GASTROINTESTINAL

DRUGS
CLASSIFICATION
 DRUGS ACTING ON THE GASTROINTESTINAL
• The gastrointestinal tract is a part of the human
digestive system, a system that includes the
mouth, esophagus, stomach, and intestines plus
the accessory organs of digestion such as the
salivary glands, pancreas, liver, and gallbladder.
• The nervous system and the endocrine system
work together to control gastric secretions and
motility associated with the movement of food
through the gastrointestinal tract.
• Digestion starts with the sight, thought, or smell of
food. When the brain anticipates an incoming
meal, the vagus nerve sends a message to the
stomach to stimulate gastric secretions.
• The mucosal lining of the stomach contains
numerous gastric glands.
GASTROINTESTINAL (GI) DISEASES
Gastrointestinal (GI) diseases are those that affect any section of the
gastrointestinal tract. There are many different types of GI diseases including
gastroesophageal reflux disease (GERD), peptic ulcers, nausea & vomiting,
constipation, and diarrhea.
GASTROINTESTINAL DRUGS

A drug used for its effect on the

gastrointestinal system by:
controlling gastric acidity, regulating
gastrointestinal motility and water flow,
and improving digestion.
 FOUR CLASSES OF
GASTROINTESTINAL DRUGS

H2 BLOCKERS

PROTON PUMP INHIBITORS

ANTIEMETICS

LAXATIVES
 HISTAMINE TYPE 2 RECEPTOR ANTAGONIST
Inhibit histamine binding at H2 receptors on the parietal cells, resulting in the
MECHANISM OF ACTION reduction of histamine-mediated acid secretions.

Gastric and duodenal ulcer, Gastro-esophageal reflux, Treatment and prophylaxis of

INDICATIONS NSAID associated ulcers.

CAUTIONS ANS CONTRAINDICATIONS Allergy, Pregnancy, and lactation, Hepatic and renal dysfunction, prolonged use

CNS: Dizziness, confusion, headache, somnolence. Cardio: Cardiac arrhythmias,

SIDE EFFECTS/ ADVERSE EEEFCTS cardiac arrest.GI: Diarrhea. Reproductive: Impotence. Skin: Rash. Misc: Gynecomastia
(cimetidine)

METABOLISM AND HALF-LIFE These drugs are excreted largely unchanged in the urine. t1/2 is 2-3h.

MONITORING No specific drug monitoring required

Cimetidine, Famotidine, and Ranitidine can slow down the metabolism of the ff:
DRUG INTERACTIONS drugs (Warfarin, Phenytoin, Lidocaine, Chloroquine, Nifedipine).

EXAMPLES Ranitidine, Cimetidine, Famotidine, Nizatidine

IMPORTANT POINTS Ranitidine can be used prior to general anesthesia in patients at high risk of
aspiration, particularly in obstetric practice (Mendelson’s Syndrome)
 NURSING CONSIDERATIONS
• Assess for possible contraindications and cautions: history of allergy to any H2 antagonists
to prevent potential allergic reactions; impaired renal or hepatic function, which could
affect the metabolism and excretion of the drug; a detailed description of the GI problem,
including length of time of the disorder and medical evaluation to evaluate the
appropriate use of the drug and possibility of underlying medical problems; and current
status of pregnancy and lactation because of the potential for adverse effects on the
fetus or newborn.
• Perform a physical examination to establish baseline data before beginning therapy,
determine the effectiveness of the therapy, and evaluate for any adverse effects
associated with drug therapy.
•Inspect the skin for evidence of lesions or rash to monitor for adverse reactions.
• Evaluate neurological status, including orientation and affect, to assess CNS effects of the
drug and to plan for protective measures.
• Assess cardiopulmonary status, including pulse, blood pressure, and electrocardiogram (if
IV use is needed), to evaluate the cardiac effects of the drug.
• Perform abdominal examination, including an assessment of the liver, to establish a
baseline and rule out an underlying medical problem.
•Monitor the results of laboratory tests, including liver and renal function tests, to predict
changes in metabolism or excretion of the drug that might require dose adjustment.
 NURSING INTERVENTIONS
• Ensure therapeutic levels. Administer the drug with or before meals and at bedtime (exact timing
varies with the product) to ensure therapeutic levels when the drug is most needed.
• Prevent serious toxicity. Arrange for decreased doses in cases of hepatic or renal dysfunction to
prevent serious toxicity.
• Monitor IV doses carefully. Monitor the patient continually if giving IV doses to allow early detection
of potentially serious adverse effects, including cardiac arrhythmias
• Assess for potential drug-drug interactions. Assess the patient carefully for any potential drug-drug
interactions if given in combination with other drugs because of the effects of the drug on liver
enzyme systems.
• Provide patient comfort. Provide comfort, including analgesics, ready to access bathroom facilities,
and assistance with ambulation, to minimize possible adverse effects.
• Reorient the patient thoroughly. Periodically reorient the patient and institute safety measures if CNS
effects occur to ensure patient safety and improve and improve patient tolerance of the drug and
drug effects.
• Attend regular follow-ups. Arrange for regular follow-ups to evaluate drug effects and the underlying
problems.
• Provide support. Offer support and encouragement to help patients cope with the disease and the
drug regimen.
• Educate the client. Provide patient teaching regarding drug name, dosage, and schedule for
administration; the importance of spacing administration appropriately as ordered; need for readily
available access to a bathroom; signs and symptoms of adverse effects and measures to minimize or
prevent them.
HISTAMINE TYPE 2 RECEPTOR ANTAGONIST

NURSING DIAGNOSIS
Nursing diagnosis related to drug
therapy might include the following:

• Acute pain related to CNS and GI effects.

• Disturbed sensory perception (kinesthetic,
auditory) related to CNS effects.
• Decreased cardiac output related to cardiac
arrhythmias.
• Risk for injury related to CNS effects.
• Deficient knowledge regarding drug
therapy.
 GASTRIC PUMP /PROTON PUMP INHIBITORS (PPI’S)
suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine
MECHANISM OF ACTION triphosphate enzyme system on the secretory surface of the gastric parietal cells./suppress the
secretion of hydrochloric acid into the lumen of the stomach.

Treatment and maintenance of erosive esophagitis, treatment of heartburn associated with

INDICATIONS GERD, gastric ulcer, Maintenance therapy for healing duodenal ulcers and esophagitis., Approved
for use in children for treatment of GERD, peptic ulcer, and Zollinger-Ellison syndrome.

Allergy ,Pregnant or lactating women (potential for adverse effects on the fetus or neonate,
CAUTIONS ANS CONTRAINDICATIONS Patients 18 years old and below(safety and efficacy is not yet established)

CNS: Headache, dizziness, vertigo, insomnia. Skin: Rash. GI: Diarrhea, abdominal pain, nausea,
SIDE EFFECTS/ ADVERSE EFFECTS vomiting, Respiratory: Upper respiratory infections, cough.

Extensively metabolized by the liver and excreted by both renal and biliary routes. t½ varies from
METABOLISM AND HALF-LIFE 40 mins to 2h.

MONITORING No specific drug monitoring required

DRUG INTERACTIONS Benzodiazepines, ketoconazole and theophylline, sucralfate and clopidogrel.

EXAMPLES Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, and Rabeprazole, Dexlansoprazole

IMPORTANT POINTS PPI’s reduce acid secretions by 90% and are therefore more effective at healing peptic ulcer s than
H2 receptor antagonists (reduce acid secretions by 50-60%). PPI’s can be used in the management
of upper GI Bleeding.
 NURSING CONSIDERATIONS
• Assess for possible contraindications and cautions: history of allergy to a proton
pump inhibitor to reduce the risk of hypersensitivity reaction and current status of
pregnancy or lactation because of the potential for adverse effects on the fetus
or nursing baby.
• Perform a physical examination to establish baseline data before beginning
therapy to determine the effectiveness of the therapy and to evaluate for the
occurrence of any adverse effects associated with drug therapy.
• Inspect the skin for lesions, rash, pruritus, and dryness to identify possible adverse
effects.
• Assess neurological status, including the level of orientation, affect, and reflexes
to evaluate for CNS effects of the drug.
• Inspect and palpate the abdomen to determine potential underlying medical
conditions; assess for changes in bowel elimination and GI upset to identify
possible adverse effects.
• Assess respiratory status, including respiratory rate and rhythm; note evidence of
cough, hoarseness, and epistaxis, to monitor for potential adverse effects of the
drugs.
 NURSING INTERVENTIONS
• Proper administration. Administer drug before meals to ensure that the patient
does not open, chew, or crush capsules; they should be swallowed whole to
ensure the therapeutic effectiveness of the drug.
• Safety and comfort measures. Provide appropriate safety and comfort measures if
CNS effects occur to prevent patient injury.
• Institute a bowel program. Monitor the patient for diarrhea or constipation in order
to institute an appropriate bowel program as needed.
• Monitor nutritional status. Monitor the patient’s nutritional status; the use of small
frequent meals may be helpful if GI upset is a problem.
• Ensure follow-up. Arrange for medical follow-up if symptoms are not resolved after
4 to 8 weeks of therapy because serious underlying conditions could be causing
the symptoms.
• Provide patient support. Offer support and encouragement to help the patient
cope with the disease and the drug regimen.
• Educate the patient and folks. Provide thorough patient teaching, including the
drug name and prescribed dosage; the importance of taking the drug whole
without opening, chewing, or crushing it; signs and symptoms of possible adverse
effects and measures to minimize or prevent them.
 PROTON PUMP INHIBITORS

Nursing diagnosis related to drug

therapy might include the following: NURSING DIAGNOSIS
• Diarrhea related to GI effects.
• Risk for constipation related to GI effects.
• Imbalanced nutrition: less than body
requirements related to GI effects.
• Disturbed sensory perception (kinesthetic,
auditory) related to CNS effects.
• Risk for injury related to CNS effects.
• Deficient knowledge regarding drug therapy
ANTIDIARRHEAL
Are a class of medications used to
treat acute and chronic diarrhea.
Help to reduce the frequency and urgency of
passing stools; however, they do not eliminate
the cause of diarrhea, and hence, diarrhea will
occur as soon as you stop the antidiarrheal
medications until the underlying cause (such
as infection or inflammation) is treated properly.
ANTIDIARRHEALS WORK
• Diarrhea can lead to a serious loss of
body water (dehydration)
and minerals (electrolytes). Drink plenty of
fluids to replace the nutrients you may
have lost. In addition, stick to a bland diet
during this time to reduce the irritation to
your stomach/intestines.
 ANTIDIARRHEALS WORK
• Antidiarrheals work by decreasing the flow of fluids and
electrolytes into the bowel and slowing down the movement
of the bowel to decrease the number of bowel movements.
• This allows more fluid to be absorbed into your body which
helps in having less diarrhea and more formed and bulky
stools.
• They help in balancing the way fluid moves through your
intestines and thus reduce inflammation.
• They also slow the growth of bacteria that might cause
diarrhea.
CHAPTER SUMMARY OF
GASTROINTESTINAL
DRUGS

LONG COUPONBOND
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