Pharmacology:

Drugs Affecting the

Gastrointestinal
System

ANNGEO D. LABOG, RN, MAN

HENRY T. BARRIGA JR., RN, MN
TRACEY JOY L. DELA CRUZ, RN, MAN
MICHAEL FRANCIS H. CAHANDIG, RN, MN
 Objectives
To understand the drug action, indication, side
effects, precautions, and nursing considerations
of:

common GI medications

Review common medical surgical problems related

to the same systems. (Gastrointestinal)
 MEDICATIONS AFFECTING THE:

The system
included in
GASTROINTESTINAL
today’s lesson SYSTEM
 COMMON
MEDICATIONS
AFFECTING THE
GASTROINTESTINAL
SYSTEM
 MEDICATIONS AFFECTING THE
GASTROINTESTINAL SYSTEM

The primary functions of the gastrointestinal

system are digestion, absorption, and
excretion.

These functions are aided by the motile and

secretory properties of the gastrointestinal
tract (GIT) and associated accessory organs.

Common conditions affecting the GIT include

nausea, vomiting, diarrhea, and some
conditions associated with the nervous system.
MEDICATIONS AFFECTING THE
GASTROINTESTINAL SYSTEM

 The gastrointestinal system is divided into two sections:

 Upper GIT, from the mouth to the stomach.

UPPER GI MEDICATIONS

 Lower GIT, from the duodenum to the anus.

LOWER GI MEDICATIONS
UPPER GASTROINTESTINAL MEDICATIONS

The most common form of medications used in the upper

GIT are antacids or acid-controlling agents since the most
common problem involving the stomach is excessive acidity
and reflux.

Other groups of medications such as anticholinergics,

antihistamines and antidepressants may also be used in the
treatment of gastric dysfunction.
UPPER GASTROINTESTINAL MEDICATIONS

UPPER GI
MEDICATIONS

ANTACIDS & ACID-

ANTIEMETICS
CONTOLLING AGENTS

H2
ANTACID PPI
ANTAGONIST
ANTACID AND
ACID-CONTROLLING AGENTS

Acid-related diseases are caused by an imbalance in the gastric

glands and their secretions.

The most common condition is HYPERACIDITY, and the most

harmful is PEPTIC ULCER DISEASE. Other diseases include
gastritis, gastroesophageal reflux disease and dyspepsia.

The major ingredients in antacids are aluminium hydroxide,

calcium carbonate, magnesium salts and sodium bicarbonate.
These can be used on their own or in combination w/ antacids.
 ANTACID
ACTIONS:
 Promote the gastric mucosal defence mechanisms, acting as a buffer by neutralising
hydrochloric acid in the stomach and reducing pepsin activity.
 By increasing the gastric pH, the rate of gastric emptying is increased. The antacid's action is
short-lived.
 Antacids promote the secretion of:
 Mucous, which provides a protective barrier against hydrochloric acid
 Bicarbonate, which helps buffer the acidic properties of hydrochloric acid
 Prostaglandins, which prevent activation of the proton pump.
 Antacids do not prevent the overproduction of acid, but they do neutralise the acid once it is
in the stomach.
 ANTACID
INDICATIONS:

• Reduction of pain associated with acid-

related disorders such as hyperacidity,
peptic ulcer, GERD, hiatal hernia,
heartburn, indigestion and nervous
dyspepsia.
• Antacid can be taken with medications
known to cause gastrointestinal irritation,
such as non-steroidal anti-inflammatory
drugs (NSAIDs).
 ANTACID

• aluminum salts (AlternaGEL)

• calcium salts (Oystercal,
Tums)
EXAMPLES • magaldrate (Losopan, Riopan)
• magnesium salts (Milk of
Magnesia, others)
• sodium bicarbonate(Bell-ans)
 ANTACID
SIDE EFFECTS:
• Aluminium hydroxide - constipation,
phosphate depletion, fecal impaction,
intestinal obstruction and albuminemia (in
chronic renal disease), chalky taste.
• Calcium salts - belching, flatulence,
constipation, hypercalcemia, alkalosis,
gastrointestinal irritation, renal calculi.
• Magnesium salts - diarrhea, chalky taste,
belching, elevated magnesium levels.
• Sodium bicarbonate - belching, abdominal
distension, systemic alkalosis,
hyperventilation, hypokalemia.
 ANTACID

PRECAUTIONS/CONTRAINDICATIONS:
• Antacids reduce the absorption of many
medications and may combine with
tetracyclines, decreasing their absorption.
• Use with caution with other medications
because of interactions.
• Antacids may cause early dissolving of enteric-
coated medications, causing stomach upset.
 ANTACID

• Assess individuals for allergies.

• Assess individuals for pre-existing
conditions that may alter effect of
antacids, such as renal disease, fluid
NURSING imbalance and gastrointestinal
CONSIDERATIONS obstruction.
• Antacids should preferably be taken two
hours before or after other medications.
• Shake liquids well before administering.
 ANTACID

• Ensure tablets are chewed thoroughly.

• Administer with at least 240 mL water to
enhance absorption.
• Liquid preparations are more fast-acting than
NURSING tablets, but tablets may be sucked to provide
CONSIDERATIONS an effect over time.
• Monitor individuals for side effects such as
nausea, vomiting, abdominal pain, diarrhea,
constipation and acid rebound.
• Monitor individuals for therapeutic effect.
H2 ANTAGONISTS
 H2 ANTAGONIST

ACTIONS:

• Reduce acid secretion from stimuli

such as food, histamine and caffeine.
• They also block histamine at the
receptors of acid-producing parietal
cells and reduce the production of
hydrogen ions, resulting in decreased
hydrochloric acid production.
 H2 ANTAGONIST

INDICATIONS:

• Treatment of maintenance
of gastric and duodenal
ulcers, dyspepsia,
gastroesophageal reflux
disease and upper
gastrointestinal bleeding.
H2 ANTAGONIST

•ranitidine
Examples: •famotidine
•cimetidine
 H2 ANTAGONIST

SIDE EFFECTS:

• Depends on the medication

chosen but can include
headache, constipation,
nausea, diarrhea, rash,
dizziness, flatulence,
musculoskeletal pain.
H2 ANTAGONIST

PRECAUTIONS/CONTRAINDICATIONS:
• Individuals should avoid alcohol, spicy food,
smoking and caffeine as gastric acid secretion
may be increased and their condition may
worsen.
 H2 ANTAGONIST

• Not to be taken with antacid

medications or separate them by at least
two hours as absorption decreased.
• Dispersible tablets are dissolved in half a
NURSING glass of water before swallowing.
CONSIDERATIONS: • IV solutions should not be administered
rapidly because this may cause dizziness
and peripheral vasodilation.
• Tablets should be protected from light.
PROTON PUMP
INHIBITOR
(PPI)
 PROTON PUMP INHIBITOR

Proton pump inhibitors reduce the production of gastric acid by

blocking the enzyme in the wall of the stomach that produces
acid.

The reduction of acid prevents ulcers and allows any ulcers that
exist in the esophagus, stomach and duodenum to heal.

ACTIONS:
• Reduce gastric acid secretion by inhibiting the action of the
proton pump in the parietal cells.
• When sufficient molecules of the medication bind to the proton
pump, they block the final steps of acid production, inhibiting
basal and stimulated gastric acid secretion.
 PROTON PUMP
INHIBITOR

INDICATIONS:

• Treatment of duodenal ulcer,

benign gastric acid reflux,
esophagitis, gastrinoma and
Helicobacter pylori-induced ulcers,
and maintenance therapy for
gastroesophageal reflux disease.
PROTON PUMP INHIBITOR

• omeprazole
EXAMPLES: • pantoprazole
• esomeprazole
 PROTON PUMP
INHIBITOR

SIDE EFFECTS:

• Depends on the medication

chosen but can include rash,
urticaria, alopecia, arthralgia,
muscle weakness, headache,
dizziness, insomnia, abdominal
pain, diarrhea.
 PROTON PUMP INHIBITOR

PRECAUTIONS/CONTRAINDICATIONS:
• Individuals should be advised not to drive or
to operate machinery should dizziness occur.
PROTON PUMP INHIBITOR

• Capsules, tablets and pellets

should be swallowed whole
NURSING with water and should not be
CONSIDERATIONS: chewed or crushed.
• Powder should be protected
from light.
ANTIEMETICS
ANTIEMETICS

Nausea and vomiting have many

causes such as gastric irritation,
motion sickness, pregnancy, or as a
side effect of many medications.

Nausea and vomiting are also often a

response by the body to remove
harmful substances before further
absorption occurs.
 ANTIEMETICS

ACTIONS:

• These medications can act on various body

systems such as the GIT, semi-circular canals of
the ear, and the vomiting centre in the brain.
• They are often prokinetic agents or dopamine
antagonists, may stimulate peristalsis and
therefore increase the rate of gastric emptying.
They may reduce the impulse to the vomiting
centre caused by local emetics in the pylorus
and duodenum.
 ANTIEMETICS

INDICATIONS:

• To relieve nausea and vomiting

caused by cytotoxic
chemotherapy,
gastroesophageal reflux,
vertigo, or in the postoperative
period.
 ANTIEMETICS

• dolasetron
• ondansetron
EXAMPLES: • domperidone
• prochlorperazine
• metoclopramide
 ANTIEMETICS
SIDE EFFECTS:

• Depends on the medication chosen

but can include oculogyric crisis,
headache, dizziness, drowsiness,
diarrhoea, constipation, pain,
pruritis, headache, insomnia,
gastroesophageal reflux,
hyperkalaemia, extrapyramidal
reactions.
 ANTIEMETICS

PRECAUTIONS/CONTRAINDICATIONS:
• Hypotension may occur so caution is advised when
administering, especially to the elderly.
• Individuals should be warned not to drive or
operate machinery because drowsiness may occur.
ANTIEMETICS

• Do not administer an antiemetic until

the underlying cause of the vomiting
or nausea has been determined.
• Monitor the individual's vital signs.
NURSING
• Metoclopramide is compatible with
CONSIDERATIONS:
morphine or pethidine when mixed in
the same syringe.
• Medication must be protected from
light.
ANTIEMETICS

• May be administered orally,

intramuscularly, intravenously or by
suppository.
• If administered intravenously, slow
administration over one to two minutes
NURSING
is advised to prevent feelings of
CONSIDERATIONS: restlessness, drowsiness and anxiety.
• Individuals taking phenothiazines for
nausea and vomiting should be advised
to wear protective clothing when
exposed to sunlight.
 LOWER
GASTROINTESTINAL
MEDICATIONS
 LOWER GASTROINTESTINAL
MEDICATIONS

Medications used to treat

the lower GIT include those
relating to bowel conditions
such as diarrhea,
constipation, and impaired
digestion.
 LOWER GASTROINTESTINAL MEDICATIONS

LOWER GI MEDICATIONS

ANTIDIARRHEALS LAXATIVES

INTESTINAL
ANTI- BULK- EMOLLIENTS
ADSORBENTS FLORA OPIATES STIMULANTS SALINE
CHOLINERGIC FORMING
MODIFIERS
 ANTIDIARRHEALS
Acute diarrhea has a sudden onset, is self-limiting and
usually resolves without further problems.

It is often caused by bacteria, viral or protozoan

infection.

Causes of chronic diarrhea that may include tumours,

DM, Addison's disease and irritable bowel syndrome.

Antidiarrheal agents are used to relieve the symptoms

of diarrhea and to prevent fluid and electrolyte loss.

These agents include adsorbents and anti-motility

agents.
 ANTIDIARRHEALS:
ADSORBENTS

ACTIONS:
• Adsorbents work by coating the
intestinal mucosa, by binding to and
absorbing the causative bacteria or
toxin and passing them out with the
stools.
INDICATIONS:
• To relieve the symptoms of diarrhea
 ANTIDIARRHEALS: ADSORBENTS

EXAMPLE: • loperamide
 ANTIDIARRHEALS: ADSORBENTS

Precautions/Contraindications:
• Reduces the absorption of certain agents
including digoxin, oral iron, hyoscine and
atropine.
• Adsorbents may cause increased bleeding
time when given with anticoagulants.

Side Effects:
• Nausea, abdominal cramps, constipation.
 • Decrease intestinal muscle tone and
ACTIONS: peristalsis of the GIT, thereby slowing
ANTIDIARRHEALS: the movement of fecal matter.

ANTICHOLINERGICS USE:
• To counteract gastrointestinal
muscle spasm
 ANTIDIARRHEALS: ANTICHOLINERGICS

EXAMPLE:
• Hyoscine N-
butylbromide
 ANTIDIARRHEALS: ANTICHOLINERGICS

SIDE EFFECTS:

• May cause urinary retention

and hesitancy, impotence,
headache, dizziness, confusion,
anxiety, drowsiness,
tachycardia, impotence, dry
skin, rash, flushing, blurred
vision, photophobia.
 ANTIDIARRHEALS: INTESTINAL FLORA MODIFIERS

ACTIONS:
• Lactobacillus bacterial cultures
work by supplying missing
beneficial bacteria to the GIT and
suppressing the growth of
diarrhoea-causing bacteria.

INDICATIONS:
• Gut flora replacement. (Example:
Lactobacillus acidophilus, Bacillus
clausii)
 ANTIDIARRHEALS: INTESTINAL FLORA MODIFIERS

• Lactobacillus acidophilus
EXAMPLE: • Bacillus clausii (Erceflora)
 ANTIDIARRHEALS: OPIATES

ACTIONS:
• Reduce peristalsis by
suppressing intestinal motility,
relieve rectal spasms, and
decrease the transit time
through the bowel, allowing
more time for water and
electrolytes to be absorbed.
 ANTIDIARRHEALS: OPIATES

EXAMPLE:
• Codeine
phosphate
 ANTIDIARRHEALS: OPIATES

SIDE EFFECTS:
• Depends on the medication chosen but can
include nausea and vomiting, dizziness,
drowsiness, anorexia, constipation,
bradycardia, hypotension, palpitations,
urinary retention, rash, urticaria.

PRECAUTIONS/CONTRAINDICATIONS:
• Do not use if pregnant or breastfeeding
 ANTIDIARRHEALS:
GENERAL NURSING CONSIDERATIONS

1. Obtain a thorough history of the individual's bowel habits,

dietary changes, allergies.

2. Some antidiarrheals are not recommended for children

under 12 years.

3. Use adsorbents carefully in elderly individuals and those

with bleeding disorders.

4. Anticholinergics should not be administered to individuals

with glaucoma, urinary retention or cardiac problems.
 ANTIDIARRHEALS:
GENERAL NURSING CONSIDERATIONS

5. Assess fluid balance and mucous membranes

before administering medications.

6. Encourage individuals to take fluids and

monitor for hydration.

7. Discontinue antidiarrheals if symptoms

persist longer than 48 hours.
LAXATIVES
 LAXATIVES
Laxatives, also known as aperients, purgatives,
cathartics and evacuants, are used to improve the
transit of food through the intestine and are
indicated for use in constipation resulting from
poor bowel habits, the use of opioid analgesics
and loss of intestinal muscle tone, as well as in
individuals on bed rest, and older persons.

Types of laxatives:

• Bulk-forming
• Stimulants
• Saline or osmotic laxatives
• Emollients
 LAXATIVES: BULK-FORMING

ACTIONS:
• High in fibre, they increase the volume of
feces by absorbing water and thereby
increasing peristalsis.

INDICATIONS:
• For constipation, hemorrhoids, pre-
operative bowel emptying, control of
colostomy, ileostomy and diverticular
disease and the symptomatic relief of
acute diarrhea.
 LAXATIVES: BULK-FORMING

EXAMPLES:
• Psyllium, sterculia, ispaghula.

SIDE EFFECTS:
• Depends on the medication chosen but can
include nausea, flatulence and discomfort.
 LAXATIVES: STIMULANTS

ACTIONS:
• Increase peristalsis, by stimulating
sensory nerves endings in the mucosa.
• Increase the secretion of water and
electrolytes.

INDICATIONS:
• Acute and chronic constipation, bowel
preparation before surgery.
 LAXATIVES: STIMULANTS

EXAMPLES:
• Bisacodyl and glycerol/glycerin

SIDE EFFECTS:
• Depends on the medication chosen but can
include abdominal colic, nutrient
malabsorption, excessive loss of water and
electrolytes, skin rash, nausea and vomiting
 LAXATIVES: SALINE OR OSMOTIC LAXATIVES

ACTIONS :
• Increase osmotic pressure within the
bowel, causing more water to enter the
intestines; bowel cleanser by inducing
diarrhea while maintaining water and
electrolyte balance. Cause bowel
distension and increased peristalsis and
evacuation.

INDICATIONS:
• Constipation, diagnostic bowel preparation
and removal of parasites and helminths.
 LAXATIVES: SALINE OR
OSMOTIC LAXATIVES

• Lactulose, colon electrolyte

EXAMPLES: lavage, sodium phosphate,
sorbitol, movicol preparations.

• Depends on the medication

SIDE chosen but can include nausea,
abdominal bloating and
EFFECTS: cramps, vomiting, rectal
irritation.
 LAXATIVES: EMOLLIENTS

ACTIONS:
• Act as a stool softener, promoting more water and fat in
the stools and lubricating faecal matter and the
intestinal walls.

USE:
• In acute and chronic constipation, to allow defaecation
without straining, and in painful anorectal disorders.
 LAXATIVES: EMOLLIENTS

EXAMPLES:
• Docusate sodium, poloxamer, liquid paraffin, sodium
citrate with sodium lauryl sulfoacetate and sorbitol
SIDE EFFECTS:
• Abdominal colic and cramps, skin rashes, decreased
absorption of vitamins, diarrhea with excess water
and electrolyte loss.
LAXATIVES:
GENERAL NURSING CONSIDERATION

Obtain from the individual a thorough medical history of all

presenting symptoms and bowel patterns.

Assess fluid and electrolyte balance before commencing therapy.

Generous amounts of water should be given with all bulk-forming

laxatives.

Individuals should not take laxatives if they are experiencing nausea

and/or vomiting and abdominal pain and faecal impaction.
 LAXATIVES:
GENERAL NURSING CONSIDERATION

Be aware of the potential for esophageal obstruction with the powdered

form.

Long-term use of laxatives may result in decreased bowel tone and laxative
dependency.

Encourage a high-fibre diet and increased fluid intake as an alternative to

laxative use.

Monitor individuals for therapeutic effect of treatment.

Monitor individuals for side effects.