now let's focus on drugs for bowel disorders and other GI conditions this is in chapter 42 starting on page 649 in your text the lower digestive tract consists of small and large intestines the first 10 inches of the small intestine is called the duodenum here it receives chyme chyme is a mixture a partially digested food from the stomach mixed with bile from the gallbladder in pancreatic enzymes from the pancreas the small intestines is where most nutrient and Drug absorption occurs this areas consistent of the duoden also the jejunum and the ilium the jejunum is where most nutrient absorption occurs ilium conversely will empty the contents into large intestine through the ileocecal valve peristosis or a rhythmic motion of the lower adjusted lower digestive tract enzymes is controlled by the autonomic nervous system however peristalsis is highly encouraged through activation of the parasympathetic nervous system speeding up the digestion while sympathetic nervous system slows everything down so it's important to reflect back onto the parasympathetic and sympathetic nervous system to think about which meds can also affect the overall digestive process last we want to talk a little bit about peptic ulcers this is the most common disorder in this area it can be affected with digestion process it also can be affected by increasing problematic areas causing bleeding and decreased absorption now the large intestine is responsible for reabsorption of water excretion of fecal matter synthesizing of vitamins and remember it's colonized with host Flora allowing protective bacteria to protect the inside of the intestine from any disease process however that could easily be affected by medications and Foods passing through we'll talk about this more throughout the slides let's reflect a little bit on some problems that can have in the intestine now constipation is one of the major focuses and problematic areas in the intestine this is otherwise known as infrequent passage of hard and small stools symptoms are usually of underlying disorder so it's important to identify what's causing these so it can quickly be fixed common conditions can be lack of exercise insufficient dietary fiber from intake diminish fluid intake slow motility of waste materials through the large intestine this can again be caused by Foods medication and underlying disease let's talk about ways we can accelerate this tool from passing through the intestine and prevent or treat constipation these medications are in the categories of laxatives or cathartics they may be used to prepare bowel for surgery or diagnostic procedures empty the large intestine and other reasons why we need to get this stool moving quicker there are several different types bulk forming agents otherwise known as stool stuffers or surfactants can also be categorized with saline or osmotic laxatives these add more bulk or water to the colon contents encouraging quicker exit also opiate antagonists these block receptors for the large intestine stimulants or herbal agents stimulate peristalsis remember that wave-like motion in the intestine encouraging that fecal Mass to move forward to the anus for evacuation and then lastly mineral oil helps lubricate the fecal mass and help it move through the intestine a little bit easier prototype we're going to talk about is a prototype laxative psyllium otherwise known as Metamucil the mechanism of action is its swelling and increasing the size of the fecal Mass primary use to promote the passage of stool adverse effects are very rare and cause cramping and a little bit of abdominal pain at times however less cramping than stimulant type laxatives biggest concern with this drug is with insufficient water intake it may actually cause an obstruction either in the esophagus or the intestine nurse work for bowel evacuation assess the abdominal abdominal area for distension vowel sounds and bowel patterns it's important to take the patient's intake and talk to them about what's been going on with their history not just today but let's talk about a pattern It's always important to listen to your vowel sounds before you assess and palpate for any type of a distinction or if you're percussing the Bell remember peristalsis must be restored prior to laxative therapy you want to ensure the bowel is still working it's important to assess for colon cancer esophageal obstruction intestinal obstruction fecal impaction and undiagnosed abdominal pain if diarrhea occurs it's important to discontinue the laxative use you should use with caution during pregnancy and lactation because fluid hydration is so very important during those stages it's important to take with one to two glasses of water assess the patient's ability to swallow again assess for diarrhea and cramping and assess for and educate patients about the proper use of laxatives and stool softeners these should not be used consistently or routinely [Music] let's talk about too fast or too frequent bowel evacuation so again diarrhea is the increase in frequency or fluidity of bowel movements this occurs when the colon fails to absorb water in its normal process it's important to recognize this is the body's type of Defense to eliminate toxins and pathogens also sometimes eliminate certain medications and infections remember because the colon is primarily used to reabsorb water if prolonged can lead to fluid electrolyte and acid excuse me acid-base imbalance if diarrhea is frequent it may eliminate the normal colonized bacteria in the intestine and may be related to a condition called pseudomembranous colitis otherwise known as Clostridium difficile this is a very dangerous infection and should be recognized and treated very very quickly pharmacotherapy for diarrhea remember treatment is going to depends on the severity in etiology so again trending is very important some opioids may be used for severe diarrhea they are very very effective and slow peristalsis however remember they can become habit-forming bind toxins psyllium preparations remove fluid allowing the stool to bulk and probiotic supplements correct bacterial imbalance it's important to recognize you don't have to take a probiotic in a pill form there are several other ways to find probiotic in your diet including yogurt and fermented foods such as kimchi and other fermented drinks prototype anti-diarrheals are diphonoxinate with atropine mechanism of action slowing peristalsis primary use for moderate to severe diarrhea remember to assess for dizziness and drowsiness with this medication it is very important to recognize patients should have routine stool studies prior to giving these drugs it's important not to hold in any infection if it is present let's recap nurse work for antidiarrheals are assess the fluid and electrolyte status this can be done by assessing intake and output as well as looking at your lab studies for electrolyte status on the metabolic profiles it's important to assess for blood in the stool and remind patients it is not to be used if they are constipated they really should be avoided assess the patient's ability to get out of bed safely for risk of Falls and ensure patients recognize that antidiarrheals are contraindicate contraindicated in some patients specifically those with severe dehydration electrolyte imbalance and patients with liver renal disorders also glaucoma so let's talk about a condition when the colon is too active it is called irritable bowel syndrome also known as colon most common disorder of the lower Di excuse me lower gastrointestinal or GI tract symptoms are recurrent abdominal pain with three days to a month or three months along with two of the following pain is relieved by defecation onset of pain is associated with change and stool or frequency also onset is also associated with change in former appearance oftentimes patient will have diarrhea followed by constipation or vice versa this is a functional bowel Disorder so no presence of detectable disease is usually identified stress and dietary factors often precipitate symptoms making them more frequent irritable bowel syndrome treatment includes supportive symptomatic treatment including dietary changes sometimes support groups and relaxation therapy to decrease anxiety or stress also bulk forming laxatives may be used such as psyllium and anticholinergic medications these reduce bowel spasms inflammatory inflammatory bowel disease may include specific conditions such as ulcerative colitis or the erosion in the large large intestine Crohn's disease ulceration in the distal part of the small intestine remember these symptoms may be ranging from mild to acute and may have symptoms such as abdominal cramping and diarrhea it's important to recognize there may be periods of remission and exacerbation [Music] IBD treatment should be treated in a stepwise manner starting with five aminosalic acid or five ASC agents sofasalazine osasalazine and methylamine next glucocorticoids including prednisone methylprednisone Hydrocortisone and sometimes topical Pizza side these help slow and suppress the otherwise inflammatory type response next immunosuppressant drugs are last stage therapy and should be used only with Reserve when the other two treatments are not working prototype drug sulfasalazine inhibits mediators of inflammatory inflammation of the colon it's activated by colon bacteria these are used to treat mild to moderate ulcerative colitis adverse effect nausea vomiting anorexia abdominal pain headache rashes Stephen Johnson syndrome decreased sperm count low blood sugar and type 2 diabetics and Nevada toxicity it's important to give only for ages 2 and older and to swallow it whole so let's recap on Nurse work remember should give the medication whole and only to ages two or older this drug is contraindicated in any patient with a urinary obstruction anemia and folate disorders again use cautiously in type 2 diabetics because increase of low blood sugar episode and remember it does have a cost sensitivity with patients who are allergic to sulfonamide and Lasix let's talk about other bowel disorders including something common enough as nausea and vomiting this is associated with many conditions including infection poisoning psychological factors otherwise stress pain and changes in body position many drugs can cause nausea and vomiting as a normal side effect this is a common reason why many patients will discontinue a drug excessive vomiting can result in dehydration and significant weight loss also severe acid-base disturbances leading to a vascular collapse due to dehydration treatment of nausea and vomiting include myotomodorant treatment and with over-the-counter drugs and herbal options think about those that you can get over the counter including acid reducers such as Tums or something simple like ginger a normal and very frequently used herbal option moderate to severe nausea is treated with prescription drugs including in phenothiazines antihistamines and anticholinergics also cannabinoids corticosteroids bendo benzodiazepines and lastly serotonin receptor antagonists your prototype drug for antiemetics is ondansetron these block this action of Serotonin receptors in the GI tract as well as the triggered Zone in the brain primary use of a nausea and vomiting especially after surgery adverse effects headache dizziness drowsiness constipation or diarrhea and dysrhythmia to work for antiemetics assess symptoms and that precipitated the vomiting a sedation occurs and continued vomiting occurs place a nasal gastric tube with suction into the stomach to help decompress it's important to recognize patient safety may be of concern because the drowsiness so assess the risk for Falls also immediately immediately report vomiting of blood and it's important to recognize and educate patients over-the-counter antiemetics should not be used for prolonged period of time well let's talk about develop a the upper the other opposite direction in medics or drugs that cause you to vomit these should only be used in emergency situations specifically only used when a patient is alert because of risk for aspiration and then along if the patient is comatose gastrovage tube may be placed and attached to suction to empty gastric contents it's important to recognize that all not all poisonous agents will be used with emetics some poisons and caustic chemicals should not be vomited so it's important to when you have any questions contact your local poison control for more information all right let's go ahead and switch gears and talk about pancreatitis this is the inflammation of the pancreas this is specifically due to pancreatic enzymes otherwise known as amylase and lipase being trapped in the pancreas this is not allow release into the duodenum for the digestion process occurs this is often associated with gallstones in women and alcoholism in men steatateria occurs late in the disease so it's important to recognize what the stool looks like pancreatitis often leads to diabetic condition pharmacotherapy for treatment includes replacement of these enzymes and supportive drugs for the reduction of pain and gastric acid secretion prototype drug for pancreatic enzyme replacement is called pancreoli piece the mechanism of action is it contains lipase protease and amylase of pork origin it facilitates conversion of lipids into glycerol and fatty acids also converts starches and dextrin and sugars lastly converts proteins into peptides primary use is a replacement therapy for patients with insufficient pancreatic exocrine secretions it can cause metabolic syndrome or hyperuricemia so it's very important to assess for adverse effects include GI symptoms of nausea vomiting and diarrhea nurse will conclude assess for use for foods that stimulate gastric and pancreatic secretions assessor monitor the presence amount in types of pain also check for duration of pain assess for the respiratory status monitor elevated serum and urine urinary amylase and elevated bilirubin and monitor the patient's nutritional and hydration status as well as signs of infection lastly remember because of its pork origin you need to assess for pork allergy