ANTI INFECTIVE AGENTS BACTERICIDAL

 Drugs that are designed to act  Kill bacteria or microorganisms

selectively on foreign organisms that
have invaded and infected the body of a NARROW SPECTRUM
human host  Antibacterial drugs which are effective
only to a few groups of microorganisms
Goal: To reduce microbes to a point at which
the human immune response can take care of BROAD SPECTRUM
the infection.  Antibacterial drugs that are effective
agaisnts several groups of
ANTI INFECTIVE microorganisms.
 Or anti microbial
 Drugs used to prevent or treat
infections cause by pathogenic CLASSIFICATION OF BACTERIA
microorganisms
 Antibacterial GRAM POSITIVE
 Antiviral  organisms are usually community-
 Antifungal acquired pathogens
include:
ANTIVIRAL  Streptococcal organisms
 Drugs used to treat viral infections  Staphylococcal organisms

ANTIFUNGAL GRAM NEGATIVE

 Drugs used to treat fungal infections  infections are potentially life
threatening
ANTIPARASITIC  Usually nosocomial in origin
 Drugs used to treat parasitic infections
or infestations Gram negative organisms include:
 Escheria Coli (E. coli)
ANTIBACTERIAL  Pseudomonas salmonella
 or ANTIBIOTICS  Enterococcus
 Usually refer only to drugs used in  Klebsiella
bacterial infections  Shigella
 substances that inhibit bacterial growth  Bacteroides
or kill bacteria.
MECHANISM OF ACTION
INDICATIONS FOR USE Most act on specific target in the BACTERIAL
CELL WALL by:
1. To treat already existing infections 1. Inhibition of bacterial wall synthesis.
2. To prevent development of infections 2. Inhibition of protein synthesis.
(called prophylactic therapy) 3. Disruption of microbial cell membrane.
4. Inhibition of organism production by
ANTI INFECTIVE ACTIVITY interfering nucleic acid synthesis.
BACTERIOSTATIC 5. Inhibition of cell metabolism and
 Inhibit the growth of bacteria or growth.
microorganisms
CATEGORIES OF ANTI INFECTIVE AGENTS
AMINOGLYCOSIDES “mycins”
 Group of powerful antibiotics used to
treat serious infections caused by gram-
negative aerobic bacilli
o Pseudomonas aeruginosa
o E. coli
o Proteus species
o Klebsiella-Enterobacter-Serratia group
o Staphylococcus
o Citrobacter species
 Bactericidal – inhibit protein synthesis
 Poorly absorbed from GIT; rapidly
absorbed after IM injection
 Most of these drugs have potentially
serious adverse effects
EXAMPLES:
 Amikacin (Amikin)
 Gentamycin (Garamycin)
 Kanamycin (Kantrex)
 Neomycin (Mycifradin)
 Tobramycin (Tobrex)
Nursing Responsibility:
1. Monitor for ototoxicity, renal toxicity,
GI disturbances, BMD, super-infections
FLUOROQUINOLONES “oxacin”
 relatively new class of antibiotics with a
broad spectrum of activity
 all made synthetically but with
relatively mild adverse reactions
EXAMPLES:
 Ciprofloxacin (Cipro)
 Levofloxacin (Levaquin)
 Ofloxacin (Floxin)
 Sparfloxacin (Zagam)
 Moxifloxacin (Avelox)
Nursing Responsibility:
1. Monitor for headache, dizziness, GI
upsets & BMD
2. Caution about the risk of
photosensitivity reactions
MACROLIDES “mycins”
 Interfere with protein synthesis
EXAMPLES
 Erythromycin (E-mycin)
 Clarithromycin (Biaxin)
 Azithromycin (Zithromax)
Nursing Responsibility:
 monitor for nausea and vomiting,
diarrhea, dizziness, and other CNS
effects
LINCOSAMIDES
 similar to the macrolides but are more
toxic
EXAMPLES
 Clindamycin (Cleocin)
 Lincomycin (Lincocin)
Nursing Responsibility:
1. monitor for pseudomonas colitis, Bone
Marrow Depression, pain, Central
Nervous System effects
MONOBACTAM ANTIBIOTICS
1. Aztreonam
 the only
monobactam antibiotic
currently available
 effective against
gram – enterobacteria
 no effect on
gram+ or anaerobic
 disrupts cell wall
synthesis which promotes
leakage of cellular contents
 Urinary Tract
Infections, Systemic Infections,
intra-abdominal infections
Nursing Responsibility:
 1. monitor for GI problems, liver toxicity,
pain at the injection site
. PENICILLINS
1. Penicillins G benzathine
 Systemic Infections, Erysipeloid
infections
2. Penicillin G potassium
 Severe infections
3. Penicillin G procain
 Moderately severe infections
4. Penicillin V
 Prophylaxis for bacterial endocarditis,
Lyme disease, Urinary Tract Infections
EXTENDED-SPECTRUM PENICILLIN
1. Amoxicillin
 broad spectrum of uses for
adults and children
2. Ampicillin
 switch from parenteral to
oral monitor for nephritis
3. Carbenicillin
 Urinary Tract Infection in adults
 Not used in children
Nursing Responsibility:
1. Monitor for N/V, diarrhea,
superinfections,
hypersensitivity reactions
PENICILLINASE-RESISTANT ANTIBIOTICS
1. Dicloxacillin – must be taken x 10 days
RTC
2. Nafcillin – DOC if switch to oral form is
needed
3. Oxacillin – DOC if switch to oral form is
needed
SULFONAMIDES “sulfa”
 Sulfa drugs inhibit folic acid synthesis
 Folic acid is necessary for the synthesis
of purine and pyrimidines, which are
precursors of DNA and RNA
 Not used much anymore, however, they
remain inexpensive and effective for
UTI.
EXAMPLES:
1. Cotrimoxazole (Septra, Bactrim)
 a combination drug that
contains sulfamethoxazole and
trimethoprim
 effective in OM, UTI, bronchitis,
pneumonitis
2. Sulfadiazine - with broad use in
infections
3. Sulfisoxazole (Gantrisin) - includes
various STDs
Nursing Responsibility
1. Monitor for CNS toxicity, N/V, diarrhea,
liver injury, renal toxicity, BMD
TETRACYCLINES “cycline”
 Developed as semisynthetic antibiotics
based on the structure of a common
soil mold
 Inhibit protein synthesis
 Composed of four rings
EXAMPLES:
1. Doxycycline (Periostat)
 Recommended for traveller’s diarrhea,
periodontal disease, acne, some STDs
2. Minocycline (Minocin)
 Drug of choice in treating
meningococcal carriers
3. Oxytetracycline (Terramycin)
 Also used as an adjunctive therapy in
acute intestinal amoebiasis.
4. Tetracycline (Sumycin)
 Oral & topical & opthalmic
 Acne vulgaris & minor skin infections
Nursing responsibilities:
1. Monitor for GI effects, BMD, rash,
superinfections
2. Caution women that these may make
oral contraceptives ineffective

Acquiring Resistance
1. Producing an enzyme that deactivates
the drug
Ex. penicillinase
2. Changing cellular permeability to
prevent the drug from entering the cell
or altering transport systems to exclude
the drug from active transport into the
cell.
3. Altering binding sites on the
membranes or ribosomes, which then
no longer accept the drug.
4. Producing a chemical that acts as an
antagonist to the drug
Preventing Resistance
1. Doses should be high enough and long
enough to eradicate even slightly
resistant microbes.
2. Correct timing – maintain a constant
therapeutic level
3. Avoid indiscriminate use of anti-
infectives – identify first the causative
organism
COMBINATION THERAPY
- Combination of 2-3 antibiotics
is suggested in severe
infections.
EFFECTS of COMBINATION Therapy:
1. smaller dosage of each drug is used
fewer adverse effects
2. SYNERGISM – more powerful when
given in combination
3. POTENTIATIVE – occurs when one
antibiotics potentiates the effect of the
2nd antibiotics.
4. ADDICTIVE- effect is equal to the sum
of the effects of 2 antibiotics.
5. ANTAGONISTIC- result is a combination
of bacteriostatic and bactericidal. When
these 2 drugs are used together, the
desired effect may be greatly REDUCED.
6. delay the emergence of resistant strains
– TB
Adverse Reactions to Infective Therapy:
KIDNEY DAMAGE
 most frequently with drugs that are
metabolized and excreted by the
kidney
Ex. aminoglycosides
 Stay well hydrated throughout the
course of therapy
GI TOXICITY
 N/V, stomach upset, diarrhea
Ex. Meropenem – used to treat intra-
abdominal infections & some cases of
meningitis
NEUROTOXICITY
 Can damage or interfere with the
function of nerve tissue, usually in
areas where drugs tend to
accumulate in high concentrations
Ex. aminoglycosides – collect in the
8th CN  dizziness, vertigo, loss of
hearing
Ex. Chloroquine for malaria – can
accumulate in the retina & optic
nerve  blindness
HYPERSENSITIVITY REACTIONS
 Induce antibody formation in
susceptible people
SUPERINFECTIONS
 Destruction of normal flora – broad
spectrum
 Opportunistic pathogens have the
opportunity to invade tissues & cause
infections
Ex. vaginal or GI yeast infections
.

DRUGS USED TO TREAT OBSTRUCTIVE
PULMONARY DISORDERS
BRONCHODILATORS/ ANTIASHMATICS
 are medications used to facilitate
respirations by dilating the airways.
 They are helpful in symptomatic relief
or prevention of bronchial asthma and
for bronchospasm associated with
COPD.
 Other medications are administered
directly into the airways by nebulizers.
These medications have the advantages
of a decreased of systemic adverse
reactions.
DESCRIPTION
1. Sympathomimetic bronchodilators
2. Xanthine bronchodilators
3. Anticholinergic brochodilators
4. Corticosteroids
5. Leukotriene receptor antagonist
6. Lung surfactant
XANTHINES
 Including caffeine and theophylline
come from a variety of naturally
occurring sources.
 Stimulate the central nervous system
and respiration, dilate coronary and
pulmonary vessels, cause diuresis and
relax smooth muscle.
 Peak level : 2 hours
1. Aminophylline (Truphylline)
2. Theophylline (Slo- bid, Theo-Dur)
3. Oxtrophylline (Choledyl)
IMPLEMENTATION
1. Administer with food or milk.
2. Monitor patient response to drug
3. Assess for cough, wheezing, decreased
breath sounds and sputum production.
4. IV preparations should be administered
slowly and always via an infusion pump.
5. Monitor for therapeutic serum
theophylline level of 10-20ug/ ml.
SYMPATOMIMETICS
 are drugs that mimics the effect of the
sympathetic nervous system.
 One of the action of SNS- dilate the
airways of the respiratory tree, making
air exchange and respirations easier for
the client, and relax the smooth muscle
of the brochi.
1. Albuterol (Proventil)
2. Bitolterol (Tornalate)
3. Epinephrine
4. Formoterol (Foradil)
5. Isoproterenol (Isoprel)
6. Levalbuterol (Xopenex)
7. Terbutaline (Brethaire)
IMPLEMENTATION
1. Reassure the patient that the drug of
choice will vary with each individual.
2. Teach the patient to use one of these
drugs for exercise induced asthma to
use it 30-60 minutes before exercising
to ensure peak therapeutic effect.
3. Provide safety measures.
4. Provide small, frequent feeding and
nutritional consultation if GI effects
interfere with eating to ensure proper
nutrition.
5. Provide thorough health teachings .
SIDE EFFECTS
1. Palpitations and tachycardia
2. Restlessness, nervousness, tremors
3. Anorexia, nausea and vomiting
4. Headaches and dizziness
5. Hyperglycemia
6. Mouth dryness and throat irritations
with inhalers
  LUNGS – has two effect – promote
smooth muscle relaxation and inhibit
bronchoconstriction.

ANTICHOLINERGIC
 used as bronchodilators because of  Decreased swelling associated with
their effect on the vagus nerve, which is inflammation.
to block or antagonize the action of the
neurotransmitter acetylcholine at vagal- VIA NOSE
mediated receptor site.  Beclomethasone dipropionate
 Ipratropium is the only anticholinergic  Budesonide
recommended fro brochodilation.  Flunisonide
 Onset of action: 15 minutes  Fluticasone propionate
 Peak effect: 1 to 2 hours  Triamcinolone acetonide
 Duration effect: 3-4 hours
VIA MOUTH
Adverse reactions  Prednisolone
 Nervousness  Prednisone
 Tachycardia
 Nausea and vomiting VIA VEIN
-methyprednisolone sodium succinate
IMPLEMENTATION - Hydrocortisone sodium succinate
 ensure adequate hydration and provide
environmental controls, such as use of a ADVERSE REACTION
humidifier.  Mouth irritation
 Ensure the patient to void before each  Oral candidiasis
dose of medication.  URTI
 Provide safety measures
 Provide health teachings IMPLEMENTATION
1. Do not administer the drug to treat an
 Monitor the medication regimen. acute asthma attack.
Total inhalation should not exceed 2. Have the patient use decongestant
in 12-24 hours and total nasay drops before using the inhaled steroid
sprays shouldn’t exceed 8 in each 3. Have the patient rinse the mouth after
nostrils in 24 hours. using the inhaler.
 If more than one inhalation is 4. Monitor the patient for any sign of
ordered, 2 minutes should elapse respiratory infection.
between inhalations. If more than 5. Health teachings
one type of inhalant is ordered,
always gve bronchodilator first and LEUKOTRIENE RECEPTOR ANTAGONIST
wait 5 minutes before 1. Zafirlukast (Accolate)
administering the other. 2. Montelukast (Singulair)
3. Zileuton (Zyflo)
CORTICOSTEROIDS
 Used to decrease the inflammatory
response in the airway.
  work to breakdown mucus in order to
aid the high risk respiratory patient in
coughing up thick, tenacious secretions.
 Maybe administered by nebulization or
DRUGS ACTING ON THE UPPER by direct instillation into the trachea via
an endotracheal tube or tracheostomy.
RESPIRATORY TRACT 1. Acetylcysteine (Mucomyst)
2. Dornase alfa (Pulmozyme)
ANTITUSSIVES- which blocks the cough reflex.
IMPLEMENTATIONS
DECONGESTANTS- which decrease the blood
 Instruct the patient to avoid combining
flow to the upper respiratory tract and decrease
with other drugs in the nebulizer to
the overproduction of secretions.
avoid formation of drug can be
administered via nebulizers with the
ANTIHISTAMINES- which block the release or
drug diluted with sterile water.
action of histamine, a chemical release during
 Remind the patient that the drug may
inflammation that increases secretions and
irritate the respiratory mucosa
narrows airways.
ANTITUSSIVES
EXPECTORANTS- which increase productive
 Act on the cough control center in the
cough to clear the airways
medulla to suppress the cough reflex.
 Used for cough that is non productive
MUCOLYTICS- which increase or liquefy
and irritating
respiratory secretions to aid the clearing of the
1. Benzonatate= narcotic anti-tussive
airways.
2. Butamirate citrate= non-narcotic
3. Codeine= narcotic
EXPECTORANT
4. Dextromethorphan= non-narcotic
 liquefy the lower respiratory tract
5. Hydrocodone= narcotic
secretions, reducing the viscosity of
these secretions and making it easier
Contraindications and Indications for use of
for the patient to cough them up.
antitussives These agents are NOT given to
 Guaifenesin (Anti-tuss, Glycotuss,
patients who have undergone thoracic and
Humibid, Robitussin)
abdominal surgeries because they need to
cough to maintain airway patency.
IMPLEMENTATION
Precautions are instituted when giving to
1. Instruct the client to take medication
patients with asthma, emphysema or COPD
with a full glass of water to loosen
because an accumulation of secretions may
mucus
occur
2. Maintain an adequate fluid intake
3. Encourage the client to cough and deep
IMPLEMENTATION
breath
 Emphasize that the drug should be
4. Caution the client not to use these
taken only on a specified time frame as
drugs for longer 1 week and seek
ordered
medical attention if cough still persists.
 Provide other measures to relieve
cough like provide humidified oxygen,
MUCOLYTICS
cool temperatures, fluids and use of
lozenges
  Caution that alcohol, narcotics,
sedatives-hypnotics can cause CNS
depression when used with
antitussives.
3. Provide safety measures if drowsiness
may occur. Side rails up, assist in
ambulation, and advise not to drive or
operate dangerous machineries or
delicate tasks.

4. Increase humidity in the room by

utilizing nebulizers and provide
ANTIHISTAMINES adequate hydration
 Also called H1 blockers or H1
antagonists, these are agents designed 5. Caution the patient against use of OTC
to relieve respiratory symptoms and to drugs, alcoholic beverages and
treat allergic conditions. sedatives because they may cause
 The ANTIHISTAMINES The anti- extreme sedation.
histamines are group according to the
“generation”.
 The FIRST GENERATION agents have
greater anticholinergic effects and can
cause more sedation and drowsiness!
These agents cause drowsiness .
 The SECOND GENERATION agents have
fewer anticholinergic effects that is why
they cause less sedation.
FIRST GENERATION ANTIHISTAMINES
 1. Azatadine
 2. Dimenhydrinate
 3. Azelastine
 4. Diphenhydramine
 5. Brompheniramine
 6. Chlorpheniramine
 7. Promethazine
SECOND GENERATION ANTIHISTAMINES
 Loratidine
 Cetirizine

IMPLEMENTATIONS

1. The nurse should administer the drug

on an EMPTY stomach, or 1 hour before
or 2 hours after meals to increase the
absorption.

2. Give with food if GI upset occurs Offer

sugarless lozenges or hard candy to
counteract dryness of the mouth. Give
frequent oral care

DRUGS ACTING ON
GASTROINTESTINAL SYSTEM
H2 BLOCKERS
 Blocks the release of hydrocholoric acid
in response to gastrin.
 Blocks the H2 receptors located in the
parietal cells.
 H2 receptors can also found in the
heart and high levels of this drugs can
cause cardiac arrythmias.
CONTRAINDICATIONS
1. Allergy
2. Pregnancy and lactation
3. Hepatic and renal dysfunction that
could interfere with drug metabolism
and excretion
4. Care should be taken if prolonged or
continual use of this drugs is necessary.
ADVERSE EFFECTS
1. Diarrhea or constipation
2. Dizziness, headaches, confusion and
even hallucination
3. Cardiac arrythmias and hypotension
4. Gynecomastia and impotence.
IMPLEMENTATIONS
 Administer with or before meals and at
bedtime
 Arrange for decrease dosage in cases of
hepatic or renal problem
 Monitor patient continually if giving
intravenous dosage
 Provide comfort and safety measures
 Health teachings
 Offer support and encouragement.
PROTON PUMP INHIBITORS
 Inhibits the hydrogen potassium
adenosine triphosphatase enzyme
system on the secretory surface of the
gastric parietal ceells. This action blocks
the final step of acid production,
lowering the acid levels in the stomach.
 Suppress the secretion of hydrocholoric
acid into the lumen of the stomach.
ADVERSE EFFECTS
1. Dizziness, headaches
2. Asthenia
3. Vertigo, insomia, dream abnormalitis
4. Diarrhea, abdominal pain, nausea and
vomiting, dry mouth.
5. Cough, stuffy nose, hoarseness and
epistaxis
implementation
1. Administer before meals
2. Ensure that the patient does not open,
chew or crush capsules, they should be
swallowed whole.
3. Provide safety measures
4. After 4- 8 weeks of therapy should
consult the physician
5. Health teachings
6. Support and encouragement
ANTIPEPTIC AGENTS
 Given to protect eroded ulcer sites in
the GI tract from further damage by
acids and digestive enzymes
SUCRALFATE
 Forms an ulcer adherent complex at
duodenal ulcer sites ->protects the sites
against acid, pepsin and bile salts
->prevents further breakdown of the
area ->promoters ulcer healing.
contraindications
1. Allergy
2. Renal failure or dialysis
3. Pregnancy and lactation
4. Adverse effects
5. Constipation- most common
 6. Nausea, indigestion, gastric discomfort
and dry mouth
7. CNS stimulation
implementation
1. Administer drug in to an empty
stomach,1 hour before meals and at
bedtime.
2. Monitor patient from GI pain
3. Administer antacids between doses of
sucralfate, not with in 30 minutesof a
sucralfate dose bec. Sucralfate can
interfere with the absorption of oral
agents.
4. Provide safety measures
5. Frequent mouth car, sugarless lozenges
to suck
6. Health teachings
7. Support and encouragement
ANTACIDS
 Provide a protective coating on the
stomach lining and lower the gastric
acid level; allows more rapid
movement of stomach contents
into duodenum
 Neutralize gastric acid; effective in
the treatment of ulcers.
 Available in oral preparations.
EXAMPLES
1. Aluminum hydroxide gel (Amphogel)
2. Al and MgOH (Maalox)
3. Sodium bicardonate
4. Calcium bicarbonate (Tums)- may cause
hypercalcemia and hypophosphatemia.
 Caution client on a sodium-restricted
diet that many antacid contains sodium
 Shake oral suspension well before
administrations
 Administer with small amount of water
to ensure passage to stomach
 Can interfere with sucralfate
MAJOR SIDE EFFECTS
1. Constipation
2. Diarrhea
3. Alkalosis
4. Reduce absorption of calcium and iron
NURSING CARE
 Instruct the client regarding:
 prevention of overuse of antacids
which can result in rebound
hyperacidity.
 Need for continous supervision
 Foods high in calcium and iron
 Dietary restrictions related to
gastric distress
ANTIEMETICS
 Alleviate nausea and vomiting.
 Prevent and control emesis and motion
sickness
 Available in oral, parenteral, rectal and
transdermal preparations.
1. Metoclopramide (Plasil, Reglan)
2. Dronabinol (Marinol)
3. Ondansetron (Zofran)
MAJOR SIDE EFFECTS
 Drowsiness
 Hypotension
 Dry mouth
 An EPS symptom due to dopamine
antagonism
NURSING CARE
 Observe occurence and
charateristics of vomitus.
 Provide oral hygiene
 Caution the client to avoid engaging
in hazardous activities
 Offer sugar free chewing gum or
hard candy to promote salivation.
 Instruct client to change position
slowly.
 2. Abdominal distention and constipation
EMETICS (decrease peristalsis)
 Stimulate the vomiting center and 3. Dry mouth
induce vomiting 4. CNS disturbance
 Use to treat acute poisoning. 5. Blurred vision

NURSING CARE
EXAMPLES  Provide dietary counseling with
emphasis on bland foods
APOMORPHINE  Provide oral hygiene
- Given subQ.  ANTISECRETORY AGENTS
- Emesis occurs 5-15 mins after sub q  Inhibit gastric acid secretion.
administrations  Act at the H2 receptors of the stomach
- Do not give to patient who is allegic to parietal cells to limit the gastric
morphine or other opiates secretion (H2 ANTAGONIST)
 Inhibit hydrogen/ potassium ATPase
ADVERSE EFFECTS enzyme system to block acid production
 DEPRESSION (proton pump inhibitors)
 EUPHORIA  Available in oral and parenteral (IM, IV)
 Respiratory depression preparations
 Orthostatic hypotension
MAJOR SIDE EFFECTS
IPECAC SYRUP  CNS disturbances
- 30 cc or less cause no systemic, adverse  Blood dyscrasias
effects  Skin rash
- Emesis occurs after 20- 30 mins
- 200-300 ml of water may facilitate the NURSING CARE
emetic action. 1. Do not administer at the same time as
DO NOT give to patients who: antacids; allow 1 to 2 hour between
 Have altered LOC drugs
 Have seizures 2. Administer oral preparation with meals.
 Ingested corrosives 3. Assess for potentiation of oral
 Ingested petroleum distillates anticoagulant effect.
4. Instruct client to follow prescription
ANTICHOLINERGICS exactly.
 Inhibit smooth muscle contraction in 5. Administration should not exceed 8
the GI tract weeks without medical supervision.
 Alleviate pain associated with peptic
ulcer ANTIDIARRHEALS
 Available in oral and parenteral  Promote the formation of formed stools
 Alleviate diarrhea.
MAJOR SIDE EFFECTS  Available in oral and parenteral
1. All related to decreased (IM)preparations
parasympathetic stimulation.
  Intestinal lubricants: use peripad to
protect clothing.
MAJOR SIDE EFFECCTS  Bulk forming laxatives: mix thoroughly
1. Fluid absorbents: GI disturbances, CNS in 8 oz of fluid and follow with another
disturbance. 8 oz of fluid to prevent obstruction
2. Enteric bacteria replacements:  Administer at bedtime to promote
excessive flatulence; abdominal cramps defecation in the morning.
3. Motility suppressants: urinary
retention. Tachycardia, dry mouth
sedation, respiratory depression.
NURSING CARE
 Monitor bowel movement for color,
characteristics and frequency. PANCREATIC ENZYMES
 Assess for fluid and electrolytes  Replace natural endogenous pancreatic
imbalance enzyme; promote the digestion of
 Assess and eliminate cause of protiens, fats and carbohydrates
diarrhhea.  Available in oral preparations
 Motility suppressants
- Warn client of interfere with the ability to MAJOR SIDE EFFECTS and Nursing CARE
perform hazardous activities and risk of physical  Nausea and diarrhea
dependence with long term use.  Administer with meals
- Offer sugar free chewing gum and hard candy  Avoid crushing preparations that are
to promote salivation. enteric coated.
 Provide a balances diet to prevent
CATHARTICS/ LAXATIVES indigestion
 Alleviate or prevent constipation and
promote evacuation of stool. ANTI SPASMODICS
 Available in oral and rectal preparations  Relax smooth muscle of the GI.
 MAJOR SIDE EFFECTS
 Laxative dependence with long term Side effects:
use 1. Constipation
 GI disturbances 2. Rash
Intestinal Lubricants: inhibit absorption of fat 3. Euphoria
soluble vitamins A, D, E,K can cause anal leaking 4. Dizziness
of oil
EXAMPLE:
Saline Cathartics: dehydration, hypernatremia - HNBB - Buscopan
 BILE ACID SEQUESTRANTS
NURSING CARE  Treat pruritus associated with biliary
 Instruct the client regarding: overuse of disease
cathartics and intestinal lubricants;  Act by absorbing and combining with
increasing intake of fluids and dietary intestinal bile salts.
fibers; increasing activity level;  Take with flavoured products or juice to
compliance with vowel- retaining mask bad taste.
program.
 Monitor bowel movements for SIDE EFFECTS
consistency and frequency of stool.  Constipation
 Bloating
  Flatulence
 Nausea
 Decreased vitamin absorptio
 HEPATIC ENCEPHALOPATHY

LACTULOSE (Duphalac)
- Reduces ammonia level.
- Improves protein tolerance in client
with advanced hepatic cirrhosis
- Lowers colonic pH from 7 to 5:
acidification pulls ammonia into the
bowel to be excreted in the feces, thus
lowering the ammonia level.

NEOMYCIN (Mycifradin)
-reduces the number of colonic bacteria that
normally convert urea and amino acids into
ammonia.