Gastrointestinal System and Nutrition

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs Histamine-Receptor Antagonists Suppress action of gastric acid by blocking H2 receptors in parietal cells in stomach Gastric and peptic ulcers, GERD, hypersecretory conditions May decrease libido, CNS effects such as lethargy, depression, confusion Can increase levels of warfarin, dilantin, theophylline, lidocaine Advise clients to eat small meals, avoid ASA and NSAIDS, Cimetridine (Tagamet), ranitidine hydrochloride (Zantac), famotidine (Pepcid)

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Mucosal Protectant Protects ulcer from further injury by changing sucralfate into a thick substance that covers ulcers Duodenal ulcers, maintenance therapy Constipation Sucralfate may interfere with absorption of phenytoin, digoxin, warfarin, cipro Must increase dietary fiber intake to reduce constipation Sucralfate (Carafate)

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Antacids Neutralize gastric acid and inactivate pepsin Peptic ulcer disease, promoting and relieving pain, GERD Constipation, (magnesium compounds cause diarrhea), Aluminum compounds bind to wafarin and tetracycline and interfere with absorption Medications at least 1 hour before or after antacid use Alumnum hydroxide (Amphojel), magnesium hydroxide (milk of magnesia)

Name Mechanism of Action

Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Prostaglandin Analog Acts as endogenous prostaglandin in GI tract to decrease acid secretion, increase bicarbonate and protective mucus, promote vasodilation to maintain submucosal blood flow For clients on long term NSAID therapy to prevent ulcers, cervical ripening to induce labor Diarrhea, dysmenorrhea Take at bedtime. Misoprostol (Cytotec)

Name Types/Mechanism of Action

Antiemetics, many different types. Glucocorticoids: unknown mechanism ( dexamethason) Substance P/neurokinin antagonists: inhibits aprepitant (Emend) Serotonin antagonists: prevents emesis by blocking the serotonin receptors in chemoreceptors zone (Zofran) Dopamine antagonists: blockade of dopamine (Reglan) Cannabinoids: unknown mechanism (Marinol) Antihistamine (Dramamine) Benzodiazepines (Ativan) (Valium)

Name Mechanism of Action

Therapeutic Uses

Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Laxatives Bulk forming: soften fecal mass and increase bulk (identical to fiber) Surfactant laxatives: lower surface tension of stool Stimulant Laxatives: stimulation of intestinal peristalsis Osmotic laxatives: draw water into intestine, results in peristalsis Bulk forming: decrease diarrhea in cases of diverticulosis or IBS Surfactant: for constipation, prevention of hemorrhoids/straining Stimulant: preparation for specific surgeries, short term treatment for constipation Osmotic: prevent painful elimination, surgery, rapid evacuation if poison is ingested . GI upset, rectal burning, accumulation of magnesium, fluid retention, or dehydration depending on type used Milk and antacids can destroy enteric coating of bisacodyl Maintain adequate hydration Metamucil, Colace, Dulcolax, Milk of Magneisa

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Antidiarrheals Activate opioid receptors in GI tract to decrease intestinal motility specific uses such as diarrhea caused by bacteria or nonspecific for symptoms CNS effects can be present at high doses (euphoria or CNS depression) Alcohol/ CNS depressants may enhance CNS depression Fluid intake to maintain electrolytes, Caffeine exacerbates diarrhea by increasing GI motility Loperamide (Imodium), difenoxin (Motofen)

Medication for Irritable Bowel Syndrome with diarrhea: alosetron (Lotronex), selective blockade of 5-HT3 receptors, result is increase firmness in stool and decrease urgency. Medication for Irritable Bowel Syndrome with constipation: lubiprostone (Amitiza), increases fluid secretion in the intestine to promote motility Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs 5 Aminosalicylates Decrease inflammation by inhibiting prostaglandin synthesis Inflammatory bowel disease such as Crohns disease or ulcerative colitis Agranulocytosis, anemia None 4 does divided throughout the day Sulfasalazine (Axulfidine) Glucocorticoids Immunosuppresants such as Imuran Immunomodulators such as Remicade Antibiotics such as metronidazole (Flagyl)

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Iron Provide iron needed for RBC development and oxygen transport Iron deficiency anemia GI distress (constipation), teeth staining, anaphylaxis risk, hypotension Antacids and tetracyclines reduces absorption of iron Iron is poorly absorbed by body, so large amounts are needed. Increase in hemoglobin of 2 g/dl expected one month after beginning therapy Ferrous sulfate (Feosol)

Name Mechanism of Action

Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Vit B 12 Necessary to convert folic acid in inactive form to its active form. Loss of intrinsic factor within cells of stomach causes inability to absorb vit B12 so supplementation is necessary in high doses Vitamin B12 deficiency, megaloblastic anemia Hypokalemia secondary to increased RBC production Concurrent administration of folic acid may mask symptoms of deficiency of B12 Signs of B12 deficiency: beefy red tongue, pallor, neuropathy B12

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Folic acid Essential in production of DNA and erythropoiesis (RBC, WBC, platelets) Treatment of megaloblastic anemia, prevention of neural tube defects Indiscriminate use of folic acid is not appropriate because it mask the symptoms of B12 deficiency Decreased levels with use of sulfonamides, sulfasalazine, methotrexate Green leafy veg and liver are high in folic acids, Folate level should be between 6 15 mcg/ml Folic acid