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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
27
Drugs Used to
Treat
Gastrointestinal
Conditions
Figure 27-1
The digestive system.
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Liver
• Center of metabolic activity in body
• Detoxifies blood and secretes bile
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Peptic Ulcers
• Caused by hyperacidity and excessive
pepsin activity
• Alcohol, caffeine, and smoking have
been linked to peptic ulcers
• Many cases of gastric ulcers or gastritis
are due to Helicobacter pylori
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Table 27-1
Drugs Commonly Used in Peptic Ulcer Disease
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Table 27-1 (continued) Drugs Commonly Used in Peptic Ulcer Disease
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Table 27-1 (continued) Drugs Commonly Used in Peptic Ulcer Disease
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Antacids: Uses
• Alkaline compounds that neutralize
hydrochloric acid
• Most common types contain aluminum
hydroxide and magnesium carbonate.
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Antacids: Adverse Effects
• Common: diarrhea or constipation,
anorexia, weakness, bone pain,
tremors
• Hypermagnesemia may produce
nausea, vomiting, confusion, renal
calculi, metabolic alkalosis, and
headache
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Antacids: Contraindications
• Contraindicated in patients with
hypercalcemia, hyperparathyroidism,
vitamin D-overdosage, and decalcifying
tumors (depending on type of antacid)
• Cautious use in patients with impaired
kidney function or dialysis, and in
lactation
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Antacids: Patient Information
• Instruct patients to take antacids 1 to 3
hours after meals and at bedtime, and
not within 1 to 2 hours of taking other
oral medications.
• Advise patients to increase fluid intake
to prevent kidney stones.
• Patients with cardiovascular disease
should avoid antacids that are high in
sodium.
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Tums Use by Older Adults
• Calcium carbonate (Tums) should be
used with caution in older adults. This
is because of their likelihood of having
the following disorders:
– Renal disease or calculi
– Ventricular fibrillation
– Cardiovascular disease
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H2-receptor Antagonists: Uses
• H2-receptor antagonists reduce
secretion of gastric acid by blocking H2receptors
• Used in short-term treatment of active
duodenal ulcers and prevention of ulcer
recurrence
• Also used for heartburn
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H2-receptor Antagonists:
Adverse Effects
• Common: GI disturbances, headache,
drowsiness, confusion, agitation,
hallucinations, and reversible
impotence
• Serious: cardiac arrhythmias and
cardiac arrest after IV bolus dose
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H2-receptor Antagonists:
Contraindications
• The agents are contraindicated in:
– Pregnancy and lactation
– Children younger than 16 years of age
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H2-receptor Antagonists:
Patient Information
• Warn patients to avoid smoking and
drinking alcohol.
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Proton Pump Inhibitors: Uses
• Act by blocking hydrochloric acid
production
• Used to heal stomach and duodenal
ulcers and relieve symptoms of GERD
and esophagitis
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Proton Pump Inhibitors:
Adverse Effects
• Common: headache, dizziness, fatigue,
diarrhea, abdominal pain, nausea
• Rare: hematuria
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Proton Pump Inhibitors:
Contraindications
• Long-term use is contraindicated.
• Should not be used in children younger
than 18 years
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Proton Pump Inhibitors:
Patient Information
• Advise patients that treatment is for
short term only (4–8 weeks).
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OTC Gastric Medications
in Children
• Omeprazole (Prilosec and Zegerid) has
not been significantly tested in children.
• Do not use in children younger than 18.
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Prostaglandins: Uses
• Affect GI motility and gastric acid
secretion
• Used to prevent complications of
gastric ulcers that result from NSAID
use
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Prostaglandins: Adverse Effects
and Contraindications
• Common adverse effects are: diarrhea
and menorrhagia (in women)
• Contraindicated in pregnancy and
lactation
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Prostaglandins:
Patient Information
• Advise women to immediately report
pregnancy.
• Advise patients that diarrhea may occur
but will disappear after the first month
of therapy.
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Table 27-2
Classifications of Antidiarrheal Drugs
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Table 27-3
The Most Common Antidiarrheals
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Opioids: Uses
• Narcotic analgesics act as stimulants on
opioid receptors in the GI tract to
increase mixing movements of the gut
and decrease peristatic movements
• Used to treat diarrhea
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Opioids: Adverse Effects
•
•
•
•
•
•
Constipation
Nausea and vomiting
Agitation
Drowsiness
Tachycardia
Numbness of hands and feet
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Opioids: Contraindications
• Contraindicated in intestinal obstruction
and in children younger than 6 years
• Not recommended for treatment of
chronic diarrhea.
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Opioids: Patient Information
• Encourage patients to keep a record of
bowel movements to determine
effectiveness or possible constipation.
• Advise patients to drink clear fluids for
a few days.
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Opioids in Elderly Patients
• Monitor opioid use in elderly patients
carefully because opioids can cause
respiratory depression and decreased
blood pressure in this population.
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Absorbents
• Absorb toxins in GI tract that might be
causing diarrhea
• Adverse effects: constipation
• Contraindications: bowel obstruction,
colitis, fever, pregnancy, lactation
• Patient education: Instruct patients to
report diarrhea that is not controlled
within 48 hours.
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Table 27-4
Categories of Laxatives
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Table 27-4 (continued) Categories of Laxatives
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Osmotic Laxatives: Uses
• Sodium and magnesium ions attract
water into bowel causing a more liquid
stool.
• Used for short-term treatment of
occasional constipation
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Osmotic Laxatives:
Adverse Effects
• Common: nausea, vomiting, abdominal
cramps, diarrhea, weakness, lethargy,
electrolyte imbalances
• Serious: hypotension, bradycardia,
mental depression, coma
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Osmotic Laxatives:
Contraindications
• Contraindicated in renal impairment
and hypertension
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Osmotic Laxatives:
Patient Education
• Instruct patients that 24 to 48 hours
are needed for effect to occur.
• Women should not breast feed while
taking these drugs.
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Laxative Abuse
• Evaluate laxative use in patients
suspected of having bulimia or
anorexia.
• Elderly patients may perceive
constipation and overuse laxatives. Be
alert for volume depletion in older
adults.
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Stool Softeners
• Uses: to ease bowel movements in
constipated patients
• Adverse effects: mild abdominal
cramps, diarrhea, nausea
• Contraindications: Atonic constipation,
abdominal pain, intestinal obstruction,
heart failure, edema, diabetes
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Stool Softeners
• Patient education: Instruct patients to
drink lots of fluids and not use these
drugs for a long period.
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Laxative Stimulants
• Uses: temporary relief of constipation
• Adverse effects: anorexia, nausea,
gripping, rebound constipation,
melanosis
• Contraindications: abdominal pain,
fecal impaction, GI bleeding,
ulcerations, pregnancy, heart failure
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Laxative Stimulants
• Patient education: Advise patients that
prolonged use disrupts normal colon
function.
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Bulk-forming Laxatives
• Work by absorbing free water in
intestinal tract; use in atonic or spastic
constipation
• Adverse effects: nausea, vomiting,
diarrhea, abdominal cramps
• Contraindications: esophageal and
intestinal obstruction, fecal impaction,
children younger than 2 years
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Bulk-forming Laxatives
• Patient education: Advise patients with
diabetes that these drugs contain
sugar.
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Emetics
• Use: to induce vomiting (emergency)
• Adverse effects: stiff muscles,
myopathy, convulsions, coma,
arrhythmias, fatal myocarditis
• Contraindications: shock, seizures,
impaired cardiac function, sedation
• Patient education: Advise patients not
to use before calling poison control
center.
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Table 27-5
The Most Commonly Used Antiemetics
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Table 27-5 (continued) The Most Commonly Used Antiemetics
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Antiemetics
• Uses: to prevent or treat nausea and
vomiting
• Adverse effects: drowsiness, dry
mouth, confusion, hypotension, blurred
vision
• Contraindications: coma, CNS
depression, pregnancy, and lactation
• Patient education: Advise patients to
avoid driving and alcohol.
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