ACID-CONTROLLING,
ANTIDIARRHEAL, LAXATIVE, AND
ANTIEMETIC DRUGS
I. ACID-CONTROLLING AGENTS
Stomach Secretions:
Substance Function
HCl (hydrochloric acid) Made by parietal cells; aids digestion, kills microbes
Bicarbonate Buffers acid, prevents hyperacidity
Pepsinogen → Pepsin Breaks down proteins
Intrinsic factor Helps absorb vitamin B12
Mucus Protects stomach lining
Prostaglandins Promote mucus & bicarbonate, protect mucosa
Gastric Cell Types
Cell Function
Parietal Secrete HCl → maintain pH 1–4; site of action for acid-controlling drugs
Chief Secrete pepsinogen (protein digestion)
Mucous cells Secrete mucus barrier
Acid-Related Disorders
GERD → reflux of acid → esophagitis, Barrett’s esophagus
PUD (Peptic Ulcer Disease) → gastric or duodenal ulcers (often H. pylori)
Hyperacidity/Dyspepsia → heartburn, indigestion
Stress ulcers → in critically ill patients (e.g., Curling or Cushing ulcers)
H. pylori treatment:
o Triple therapy: PPI + clarithromycin + (amoxicillin OR metronidazole)
o Quadruple therapy: PPI + bismuth + tetracycline + metronidazole
1. Antacids
Mechanism: Neutralize acid, ↑ gastric pH, stimulate mucus/bicarb/PG protection
Do NOT prevent acid production.
Indications:
Heartburn, GERD, PUD, gastritis
Contraindications:
Renal failure, GI obstruction, electrolyte imbalance, pregnancy (caution)
Drug Interactions:
↓ absorption of other drugs (chelation)
↑ stomach pH → affects absorption
Take 1–2 hrs apart from other meds
Types:
Type Examples Notes
Aluminum hydroxide
Aluminum salts Constipation, hypophosphatemia
(Maalox)
Magnesium hydroxide (Milk
Magnesium salts Diarrhea; avoid in renal failure
of Magnesia)
Constipation, kidney stones, milk-alkali
Calcium salts Tums
syndrome
Sodium Quick relief, risk of metabolic alkalosis,
Alka-Seltzer
bicarbonate avoid in HF/renal pts
Nursing Tips:
Take with 240 mL water
Avoid long-term use (acid rebound)
Chew thoroughly
2. H2 Receptor Antagonists (“-tidine”)
Examples:
Cimetidine, Ranitidine (Zantac), Famotidine (Pepcid)
Mechanism:
Blocks H2 receptors → ↓ HCl secretion, ↑ pH
Uses:
GERD, PUD, esophagitis, stress ulcer prophylaxis
Adverse Effects:
Confusion (elderly), hypotension (IV), impotence (Cimetidine), gynecomastia
Thrombocytopenia (rare)
Interactions:
Cimetidine inhibits liver enzymes → ↑ warfarin, phenytoin, theophylline
Smoking ↓ drug effectiveness
Nursing Notes:
Take 30–60 min before meals
Do not take with antacids
Monitor LFTs, renal labs
3. Proton Pump Inhibitors (PPIs) — “-prazole”
Examples: Omeprazole, Pantoprazole, Lansoprazole, Esomeprazole
Mechanism:
Irreversibly blocks H⁺/K⁺ ATPase pump → stops acid secretion
Indications:
GERD, PUD, Zollinger-Ellison syndrome, H. pylori therapy, stress ulcer prophylaxis
Adverse Effects:
Long-term: Osteoporosis, ↓ magnesium, ↑ risk of C. difficile & pneumonia
Possible kidney injury
Interactions:
↑ Warfarin, Phenytoin, Diazepam levels
↓ absorption of iron, digoxin, ampicillin
Nursing Notes:
Take before meals, swallow whole
If difficulty swallowing → open capsule, sprinkle on applesauce
Avoid long-term use without follow-up
4. Other Acid-Controlling Drugs
Sucralfate:
Coats ulcers → “liquid bandage”; promotes healing
Give 1 hr before meals, 2 hr apart from other meds
Misoprostol:
Synthetic prostaglandin → protects stomach lining
Used for NSAID ulcer prevention
🚫 Contraindicated in pregnancy (causes uterine contractions)
Simethicone (antiflatulent):
Breaks gas bubbles; used for flatulence
Found in Ovol, Maalox, Rolaids
II. ANTIDIARRHEAL DRUGS
💧 Diarrhea Overview
Acute: < 2 weeks; infection or food-related
Chronic: > 3 weeks; linked to IBS, diabetes, tumors
Goals: Decrease frequency, relieve cramps, restore fluids/electrolytes
Classes of Antidiarrheals
Class Mechanism Example Notes
Black stool/tongue, ↑
Coat intestinal Bismuth subsalicylate (Pepto-
Adsorbents bleeding time, avoid in
wall, bind toxins Bismol), Activated charcoal
kids → Reye’s syndrome
↓ peristalsis, dry Urinary retention, blurred
Anticholinergics Atropine, Hyoscyamine
secretions vision, 🚫 glaucoma
↓ bowel motility, Loperamide Constipation, CNS
Opiates ↑ water (Imodium), Diphenoxylate + depression, dependence
absorption Atropine (Lomotil) (Lomotil)
Restore normal
Probiotics Lactobacillus acidophilus Used after antibiotics
flora
Nursing Notes:
Avoid in infectious diarrhea (keeps pathogen inside)
Do not give bismuth to <16 yrs (Reye’s)
Assess for dehydration, electrolytes
III. LAXATIVES
Causes of Constipation
↓ fiber, ↓ fluids, inactivity, meds (opioids, iron, anticholinergics)
🧾 Laxative Types & Key Points
Type Mechanism Example Notes
Absorb water → ↑
Safest; take with ≥240 mL
Bulk-forming stool bulk → reflex Psyllium (Metamucil)
water
peristalsis
Emollient (stool Lubricate & soften Docusate sodium Prevents straining; not
softener) stool (Colace), Mineral oil stimulant
Used for bowel prep,
Draw water into Lactulose, Polyethylene
Hyperosmotic hepatic encephalopathy
bowel → distention glycol (PEG), Glycerin
(Lactulose ↓ ammonia)
↑ osmotic pressure
Magnesium hydroxide, Fleet Quick action; avoid in
Saline → water in
enema renal/cardiac patients
intestines
Nerve stimulation Risk for dependency;
Stimulant Bisacodyl (Dulcolax), Senna
→ ↑ peristalsis fastest acting
Adverse Effects (General):
Cramping, dehydration, electrolyte imbalance
Bulk-forming → impaction
Saline → magnesium toxicity
Nursing Notes:
Do NOT give if bowel obstruction or undiagnosed pain
Encourage fiber + fluids + activity
Take with 6–8 oz water
Long-term stimulant use → ↓ bowel tone
IV. ANTIEMETIC & ANTINAUSEA DRUGS
🧠 Pathway:
Vomiting Center (VC) & Chemoreceptor Trigger Zone (CTZ) in brain
Stimulated by neurotransmitters (ACh, dopamine, serotonin)
💊 Drug Classes
Class Mechanism Example Key Nursing Points
Block ACh in Motion sickness; 🚫
Anticholinergic Scopolamine patch
inner ear & VC glaucoma
Block
Antihistamines (H1 Dimenhydrinate Sedation, avoid
vestibular &
blockers) (Gravol), Meclizine, Promethazine alcohol
reticular ACh
Block
Antidopaminergic EPS, hypotension,
dopamine in Prochlorperazine, Promethazine
(Neuroleptic) sedation
CTZ
Risk for tardive
Block
dyskinesia; avoid
Prokinetic dopamine; ↑ Metoclopramide (Reglan)
with seizure
peristalsis
disorders
Block 5-HT3 Used for chemo &
Serotonin blockers in GI, CTZ, Ondansetron (Zofran) post-op N/V; HA
VC common
THC Act on cerebral For chemo or AIDS;
Dronabinol
(Cannabinoids) cortex stimulates appetite
Avoid in pregnancy
Natural
Herbal (Ginger) Zingiber officinale & with
antiemetic
anticoagulants
General Nursing Implications:
Assess cause of nausea (drug, motion, chemo)
Administer 30–60 min before chemo or travel
Warn: Drowsiness → avoid driving/alcohol
Monitor for dehydration, I&O
Ondansetron may cause headache (treat with acetaminophen)
Antacids = neutralize acid (fast relief)
H2 blockers = “-tidine” → ↓ acid production
PPIs = “-prazole” → stop acid entirely
Laxatives: “Bulk, Soft, Osmotic, Saline, Stimulate” 💩
Antidiarrheals: “Slow down or coat”
Antiemetics: target CTZ/VC — each class blocks a neurotransmitter