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MODULE 3.5 - GASTRO., Lecture notes of Pharmacology

Don Mariano Marcos Memorial State University (DMMMSU)Pharmacology

MODULE 3.5 - GASTRO. LECTURE NOTES

Typology: Lecture notes

2021/2022

Available from 10/25/2022

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NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
LESSON 4
GASTROINTESTAL TRACT
(GIT) DRUGS
ANTIEMETICS
A. Description
1. Diminish the sensitivity of the chemoreceptor trigger zone (CTZ) to irritants.
2. Alleviate nausea and vomiting
3. Prevent and control emesis and motion sickness
4. Available in oral, parenteral (IM, IV), rectal, and transdermal preparations
B. Examples
1. Centrally-acting agents: ondansetron HCl (Zofran);
prochlorperazine (Compazine);
trimethobenzamide HCl (Tigan)
2. Agents for motion sickness control: dimenhydrinate (Dramamine);
mechlizine HCl (Antivert, Bonine);
promethazine HCl (Phenergan)
3. Agents that promote gastric emptying: cisapride (ProPULSID);
metoclopramide (Reglan)
C. Major side effects: drowsiness (CNS depression);
hypotension (vasodilation via central mechanism);
dry mouth (decreased salivation from anticholinergic effect);
incoordination (an extrapyramidal symptom due to dopamine
antagonism)
D. Nursing Care
1. Observe occurrence and characteristics of vomitus
2. Eliminate noxious substances from the diet and environment
3. Provide oral hygiene
4. Caution client to avoid engaging in hazardous activities
5. Offer sugar-free chewing gum or hard candy to promote salivation
6. Instruct client to change positions slowly
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LESSON 4

GASTROINTESTAL TRACT

(GIT) DRUGS

ANTIEMETICS

A. Description

  1. Diminish the sensitivity of the chemoreceptor trigger zone (CTZ) to irritants.
  2. Alleviate nausea and vomiting
  3. Prevent and control emesis and motion sickness
  4. Available in oral, parenteral (IM, IV), rectal, and transdermal preparations B. Examples
  5. Centrally-acting agents: ondansetron HCl (Zofran); prochlorperazine ( Compazine ); trimethobenzamide HCl (Tigan)
  6. Agents for motion sickness control: dimenhydrinate (Dramamine); mechlizine HCl (Antivert, Bonine); promethazine HCl ( Phenergan )
  7. Agents that promote gastric emptying: cisapride (ProPULSID); metoclopramide ( Reglan ) C. Major side effects: drowsiness (CNS depression); hypotension (vasodilation via central mechanism); dry mouth (decreased salivation from anticholinergic effect); incoordination (an extrapyramidal symptom due to dopamine antagonism) D. Nursing Care
  8. Observe occurrence and characteristics of vomitus
  9. Eliminate noxious substances from the diet and environment
  10. Provide oral hygiene
  11. Caution client to avoid engaging in hazardous activities
  12. Offer sugar-free chewing gum or hard candy to promote salivation
  13. Instruct client to change positions slowly

EMETICS

A. Description

 Stimulate the vomiting center & induce vomiting  Used to treat acute poisoning

B. Examples

1. Apomorphine Controlled substance Given subq Emesis occurs 5-15 mins after subq. administration DO NOT GIVE to patients who are allergic to morphine or other opiates AE: depression, euphoria, respiratory depression, orthostatic hypotension 2. Ipecac syrup  30 cc or less cause no systemic, adverse effects  Emesis occurs after 20-30 mins  200 - 300 mL of water may facilitate the emetic action  DO NOT GIVE to patients who: a) Have altered LOC b) Have seizures c) Ingested corrosives d) Ingested petroleum distillates

ANOREXIANTS

A. Description

  1. suppress the desire for food at the hypothalamic appetite centers; generally produce CNS stimulation
  2. Available in oral preparations B. Examples:
  3. amphetamine sulphate (Bezedrinea)
  4. dextroamphetamine sulphate (Dexedrine) C. Major side effects: nausea, vomiting (irritation of gastric mucosa); constipation (delayed passage of stool in GI tract); tachycardia (sympathetic stimulation); CNS stimulation activation D. Nursing care
  5. Educate client regarding: a. Drug misuse(controlled substances) b. Concurrent exercise and diet therapy c. Need for medical supervision during therapy d. Possibility of affecting ability to engage in hazardous activities
  6. Monitor weight

ANTICHOLINERGICS

A. Description

  1. Inhibit smooth muscle construction in the GI tract
  2. Alleviate pain associated with peptic ulcer
  3. Available in oral and parenteral (IM, SC, IV) preparations B. Examples:
  4. atropine sulphate
  5. dicyciomine HCI (Bentryl)
  6. glycopyrrolate (Robinul)
  7. propantheline bromide (Pro-Banthine)
  8. methaneline bromide (Banthine)
  9. Belladona C. Major side effects (all related to decreased parasympathetic stimulation)
  10. Abdominal distention and constipation (decrease peristalsis)
  11. Dry Mouth (decreased salivation )
  12. Urinary retention (decreased parasympathetic stimulation)
  13. CNS disturbances (direct CNS toxic effect) – confusion
  14. Blurred vision D. Nursing care
  15. Provide dietary counseling with emphasis on bland foods
  16. Provide oral hygiene

ANTISECRETORY AGENTS

A. Description

  1. Inhibit gastric acid secretion
  2. Act at the H 2 receptors of the stomach parietal cells to limit gastric secretion (H 2 ) antagonists)
  3. Inhibit hydrogen/ potassium ATPase enzyme system to block acid production (proton pump inhibitors)
  4. Available in oral and parental (IM, IV) preparations B. Examples
  5. H 2 antagonists a) famotidine (Pepcid) b) ranitidine (Zantac) c) cimetidine (Tagamet) d) nizatidine (Axid) – for GERD
  1. Proton pump inhibitors a) omeprazole (Prevacid) – for esophagitis, GERD, ulcer
  2. misoprostol (Cytotec) – suppresses gastric acid secretion; promotes secretion of HCO 3 & cytoprotective mucus; maintains submucosal blood flow through vasodilation C. Major side effects
  3. CNS disturbances (decreased metabolism of drug because of liver or kidney impairment)
  4. Blood dyscrasias (decreased RBCs, WBCs , platelet synthesis)
  5. Skin rash (hypersensitivity) D. Nursing care
  6. Do not administer at the same time as antacids; allow 1 to 2 hour between drugs
  7. Administer oral preparation with meals
  8. Assess for potentiation of oral anticoagulant effect
  9. Instruct client to follow prescription exactly
  10. Administration should not exceed 8 weeks without medical supervision SUCRALFATE (Carafate)  Forms a highly-condensed, paste-like substance after reacting with gastric acid that binds to gastric & duodenal ulcers, forming a protective barrier to pepsin, acid, bile – allowing ulcers to heal  Wait for 2 hrs after other drugs

ANTIDIARRHEALS

A. Description

  1. Promote the formation of formed stools
    1. Alleviate diarrhea
  2. Available in oral and parental (IM) preparations B. Examples
  3. Fluids adsorbents: decrease the fluid content of stool: bismuth carbonate; kaolin and pectin (Kaopectate)
  4. Enteric bacteria replacements: enhance production of lactic acid from carbohydrates in intestinal lumen; acidity suppresses pathogenic bacterial over growth: Lactobacillus acidophilus (Bacid); Lactobacillus bulgaricus (Lactin-ex)
  5. Motility suppressants: decrease GI tract motility so that more water will be absorbed from the large intestine: diphenoxylate HCI (Lomotil); Loperamide HCI (Imodium)
  1. Saline cathartics: increase osmotic pressure within intestine, drawing fluid from blood and bowel wall, thus increasing bulk and stimulating peristalsis: effervescent sodiumphosphate (Fleet Phospho-Soda); magnesium citrated solution; Milk of Magnesia C. Major side effects
  2. Laxative dependence with long term use (loss of normal defecation mechanism)
  3. GI disturbances (local effect)
  4. Intestinal lubricants: inhibit absorption of fat soluble vitamins A, D, E, K; can cause anal leaking of oil (accumulation of lubricant near rectal sphincter)
  5. saline cathartics: dehydration (fluid volume depletion resulting from hypertonic state in GI tract); hypernatremia (increased sodium absorption into circulation; shift of fluid from vasculature to intestinal lumen) D. Nursing care
  6. Instruct the client regarding: overuse of cathartics and intestinal lubricants; increasing intake of fluids and dietary fiber; increasing activity level; compliance with vowel- retraining program.
  7. Monitor bowel movements for consistency and frequency of stool
  8. Intestinal lubricants: use peripad to protect clothing
  9. Bulk-forming laxatives: mix thoroughly in 8 oz of fluid and follow with another 8 oz of fluid to prevent obstruction
  10. administer at bedtime to promote defection in the morning

PANCREATIC ENZYMES

A. Description

  1. Replace natural endogenous pancreatic enzymes (protease, lipase, amylase); promote the digestion of proteins, fats and carbohydrates
  2. Available in oral preparations B. Examples: pancreatin (donnazyme); pancrelipase (Cotazym, Pancrease, Viokase) C. Major side effec t: nausea and diarrhea (GI irritation) D. Nursing care
  3. Administer with meals
  4. Avoid crushing preparations that are enteric coated
  5. Provide a balanced diet to prevent indigestion

BILE ACID SEQUESTRANTS

A. Description  Treat pruritus associated with biliary disease  Act by absorbing & combining with intestinal bile salts – secreted in the feces  Take with flavored products or juice to mask bad taste  Abate GI effects through stool softeners B. Examples

  1. Cholestyramine (Questran, Prevalite)
  2. Colestipol (Colestid) C. Side effects
  3. Constipation
  4. Bloating
  5. Flatulence
  6. Nausea
  7. Decreased vitamin absorption

HEPATIC ENCEPHALOPATHY

A. Lactulose (Duphalac)  Reduces ammonia level  Improves protein tolerance in clients with advanced hepatic cirrhosis  Lowers colonic pH from 7 t0 5: acidification pulls ammonia into the bowel to be excreted in the feces, thus lowering the ammonia level B. Neomycin (Mycifradin) Reduces the number of colonic bacteria that normally convert urea & amino acids into ammonia

ANTISPASMODICS

A. Description  Relax smooth muscle of the GI B. Side effects  Constipation  Rash  Euphoria  dizziness C. Examples

  1. HNBB - Buscopan
  1. FILARIASIS  Infection of blood & tissues  skin bites  inflammatory reactions  swelling of hands, feet, scrotum, arms, legs, breast  Elephantiasis
  2. SCHISTOSOMIASIS  Infection by a fluke carried by a snail  Larvae skinbloodstream & lymphatics  lungs & liver  mature & mate  migrate to intestine & urinary bladder  urine & feces  s/s : Swimmer’s itch, fever, chills, h/a, abdominal pain, diarrhea, spleen & liver enlargement AVAILABLE DRUGS:
  3. PYRANTEL (Antiminth)  Single oral dose  Pinworms & roundworms
  4. THIABENDAZOLE (Mintezol)  Roundworm, hookworm, pinworm  Not as effective as others & has more adverse effects
  5. ALBENDAZOLE (Albenza) Effective against active lesions caused by pork tapeworm & cystic disease of the liver, lungs, & peritoneum caused by dog tapeworm RF & BMD – adverse effects
  6. IVERMECTIN (Stromectol)  threadworm
  7. PRAZIQUANTIL (Biltricide)  Schistosomiasis & flukes  3 doses with 4-6 hours interval

ANTIPROTOZOAL AGENTS

 Infections caused by insect bites (malaria, trypanosomiasis, leishmaniasis)  Infections caused by ingestion or contact with the causal organism (amoebiasis, giardiasis, trichomoniasis) MALARIA  Spread via the bite of Anopheles mosquito  The plasmodium parasites:

  1. P. Falciparum
    • Most dangerous
    • Fever, hypotension,swelling, of limbs, RBC loss, death
  2. P. Vivax
    • Milder & seldom results in death
  3. P. Malariae
    • Very mild s/s
    • Acute disease in travellers to endemic areas
  4. P. Ovale
    • Rare; on the verge of eradication Combination of drugs attack the plasmodium at various stages a) QUININE – first to be discovered
  • Reserved for chloroquine resistant infections
  • May lead to severe diarrhea & CINCHONISM (n/v, tinnitus, vertigo) b) CHLOROQUINE (Aralen)
  • Mainstay of antimalarial therapy
  • Hepatotoxic, eye damage, blindness c) HYDROXYCHLOROQUINE (Plaquenil)
  • Combined with PREMAQUINE for greater effectiveness d) PRIMAQUINE
  • Prevent relapse of vivax & malariae infections e) MEFLOQUINE (Lariam)
  • Prevention & treatment f) PYRIMETHAMINE (Daraprim)
  • Combined with other drugs AMEBIASIS  Caused by Entamoeba histolytica  Aka amebic dysentery  Transmitted while in the cystic stage in fecal matter  water, ground  Ideal environment is large intestine – TROPHOZOITE  Eat away tissues vascular area  liver, lungs, heart, etc.