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    Drugs Affecting Gastrointestinal Motility Drugs Affecting Gastrointestinal Motility

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    Drugs Affecting Gastrointestinal Motility Drugs Affecting Gastrointestinal Motility

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    153 views34 pages

    Drugs Affecting Gastrointestinal Motility Drugs Affecting Gastrointestinal Motility

    Uploaded by

    Jojo Justo

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    © All Rights Reserved
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    of 34

    Chapter 58:

    Drugs Affecting Gastrointestinal Motility

    Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Actions of Drugs Used to Affect Motor
    Activity of the GI Tract
     Speed up or improve movement of intestinal contents
    when movement becomes slow or sluggish (constipation)
     Increase the tone of the GI tract and stimulate motility
    throughout the system
     Decrease movement along the GI tract when rapid
    movement decreases the time for absorption of nutrients
    (diarrhea)

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Sites of Action of Drugs Affecting
    GI Motility

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Use of Laxative and Antidiarrheal Agents
    Across the Lifespan

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Types of Laxatives
     Chemical Stimulants
    o Chemically irritate the lining of the GI tract
     Bulk Stimulants
    o Cause the fecal matter to increase in bulk
     Lubricants
    o Help the intestinal contents move more smoothly

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Laxatives #1
     Actions
    o Work in three ways:
     Direct chemical stimulation of the GI tract
     Production of bulk or increased fluid in the lumen
     Lubrication of the intestinal bolus to promote passage
    through the GI tract
     Indications
    o Short-term relief of constipation
    o Prevent straining when it is clinically undesirable
    o Evacuate the bowel for diagnostic procedures
    o Removal of ingested poisons
    o Adjunct in antihelmintic therapy

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Laxatives #2
     Pharmacokinetics
    o Only minimally absorbed and exert their therapeutic
    effect directly in the GI tract
     Contraindications
    o Acute abdominal disorders
     Caution
    o Pregnancy or lactation

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Laxatives #3
     Adverse Effects
    o GI effects - Diarrhea, abdominal cramping, and
    nausea
    o CNS effects – Dizziness, headache, and weakness
    o CV effects – Sweating, palpitations, flushing, and
    fainting
    o Cathartic dependency
     Drug-to-Drug Interactions
    o Some interfere with the timing or process of
    absorption

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Types of Bulk Stimulants
     Magnesium Sulfate (Epsom Salts)
     Magnesium Citrate (Citrate of Magnesia)
     Magnesium Hydroxide (Milk of Magnesia)
     Lactulose (Chronulac)
     Polycarbophil (FiberCon)
     Psyllium (Metamucil)

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Types of Lubricating Laxatives
     Docusate (Colace)
    o Has a detergent action on the surface of the
    intestinal bolus, making a softer stool
     Glycerin (Sani-Supp)
    o Hyperosmolar laxative used to gently evacuate the
    rectum without systemic effects higher in the GI tract
     Mineral Oil (Agoral Plain)
    o Forms a slippery coat on the contents of the
    intestinal tract

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Types of Chemical Stimulants
     Cascara (Generic): Reliable agent that leads to intestinal
    evacuation
     Senna (Senokot): Reliable drug, similar to cascara (OTC)
     Castor Oil (Neoloid): Old standby for thorough evacuation
    of the intestine
     Bisacodyl (Dulcolax): Very popular OTC laxative

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Nursing Considerations for Laxatives
     Assess:
    o History and Physical Exam and known allergy
    o Fecal impaction or intestinal obstruction, acute
    abdominal pain, abdomen and BS, elimination
    pattern, nausea, or vomiting
    o Pregnancy or lactation, neurological status, level of
    activity and appropriate lab values

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Prototype Chemical Stimulant Laxative

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Prototype Bulk Laxative

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Prototype Lubricant Laxative

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Types of Gastrointestinal Stimulants

     Dexpanthenol (Ilopan)
    o Increases acetylcholine levels and stimulates the
    parasympathetic system
     Metoclopramide (Reglan)
    o Blocks dopamine receptors and makes the GI cells
    more sensitive to acetylcholine
    o Leads to increased GI activity and rapid movement of
    food through the upper GI tract

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Gastrointestinal Stimulants #1

     Actions
    o Stimulate parasympathetic activity within the GI tract
    o Increase GI secretions and motility
     Indications
    o Rapid movement of GI contents is desirable
     Pharmacokinetics
    o Rapidly absorbed
    o Metabolized in the liver
    o Excreted in the urine

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Gastrointestinal Stimulants #2

     Contraindications
    o Allergy
    o GI obstruction
     Caution
    o Pregnancy
    o Lactation

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Gastrointestinal Stimulants #3
     Adverse Effects
    o Nausea, vomiting, diarrhea, intestinal spasms,
    cramping, decreased blood pressure and heart rate,
    weakness, and fatigue
     Drug-to-Drug Interactions
    o Digoxin
    o Cyclosporine
    o Alcohol

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Nursing Considerations for
    Gastrointestinal Stimulants

     Assess:
    o History and Physical Exam
    o Intestinal obstruction, bleeding, or perforation
    o Pregnancy and lactation
    o cardiopulmonary status, including pulse and blood
    pressure
    o Skin

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Prototype Gastrointestinal Stimulants

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Question #1

    Which of the following is a very popular OTC laxative?


    A. Cascara
    B. Magnesium citrate
    C. Bisacodyl
    D. Polycarbophil

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Answer to Question #1

    C. Bisacodyl

    Rationale: Bisacodyl (Dulcolax): Very popular OTC laxative.

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Types of Antidiarrheal Drugs

     Bismuth Subsalicylate (Pepto-Bismol): Coats the lining of


    the GI tract and soothes irritation stimulating local
    reflexes to cause excessive GI activity and diarrhea
     Loperamide (Imodium): Has a direct effect on the muscle
    layers of the GI tract; slows peristalsis and allows
    increased time for absorption of fluid and electrolytes
     Opium Derivatives (Paregoric): Stimulates spasm within
    the GI tract, stops peristalsis and diarrhea

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Antidiarrheal Drugs #1

     Actions
    o Slow the motility of the GI tract through direct action
    on the lining of the GI tract
     Indications
    o Relief of symptoms of acute or chronic diarrhea
    o Reduction of volume of discharge from ileostomies
    o Prevention and treatment of traveler’s diarrhea
     Pharmacokinetics
    o Vary depending on agent

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Antidiarrheal Drugs #2

     Contraindications
    o Allergy
     Caution
    o Pregnancy
    o Lactation
    o History of GI obstruction
    o History of acute abdominal conditions
    o Diarrhea due to poisonings

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Antidiarrheal Drugs #3
     Adverse Effects
    o Constipation
    o Abdominal distension
    o Abdominal discomfort
    o Nausea
    o Dry mouth
    o Toxic megacolon
    o Fatigue
    o Weakness
    o Dizziness

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Antidiarrheal Drugs #4
     Drug-to-Drug Interactions
    o Depends on the drug

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Nursing Considerations for
    Antidiarrheal Drugs
     Assess:
    o History and Physical Exam and known allergy
    o Acute abdominal conditions, GI activity, hepatic
    impairment, BS and abdomen
    o Elimination patterns, neurological status

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Prototype Antidiarrheal Drugs

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Question #2
    Please answer the following statement as true or false.

    Pepto-Bismol can be involved in salicylate toxicity.

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Answer to Question #2

    True

    Rationale: Bismuth Subsalicylate (Pepto-Bismol) coats


    the lining of the GI tract and soothes irritation stimulating
    local reflexes to cause excessive GI activity and diarrhea.

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Question #3
    Why should laxatives be taken only on a short-term
    basis?
    A. To prevent a fluid volume deficit
    B. To prevent cathartic dependence
    C. To obtain relief of abdominal distention
    D. To obtain relief of intestinal cramping

    Copyright © 2017 Wolters Kluwer • All Rights Reserved


    Answer to Question #3

    B. To prevent cathartic dependence

    Rationale: Administer laxative only as a temporary


    measure to prevent development of cathartic
    dependence.

    Copyright © 2017 Wolters Kluwer • All Rights Reserved

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