Chapter 57

Drugs Affecting Gastrointestinal

Secretions

Copyright 2008 Lippincott Williams & Wilkins.

Underlying Causes of GI Disorders

Dietary excess

Stress

Hiatal hernia

Esophageal reflux

Adverse drug effects

Peptic ulcer disease

Copyright 2008 Lippincott Williams & Wilkins.
 Effect of Drugs on GI Secretions

Decrease GI secretory activity

Block the action of GI secretions

Form protective coverings on the GI lining to

prevent erosion from GI secretions

Replace missing GI enzymes that the GI tract or

ancillary glands and organs can no longer produce

Copyright 2008 Lippincott Williams & Wilkins.

 Peptic Ulcers
Definition
Erosions in the lining of the stomach and
adjacent areas of the GI tract
Symptoms
Gnawing, burning pain that often occurs after
meals
Cause
Bacterial infection by Helicobacter pylori bacteria

Copyright 2008 Lippincott Williams & Wilkins.

Drugs Used in the Treatment of Ulcers

Histamine-2 (H2) antagonists

Block the release of hydrochloric acid in
response to gastrin
Antacids
Interact with acids at the chemical level to
neutralize them
Proton pump inhibitors
Suppress the secretion of hydrochloric acid
into the lumen of the stomach
Copyright 2008 Lippincott Williams & Wilkins.
 Drugs Used in the Treatment of Ulcers
(cont.)
Antipeptic agents

Coat any injured area in the stomach to prevent

further injury from acid

Prostaglandins

Inhibit the secretion of gastrin and increase the

secretion of the mucous lining of the stomach,
providing a buffer

Copyright 2008 Lippincott Williams & Wilkins.

Sites of Actions of Drugs Affecting
Gastrointestinal Secretions

Copyright 2008 Lippincott Williams & Wilkins.

 Histamine-2 (H2) Antagonists

Action
Selectively block histamine-2 receptor sites,
leading to a reduction in gastric acid secretion
and reduction in overall pepsin production
Indications
Short-term treatment of active duodenal ulcer
or benign gastric ulcer
Treatment of pathological hypersecretory
conditions such as ZollingerEllison syndrome

Copyright 2008 Lippincott Williams & Wilkins.

 Histamine-2 (H2) Antagonists (cont.)

Indications (cont.)
Prophylaxis of stress-induced ulcers and acute
upper GI bleeding in critical patients
Treatment of erosive gastroesophageal reflux
Relief of symptoms of heartburn, acid
indigestion, and sour stomach (OTC
preparations)
Pharmacokinetics
Readily absorbed after oral administration
Metabolized in the liver and excreted in the urine
Copyright 2008 Lippincott Williams & Wilkins.
Histamine-2 (H2) Antagonists (cont.)

Contraindications

Known allergy

Cautions

Pregnancy and lactation

Hepatic or renal dysfunction

Copyright 2008 Lippincott Williams & Wilkins.

Histamine-2 (H2) Antagonists (cont.)

Adverse effects
GI effects: diarrhea, constipation
CNS effects: dizziness, headache, somnolence,
confusion or even hallucinations
Cardiac arrhythmias and hypotension
Drug-to-drug interactions
Warfarin, phenytoin, beta-blockers, alcohol,
quinidine, lidocaine, theophylline, chloroquine,
benzodiazepines, nifedipine, pentoxifylline,
tricyclics, procainamide, and carbamazepine
Copyright 2008 Lippincott Williams & Wilkins.
 Antacids
Action
Neutralize stomach acid by direct chemical reaction
Indication
Symptomatic relief of upset stomach associated with
hyperacidity as well as hyperactivity
Contraindication
Allergy
Cautions
Any condition that can be exacerbated by electrolyte
imbalance
GI obstruction
Copyright 2008 Lippincott Williams & Wilkins.
 Antacids (cont.)
Adverse effects
Relate to acidbase levels and electrolytes
Rebound acidity
Alkalosis
Hypercalcemia
Constipation and diarrhea
Hypophosphatemia
Drug-to-drug interactions
Absorption of many other drugs
Copyright 2008 Lippincott Williams & Wilkins.
 Proton Pump Inhibitors
Action
Act at specific secretory surface receptors to
prevent the final step of acid production and
thereby decrease the level of acid in the stomach
Indications
Short-term treatment of active duodenal ulcers,
GERD, erosive esophagitis, and benign active
gastric disease
Long-term treatment of pathological hypersecretory
conditions
Copyright 2008 Lippincott Williams & Wilkins.
 Proton Pump Inhibitors (cont.)

Pharmacokinetics
Acid labile; rapidly absorbed in the GI tract
Metabolized in the liver and excreted in the urine
Contraindication
Allergy
Cautions
Pregnancy and lactation

Copyright 2008 Lippincott Williams & Wilkins.

 Proton Pump Inhibitors (cont.)
Adverse effects
CNS:
Dizziness, headache, asthenia, vertigo, insomnia,
and apathy
GI:
Diarrhea, abdominal pain, and tongue atrophy
Upper respiratory tract:
Cough, stuffy nose, hoarseness, and epistaxis
Other:
Rash, alopecia, pruritus, dry skin, back pain, and
fever
Copyright 2008 Lippincott Williams & Wilkins.
 Antipeptic Agents
Action

Form an ulcer-adherent complex at duodenal

ulcer sites, protecting the sites against acid,
pepsin, and bile salts
Indication
Promote ulcer healing
Pharmacokinetics

Rapidly absorbed, metabolized in the liver, and

excreted in the feces
Copyright 2008 Lippincott Williams & Wilkins.
 Antipeptic Agents (cont.)

Contraindications
Allergy
Renal failure
Caution
Pregnancy and lactation
Adverse effects
GI effects: constipation, diarrhea, nausea,
indigestion, gastric discomfort, and dry mouth
Dizziness
Sleepiness
Copyright 2008 Lippincott Williams & Wilkins.
 Antipeptic Agents (cont.)
Adverse effects (cont.)

Vertigo

Skin rash

Back pain

Drug-to-drug interactions

Aluminum salts

Phenytoin, fluoroquinolone, and penicillamine

Copyright 2008 Lippincott Williams & Wilkins.
 Prostaglandins
Action
Inhibit gastric acid secretion and increase
bicarbonate and mucus production in the stomach
Indications
Prevention of NSAID-induced gastric ulcers
Treatment of duodenal ulcers
Pharmacokinetics
Rapidly absorbed from the GI tract, metabolized in
the liver, and excreted in the urine
Contraindication
Pregnancy
Copyright 2008 Lippincott Williams & Wilkins.
 Prostaglandins (cont.)
Caution
Lactation
Adverse effects

GI: nausea, diarrhea, abdominal pain,

flatulence, vomiting, dyspepsia, and constipation
GU: miscarriages, excessive bleeding, spotting,
cramping, hypermenorrhea, dysmenorrhea, and
other menstrual disorders

Copyright 2008 Lippincott Williams & Wilkins.

 Patients Who May Require
Digestive Enzyme Supplements
Saliva supplements
Stroke
Salivary gland disorder
Extreme surgery of the head and neck
Pancreatic enzyme supplements
Common duct problems
Pancreatic disease
Cystic fibrosis
Copyright 2008 Lippincott Williams & Wilkins.
 Digestive Enzymes
Actions
Saliva substitute: contains electrolytes and
carboxymethylcellulose to act as a thickening
agent in dry mouth conditions
Pancreatic enzymes are replacement enzymes
that help the digestion and absorption of fats,
proteins, and carbohydrates
Indications
Replacement therapy
Copyright 2008 Lippincott Williams & Wilkins.
 Digestive Enzymes (cont.)
Contraindications
Saliva: allergy
Pancreatic enzymes: allergy
Cautions
Saliva: CHF, hypertension, and renal failure
Pancreatic enzyme: pregnancy and lactation
Adverse effects
Saliva: complications from abnormal electrolytes
and increased levels of magnesium, sodium, or
potassium
Pancreatic enzyme: GI irritation, nausea,
abdominal cramps, and diarrhea
Copyright 2008 Lippincott Williams & Wilkins.
Use of Agents Affecting Gastrointestinal
Secretions Across the Lifespan

Copyright 2008 Lippincott Williams & Wilkins.

Prototype Histamine-2 (H2) Antagonists

Copyright 2008 Lippincott Williams & Wilkins.

Prototype Antacids

Copyright 2008 Lippincott Williams & Wilkins.

Prototype Proton Pump Inhibitors

Copyright 2008 Lippincott Williams & Wilkins.

Prototype Digestive Enzymes

Copyright 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Histamine-2
(H2) Antagonists

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

Copyright 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Antacids

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

Copyright 2008 Lippincott Williams & Wilkins.

 Nursing Considerations for
Proton Pump Inhibitors

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

Copyright 2008 Lippincott Williams & Wilkins.

 Nursing Considerations for
Antipeptic Agents

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

Copyright 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Prostaglandins

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

Copyright 2008 Lippincott Williams & Wilkins.

 Nursing Considerations for
Digestive Enzymes

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

Copyright 2008 Lippincott Williams & Wilkins.