Overview
This lecture covered gastrointestinal (GI) medications, focusing on drug classes, indications, side effects, nursing considerations, and special cautions in treatment of GI disorders.
Peptic Ulcer Disease (PUD)
- Gastric ulcers: worsened by eating, may cause malnourishment and hematesis (bloody vomit).
- Duodenal ulcers: pain relieved by eating, symptoms appear hours after meals, may have melena (dark, tarry stools).
- Main cause is often H. pylori infection; antibiotics frequently used.
- GI bleed signs: low BP, high pulse, loss of consciousness, petechiae, easy bruising.
Medications for PUD and Acid Disorders
- H2 Blockers (end in -tidine): decrease gastric acid; side effects include gynecomastia, impotence, CNS effects (lethargy, confusion, hallucinations).
- Do not take H2 blockers with antacids.
- Proton Pump Inhibitors (PPIs) (end in -prazole): reduce acid; short term: nausea, vomiting, headache; long term: pneumonia, osteoporosis, hypomagnesemia, C diff, rebound acid.
- Take PPIs once daily, do not crush or open capsules.
- Mucosal Protectants (sucralfate): form protective barrier; may cause constipation, take 4× daily, avoid with antacids.
- Antacids: neutralize stomach acid; calcium/aluminum cause constipation; magnesium causes diarrhea; risk of alkalosis; separate from other meds by 30+ min.
Prostaglandin Analog
- Misoprostol: prevents NSAID-induced ulcers, induces labor, terminates pregnancy; main AE: diarrhea, dysmenorrhea; contraindicated in pregnancy unless indicated.
Antiemetics
- Serotonin antagonists (ondansetron): for nausea/vomiting; AEs: headache, diarrhea, dizziness, prolonged QT.
- Dopamine antagonists (prochlorperazine, promethazine): for nausea/vomiting, EPS (movement disorders), hypotension, sedation, anticholinergic effects.
- Cannabinoids: for nausea and appetite stimulation in AIDS; AE: dissociation, dysphoria, hypotension, tachycardia; avoid in psych disorders.
- Anticholinergic/Antihistamines (scopolamine, hydroxyzine): for motion sickness; sedation and anticholinergic effects.
Laxatives and Other GI Meds
- Bulk-forming laxatives (psyllium): safest for regular use, take with fluids.
- Surfactant laxatives (docusate): soften stool, monitor for GI irritation and electrolyte imbalances.
- Stimulant laxatives (senna, bisacodyl): increase peristalsis, risk of electrolyte imbalance, rectal burning.
- Osmotic laxatives (magnesium hydroxide, lactulose): increase peristalsis, dehydration risk; lactulose lowers ammonia.
- Antidiarrheals (diphenoxylate/atropine): anticholinergic effects, slows GI motility.
- Prokinetic agents (metoclopramide): increase GI motility, risk of EPS, sedation, diarrhea.
IBS Medications
- IBS-D (diarrhea): alosetron; only in females, requires special consent, risks: constipation, ischemic colitis, serious GI complications.
- IBS-C (constipation): lubiprostone; only in females, causes diarrhea and nausea.
Key Terms & Definitions
- Peptic Ulcer Disease (PUD) — sores in stomach or duodenal lining.
- H2 Blockers — drugs that reduce stomach acid by blocking histamine-2.
- Proton Pump Inhibitors (PPIs) — suppress gastric acid production.
- Mucosal Protectant — coats ulcer sites to prevent further injury.
- Antacid — neutralizes existing stomach acid.
- Antiemetic — prevents or relieves nausea and vomiting.
- Prokinetic Agent — increases GI motility.
- IBS — Irritable Bowel Syndrome (D: diarrhea; C: constipation).
Action Items / Next Steps
- Review PowerPoint for additional details on PUD and GI medications.
- Monitor for and educate patients about GI bleed signs and medication side effects.
- Avoid mixing antacids with other drugs; follow timing guidelines.
- Read up on special considerations for IBS-D and IBS-C medications.