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Keperawatan UNEJ
 Sehat adalah kebutuhan setiap manusia hidup
 Sehat dartikan sebagai keadaan sejahtera badan, jiwa
dan sosial yang memungkinkan setiap orang dapat
hidup produktif secara ekonomi dan sosial
 Tak seorang pun ingin menderita sakit dan bagi yang
terlanjur sakit akan berusaha untuk sehat kembali.
Orang yang sehat bahkan berusaha dengan berbagai
cara untuk memperlambat proses penuaan ( aging )
 Sehat selama ini dipahami dipengaruhi oleh 4 faktor
yakni : genetis, lingkungan, pelayanan kesehatan dan
perilaku
 Genetika

Fasilitas Lingkungan
Layanan Kesehatan Sehat

Perilaku
 Faktor Luar:
Cuaca, makana-minuman, bakteri, virus dll

Faktor Dalam:
Emosi , kejiwaan dan bawaan
 Perilaku Hidup Sehat mencakup :
 Pilihan Asupan Makanan
 Apa yang layak dimakan
 Apa yang layak dipikirkan
 Apa yang layak disyukuri
 Pilihan gaya hidup layak
 Apa yang layak dikerjakan
 Apa yang layak dipertahankan
 Apa yang layak diubah
 Pilihan menjadi kritis
 Menjadi cerdas dan selektif
 Pemberdayaan diri
 Sejak zaman purbakala manusia telah dihadapkan pada
masalah kesehatan yang memaksa dirinya mencari pengobatan
Para ahli pengobatan memperoleh pengetahuan tentang obat
dan cara pengobatan hanya berdasarkan intuisi dan
pengalaman empiris.
 Baru pada 400 tahun sebelum masehi berdiri sekolah
kedokteran di Yunani yang salah satu alumninya bernama
Hipokrates yang memperkenalkan cara-cara pengobatan yang
rasional dan etis .
 Tahun 1240 Kaisar Frederick II memberikan maklumat kepada
rakyatnya tentang pemisahan Kedokteran dan Farmasi dengan
tujuan agar masyarakat mendapat perawatan medis yang layak
serta memperoleh obat (farmacon) yang cocok yang dapat
dipertanggung jawabkan
 Konsep pemisahan tersebut hingga kini dirasakan oleh
masyarakat dunia
 Farmakologi berasal dari kata
farmacon yang berarti obat dan
logos yang berarti ilmu sehingga
 Farmakologi didefinisikan
sebagai ilmu yang mempelajari
tentang obat khususnya yang
berkaitan dengan pengaruh sifaf
fisika-kimiawinya terhadap tubuh,
respons bagian-bagian tubuh
terhadap sifat obat ,nasib yang
dialami obat dalam tubuh dan
kegunaan obat bagi kesembuhan.
Terkait dengan Farmakologi
tersebut adalah ilmu tentang :
◦ Farmakodinamika
◦ Farmakokinetika
◦ Toksikologi
◦ Farmakoterapeutika
◦ Farmakognosi
◦ Farmasi
 Farmakodinamika adalah ilmu yang mempelajari tentang pengaruh
obat terhadap tubuh
 Obat dapat mempengaruhi seluruh atau bagian-bagian tertentu dari
tubuh . Pengaruh tersebut disebut pengaruh farmakologis.
 Pengaruh atau efek obat meliputi :
 Efek terapi ( Indikasi )
 Kontraindikasi
 Toksisitas
 Efek samping
 Interaksi
 Farmakokinetika adalah ilmu yang mempelajari tentang bagaimana
obat diperlakukan oleh tubuh.
 Farmakokinetika juga dikenal dengan ilmu ADME yakni ilmu yang
mempelajari Absorpsi, Distribusi, Metabolisme dan Sekresi
termasuk didalamnya dibahas tentang ketersedian bahan aktif obat
dalam tubuh ( bioavailabilitas )
 Absorpsi obat dalam usus sangat dipengaruhi PH cairan lambung
 Hal ini menyebabkan ada obat yang diberikan sebelum atau
sesudah makan
 Obat yang diberikan sebelum makan ( Covering agents ), appetizers
( stomachica ) dan obat-obat yang tak tahan terhadap asam
lambung ( penicillin )
 Distribusi obat diawali dengan absorpsi dimana obat terlebih dahulu
menembus membran sel masuk kedalam cairan interstisiil . Obat
dalam tubuh terikat oleh protein plasma dalam keadaan reversible
 Biotransformasi obat sebagian besar terjadi di hepar terutama oleh
enzym mikrosomal untuk mengurangi toksisitas dan ekskresi
 Reaksi kimia yang terjadi dalam biotransformasi dapat dibedakan
kedalam 2 golongan :
 Reaksi sintetik ( konjugasi ) yang dapat mengurangi toksisitas
 Reaksi ini memerlukan ATP sebagai sumber energi
 Reaksi non – sintetik berupa oksidasi, reduksi dan hydrolisa
 Reaksi ini memerlukan NADPH ( Nicotinamida Adenin
Dinucleotide Phosphate Hydrogen )
 Ekskresi obat dilakukan oleh organ tubuh seperti :
Renal
Hepar
Pulmo
Kelenjar ASI
Kelenjar Keringat
Kelenjar ludah
 Obat-obat yang tidak dapat diekskresi dikeluarkan
lewat faeces
 Distribusi

Obat Absorpsi Metabolisme/biotranformasi Eksekresi

Fase-fase yang dialami oleh obat dalam tubuh ada 3 tingkatan :

Fase biofarmaseutik
Fase farmakokinetik
Fase farmakodinamik
 Obat adalah zat atau bahan
yang digunakan untuk
diagnotis,pencegahan,
pengobatan ( therapy ) dan
pemulihan penyakit
 Pengobatan dengan obat
disebut Farmakoterapi
 Pengobatan tanpa obat
disebut Non Farmakoterapi a.l.
Psychoterapi,
Fisioterapi,hydroterapi, Ozon –
terapi, color – therapi, music-
therapy, speech-therapy etc.
 Perilaku masyarakat dalam
mencari kesembuhan
terhadappenyakit yang
dideritanya berdasarkan
SKRT dikategorikan sbb:
◦ Tidak berbuat apa-apa 5 %
◦ Pergi ke Dokter 18 %
◦ Mengobati Sendiri 77 %
 Caranya sendiri
 Minum jamu
 Menggunakan obat yang
dijual bebas
Obat adalah ibarat madu disatu sisi dan racun disisi
lainnya
Obat adalah kebutuhan dasar masyarakat oleh
karenanya harus diawasi peredaran dan
pengunaannya
Pengawasan obat dulu dilakukan oleh Direktorat
Jenderal Pengawasan Obat dan Makanan dan kini
dilakukan oleh Badan Pengawasan obat dan
Makanan (Badan POM )
 Merangsang ( stimulasi ) dan menekan ( depresi )
fungsi spesifik dari sel tubuh
 Membunuh atau menghambat aktivitas sel-sel
asing dan bakteri
 Menimbulkan aksi non spesifik
 Mensubstitusi zat-zat tertentu yang diperlukan
oleh tubuh
 Therapi diterjemahkan dengan pengobatan
 Pengobatan dapat dilakukan dengan obat diistilahkan
dengan farmakoterapi
 Pengobatan tanpa obat disebut non farmakoterapi
 Preventif
 Hygienis –dietis
 Immunisasi
 Kuratif
 Physiotherapy
 Psychoteraphy
 Hygienis –Dietis
 Aroma Theraphy
 Colour theraphy
 hydroterapy
 Sistem tubuh dalam garis besarnya terdiri dari sub sistem:
 Sistem Syaraf
 Sistem Hormonal
 Sistem Sirkulasi
 Sistem Ekskresi
 Sistem-sistem tersebut dikendalikan 3 unsur yakni air, udara dan
panas Untuk sehat ketiga unsur tersebut harus selalu dalam
keadaan seimbang. Sistem tubuh seimbang apabila :
 Makan ,istirahat tidur teratur
 Pencernaan berfungsi baik
 Ekskresi bekerja optimal
 Kelima inderanya berfungsi menerima rangsangan dengan baik
 Berat Badan
Umur
Jenis Kelamin
Kondisi Patologik
 Sistemik (keseluruh tubuh yang melewati peredaran darah),
a.l :
◦ oral
◦ oromukosal (sublingual, bucal)
◦ injeksi (subcutan, intra muskular, intra vena, intra arteri,
intra cutan, intra lumbal / intra tekal, intra peritonial, intra
cardial, intra pleura, intra articuler)
◦ Implantasi
◦ rektal
◦ transdermal
 Lokal (efek setempat)
- percutan / kulit
- inhalasi
- mukosa mata / telinga
- intra vaginal
- intra nasal
A. Tepat pasien
B. Tepat obat
C. Tepat waktu
D. Tepat dosis
E. Tepat rute (cara pemberian)
F. Tepat dokumentasi
1. Antiinfektikum 12. Obat kardiovaskular
2. Antineoplastikum 13. Obat darah
3. Immunoglukosidum 14. Obat Saluran Nafas
15. Obat Saluran Cerna
4. Obat Bantuan dan
16. Obat Saluran urogenital
Penolong
17. Obat kulit dermatologikum
5. Obat metabolisme dan Gizi 18. Obat Telinga ( oticum )
6. Obat Sistem Endokrin 19. Obat Mata (oftamologikum)
7. Depresan Sistem syaraf 20. Obat Mulut & Gigi
8. Antiradang, antireumatik 21. Obat anti Parasit
dan antiencok 22. Obat lain-lain
9. Psikotropika
10. Anti sistem syaraf lain
11. Relaksan otot
 Fungsi Saluran Cerna
 Mencerna makanan
 Meneyerap sari makanan
 Menegekskresikan sisa makanan yang tidak
terserap
 Sistem pencernaan terentang dari mulut hingga ke anus
(9m)
 Gangguan terhadap sistem pencernaan muncul dengan
berbagai gejala seperti mual, muntah, nyeri lambung,
hiperacidity, rasa melilit, kembung, diare, konstipasi dls
 Anatomi Saluran Cerna terdiri dari :
 Rongga mulut ( oral Cavity ) yang dibatasi oleh
maxilary bone dan mandibular bone )
 Oesophagus ( Isofagus atau Usofagus )
 Lambung
 Usus halus
 Usus besar
 Dubur ( anus )
 4 lapisan saluran cerna : mukosa, submukosa, otot
polos dan serosa
 System syaraf yang bekerja pada saluran cerna adalah
SSO yang memiliki pusat integrasi dengan SSP di
Cortex Cerebri
 Aliran darah terbesar ke hati dan limpa dan ke saluran
cerna terutama pada lapisan mukosa lamina propria
yang banyak memiliki Pembuluh Darah dan saluran
limpa
 Kelenjar ludah menghasilkan ludah yang berasal dari:
 Kelenjar parotis terletak dibawah tulang pipi depan
telinga
 Kelenjar submandibularis terletak didasar mulut
dekat tulang rahang bawah
 Kelenjar sublingualis terletak didasar lidah
 Kelenjar hati mengeluarkan empedu yang kemudian
disimpan dalam kandung empedu yang berfungsi
mencerna lemak
 Kelenjar pancreas
 Dalam rongga mulut terdapat kelenjar ludah dan
kelenjar bukal yang terletak pada lapisan mukosa
 Kelenjar ludah terdiri dari 3 jenis kelenjar yaitu kelenjar
parotis, sub mandibularis dan sublingual bersama
dengan kelenjar bukal menghasilkan air ludah yang 95
% terdiri dari air dan sisanya mengandung lendir dan
garam kalium dan natrium serta albumin, globulin,
serum, ptyalin, amilase dan lisozym
 Secara anatomi lambung terdiri dari cardia, fundus,
corpus dan pilori
 Cairan lambung diproduksi pada dinding saluran cerna
yang bersifat isotonis
 Asam lambung ( HCl) dihasilkan oleh lapisan mukosa
dengan pH 2-5
 Mukosa sendiri banyak mengandung Histamin yang
tersimpan dalam mast cell
 Hati merupakan kelenjar terbesar dalam tubuh dengan
berat lebih kurang 1,4 kg
 Hati tempat metabolisme secara kimiawi dimana semua
zat yang dihasilkannya dieksekresikan kedalam darah
kecuali cairan empedu yang dialirkan kekantong
empedu
 Cairan empedu berfungsi mengemulsi lemak agar
mudah terserap dalam usus
 Pankreas adalah kelenjar yang terhubung dengan
duodenum yang didalamnya terdapat sel-sel pulau
Langerhans yang menghasilkan insulin dan glukagon
1. Radang Kerongkongan (reflux oesophagitis)
2. Radang Lambung (gastritis)
3. Tukak Lambung (ulcus pepticum)
4. Tukak Usus
5. Kanker Lambung
 Digestive system and drug therapy have a
reciprocal relationship
 Some medications cause GI symptoms (e.g. EES);
conversely, some GI disorders alter the absorption
and metabolism of drugs (liver failure)
 Drugs affecting the GI tract include: laxatives,
antidiarrheals, antiemetics, drugs used in acid-
peptic disorders . Others include cholinergics
(Aricept) anticholinergics (atropine), corticosteroids
and anti-infectives.
 Review physiology of the digestive system organs
and some associated disorders
◦ Oral cavity-stomatitis
◦ Esophagus-GERD
◦ Stomach—peptic ulcers, gastritis
◦ Small intestine—malabsorption, Inflammatory
bowel
◦ Large intestine—diarrhea, constipation
◦ Pancreas—pancreatitis, Diabetes, ARDS
◦ Gallbladder—cholestasis,cholelithiasis,
cholecystitis
◦ Liver—hepatitis, cirrhosis
 Secretion of mucus and bicarbonate
 Dilution of gastric acid by food and secretions
 Prevention of diffusion of HCL from the stomach
lumen back into the gastric mucosal lining
 Presence of prostaglandin E
 Alkalinization of gastric secretions by pancreatic
juices and bile
mucus
Proglumide
The stomach secretes:
 Hydrochloric acid (HCl)
 Bicarbonate

 Pepsinogen
 Intrinsic factor
 Mucus
 Prostaglandins
 Cardiac
 Pyloric
 Gastric*

* The cells of the gastric gland are the largest in number

and of primary importance when discussing acid control
 Parietal cells
◦ Produce and secrete HCl
◦ Primary site of action for many acid-controller drugs
 Secreted by the parietal cells when stimulated
by food
 Maintains stomach at pH of 1 to 4
 Secretion also stimulated by:
◦ Large fatty meals
◦ Excessive amounts of alcohol
◦ Emotional stress
 Chief cells
◦ Secrete pepsinogen, a proenzyme
◦ Pepsinogen becomes pepsin when activated by
exposure to acid
◦ Pepsin breaks down proteins (proteolytic)
 Mucoid cells
◦ Mucus-secreting cells (surface epithelial cells)
◦ Provide a protective mucous coat
◦ Protect against self-digestion by HCl
 Caused by imbalance of the three cells of the
gastric gland and their secretions
 Most common: hyperacidity
 Clients report symptoms of overproduction of
HCl by the parietal cells as indigestion, sour
stomach, heartburn, acid stomach
 PUD: peptic ulcer disease
 GERD: gastroesophageal reflux disease
 Helicobacter pylori (H. pylori)
◦ Bacterium found in GI tract of 90% of patients
with duodenal ulcers, and 70% of those with
gastric ulcers
◦ Combination therapy is used most often to
eradicate H. pylori
flagellum
 H. pylori is not associated with acute
perforating ulcers
 It is suggested that factors other than the
presence of H. pylori lead to ulceration
 Requires combination of two antimicrobials
and a PPI or an H2RA
 Use amoxicillin, clarithromycin,
metronidazole or tetracycline for antibiotic
portion
 More than antimicrobial is indicated to
prevent resistance
 Bismuth compound is added for its
antibacterial effects as well as increasing
the HCO3- and mucous contents of the
stomach
 Adding an H2RA or PPI decreases S/S and
hastens healing
Gastric Ulcers
 Associated with stress, NSAIDs or H. pylori
 Manifested by painless bleeding
 Take longer to heal than duodenal ulcers
 When associated w/stress, can occur at any
age
 With H. pylori and NSAIDs generally are in 6th
or 7th decade
 chronic
A benign, localized defect in the mucosa of any part
of the gastrointestinal tract.

duodenal ulcer gastric ulcer

Duodenal Ulcers
 Can occur at any age
 Occur equally in men and women
 Manifested by abdominal pain
 Associated with cigarette smoking
 Also associated with NSAIDs and H. pylori
 Antacids
 H2 antagonists
 Proton pump inhibitors
Promote gastric mucosal defense mechanisms
 Secretion of:
◦ Mucus: protective barrier against HCl
◦ Bicarbonate: helps buffer acidic properties of HCl
◦ Prostaglandins: prevent activation of proton pump
which results in  HCl production
 Antacids DO NOT prevent the over-
production of acid
 Antacids DO neutralize the acid once it’s in
the stomach
Reduction of pain associated with acid-related
disorders
◦ Raising gastric pH from 1.3 to 1.6 neutralizes 50% of
the gastric acid
◦ Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90%
of the gastric acid
◦ Reducing acidity reduces pain
 Used alone or in combination
 Forms: carbonate, hydroxide
 Have constipating effects
 Often used with magnesium to counteract
constipation
 Examples
◦ Aluminum carbonate: Basaljel
◦ Hydroxide salt: AlternaGEL
◦ Combination products (aluminum and magnesium):
Gaviscon, Maalox, Mylanta, Di-Gel
 Forms: carbonate, hydroxide, oxide, trisilicate
 Commonly cause diarrhea; usually used with
other agents to counteract this effect
 Dangerous when used with renal failure —the
failing kidney cannot excrete extra magnesium,
resulting in hypermagnesemia
 Examples
◦ Hydroxide salt: magnesium hydroxide (MOM)
◦ Carbonate salt: Gaviscon (also a combination
product)
◦ Combination products such as Maalox, Mylanta
(aluminum and magnesium)
Forms: many, but carbonate is most common
 May cause constipation
 Their use may result in kidney stones
 Long duration of acid action may cause
increased gastric acid secretion (hyperacidity
rebound)
 Often advertised as an extra source of dietary
calcium
◦ Example: Tums (calcium carbonate)
 Highly soluble
 Buffers the acidic properties of HCl
 Quick onset, but short duration
 May cause metabolic alkalosis
 Sodium content may cause problems in
patients with HF, hypertension, or renal
insufficiency (fluid retention)
 Antiflatulents: used to relieve the painful
symptoms associated with gas
 Several agents are used to bind or alter
intestinal gas and are often added to antacid
combination products
OTC antiflatulents
 Activated charcoal
 Simethicone
◦ Alters elasticity of mucus-coated bubbles, causing
them to break
◦ Used often, but there are limited data to support
effectiveness
Minimal, and depend on the compound used
 Aluminum and calcium
◦ Constipation
 Magnesium
◦ Diarrhea
 Calcium carbonate
◦ Produces gas and belching; often combined with
simethicone
 Adsorption of other drugs to antacids
◦ Reduces the ability of the other drug to be
absorbed into the body
 Chelation
◦ Chemical binding, or inactivation, of another drug
◦ Produces insoluble complexes
◦ Result: reduced drug absorption
 Assess for allergies and preexisting conditions
that may restrict the use of antacids, such as:
◦ Fluid imbalances – Renal disease – HF
◦ Pregnancy – GI obstruction
 Patients with HF or hypertension should use
low-sodium antacids such as Riopan, Maalox,
or Mylanta II
 Use with caution with other medications due
to the many drug interactions
 Most medications should be given 1 to 2
hours after giving an antacid
 Antacids may cause premature dissolving of
enteric-coated medications, resulting in
stomach upset
 Be sure that chewable tablets are chewed
thoroughly, and liquid forms are shaken well
before giving
 Administer with at least 8 ounces of water to
enhance absorption (except for the “rapid
dissolve” forms)
 Caffeine, alcohol, harsh spices, and black
pepper may aggravate the underlying GI
condition
 Monitor for side effects
◦ Nausea, vomiting, abdominal pain, diarrhea
◦ With calcium-containing products: constipation,
acid rebound
 Monitor for therapeutic response
◦ Notify heath care provider if symptoms are not
relieved
 Reduce acid secretion
 All available OTC in lower dosage forms
 Most popular drugs for treatment of acid-
related disorders
◦ cimetidine (Tagamet)
◦ famotidine (Pepcid)
◦ ranitidine (Zantac)
 Block histamine (H2) at the receptors of acid-
producing parietal cells
 Production of hydrogen ions is reduced,
resulting in decreased production of HCl
 GERD
 PUD
 Erosive esophagitis
 Adjunct therapy in control of upper GI
bleeding
 Pathologic gastric hypersecretory conditions
(Zollinger-Ellison syndrome)
 Overall, less than 3% incidence of side effects
 Cimetidine may induce impotence and
gynecomastia
 May see:
◦ Headaches, lethargy, confusion, diarrhea, urticaria,
sweating, flushing, other effects
 Cimetidine (Tagamet)
◦ Binds with P-450 microsomal oxidase system in the
liver, resulting in inhibited oxidation of many drugs
and increased drug levels
◦ All H2 antagonists may inhibit the absorption of
drugs that require an acidic GI environment for
absorption
 SMOKING has been shown to decrease
the effectiveness of H2 blockers (increases
gastric acid production)
 Assess for allergies and impaired renal or
liver function
 Use with caution in patients who are
confused, disoriented, or elderly (higher
incidence of CNS side effects)
 Take 1 hour before or after antacids
 For intravenous doses, follow administration
guidelines
 The parietal cells release positive hydrogen
ions (protons) during HCl production
 This process is called the “proton pump”
 H2 blockers and antihistamines do not stop
the action of this pump
 Irreversibly bind to H+/K+ ATPase enzyme
 Result: achlorhydria—ALL gastric acid
secretion is blocked
 Total inhibition of gastric acid secretion
◦ lansoprazole (Prevacid)
◦ omeprazole (Prilosec)*
◦ rabeprazole (AcipHex)
◦ pantoprazole (Protonix)
◦ esomeprazole (Nexium)

*The first in this new class of drugs

 GERD maintenance therapy
 Erosive esophagitis
 Short-term treatment of active duodenal and
benign gastric ulcers
 Zollinger-Ellison syndrome
 Treatment of H. pylori–induced ulcers
 Safe for short-term therapy
 Incidence low and uncommon
 Assess for allergies and history of liver disease
 pantoprazole (Protonix) is the only proton
pump inhibitor available for parenteral
administration, and can be used for patients
who are unable to take oral medications
 May increase serum levels of diazepam,
phenytoin, and cause increased chance for
bleeding with warfarin
Instruct the patient taking omeprazole
(Prilosec):
 It should be taken before meals
 The capsule should be swallowed whole, not
crushed, opened, or chewed
 It may be given with antacids
 Emphasize that the treatment will be short
term
 sucralfate (Carafate)
 misoprostol (Cytotec)
 Cytoprotective agent
 Used for stress ulcers, erosions, PUD
 Attracted to and binds to the base of ulcers
and erosions, forming a protective barrier over
these areas
 Protects these areas from pepsin, which
normally breaks down proteins (making ulcers
worse)
 Little absorption from the gut
 May cause constipation, nausea, and dry mouth
 May impair absorption of other drugs,
especially tetracycline
 Binds with phosphate; may be used in chronic
renal failure to reduce phosphate levels
 Do not administer with other medications
 Synthetic prostaglandin analog
 Prostaglandins have cytoprotective activity
◦ Protect gastric mucosa from injury by enhancing
local production of mucus or bicarbonate
◦ Promote local cell regeneration
◦ Help to maintain mucosal blood flow
 Used for prevention of NSAID-induced gastric
ulcers
 Doses that are therapeutic enough to treat
duodenal ulcers often produce abdominal
cramps, diarrhea
 Contraindicated in women of childbearing
age and during pregnancy (see text p. 862)
 May induce abortion
 Dietary folate, iron and Vitamin B12 are
better absorbed from an acidic environment
 Less acidic environment can cause
deficiencies of these nutrients
 Sucralfate interferes with the absorption of
the fat soluble vitamins
 Magnesium containing antacids interfere with
absorption of Vitamin A
 Abnormal frequent passage of loose stool or
 Abnormal passage of stools with increased
frequency, fluidity, and weight, or with
increased stool water excretion
Acute diarrhea
 Sudden onset in a previously healthy person
 Lasts from 3 days to 2 weeks
 Self-limiting
 Resolves without sequelae
Chronic diarrhea
 Lasts for more than 3 weeks
 Associated with recurring passage of
diarrheal stools, fever, loss of appetite,
nausea, vomiting, weight loss, and chronic
weakness
Acute Diarrhea Chronic Diarrhea
Bacterial Tumors
Viral Diabetes
Drug induced Addison’s disease
Nutritional Hyperthyroidism
Protozoal Irritable bowel
syndrome
Adsorbents
 Coat the walls of the GI tract
 Bind to the causative bacteria or toxin, which
is then eliminated through the stool
 Examples: bismuth subsalicylate (Pepto-
Bismol), kaolin-pectin, activated charcoal,
attapulgite (Kaopectate)
Anticholinergics
 Decrease intestinal muscle tone and
peristalsis of GI tract
 Result: slowing the movement of fecal matter
through the GI tract
 Examples: belladonna alkaloids (Donnatal),
atropine
Intestinal flora modifiers
 Bacterial cultures of Lactobacillus organisms
work by:
◦ Supplying missing bacteria to the GI tract
◦ Suppressing the growth of diarrhea-causing
bacteria
 Example: L. acidophilus (Lactinex)
Opiates
 Decrease bowel motility and relieve rectal
spasms
 Decrease transit time through the bowel,
allowing more time for water and electrolytes
to be absorbed
 Examples: paregoric, opium tincture, codeine,
loperamide (Imodium), diphenoxylate
(Lomotil)
Adsorbents
 Increased bleeding time
 Constipation, dark stools
 Confusion, twitching
 Hearing loss, tinnitus, metallic taste, blue
gums
Anticholinergics
 Urinary retention, hesitancy, impotence
 Headache, dizziness, confusion, anxiety,
drowsiness
 Dry skin, rash, flushing
 Blurred vision, photophobia, increased
intraocular pressure
 Hypotension, hypertension, bradycardia,
tachycardia
Opiates
 Drowsiness, sedation, dizziness, lethargy
 Nausea, vomiting, anorexia, constipation

 Respiratory depression
 Bradycardia, palpitations, hypotension
 Urinary retention
 Flushing, rash, urticaria
 Adsorbents decrease the absorption of many
agents, including digoxin, clindamycin,
quinidine, and hypoglycemic agents
 Adsorbents cause increased bleeding time
when given with anticoagulants
 Antacids can decrease effects of
anticholinergic antidiarrheal agents
 Obtain thorough history of bowel patterns,
general state of health, and recent history of
illness or dietary changes, and assess for
allergies
 DO NOT give bismuth subsalicylate to
children younger than age 16 or teenagers
with chickenpox because of the risk of Reye’s
syndrome
 Use adsorbents carefully in geriatric patients or
those with decreased bleeding time, clotting
disorders, recent bowel surgery, confusion
 Anticholinergics should not be administered to
patients with a history of glaucoma, BPH,
urinary retention, recent bladder surgery,
cardiac problems, myasthenia gravis
 Teach patients to take medications exactly as
prescribed and to be aware of their fluid
intake and dietary changes
 Assess fluid volume status, I&O, and mucous
membranes before, during, and after
initiation of treatment
 Teach patients to notify their physician
immediately if symptoms persist
 Monitor for therapeutic effect
 Abnormally infrequent and difficult passage
of feces through the lower GI tract
 Symptom, not a disease
 Disorder of movement through the colon
and/or rectum
 Can be caused by a variety of diseases or
drugs
Bulk forming
 High fiber
 Absorbs water to increase bulk

 Distends bowel to initiate reflex bowel activity

 Examples:
◦ psyllium (Metamucil)
◦ methylcellulose (Citrucel)
◦ Polycarbophil (FiberCon)
Emollient
 Stool softeners and lubricants
 Promote more water and fat in the stools

 Lubricate the fecal material and intestinal walls

 Examples:
◦ Stool softeners: docusate salts (Colace, Surfak)
◦ Lubricants: mineral oil
Hyperosmotic
 Increase fecal water content
 Result: bowel distention, increased peristalsis,
and evacuation
 Examples:
◦ polyethylene glycol (GoLYTELY)
◦ sorbitol (increases fluid movement into intestine)
◦ glycerin
◦ lactulose (Chronulac)
Saline
 Increase osmotic pressure within the
intestinal tract, causing more water to enter
the intestines
 Result: bowel distention, increased
peristalsis, and evacuation
 Saline laxative examples:
◦ magnesium sulfate (Epsom salts)
◦ magnesium hydroxide (MOM)
◦ magnesium citrate
◦ sodium phosphate (Fleet Phospho-Soda, Fleet
enema)
Stimulant
 Increases peristalsis via intestinal nerve
stimulation
 Examples:
◦ castor oil (Granulex)
◦ senna (Senokot)
◦ cascara
◦ Bisacodyl
Laxative Group Use
Bulk forming Acute and chronic
constipation
Irritable bowel syndrome
Diverticulosis
Acute and chronic
constipation
Softening of fecal
Emollient impaction; facilitation
of BMs in anorectal
conditions
Laxative Group Use
Hyperosmotic
Chronic constipation
Diagnostic and
surgical preps
Saline Constipation
Diagnostic and
surgical preps
Removal of helminths
and parasites
Laxative Group Use
Stimulant Acute constipation
Diagnostic and surgical
bowel preps
 Bulk forming
◦ Impaction
◦ Fluid overload
 Emollient
◦ Skin rashes
◦ Decreased absorption of vitamins
 Hyperosmotic
◦ Abdominal bloating
◦ Rectal irritation
 Saline
◦ Magnesium toxicity (with renal insufficiency)
◦ Cramping
◦ Diarrhea
◦ Increased thirst
 Stimulant
◦ Nutrient malabsorption
◦ Skin rashes
◦ Gastric irritation
◦ Rectal irritation
All laxatives can cause electrolyte imbalances!
 Obtain a thorough history of presenting
symptoms, elimination patterns, and allergies
 Assess fluid and electrolytes before
initiating therapy
 Patients should not take a laxative or cathartic
if they are experiencing nausea, vomiting,
and/or abdominal pain
 A healthy, high-fiber diet and increased
fluid intake should be encouraged as an
alternative to laxative use
 Long-term use of laxatives often results in
decreased bowel tone and may lead to
dependency
 All laxative tablets should be swallowed whole,
not crushed or chewed, especially
if enteric coated
 Patients should take all laxative tablets with 6
to 8 ounces of water
 Patients should take bulk-forming laxatives
as directed by the manufacturer with at least
240 mL (8 ounces) of water
 Bisacodyl and cascara sagrada should be
given with water due to interactions with
milk, antacids, and H2 blockers
 Patients should contact their provider if they
experience severe abdominal pain, muscle
weakness, cramps, and/ or dizziness, which
may indicate fluid or electrolyte loss
 Monitor for therapeutic effect
 Nausea
◦ Unpleasant feeling that often precedes vomiting
 Emesis (vomiting)
◦ Forcible emptying of gastric, and occasionally,
intestinal contents
 Antiemetic agents
◦ Used to relieve nausea and vomiting
 Vomiting center (VC)
 Chemoreceptor trigger zone (CTZ)
◦ Both located in the brain
◦ Once stimulated, cause the vomiting reflex
 Vomiting center is located in medulla
oblongata
 Stimuli are relayed to the vomiting center
from the periphery (gastric mucosa,
peritoneum, intestines, joints(?)) and centrally
(from the cerebral cortex; vestibular
apparatus and from neurons in the fourth
ventricle==chemoreceptor trigger zone) sites
 The vomiting center, chemoreceptor trigger
zone and GI tract contain benzodiazepine,
cholinergic, dopamine, histamine, opiate and
serotonin receptors that are stimulated by
emetogenic drugs and toxins
 For example: chemotherapy may stimulate the
CTZ which then signals the vomiting center
 Motion sickness—changes in body
motion>>stimulate receptors in inner
ear>>transmitted to the CTZ and the vomiting
center
 Efferent impulses cause glottic closure
 Contraction of abdominal muscles and
diaphragm
 Relaxation of the GE sphincter
 Reverse peristalsis
 Projection or expulsion
 Pain
 Emotional disturbances
 Radiation therapy
 Motion sickness
 Drug therapy: especially with alcohol, ASA,
digoxin, anticancer drugs, antimicrobials,
estrogen preparations and Opioids
 GI disorders such as inflammation of the GI
tract, liver, gallbladder, pancreas, impaired GI
motility and muscle tone (gastroparesis) and
ingestion of food that is irritating to the
mucosa
 Cardiovascular, infectious, neurologic or
metabolic disorders
 Many different mechanisms of action
 Most work by blocking one of the vomiting
pathways, thus blocking the stimulus that
induces vomiting
 Specific indications vary per class of
antiemetics
 General use: prevention and reduction of
nausea and vomiting
 Anticholinergic agents (ACh blockers)
◦ Bind to and block acetylcholine (ACh) receptors in the
inner ear labyrinth
◦ Block transmission of nauseating stimuli to CTZ
◦ Also block transmission of nauseating stimuli from
the reticular formation to the VC
◦ Scopolamine
◦ Also used for motion sickness
 Antihistamine agents (H1 receptor blockers)
◦ Inhibit ACh by binding to H1 receptors
◦ Prevent cholinergic stimulation in vestibular and
reticular areas, thus preventing N&V
◦ Diphenhydramine (Benadryl), meclizine (Antivert),
promethazine (Phenergan)
◦ Also used for nonproductive cough, allergy
symptoms, sedation
 Neuroleptic agents
◦ Block dopamine receptors on the CTZ
◦ chlorpromazine (Thorazine), prochlorperazine
(Compazine)
◦ Also used for psychotic disorders, intractable
hiccups
 Prokinetic agents
◦ Block dopamine in the CTZ
◦ Cause CTZ to be desensitized to impulses it
receives from the GI tract
◦ Also stimulate peristalsis in GI tract, enhancing
emptying of stomach contents
◦ Metoclopramide (Reglan)
◦ Also used for GERD, delayed gastric emptying
 Serotonin blockers
◦ Block serotonin receptors in the GI tract, CTZ, and
VC
◦ Dolasetron (Anzemet), granisetron (Kytril),
ondansetron (Zofran)
◦ Used for N&V for patients receiving chemotherapy
and postoperative nausea and vomiting
 Ondansetron, granisetron and dolasetron are
used to prevent or treat moderate to severe
nausea and vomiting r/t cancer
chemotherapy, radiation therapy and
postoperatively
 Some anticancer drugs seem to affect a
subset of 5-HT3 recptors in the CTZ and the
GI tract
 These drugs antagonize receptors both
peripherally (GI) and in the CTZ to prevent
activation
 Can be given IV or orally
 Side effects are mild to moderate and include:
diarrhea, headache, dizziness, constipation,
muscle aches and transient liver enzymes
elevation
 Ondansetron (Zofran) is the prototype
 Metabolized by the liver
 Tetrahydrocannabinoids (THC)
◦ Major psychoactive substance in marijuana
◦ Inhibitory effects on reticular formation, thalamus,
cerebral cortex
◦ Alter mood and body’s perception of its
surroundings
 Tetrahydrocannabinoids (cont'd)
◦ dronabinol (Marinol)
◦ Used for N&V associated with chemotherapy, and
anorexia associated with weight loss in AIDS
patients
 Vary according to agent used
 Stem from their nonselective blockade of
various receptors
 Assess complete nausea and vomiting
history, including precipitating factors
 Assess current medications
 Assess for contraindications and potential
drug interactions
 Many of these agents cause severe
drowsiness; warn patients about driving or
performing any hazardous tasks
 Taking antiemetics with alcohol may cause
severe CNS depression
 Teach patients to change position slowly to
avoid hypotensive effects
 For chemotherapy, antiemetics are often
given ½ to 3 hours before a chemotherapy
agent
 Monitor for therapeutic effects
 Monitor for adverse effects
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