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Gastrointestinal Drugs: Karen Ruffin RN, MSN Ed
Gastrointestinal Drugs: Karen Ruffin RN, MSN Ed
By
Karen Ruffin RN, MSN Ed.
Acid-Controlling Agents
Acid-Related
Pathophysiology
The stomach secretes:
Hydrochloric acid (HCl)
Bicarbonate
Pepsinogen
Intrinsic factor
Mucus
Prostaglandins
perut mensekresikan:
asam klorida (HCl)
Bikarbonat
pepsinogen
Faktor intrinsik
Lendir
prostaglandin
Glands of the Stomach
Cardiac
Pyloric
Gastric*
The cells of the gastric gland are the largest in number
and of primary importance when discussing acid control
jantung
pilorus
Lambung *?
* Sel-sel dari kelenjar lambung adalah yang
terbesar dalam jumlah dan kepentingan utama
ketika membahas kontrol asam
Cells of the Gastric Gland
Parietal cells
Produce and secrete HCl
Primary site of action for many acid-controller drugs
sel parietal
Memproduksi dan mengeluarkan HCl
situs utama tindakan untuk banyak obat asam-
controller
Hydrochloric Acid
Secreted by the parietal cells when stimulated by food
Maintains stomach at pH of 1 to 4
Secretion also stimulated by:
Large fatty meals
Excessive amounts of alcohol
Emotional stress
sel berlendir
sel penghasil mukus (permukaan sel epitel)
Menyediakan lapisan mukosa pelindung
Melindungi diri pencernaan dengan HCl
Acid-Related Diseases
Caused by imbalance of the three cells of the gastric
gland and their secretions
Most common: hyperacidity
Clients report symptoms of overproduction of HCl by
the parietal cells as indigestion, heartburn, acid
stomach
Disebabkan oleh ketidakseimbangan dari tiga sel
kelenjar lambung dan sekresi mereka
Yang paling umum: hyperacidity
Klien melaporkan gejala kelebihan HCl oleh sel
parietal sebagai gangguan pencernaan, mulas,
asam lambung
Acid-Related Diseases
(cont'd)
PUD: peptic ulcer disease
GERD: gastroesophageal reflux disease
Helicobacter pylori (H. pylori)
Bacterium found in GI tract of 90% of patients with
duodenal ulcers, and 70% of those with gastric ulcers
Combination therapy is used most often to eradicate H.
pylori
antasida
antagonis H2
inhibitor pompa proton
Antacids: Mechanism of
Action
Promote gastric mucosal defense mechanisms
Secretion of:
Mucus: protective barrier against HCl
Bicarbonate: helps buffer acidic properties of HCl
Prostaglandins: prevent activation of proton pump which
results in HCl production
contoh
garam hidroksida: magnesium hidroksida (MOM)
garam karbonat: Gaviscon (juga produk kombinasi)
produk kombinasi seperti Maalox, Mylanta (aluminium
dan magnesium)
Antacids: Calcium Salts
Forms: many, but carbonate is most common
May cause constipation
Their use may result in kidney stones
Long duration of acid action may cause increased gastric acid
secretion (hyperacidity rebound)
Often advertised as an extra source of dietary calcium
Example: Tums (calcium carbonate)
sangat larut
Buffer sifat asam HCl
onset cepat, namun durasi pendek
Dapat menyebabkan alkalosis metabolik
konten natrium dapat menyebabkan masalah pada pasien
dengan HF, hipertensi, atau insufisiensi ginjal (retensi cairan)
Antacids and Antiflatulents
Antiflatulents: used to relieve the painful
symptoms associated with gas
Several agents are used to bind or alter intestinal
gas and are often added to antacid combination
products
antiflatulents OTC
Arang aktif
simetikon
Mengubah elastisitas gelembung lendir berlapis,
menyebabkan mereka untuk istirahat
Sering digunakan, tetapi ada data terbatas untuk mendukung
efektivitas
Antacids: Side Effects
Minimal, and depend on the compound used
Aluminum and calcium
Constipation
Magnesium
Diarrhea
Calcium carbonate
Produces gas and belching; often combined with
simethicone
Minimal, dan tergantung pada senyawa yang digunakan
Aluminium dan kalsium
Sembelit
Magnesium
Diare
Kalsium karbonat
Menghasilkan gas dan sendawa; sering dikombinasikan
dengan simetikon
Antacids: Drug Interactions
Adsorption of other drugs to antacids
Reduces the ability of the other drug to be absorbed into the
body
Chelation
Chemical binding, or inactivation, of another drug
Produces insoluble complexes
Result: reduced drug absorption
GERD
PUD
esophagitis
terapi tambahan mengendalikan perdarahan GI atas
Patologis kondisi hipersekresi lambung (Zollinger-Ellison
syndrome)
H2 Antagonists: Side Effects
Overall, less than 3% incidence of side effects
Cimetidine may induce impotence and gynecomastia
May see:
Headaches, lethargy, confusion, diarrhea, urticaria,
sweating, flushing, other effects
Secara keseluruhan, kurang dari 3% kejadian efek
samping
Cimetidine dapat menyebabkan impotensi dan
ginekomastia
Mungkin melihat:
Sakit kepala, lesu, bingung, diare, urtikaria,
berkeringat, memerah, efek lain
H2 Antagonists:
Drug Interactions
Cimetidine (Tagamet)
Binds with P-450 microsomal oxidase system in the
liver, resulting in inhibited oxidation of many drugs
and increased drug levels
All H2 antagonists may inhibit the absorption of drugs
that require an acidic GI environment for absorption
agen sitoprotektif
Digunakan untuk ulkus stres, erosi, PUD
Tertarik dan mengikat ke dasar ulkus dan erosi,
membentuk penghalang pelindung di atas area tersebut
Melindungi daerah ini dari pepsin, yang biasanya
memecah protein (membuat borok buruk)
sucralfate (Carafate)
(cont'd)
Little absorption from the gut
May cause constipation, nausea, and dry mouth
May impair absorption of other drugs, especially
tetracycline
Binds with phosphate; may be used in chronic renal failure
to reduce phosphate levels
Do not administer with other medications
adsorben
Melapisi dinding saluran GI
Mengikat bakteri penyebab atau racun, yang kemudian
dieliminasi melalui tinja
Contoh: bismuth subsalicylate (Pepto-Bismol), kaolin-pektin,
arang aktif, atapulgit (Kaopectate)
Antidiarrheals:
Mechanism of Action (cont'd)
Anticholinergics
Decrease intestinal muscle tone and peristalsis of GI tract
Result: slowing the movement of fecal matter through the GI
tract
Examples: belladonna alkaloids (Donnatal), atropine
antikolinergik
Penurunan tonus otot usus dan peristaltik saluran GI
Hasil: memperlambat pergerakan kotoran melalui saluran
pencernaan
Contoh: alkaloid belladonna (Donnatal), atropin
Antidiarrheals:
Mechanism of Action (cont'd)
Intestinal flora modifiers
Bacterial cultures of Lactobacillus organisms work by:
Supplying missing bacteria to the GI tract
Suppressing the growth of diarrhea-causing bacteria
Example: L. acidophilus (Lactinex)
flora usus pengubah
kultur bakteri organisme Lactobacillus bekerja dengan:
Memasok bakteri hilang pada saluran GI
Menekan pertumbuhan bakteri penyebab diare
Contoh: L. acidophilus (Lactinex)
Antidiarrheals:
Mechanism of Action (cont'd)
Opiates
Decrease bowel motility and relieve rectal spasms
Decrease transit time through the bowel, allowing more time
for water and electrolytes to be absorbed
Examples: paregoric, opium tincture, codeine, loperamide
(Imodium), diphenoxylate (Lomotil)
opiat
Penurunan motilitas usus dan meredakan kejang dubur
Penurunan waktu transit melalui usus, memungkinkan lebih
banyak waktu untuk air dan elektrolit untuk diserap
Contoh: obat penghilang rasa sakit, opium tinktur, kodein,
loperamide (Imodium), difenoksilat (Lomotil)
Antidiarrheal Agents:
Side Effects
Adsorbents
Increased bleeding time
Constipation, dark stools
Confusion, twitching
Hearing loss, tinnitus, metallic taste, blue gums
adsorben
Peningkatan waktu perdarahan
Sembelit, tinja gelap
Kebingungan, berkedut
Gangguan pendengaran, tinnitus, rasa logam, gusi biru
Antidiarrheal Agents:
Side Effects (cont'd)
Anticholinergics
Urinary retention, hesitancy, impotence
Headache, dizziness, confusion, anxiety, drowsiness
Dry skin, rash, flushing
Blurred vision, photophobia, increased intraocular pressure
Hypotension, hypertension, bradycardia, tachycardia
antikolinergik
retensi urin, keraguan, impotensi
Sakit kepala, pusing, kebingungan, kecemasan, rasa kantuk
Kulit kering, ruam, pembilasan
penglihatan kabur, fotofobia, peningkatan tekanan intraokular
Hipotensi, hipertensi, bradikardi, takikardia
Antidiarrheal Agents:
Side Effects (cont'd)
Opiates
Drowsiness, sedation, dizziness, lethargy
Nausea, vomiting, anorexia, constipation
Respiratory depression
Bradycardia, palpitations, hypotension
Urinary retention
Flushing, rash, urticaria
opiat
Mengantuk, sedasi, pusing, lesu
Mual, muntah, anoreksia, konstipasi
depresi pernafasan
Bradikardia, palpitasi, hipotensi
Retensi urin
Flushing, ruam, urtikaria
Antidiarrheal Agents:
Interactions
Adsorbents decrease the absorption of many agents,
including digoxin, clindamycin, quinidine, and hypoglycemic
agents
Adsorbents cause increased bleeding time when given with
anticoagulants
Antacids can decrease effects of anticholinergic antidiarrheal
agents
Adsorben menurunkan penyerapan banyak agen, termasuk
digoxin, klindamisin, quinidine, dan agen hipoglikemik
Adsorben menyebabkan peningkatan perdarahan saat
diberikan dengan antikoagulan
Antasida dapat mengurangi efek dari agen antidiare
antikolinergik
Antidiarrheal Agents:
Nursing Implications
Obtain thorough history of bowel patterns, general state of
health, and recent history of illness or dietary changes, and
assess for allergies
DO NOT give bismuth subsalicylate to children younger than
age 16 or teenagers with chickenpox because of the risk of
Reyes syndrome
Mendapatkan sejarah menyeluruh pola buang air besar,
keadaan umum kesehatan, dan sejarah penyakit atau
perubahan pola makan, dan menilai untuk alergi
JANGAN memberi subsalisilat kepada anak-anak muda dari
usia 16 atau remaja dengan cacar karena risiko sindrom Reye
Antidiarrheal Agents:
Nursing Implications
Use adsorbents carefully in geriatric patients or those with
decreased bleeding time, clotting disorders, recent bowel
surgery, confusion
Anticholinergics should not be administered to patients with
a history of glaucoma, BPH, urinary retention, recent bladder
surgery, cardiac problems, myasthenia gravis
Implications
Bisacodyl and cascara sagrada should be given with
water due to interactions with milk, antacids, and H 2
blockers
Bisacodyl dan cascara sagrada harus diberikan
dengan air karena interaksi dengan susu, antasida,
dan H2 blocker
Patients should contact their provider if they
experience severe abdominal pain, muscle weakness,
cramps, and/ or dizziness, which may indicate fluid or
electrolyte loss
Pasien harus menghubungi penyedia mereka jika
mereka mengalami sakit perut yang parah,
kelemahan otot, kram, dan / atau pusing, yang
mungkin menunjukkan cairan atau elektrolit kerugian
Laxatives: Nursing
Implications
Monitor for therapeutic effect
Monitor efek terapeutic
Antiemetic and Antinausea
Agents
Definitions
Nausea
Unpleasant feeling that often precedes
vomiting
perasaan tidak menyenangkan yang sering
mendahului muntah
Emesis (vomiting)
Forcible emptying of gastric, and occasionally,
intestinal contents
pengosongan paksa lambung, dan kadang-
kadang, isi usus
Antiemetic agents
Used to relieve nausea and vomiting
Digunakan untuk meredakan mual dan muntah
VC and CTZ
Vomiting center (VC)
Chemoreceptor trigger zone (CTZ)
Both located in the brain
Once stimulated, cause the vomiting
reflex
Setelah dirangsang, menyebabkan
refleks muntah
Mechanism of Action
Many different mechanisms of action
Banyak mekanisme yang berbeda
dari tindakan
Most work by blocking one of the
vomiting pathways, thus blocking the
stimulus that induces vomiting
Kebanyakan bekerja dengan
menghalangi salah satu jalur muntah,
sehingga menghalangi stimulus yang
menginduksi muntah
Indications
Specific indications vary per class of
antiemetics
Indikasi spesifik bervariasi per kelas
antiemetik
General use: prevention and
reduction of nausea and vomiting
Umum digunakan: pencegahan dan
pengurangan mual dan muntah
Mechanism of Action and Indications