GI medications

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Rifaximin

GI bacteria causes ammonia enceph. pts. can't filter ammonia

Used for hepatic encephalopathy in conjunction with lactulose (which bind to ammonia)

Works against e. coli to tx. traveler's diarrhea

Box 58.4 on page 1028 Antibiotic that acts locally on the GI tract

Antidiarrheals

AE: constipation

Caution: hx. of GI obstruction

slows peristalsis, allows increased time for absorption

Loperamide (Imodium)

GI Stimulant

if used more than 12 weeks, should be done under care of MD

AE: Reglan can cause tardive dyskinesia symptoms

Stimulate parasympathetic activity within the GI tract

Metoclopramide (Reglan)

Laxatives

Nursing considerations

Pt. ed. about overuse, yo-yo use

Monitor for electrolyte deficiencies

Monitor for dehydration, encourage water intake

Encourage short-term use

Promote natural methods first

Lubricants

Can be used long term

Docusate (Colace): stool softener

Help the intestinal contents move more smoothly

Osmotic Laxatives

Subtopic

AE: cramping, bloating, dehydration

Lactulose (Constilac): hepatic encephalopathy Polyethylene glycol (MiraLAX): daily laxative Polyethylene glycol electrolyte solution (GoLYTELY): bowel prep for procedure. WILL cause diarrhea.

Draw fluid into GI tract & stim GI motility

Bulk Stimulants

AE: constipation if not increased slowly & used with lots of water

Methylcellulose (Citrucel) Psyllium (Metamucil)

Cause the fecal matter to increase in bulk

Chemical Stimulants

AE: cathartic dependence

Caution: acute GI disorders, pregnancy

Bisacodyl, senna

Chemically irritate the lining of the GI tract

Natural Methods

Proper diet: high fiber, fresh fruits & veg Promote healthy gut bacteria Regular exercise, ambulation Increase fluid intake Don’t ignore urges

Antiemetics

Nursing Considerations

Non pharm methods

oral care

Bowel sounds, activity, I&Os

baseline CNS

Assess for dehydration

promethazine (Phenergan)

Risk of extravasation DO NOT use hand vein

causes drowsiness

H2 antihistamine

Substance P/Neurokinin 1 receptor antagonist

Don't use w/ warfarin PO contraception

Highly emetogenic chemo (cisplatin) Used in combo w/ dexamethasone

directly block N/V receptors in CNS

5-HT3 receptor blockers

AE: Prolonged QT interval

N/V from chemo& radiation, postop N/V

ondansetron (Zofran)

block N/V receptors in CTZ and locally

Nonphenothiazines

N/V from chemo, postop N/V

metoclopramide (Reglan)

reduces responsiveness of nerve cells in CTZ

Phenothiazines

AE: Pink to red-brown urine Photosensitivity

N/V from anesthesia, intractable hiccoughs

change responsiveness of CTZ

prochlorperazine

Digestive Enzymes

Monitor: for dry mouth, pancreas labs

Saliva substitute (Mouth Kote, Salivart) Pancrelipase (Creon, Pancrease)

For pts. who don't make enzymes: stroke, chemo, salivary gland disorder, extreme head/neck surg. cystic fibrosis, pancreas dysfunction

GI reflux and ulcer meds

Prostiglandin

Pt. ed: Female pts of child-bearing yrs: use contraception

AE: abortive effect in pregnancy

misoprostol (Cytotec)

Inhibit secretion of gastrin increase mucus secretion

GI protectant

AE: constipation, can cause aluminum toxicity if taken w/ aluminum salts

Sucralfate (Carafate)

Coat any injured area in the stomach

Proton Pump Inhibitors

Long term use should be under care of MD

Long term use: gastric cancer, low Ca, Mag lvls, bone loss, HTN, increase chance of C. diff & PNA