GI Medications

GI Medications

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Index

Antiemetics

Antacids

H2 Receptor Blockers

Proton Pump Inhibitors (PPIs)

GI Stimulants

01

AntacidsCalcium Carbonate

Antacids

Many types: calcium, magnesium, aluminium Prototype Drug: calcium carbonate

Drug Interactions

Uses

Calcium Carbonate

Nursing Considerations

Adverse Effects

Patient Teaching

Contraindications

Pharmacokinetics

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02

H2 Receptor AntagonistsFamotidine

H2 Receptor Antagonists

Prototype Drug: famotidine (Pepcid)

Drug Interactions

Uses

Famotidine

Nursing Considerations

Adverse Effects

Patient Teaching

Contraindications

Pharmacokinetics

04

Proton Pump InhibitorsOmeprazole

Proton Pump Inhibitors (PPIs)

Prototype Drug: omeprazole (Prilosec)

Drug Interactions

Uses

Omeprazole

Nursing Considerations

Adverse Effects

Patient Teaching

Contraindications

Pharmacokinetics

05

GI Stimulants metoclopramide

GI Stimulants

Prototype Drug: metoclopramide (Reglan)

Drug Interactions

Uses

Metoclopramide

Nursing Considerations

Adverse Effects

Patient Teaching

Contraindications

Pharmacokinetics

06

Antiemetic MedsOndansetron

Antiemetic Meds

Prototype Drug: ondansetron (Zofran)

Drug Interactions

Uses

Metoclopramide

Nursing Considerations

Adverse Effects

Patient Teaching

Contraindications

Pharmacokinetics

Adverse Effects

• Magnesium containing can cause diarrhea
• Aluminum and calcium containing can cause constipation
• Calcium containing can cause kidney stones
• Long-term use can mask s/s of serious disease
• Rebound hyperacidity

Nursing Considerations

• Assess N/V
• Assess for extrapyramidal symptoms and depression

Pharmacokinetics

• Route: PO
• Onset: 20-60 minutes
• Peak Plasma Concentration: 1-2.5 hours
• Half-life: 2.5-6 hours
• Duration: 3-4 hours

Uses

• Ends in – prazole
• Inhibit the “proton pump” in the parietal cells, inhibit the secretion of hydrochloric acid, and the effect lasts longer than 24 hours
• Treat damage from GERD
• Treat H. Pylori

Drug Interactions

• -Very few
• Diazepam, phenytoin: increased levels of these drugs
• Oral anticoagulants: increased chance of bleeding
• Can interfere with absorption of some antifungals and antibiotics

Contraindications

• Known drug allergy
• Kidney or liver dysfunction—dosage adjustment

Nursing Considerations

• Monitor electrolytes, esp. magnesium
• Assess symptoms before and after
• Assess for GI bleed

Nursing Considerations

• Assess symptoms
• Assess bowel sounds
• Monitor for extrapyramidal symptoms
• Monitor EKG: Can cause prolonged QT interval

Pharmacokinetics

Route: PO

• Onset: 1-4 hours
• Peak Plasma Concentration: 3 hours
• Half-life: 2-4 hours
• Duration: 9-12 hours

Route: IV

• Onset: immediate
• Peak Plasma Concentration: less than 15 minutes
• Half-life: 2-4 hours
• Duration: 9-12 hours

Patient Teaching

• Call provider if symptoms worsen or black tarry stools
• Don’t use alcohol, NSAIDs, or foods that increase acid
• Swallow whole, do not crush
• Take before eating

Contraindications

• Hepatic impairment
• Pregnancy

Contraindications

• GI bleed, obstruction, or perforation
• Pheochromocytoma
• Seizure disorders
• Depression

Drug Interactions

• Decrease absorption of other meds
• Chemically inactivate other meds
• Increased stomach pH: decreased absorption of acidic drugs, increases of basic drugs
• Increased urinary pH: increases excretion of acidic drugs, decreases excretion of basic drugs

Pharmacokinetics

• Route: PO
• Onset: 2 hours
• Peak Plasma Concentration: 5 days
• Half-life: 0.5-1 hour
• Duration: 1-5 days

Contraindications

• Magnesium containing antacids should not be used in patients with renal failure.
• Electrolyte imbalances

Nursing Considerations

• Give 1-2 hours before or after other meds
• Monitor for diarrhea/constipation
• Assess condition prior to and after administration
• Monitor electrolytes

Pharmacokinetics

• Route: IV
• Onset: 15-30 minutes
• Peak Plasma Concentration: 1-1.5 hours
• Half-life: 3.5-5 hours
• Duration: 6-12 hours

Nursing Considerations

• Monitor for adverse reactions
• Monitor CBC
• Monitor symptoms

Uses

• Neutralize stomach acid; do not decrease overproduction of acid
• They stimulate secretion of mucus, prostaglandins, and bicarbonate
• Reduces symptoms of acid pain and reflux

Adverse Effects

• Hypotension, SVT
• Sedation, headache
• Dry mouth
• Diarrhea
• N/V
• Extrapyramidal effects, especially tardive dyskinesia
• lip smacking, chewing, or puckering of the mouth
• frowning or scowling
• sticking out the tongue
• blinking and moving the eyes
• shaking of the arms and leg

Contraindications

• Known drug allergy

Patient Teaching

• Can be taken with food
• Take at bedtime
• Don’t take for more than 8 weeks unless ordered
• Immediately report black tarry stools

Uses

• Block serotonin receptors in the GI tract
• Used to prevent and treat chemo, post-op, and radiation related N/V
• Also used in hyperemesis in pregnancy
• Should be given 30 minutes prior to end of surgery or to starting chemo infusion
• Given IV or SL

Uses

• Promote movement of food through the GI tract
• Increase motility
• Used to treat nausea and vomiting
• Can be given PO, IM, or IV

Patient Teaching

• Take as directed
• Report adverse reactions to provider ASAP

Adverse Effects

• Confusion, dizziness
• Headache
• Constipation
• Diarrhea

Drug Interactions

• CNS depressants and alcohol: increased CNS depression
• Some antidepressants: increased risk of extrapyramidal symptoms
• Levodopa: decreased effectiveness

Patient Teaching

• Take as directed
• May cause drowsiness
• Don’t drink alcohol while taking
• Monitor for depression and extrapyramidal symptoms, especially tardive dyskinesia

Drug Interactions

• SSRIs: increase risk of serotonin syndrome

Drug Interactions

• Very few, rare
• Tiny amount of older adults: confusion and disorientation
• Thrombocytopenia

Patient Teaching

• Take other meds 1-2 hours before or after antacids
• Don’t take for extended periods of time
• Don’t take with milk or foods high in Vitamin D (can only absorb so much at a time)
• Increase fluid and fiber intake

Pharmacokinetics

• Not normally given, absorbed and excreted quickly

Adverse Effects

• Serotonin syndrome
• Headache
• Constipation, diarrhea
• Prolonged QT

Uses

• End in -idine
• OTC PO med; can be given IV
• Blocks histamine’s action at the H2 receptor of the parietal cell, thus reducing the production of hydrochloric acid
• Used to treat GERD, peptic ulcer disease, control of upper GI bleed, heartburn

Adverse Effects

• Headache
• Hyperglycemia
• Abdominal pain, diarrhea, constipation, nausea and vomiting, flatulence, eructation
• C-Diff:
• Decrease gastric acid allows ingested C-Diff to survive (should be destroyed by stomach acid)
• Allows survival of disease causing bacteria in the upper GI tract