Gastro Intestinal Agents

Prof. Clement C. Belvis RN, RM, MPH

Assistant Professor V
De La Salle- Health Sciences Campus

Anti- diarrheal
Anti- emetic
Emetic
Laxative
Anti- ulcer
GIT Tract
Diarrhea
Constipation
Vomiting
Ulcer
 ANTI-
DIARRHEALS
 Diphenoxylate
 Difenoxin

 Lomotil

 Motofen

 Loperamide

 Somatostasin Analog: Octreotide

 Adsorbents

 Miscellaneous Antidiarrheals
 Anti-diarrheals
 MODE OF ACTION:
Inhibition of gastric
motility
 DIARRHEA-
frequent liquid
stools
I. Opiates and Opiate Related II.
Somatostatin Analog
camphorated opium tincture
octreotide acetate
deodorized opium tincture III.
Adsorbents
difenoxin and atropine bismuth
salts
diphenoxylate with atrophine kaolin-
pectin
Loperamide IV. Miscellaneous
 • Decrease intestinal motility, decreasing peristalsis
• Duration: about 2 hours.
• diphenoxylate has less potential for causing
drug dependence
• difenoxin is more potent than diphenoxylate
• frequent use of Lomotil and Motofen may lead
to physical dependence
• loperamide protects against diarrhea, reduces
fecal volume and decreases intestinal fluid and
electrolyte losses
• CNS depression may occur if diphenoxylate be
taken with alcohol, narcotics, or sedative-
hypnotics
• Decreases smooth muscle contractility
• For severe diarrhea resulting from
metastatic cancer
• Coats GI tract wall, absorb toxins or
bacteria that may be causing
diarrhea
 For management of diarrhea and
enteritis caused by bacteria or
protozoa
 For acute, non-specific diarrhea
 CNS depression
 Drowsiness

 Dizziness

 Constipation

 Dry mouth
 Monitor v/s. Report tachycardia or systolic BP rise of 10-15
mmHg.
 Monitor frequency of bowel movement and bowel sounds.
 Check for signs and symptoms of dehydration, replace lost
fluids.
 Administer cautiously to patients with glaucoma, liver
disorders, ulcerative colitis, and to pregnant women.
 Instruct patient not to take sedatives, tranquilizers
 Instruct patient to take only medication prescribed and not
exceed recommended dosage
 Encourage patient to take in clear liquids and to avoid fried
foods and milk.
 CONSTIPATION-accumulation of hard fecal
matter in the large intestine
 LAXATIVES & CATHARTICS-used to
eliminate fecal matters; Laxatives promote
soft stools, while cathartics result in a soft
to watery stools with some cramping.
 PURGATIVES-“harsh” cathartics that cause
a watery stool with some cramping
I. Osmotics
 Salts or saline products
 lactulose
 glycerin
II. Stimulant (Contact) Laxatives
 phenolphthalein
 bisacodyl
 cascara sagrada
 senna
 castor oil
III. Bulk-Forming Laxatives
 calcium polycarbophil
 methylcellulose
 fiber granules
 psyllium hydrophilic mucilloid
IV. Emollients (Stool Softeners)
 docusate calcium
 docusate potassium
 docusate sodium
 docusate sodium with casanthranol
• Made up of sodium or magnesium, small
amount is systematically absorbed
• Hypersmolar salts pull H2O into colon and
increase water in feces to increase bulk,
therefore stimulating peristalsis.
• Contains 3 types of electrolyte salts: sodium
salts, magnesium salts, potassium salts.
• lactulose is a saline laxative that is not
absorbed, draws water into the intestines to
form soft stools
• glycerin increases water in the feces in the
large intestine, bulk results from the increased
water in the feces and results to peristalsis and
defecation
• Increase peristalsis by irritating sensory nerve
endings in the intestinal mucosa
• Most frequently used and abused laxatives are
bisacodyl and phenolphthalein
• Results occur in 6-12 hours
• Castor oil is a harsh laxative, acts on the small
bowel and produces watery stool
• Bisacodyl promotes defecation by irritating the
colon
• Psyllium compounds increase fecal bulk and
peristalsis
• Natural fibrous substances which promote
large, soft stools by absorbing water into the
intestine, increasing fecal bulk and peristalsis
• Non-absorbable
• Defecation may occur within 8-24 hours
• Powdered bulk-forming laxatives should be
mixed in a glass of water or juice, stirred and
drank immediately, followed by a half to a full
glass of water
• This group of laxatives does not cause laxative
dependence
• Stool softeners and lubricant to prevent
constipation
• Decrease straining during defecation
• Lowers surface tension and promotes
water accumulation in the intestine and
stool
 Nausea

 Vomiting

 Diarrhea

 Abdominal cramping
 Reddish-brown urine caused by
excretion of phenolphthalein, senna
or cascara
• Instruct client to increase water intake if not
contraindicated
• Instruct clients to swallow tablets whole
• Advise client to store suppositories at <30 degrees C
• Advise client to avoid overuse of laxatives
• Advise client to take drug only with water to increase
absorption
• Instruct client not to take drug within 1 hour of any
other drug
• Remind client that drug is not for long term use
• Instruct client to time administration so as not to
interfere with activities or sleep.
 Emetics
Ipecacuanha

Mustard

Ipecac
 IPECACUANHA
emetic, diaphoretic,
expectorant
Dosage: Doses of water from
ten to twenty grains of the
powder, or one to one and a half
ounce of the infusion, every half
hour until vomiting takes place

Do not give more than the

dosage
MUS
TAR
emetic, diuretic,
D stimulant
a large teaspoonful
mixed with a tumbler
of warm water
 Dosage:
Action: it induces
Adult: PO 15-30 ml
vomiting
Pharmacokinetics:
by
Absorption:
water.
Side Effects:
by
200 ml tepid
stimulating the
minimal
Diarrhea,
IPEC
sedation,
AC
Nursing responsibilities:
Metabolism:
Child:
lethargy,CTZ 30 mins
> 1-12 yr:
protracted
-Do not
upvomiting
toPO: give
2 hrs. milk.
Excretion:
15ml,
(chemoreceptor followed
-If
GI emetic
(vomiting)is unsuccessful,
by 200-300
trigger zone) ml
in tepid
the
Pharmacodynamics:
Contraindication:
perform gastric lavage.
water and
Adverse
medulla Reaction:
acting Life
-Instruct the parents toPO: giveOnset: 15-30
Hypersensitivity,
Child:< 1yr:cardio-
Threatening; PO
mins 5- toxicity
depressed gagif
directly
sufficient on thewhen using
fluids
it 10ml, followedreflex,
is not vomited by(hypotension,
Duration: 20-25
unconscious
gastric
Ipecac syrup. mucosa
100 -200mlchest
tachycardia, tepid
orpain).
min semiconscious,
water. poisoning due to
 Anti – emetic
drugs
DIMENHYDRINATE

CYCLIZINE HYDROCHLORIDE
MECLIZINE HYDROCLORIDE
Use cautiously
DIMENHYDRINATEin: Narrow-angle glaucoma,
prostatic hypertrophy
Brand name: Dramamine
Adverse Effects: drowsiness, anorexia
Classification: Antihistamine;
Pharmacokinetics: anti-
Absorption: readily absorbed
inemetic
the GI tract
Prototype: Diphenhydramine
Distribution: distributed into
Action: H1
breastmilk, receptor
crosses antagonist
placenta
Elimination:
Therapeutic Effects:excreted
involveinability
urine to
Pharmacodynamics:
inhibit choligernicOnset: PO:15-30
stimulation inmins;
IV:immediate; IM: 20-30 mins
vestibular and associated neural
Duration: 3-6 hrs
pathways
Nursing Responsibilities:
Uses: Chiefly in prevention
monitor I &O, dehydration and
treatment of motion sickness.
CYCLIZINE HYDROCHLORIDE
Brand name:
Adverse Marezine
Effects: drowsiness
Classification: Antihistamine;
Pharmacodynamics: Onset:anti-emetic;
rapid
anti-vertigo agent
Duration: 4-6 hrs
Prototype:
Nursing meclizine
Responsibilities:
Action:monitor
Piperazine antihistamine
post-op (H1- as
pts v/s closely,
receptor blocking
cyclizine can agent) cause
It exhibits CNS depression and anti-
hypotension
cholinergic, anti-forspasmodic,
monitor signs of CNSlocal anesthetic
andstimulation
antihistaminic activity.
Uses: Chiefly for prevention and treatment of
 MECLIZINE HYDROCLORIDE
Adverse Effects: drowsiness
Brand name: Bonamine
Pharmacokinetics: Absorption: readily
Classification: Antihistamine(H1-
absorbed in the GI tract
receptor antagonist); anti-emetic
Distribution: crosses placenta
Prototype:Diphenhydramine
Elimination: excreted in feces
Action: anticholigernic action, marked
Pharmacodynamics: Onset: 1 hr
depressant action on labyrinthe
Duration: 8-24hrs
excitability and on conduction of
Half-life: 6 hrs
vestibular-cerebellar pathways
Nursing Responsibilities:
Uses: mgt of n/v and dizziness
assess for level of sedation
associated with motion sickness and in
administer with food
vertigo associated with diseases
 Prescription Anti-emetics
 Anti - histamines
 Anti- cholinergic (SCOPOLAMINE)

 Phenothiazine (CHLORPROMAZINE)

 Benzodiazepine (LORAZEPAM)

 Serotonin Receptor Antagonist

 Cannabinoids

 Miscellaneous (METROCLOPRAMIDE)
 Anti-histamines
Benzodiazepine
LORAZEPAM
for prevention of n/v
resulting from cancer drug
treatment
Serotonin Receptor Antagonist
to prevent n/v caused by
cancer chemotherapy
Cannabinoids
to prevent n/v caused by
 Anti-cholinergic
SCOPOLAMINE
Pharmacokinetics:Metabolism: metabolized
Brand name: Atropair, Atropisol
in liver
Classification: anti-emetic; ANS agent;
Absorption: readily
anticholinergic Actions: corrects the
absorbed in the GI tract and
imbalance between acetylcholine and
percutaneously
norepinephrine
Elimination: excreted in urine
Uses: as prophylactic agent for motion
Pharmacodynamics: Peak: 20-60 mins
sickness
Duration: 5-7 hrs
Contraindications: hypersensitivity to
Nursing Responsibilities:
anti-cholinergic drugs, hypersensitivity
In the presence of pain, scopolamine
to belladona or barbiturates, narrow
may cause delirium, restlessness and
 Pharmacokinetics:Pethoniazines
Metabolism: in liver
Absorption: rapid absorption after IM
CHLORPROMAZINE
Distribution: widely distributed,
Brand name:
accumulates Thorazine
in brain, crosses placenta
Classification: anti-emetic
Elimination: excreted in urine as
metabolites; excreted in breast
Contraindications: hypersensitivity to milk
Pharmacodynamics: Onset: 30-60 mins
pethoniazine derivatives;
Peak: 2-4 minswithdrawal states
PO; 15-20 mins IM
from alcohol, comatose
Duration: 4-6 states,
hrs brain damage,
bone marrowHalf life: 30 hrs Reye’s syndrome
depression.
Nursing Responsibilities:
Adverse effects: idiopathic edema, muscle
Establish baseline BP and PR before initiating
necrosis,
treatmentSLE-like syndrome, sudden
unexplained death, orthostatic hypotension,
Monitor BP frequently
Monitor for anti-emetic
palpitation, tachycardia,effect ECG changes,
Adverse effects: drowsiness, extra pyramidal
reactions, restlessness
Miscellaneous
Pharmacokinetics: Metabolism: minimally in liver
METROCLOPRAMIDE
Absorption: readily absorbed in GIT
Brand name: Maaloxwidely distributed,
Distribution:
Classification: GIT agent;
distributed into breast milk, anti emetic
crosses
placenta Potent central dopamine receptor
Actions:
antagonistElimination: 95% excreted in urine, 5%
in feces
Contraindications: sensitivity or intolerance
Pharmacodynamics: Onset: 30-60 mins
to drug, hx of seizure disorders. Mechanical
Peak: 2-4 mins PO; 10-15 mins
GI obstruction
IM; 1-3mins IV
Cautious use: CHF, hypokalemia,
Duration: 1-3 hrs kidney
dysfunction, GIHalf-life:
hemorrhage
2.5-6 hrs
 ANTI-ULCER DRUGS
 Tranquilizers

 Anticholinergics

 Antacids

 Histamine Blockers2
 Proton Pump Inhibitors

 Pepsin Inhibitor

 Prostaglandin Analogue
 ULCER
Predisposing Factors:
Hypersecretion of acid and pepsin
Increased number of parietal cells in the stomach
Environmental and Drug influences
Helicobacter pylori infection
Various Regimens Used to Eradicate H. pylori
Dual Therapy
Triple Therapy
Quadruple Therapy
 TRANQUILIZERS
 Drug Action:
 Reduce vagal stimulation
 Decrease anxiety.
 Side Effects: Occasionally, dry mouth,
constipation, urinary hesitancy,
drowsiness
 Contraindication: Glaucoma
 Special Precaution: Prostatic
hypertrophy. May affect ability to drive or
operate machinery. Early pregnancy.
Dependence, withdrawal precautions.
 Drug Intercation: Alcohol
 Example: Librax (Librium and Quarzan)
 ANTICHOLINERGICS /
PARASYMPATHOLYTICS
 Drug Action:
 Inhibits acetylcholine and blocks
histamine and hydrochloric acid.
 Relieves pain by decreasing GI
motility and secretion
 Delays gastric emptying
 Side Effects/ Adverse Effects: dry
mouth, decreased secretions,
tachycardia, urinary retention, and
constipation. May aggravate the
ulceration.
 Nursing Responsibility: Should be
taken before meals. Should be taken
two hours before antacids
 Examples: antimuscarinic and
parasympatholytics, pirenzepine
(Gastrozepine), Librax,
glycopyrrolate (Robinul), pirenzepine
(Gastrozepine), propantheline
bromine, tridihexethyl chloride
(Pathilon)
 ANTACIDS
 Drug Action: Neutralizes hydrochloric acid and
reduces pepsin activity
 Types: a) Systemic Effect b) Non-systemic Effect
 WITH SYSTEMIC EFFECT:
 Sodium Bicarbonate: first antiulcer drug
 Side Effects / Adverse Reaction: sodium excess
(causes hypernatremia), water retention,
metabolic alkalosis caused by excess bicarbonate,
acid rebound
 Examples: Bromo-Seltzer, Alka-Seltzer
 Calcium carbonate: most effective in neutralizing
acid.
 Side Effects / Adverse Effect: acid rebound,
hypercalcemia
 WITH NON_SYSTEMIC EFFECT
 -composed of alkaline salts
 Aluminum (aluminum hydroxide, aluminum
carbonate)
 Side Effects: hypophosphatemia,
constipation
 Magnesium (magnesium hydroxide,
magnesium carbonate, magnesium
trisilicate, magnesium phosphate)
 Drug Action: greater neutralizing power
than aluminum.
 Side Effects: diarrhea,
 Contraindication: renal impairment.
 MAALOX: Combination of magnesium and
aluminum salts
 .Nursing Interventions:
 Avoid administering antacids with oral drugs,
because antacids can delay their absorption.
 Not given with tetracycline, digoxin, or
quinidine because it binds with and
inactivates most of the drug.
 Given 1 to 2 hours after other medications.
 Ideal dosing interval: 1 and 3 hours after
meal and at bedtime
 Shake well suspensions before
administering; follow with water.
 Monitor electrolytes and urinary PH, calcium
and phosphate levels.
 HISTAMINE BLOCKER
 Most popular drugs in treatment of gastric and
duodenal ulcers.
 Drug Action:
 Prevents acid reflux in the esophagus.
 reduce gastric secretion
 Side effects: headaches, dizziness, constipation,
pruritus, skin rash, gynecomastia, decreased
libido, and impotence.
 Nursing Interventions:
 Administer drug just before meals to decrease
food-induced acid secretion or at bedtime.
 Be alert that reduced doses of drug are needed
by older adults, who have less gastric acid.
Metabolic acidosis must be prevented.
 Administer drug IV in 20 to 100ml of solution.
 Examples:
 Cimetidine
 Blocks 70% of acid secretions in 4hours
 Good kidney function is necessary
 Antacids can be given after or before an hour.
 SIDE EFFECTS: diarrhea, muscle pain, dizziness,
skin rashes
 Ranitidine (Zantac) ,Famotidine (Pepcid)
,Nizatidine (Axid)
 More potent than cimetidine.
 Block gastric acid secretions
 Promote healing of the ulcer
 Longer duration of action
 Fewer side effects
 PROTON PUMP INHIBITORS
(GASTRIC ACID, SECRETION
INIBITORS, GASTRIC ACID PUMP
INHIBITORS)
 Drug Action:
 Suppress gastric acid secretion up to 90% greater
than the Histamine blockers
 Nursing Responsibilities:
 Should be taken before meals
 Caution with clients with hepatic impairment
 Liver enzymes should be monitored
 Side effects: headache, dizziness, diarrhea,
abdominal pain, rash
 may increase the risk of cancer
 Examples: lansoprazole,rabeprazole,
pantoprazole, esomeprazole, omeprazol
PEPSIN INHIBITOR (MUCOSAL PROTECTIVE
DRUG)
 Sucralfate (Carafate)
 Drug Action:
 Combines with protein to form a viscous substance
that covers the ulcer and protects it from acid and
pepsin.
 It does not neutralize acid or decrease acid secretions.
 Promotes healing
 Side Effects: constipation.
 Nursing Responsobilities:
 If stored properly, can remain stable up to 2 years
 Administer drug on empty stomach.
 Administer an antacid 30 minutes before or after
sucralfate binds with certain drugs
(e.g.tetracycline,phenytoin) thus reducing the effect of
other drugs.
PROSTAGLANDIN ANALOGUE ANTIULCER
DRUG
Drug Action:
 Suppress gastric acid secretion

 Increase cytoprotective mucus in the GI

tract.
 It causes a moderate decrease in pepsin
secretion.
Example:
 Misoprotosol: considered as effective as
cimetidine
 Contraindication: Pregnancy