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Risk Factors for Peptic Ulcers
- NSAIDS
- Infection-H Pylori
- Alcohol (drink and don't eat and the alcohol eats at the lining of the stomach)
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Pharmacotherapy for Peptic Ulcers
- Proton Pump Inhibitors
- H2 Receptor Blockers
- Antacids
- Antibiotics
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Examples of PPI
- Nexium
- Prevacid
- Prilosec
- Protonix
- Aciphex
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Proton Pump Inhibitors
Mech of Action
Reduce acid secretion in the stomach by binding to H+ K+ -ATPase on the surface of the GI mucosa
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Proton Pump Inhibitors
Administration
PO
Take 20-30 mins before first meal of the day
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Kinetics
Proton Pump Inhibitors
Longer duration of action
Heals more than 90% of duodenal ulcers in 4 weeks and gastric ulcers in 6-8 weeks
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Proton Pump Inhibitors
Adverse Effects
- N/V/D
- Abdominal Pain
- Increased risk for Osteoporosis
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Proton Pump Inhibitors
Contraindications
Hypersensitivity to the med
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Proton Pump Inhibitors
Interactions
May increase blood levels of phenytoin, diazepam, and CNS depressants
Alcohol
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Examples of H2 Receptor Blockers
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H2 Receptor Blockers
Mech of Action
Blocks histamine 2 receptors which are responsible for secreting acid in the stomach
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H2 Receptor Blockers
Administration
-
Kinetics
H2 Receptor Blockers
May take 4-8 weeks or more for ulcers to heal
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H2 Receptor Blockers
Adverse Effects
- Minor GI upset
- In large doses, Hallucinations, confusion
- Rarely, Hepatitis, blood dyscrasias
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H2 Receptor Blockers
Contraindications
Renal or hepatic disease
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Interactions
H2 Receptor Blockers
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Examples of Antacids
- Aluminum Hydroxide
- Calcium Carbonate (TUMS)
- Milk or Mag
- Mylanta
- Alka-Seltzer
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Antacids
Mech of Action
- Alkaline
- Provides temporary relief of heartburn symptoms
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Antacids
Administration
PO
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Antacids
Adverse Effects
Phosphate depletion
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Contraindications
Antacids
Bowel Obstruction
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Antacids
Interactions
should not be taken at the same time as other meds
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What is Antibiotic Therapy
when other GI meds can be combined with Abx to kill H. Pylori infections
- common combos
- Omeprazole, clarithromycin and amoxicillin
- Omeprazole, Pepto Bismol, and tetracycline
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Carafate
sugar + aluminum hydroxide
produces gel like substances that coats ulcer and allows it to heal
Must be given QID
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Cyctotec
Inhibits gastric secretion and stimulates secretion of protection mucus
Commonly used with patients who are on high dose NSAIDs or corticosteroids
PREGNANCY CATEGORY X
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Nursing Assessment for GI Meds peptic ulcers
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Nursing Dx
peptic ulcer
- Acute Pain
- Altered Nutrition
- Ineffective health maintenance
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Nursing Interventions
Peptic ulcers
- Discuss lifestyle
- Consistent drug therapy
- monitor for GI Bleeding
- Discuss timing of medications with meals
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Constipation
- Symptom not Dx
- Occurs when waste material remains in the body for too long and too much water is reabsorbed
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Types of Laxatives
- Bulk Forming
- Saline and Osmotic
- Stimulat
- Stool Softener/surfactant
- Herbal Agents
- Misc
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Examples of Bulk Forming Laxatives
- FiberCon
- Equalactin
- Citrucel
- Metamucil
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Bulk Forming Laxatives
Mech of Action
Absorb water and increase the size of fecal mass
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Bulk Forming Laxatives
Administration
- PO
- must take with plenty of water
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Adverse Effects
Bulk Forming Laxatives
- Abdominal Fullness
- Obstruction
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Contraindication
Bulk Forming Laxatives
Bowel Obstruction
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Examples of Saline and Osmotic Laxatives
- Lactulose (Chronulac)
- Magnesium hydroxide (Milk of Mag)
- Polyethylene Glycol (Miralax, GoLYTLEY)
- Sodium Bisphosphate (Fleet Phospho-Soda)
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Saline and Osmotic Laxatives
Mech of Action
Pull water into the feces and create a more watery stool
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Saline and Osmotic Laxative
Administration
- PO
- Enema
- SHOULD ONLY BE USED SHORT TERM
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Saline and Osmotic
Adverse Effects
- Diarrhea
- Hypermagnesemia
- Dehydration
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Contraindication
Saline and Osmotic
Bowel Obstruction
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Examples of Stimulant Laxatives
- Correctol, Dulcolax
- Emusoil, Neoloid
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Stimulant Laxatives
Mech of Action
Irritates the bowel mucosa and promote peristalsis
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Administration
Stimulant Laxatives
PO
Occasional Use Only
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Adverse Effects
Stimulant Laxatives
- Diarrhea
- Abdominal Cramping
- Dehydration
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Examples of Stool softeners/Surfactants
Colace
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Stool Softener/Surfactants
Mech of Action
Causes more water and fat to be absorbed into the stools
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Administration
Stool softener/Surfactants
PO
Usually used to PREVENT constipation
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Stool Softeners/Surfactants
Adverse Effects
-
Contraindications
Stool Softeners/Surfactants
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Examples of Herbal Agents
Senna
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Herbal Agents
Mech of Action
irritates bowel and increases peristalsis
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Herbal Agents
Administration
PO
POTENT
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Adverse Effects
Herbal Agents
- Diarrhea
- Laxative induced burns in children
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Herbal Agents
Contraindications
Bowel Obstruction
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Miscellaneous Laxatives
- Mineral Oil
- Amitiza
- Relistor
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Mineral Oil
Lubricates the stool and colon mucosa
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Why is Mineral Oil Discouraged?
It interferes with absorption of fat and soluble vitamins
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Lubiprostone (Amitiza)
Used for constipation from IBS
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Methylnaltrexone (Relistor)
For patients on chronic opiate therapy
Blocks opiate effect in colon without affecting analgesia
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