NUR 221- GI Disorders & Treatment

erosion of the gut wall

• severe erosion can be complicated by hemorrhage and perforation

H. Pylori

• gram-negative bacteria that can colonize the stomach and duodenum

• NSAIDs

  • reduce blood flow, mucus, bicarbonate

• smoking

  • delays ulcer healing and increases risk for reoccurrence

• antibiotics

• mucosal protectants

should be given to all patients with gastric/duodenal ulcers and documented H. Pylori infection

• minimum of 2 antibiotics prescribed

• Cimetidine (Tagamet)

• Ranitidine (Zantac)

• Famotidine (Pepcid)

First choice drugs for treating gastric and duodenal ulcers

• promote healing by suppressing secretion of gastric acid

potent

most effective drug for suppressing secretion of gastric acid

• Omeprazole (Prilosec)

• Pantoprazole (Protonix)

inhibits gastric secretion

• ulcer prophylaxis is indicated only for patients in intensive care units

• may lead to C. Diff

• sucralfate (Carafate)

• misoprostol (Cytotec)

• antacids

creates a protective barrier for up to 6 hours

• decreases absorption of other drugs*

• drug interactions

  • antacids may interfere with effects of sucralfate

  • may inhibit absorption of other medications administered simultaneously. Give 2 HOURS BEFORE OR AFTER OTHER MEDICATIONS

only approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy

• category X (pregnancy)

react with gastric acid to produce neutral salts or salts of low acidity

diarrhea

constipation

avoided in patients with undiagnosed abdominal pain

• diarrhea

inappropriate for treating PUD: brief duration, high sodium content, can cause alkalosis

proper bowel function is highly dependent on dietary fiber (brain is best source)

• benefits of fiber

  • absorbs water- softens feces and increases size

fecal impaction or bowel obstruction

Bulk-forming laxatives

• Psyllium (Metamucil)

Surfactant laxatives

• Docusate sodium (Colace)

Stimulant Laxatives

• Bisacodyl (Dulcolax)

• Senna

function similarly to dietary fiber- swell with water to form a gel that softens and increases fecal mass

• AE = esophageal obstruction

stimulate intestinal mobility

poorly absorbed salts that draw water into intestinal lumen; fecal mass softens and swells, wall stretches, and peristalsis is stimulated

• dehydration

• renal failure

• sodium retention (heart failure, hypertension, edema)

osmotic agent that softens and lubricates hardened, impacted feces

given to suppress nausea and vomiting

• Ondansetron (Zofran)

• Metoclopramide (Reglan)

• Cannabinoids

  • Dronabinol (Marinol) and Nabilone (Cesamet)

Scopolamine

Opioids

• most commonly used: Diphenoxylate (Lomotil) and Loperamide (Imodium)

caused by exaggerated immune response to normal bowel flora

• Chron’s

• Ulcerative colitis

not curative

• Glucocorticoids (Hydrocortisone)

• Immunosuppressants (Azathioprine)

• Immunomodulators (Infliximab)

• Antibiotics (Metronidazole)

Infliximab (Remicade)

• for chrons and ulcer colitis