INDEX
[Link] Content Page no
1. Introduction 1
2. Classification of drugs 1-3
3. Antacids 4-6
4. Antidiarrheal 7-8
5. Antiulcer agents (or) proton 9-10
pump inhibitors
6. Anti histamines drugs (or) 10-11
receptor blockers
7. Laxatives 11-12
8. Anti spasmodics 12-14
9. Anti emetics 14-15
GASTRO INTESTINAL
DRUGS
GASTRO INTESTINAL DRUGS
INTRODUCTION
The organs of the digestive system are located within a tube called the alimentary canal
or gastro intestinal tract. Digestion is the process by which food is broken down with in to smaller
pieces so that the body can use them to build and nourish cells and to provide energy. Digestion
involves the mixing of food, its movement through the digestive tract , and the chemical
breakdown of larger molecules into small molecules. Every piece of food we eat has to be broken
down in to smaller nutrients that the body can absorb which is why it takes hours to fully digest
food.
Although the term digestion, strictly speaking, means the breakdown of food enzymatic
action. we will expand the term to include both the physical and chemical processes that reduce
food to small soluble molecules.
CLASSIFICATION OF DRUGS IN GASTRO INTESTINAL SYSTEM
ANTACIDS
ANTIDIARRHEAL
ANTIULCER AGENTS OR PROTON PUMP INHIBITORS.
LAXATIVES.
ANTISPASMODICS
ANTI EMETICS
ANTIHISTAMINES OR H2 RECEPTORS ANTAGONIST.
ANTACIDS
1. Aluminum Hydroxide
2. Calcium carbonate
3. Magnesium Hydroxide
4. Sodium bicarbonate
ANTIDIARRHEAL DRUGS
1. Bismuth subsalicylate.
2. Diphenoxylate Hydrochloride
3. Loperamide
4. Octreotide acetate.
ANTIULCER AGENTS (OR) PROTON PUMP INHIBITORS
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ANTI HISTAMINES (OR) H2 RECEPTORS BLOCKERS
1. Cimetidine
2. Ranitidine
3. Nizatidine
4. Famotidine
LAXATIVES
1. Psylluim
2. Glycerin
3. Lactulose
4. Magnesium sulfate
5. Bisacodyl
6. Docusate calcium
ANTISPASMODICS
1. Dicyclomine
2. Glycopyrolate
3. Methscopolamine
4. Propantheline
ANTIEMETICS
1. Aprepitant
2. Dolasetron mesylate
3. Metoclopramide
4. Ondansetron
ANTACIDS
DRUG NAME : ALUMINUM HYDROXIDE
GROUP NAME : ANTACIDS
TRADE NAME : ALUGEN
DOSAGE
ANTACID : ADULT : PO 500-1500mg 3-6 x daily, max 6 doses/day
HYPERPHOSPHATEMIA
ADULT : PO 300-600 mg TID.
CHILD : PO 50 -150 mg /kg/day.
AVAILABLE FORMS
SUSP 320 MG 15ML, 600mg/5 ml.
ROUTE
GIVE 2 Hour before meals
ACTION
Neutralizes gastric acidity; binds phosphate in Gastro Intestinal tract these phosphate are then
excreted.
INDICATIONS
Antacid Hyperphosphatemia in chronic renal failure
Adjunct in gastric peptic duodenal ulcers;
Hyperacidity reflex esophagitis
Heart burn,
Stress
GERD(Gastro Esophageal Reflex Disease)
CONTRAINDICATIONS
Hypersensitivity
PRECAUTIONS
Pregnancy
Breast feeding
Geriatric patients
Fluid restriction
GI mobility
GI obstruction
Dehydration
Sodium restricted diets
SIDE EFFECTS
GI : Constipation
Anorexia
Obstruction
fecal incontinence
NURSING CONSIDERATION
AEESES
Pain location, intensity, duration, character.
Phosphate, calcium levels because products bound in GI system.
Constipation, Increase bulk in diet if needed may use stool softners or laxatives ,record the
amount of stool
Aluminium intoxicity : severe renal disease may also be used for hyperphosphatemia
PATIENT /FAMILY TACHING
1. Not to use for prolonged periods for patients with low serum phosphate or patients on low
sodium diets.
2. To check with prescriber after 2 weeks of self prescribed antacid use.
3. To separate from medications by 2 hours.
4. To notify prescriber of black tarry stools which may indicate bleeding.
ANTIDIARRHEAL DRUGS
DRUG NAME : LOPERAMIDE
TRADE NAME : IMODIUM
GROUP NAME : ANTI DIARRHEAL DRUGS
ROUTE : ORAL
DOSAGE : 4mg ,2 mg
AVAILABLE FORMS : Cap; 2 mg, tablet;2 mg
ACTION
Direct action on intestinal muscles to decrease GI peristalsis, reduces volume, increase bulk,
electrolytes.
INDICATIONS
Diarrhea
Traveler’s diarrhea
Chronic diarrhea
CONTRAINDICATION
Hypersensitivity
Constipation
GI bleeding
Dysentery
Vomiting
SIDE EFFECTS
CNS : Dizziness, Drowsiness, fatigue
GI : Nausea, Dry mouth, vomiting,constipation , abdominal pain, anorexia
INTEG : Rash
METABOLIC : Hyperglycemia
SYST : Anaphylaxis, angioedema
NURSING CONSIDERATION
ASSESS
STOOLS: volume, color, characteristics, frequency.
Electrolytes (potassium, sodium, chloride) if receiving long term therapy.
Pregnancy, breast feeding: use only if benefits out weight fetal risk, breast feeding is not
recommended.
PATIENT /FAMILY TEACHING
1. To avoid OTC products unless directed by prescriber
2. That ileostomy patient may take product for extended time
3. Not to operate machinery is drowsiness occurs.
4. To use hard candy, sips of water for dry mouth.
ANTIULCER AGENTS (OR) PROTON PUMP INHIBITORS
DRUG NAME : PANTOPRAZOLE
TRADE NAME : PROTONIX
GROUP NAME : PROTON PUMP INHIBITORS
DOSAGE : 40 mg
ROUTE : IV
FREQUENCY : OD
AVAIABLE FORMS
Tablet 20, 40 [Link].40 mg
ACTION
Suppresses gastric secretion by inhibiting hydrogen/potassium ATP use enzyme in
gastric parital cell, characterized as gastric acid pump inhibitor because it blocks the final step of
acid production.
INDICATIONS
GERD
Sever erosive esophagitis
Zollinger Ellison Syndrome
CONTRAINDICATION
Hypersensitivity
Pregnancy
Breast feeding
Children
SIDE EFFECTS
CNS: Headache, insomnia, asthenia, malaise
GI: aiarrhea, abdominal pain, pancreatitis, weight changes
INTEGUMENTARY: Rash
METABOLIC: Hyperglycemia, weight gain/loss, hyponatremia, vitamin B12 deficiency
MUSCULAR : Myalgia
NURSING CONSIDERATION
Hepatic studies:
AST, ALT, ALK phosphate during treatment.
PATIENT /FAMILY TEACHING
1. That hyperglycemia may occur in diabetic patients.
2. To take as directed, not to skip as double dose.
3. To avoid alcohol, salicylates, NASID may cause GI irritation.
4. To continue taking even if feeling better.
ANTI HISTAMINES (OR) H2 RECEPTOR BLOCKERS
DRUG NAME : RANITIDINE
TRADE NAME : ZANTAC
GROUP NAME : H2 receptor blockers
ROUTE : IV
DOSAGE : 150 mg
FREQUENCY : OD
AVAILABLE FORM
TABLET 75,150,300 mg; INJECTION:25 [Link],300 mg.
ACTION
Inhibits histamine at H2 receptor site in parietal cells, which inhibits gastric acid secretin.
INDICATIONS
Duodenal ulcer
Gastric ulcers
Hyper secretory conditions
Stress ulcers
GERD
Heart burn
CONTRAINDICATIONS
Hypersensitivity
SIDE EFFECTS
CNS; Head ache, Dizziness, confusion, agitation, depression, hallucination
EENT: Blurred vision
GI: constipation, abdominal pain, diarrhea, nausea, vomiting.
INTEGUMENTARY: Anaphylaxis, angioedema, burning at injection site.
NURSING CONSIDERATIONS
ASSESS
GI COMPALAINTS: Nausea, diarrhea, cramps, abdominal discomfort, jaundice.
Intake and output ratio, BUN, creatinine, LFTs, Serum, periodically during therapy.
PATIENT/FAMILY TEACHING
1. To avoid driving, other hazardous activities until stabilized on product.
2. That product must be continued for prescribed time to be effective.
3. Not to take maximum OTC daily dose for 2 weeks.
4. To take oral daily dose before bed time
5. To report immediately coffee -ground emesis, black tarry stools, abdominal pain.
LAXATIVES
DRUG NAME : MEGNESIUM SULFATE
TRADE NAME : MgSO4
GROUP NAME : LAXATIVES
ROUTE : IV
DOSAGE : 25-50 mg/kg
FREQUENCY : 2 to 4 level teaspoon per day as a single dose or in a 2 divided doses
AVAILABLE FORMS
SULFATE:500 mg/ml
Premixed infusion:1gm/100ml,4 g/50ml,20g/500ml.
ACTION
Increased osmotic pressure, draws fluid in to colon neutralizes HCL.
INDICATIONS
Constipation
Dyspepsia
Eclampsia
Anti convulsant for preeclampsia.
CONTRAINDICATIONS
Hypersensitivity
Abdominal pain
Nausea/vomiting
Obstruction
Rectal bleeding
Heart block
SIDE EFFECTS
CNS :Muscle weakness, flushing, sweating, confusion, flaccid paralysis.
CV :Hypotension, heart block, circulary collapse.
GI :Nausea, vomiting, anorexia, diarrhea.
METABOLIC ; Electrolyte, fluid imbalance
RESP : Respiratory depression/paralysis.
NURSING CONSIDERATIONS
ASSESS
LAXATIVES: Cause of constipation, lack of fluid, bulk, emesis, cramping, rectal bleeding,
nausea, vomiting.
ECLAMPSIA: Seizure precautions, ECG.
Magnesium toxicity: thirsty, confusion, decrease in reflexes
Pregnancy/breast feeding : Use only if clearly needed, contraindicated in labor, toxemia during 2
hour prior to delivery, appears in breast milk.
PATIENT/FAMILY TEACHING
1. Not to use laxatives for long term therapy because bowel tone will be lost.
2. That chilling improves taste of magnesium citrate.
3. To shake suspension well.
4. To give citrate fruit after administrating to counteract unpleasant taste.
ANTISPASMODICS
DRUG NAME : GLYCOPYRROLATE
TRADE NAME : ROBINUL
GROUP NAME : ANTISPASMODICS
ROUTE : IM/IV
DOSAGE : 4mg
FREQUENCY : TID
ACTION
Inhibits the action of acetylcholine at receptor sites in parasympathetic nervous system,
which controls secretion free acids in stomach.
INDICATIONS
Decreased secretion before surgery
Reversal of neuromuscular blockage
Peptic ulcer disease
Irritable bowel syndrome
Bradycardia
CONTRAINDICATIONS
Children <3 years
Hypersensitivity
GI/GU Obstruction
Tachycardia
Myocardial ischemia
Hepatic disease .
Ulcerative colitis
Toxic megacolon
Prostate hypertrophy
SIDE EFFECTS
CNS: Confusion, anxirty, restlessness, irritability, delusion, hallucination, headache, sedation,
dizzines, lethargy, seizure.
CARDIAC: Palpitation, tachycardia, postural hypotension, paradoxical bradycardia.
ENT: Blurred vision, photophobia, dilated pupils, difficulty swallowing, cycloplegia.
GI: Dryness of mouth, constipation, nausea, vomiting, abdominal distress ,paralytic ileus, altered
taste.
GU: Urinary hesitancy , retention, impotence.
INTEGRATORY: Urticardia, allergic reaction.
MUSCULO: Suppression of lactation, nasal congestion, decreased sweating, malignant
hyperthermia.
NURSING CONSIDERATION
ASSESS
Blood pressure, respiration, heart rate before and during IM/IV administration.
Intake and output ratio.
Constipation: Abdominal distention, Bowel sounds, Increase fluids.
PATIENT/FAMILY TEACHING
1. To use hard candy
2. , frequent drinks, sugarless gum to relieve dry moth to perform good oral hygiene.
3. Not to discontinue this product abruptly to taper off over 1 week to take per oral 30
minutes -1 hour before meals.
4. To avoid driving other hazardous activities because drowsiness, blurred vision may
occur.
5. To avoid OTC medication cough, cold preparation with alcohol, antihistamine unless
directed by prescriber.
6. To avoid hot temperature since sweating is decreased heat stroke is possible.
ONDANSETRON
DRUG NAME : ONDANSTERON
TRADE NAME : ZOFRAN
GROUP NAME : ANTIEMETICS
ROUTE : ORAL, IV
DOSAGE : 4MG
FERQUENCY : TID
AVAILABLE FORMS:
INJECTION: 2 mg/ml, TABLET: 4, 8 mg.
ACTION
Prevent nausea, vomiting by blocking serotonin peripherally, centrally and in the small
intestine.
INDICATIONS
Prevention of nausea
Vomiting associated with cancer chemotherapy
Radiation therapy
Prevention of post operative nausea, vomiting
CONTRAINDICATION
Hypersensitivity
Phenyl ketonuric hypersensitivity
SIDE EFFECTS
CNS : Head ache, dizziness, drowsiness, fatigue.
GI : Diarrhea, constipation, abdominal pain, dry mouth.
MUSCULAR: Rash, bronchospasm, musculoskeletal pain, wound problems, shivering, fever,
hypoxia, urinary retention.
INTERACTION
Increase : unconsciousness, hypotension appropriate do not use together.
Increase: QT prolongation other products that along QT.
Decreas: ondenstron effect - rifampin, carbamazerpine, phenytoin
NURSING CONSIDERATION
ASSESS
Absence of nausea, vomiting during chemotherapy.
Hypersensitivity reaction –rash, bronchospasm
EPS: Shufflying gait, tremors, grimacing
Pregnancy/breast feeding
Identify whether pregnancy is planned or suspected avoid use in pregnancy, cardiac
malformation.
PATIENT /FAMILY TEACHING
1. To report diarrhea, constipation, rash changes in respiration, discomfort at insertion
site, serotonin symptoms.
2. That headache requiring analgesics is common.
3. Drink with whole glass of water.
CONCLUSION
The Gastro intestinal system represents a major interface between the human body and it’s
taminal environment, being continuously exposed to pontentially damaging agents from ingested
materials.
BIBLIOGRAPHY
Lippincott williams and willeins, “2006 Nursing Drug Guide” Published by Amy M. Karch
, RN, MS Page No:
Linda, Skidmore Roth, Mosby’s 2019 Nursing and Drug Reference, Second south Asia
edition, Published by Elsevier.
Linda, Skidmore Roth, Mosby’s 2020 Nursing and Drug Reference, Third south Asia
edition, Published by Elsevier.
Linda, Skidmore Roth, Mosby’s 2022 Nursing and Drug Reference, Fifth south Asia
edition, Published by Elsevier.
Suresh K. Sharma,Jogindra vati, Dolly Domini, Jaypee’s Nursing Drug. Book 2020-2021;
Published by Jaypee Brothers Medical Publishers.