby permitting normal dehydration of the intestinal contents to take place
DRUGS THAT REDUCE GI MOTILITY
TWO CLASSES:
OPIUM DERIVATIVES