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Chapter 19: GASTROINTESTINAL SYSTEMGI SYSTEM:Alimentary Canal: Begins at mouth & ends at anus.4 functions: Ingestion, digestion, absorption & excretion.Digestion: Food to chemical substances.Begins in mouth (mechanical/chewing) then (chemical/enzymes).Break down complex organic molecules: Fats, Carbs & ProteinsPeristalsis: Wavelike movements.If peristalsis is impeded, toxic substances can build up & infection can occur. (Can affect normal flora).Stomach has HCl (hydrochloric acid) that helps break down food.Reflux: Backflow of HCl. (Can lead to ulcers or mucosal breakdown).HCl & normal flora can kill some organisms in GI tract.Junk food causes damage by overworking pancreas, liver & gallbladder.Undereating: Anorexia NervosaOvereating: ObesityMeds can change acidity in stomach.Other substances can contain worms, viruses or bacteria.GI MEDICATIONS:Used to treat specific disorders of GI system or control certain S/S.Timing of GI med is important.FUNCTIONS OF MAJOR DIGESTIVE ORGANS:Stomach:Store foodMix food & HClPasses chyme to SISmall Intestine (SI):Carbs, fats & proteins broken down.Pancreatic enzymes & bile from liver aid digestionEnd products from digestion absorbed into bloodstream through mucous membranes.Large intestine (LI): Absorb extra water & electrolytes.Eliminate feces.MEDS TO TREAT CONSTIPATION:Constipation: When peristalsis slows, infrequent & hard stools occur.Diuretics contribute to constipation. Colon absorbs too much fluid and feces gets hard and alimentary canal can’t clear it.Laxatives can help by promoting bowel movements, can help diagnose GI disorders, can cause electrolyte imbalance and shouldn’t be used as a means of weight loss. They have a high risk of dependency. Cathartic: Stronger med that empties colon.BULK-FORMING LAXATIVE:Increase bulk water content of stool. (They resemble dietary fiber).Psyllium (Metamucil)Prunes have same effect.Best during pregnancy & routine basis. Absorb water & create larger, softer stools.Stimulate peristalsis & purge feces. 12 hours – 3 days to work.LUBRICANT LAXITIVES:Mineral oil increases water-to-fecal mass to ease passage.Suppositories6-8 hours to work.OSMOTIC LAXATIVES: Rectally: Glycerin or sorbitolImmediate reaction, draws water to stool and irritates bowel.Evacuation of stool (Diarrhea) 15-60 mins.Contraindicated in: HTN, Edema or CHF.Milk of Magnesia: Mild saline laxative. Increases water in LI. Salt ions attract water molecules toward each other. Lubricates GI tract.Safe for HTN, Edema & CHF.2-12 hours.STIMULANT LAXATIVES:Stimulate peristalsis.Act directly on mucosa and irritate bowel.6-8 hours.Biscodyl, Senna, Aloe Cascara sagrada & castor oil.Discolors urine.DO NOT use in pregnancy/lactation: Can cause premature labor & infant diarrhea.STOOL SOFTENERS:Decrease consistency of stool. Reduces surface tension by attracting water & fat to stool.Docusate (Colace): Detergent stool softener.Routinely in pts with limited mobility.BOWEL EVACUATORS:Cleansing solutions to remove stool before test. (Colonoscopy)Similar to body fluids so the bowel rejects it. Drink 1 gallon mixed fluid with bowel evacuator in 2-3 hour time frame.Polyethylene glycol electrolyte solution (Colyte) Polyethylene glycol 3350 (MiraLax)NONPHARMACOLOGICAL:Laughing, exercising, increasing dietary fiber, more fluids, decrease in dairy, drink warmed prune juice.MEDICATIONS TO TREAT DIARRHEA:Diarrhea: Increase in fluidity of bowel movements.Can lose too many electrolytes.Loss is quicker in infants & small children (within hours).Symptom, not a disease.Causes:ChemicalsInflammationInfectionsMedicationsAnti-infective therapyAnxiety disordersCirculatory disordersCauses cramping.Can be life-threatening in children and elderly.Opioid related antidiarrheal meds: Work on GI motilityDecrease peristalsisSlows function of GI systemAllows more time for absorption of water.Loperamide (Imodium)Diphenoxylate with Atropine (Lomotil)S/E: Dizziness, dry mouth, agitation, numbness, drowsiness & tachycardia.ABSORBENTS:Bismuth (Pepto-Busmol)Kaolin and Pectin (Kaopectate)Taken after every bowel movement to absorb toxins or bacteria and coat walls of GI tract.Treatment focuses on the cause of diarrhea.Also includes: AntibioticsAnti-inflammatoriesAntiparasiticsMost common antibiotic is for “traveler’s diarrhea”.Contaminated water or food.Antibiotics:Ciprofloxin (Cipro)Ofloxacin (Floxin)Azithromycin (Zithromax Z-Pak)Ulcerative Colitis: Inflammation causes diarrhea.Anti-inflammatory:Sulfasolazine (Azulfidine)Mesalamine Rectal (Canasa, Rowasa)Balsalazide (Colazal)Olsalazine (Dipentum)Antiparasitic Meds3533775328295PEPTO BISMOL:Antidiarrheal, antiulcer & absorbent.Treats: Heartburn, nausea, diarrhea, upset stomach & indigestion.Salicylate: Make gout worse.Ulcer symptoms & bleeding problems worse.May lead to overdose.Should not breastfeed.Only 12 and older.S/E: Constipation, black tongue or stools.00PEPTO BISMOL:Antidiarrheal, antiulcer & absorbent.Treats: Heartburn, nausea, diarrhea, upset stomach & indigestion.Salicylate: Make gout worse.Ulcer symptoms & bleeding problems worse.May lead to overdose.Should not breastfeed.Only 12 and older.S/E: Constipation, black tongue or stools.left323850Nausea: Caused by unusual smells, pregnancy hormones, or emptiness of stomach.Emesis: (Vomiting) Ejection of stomach contents.Antiemetics: Decrease nausea, vomiting & motion sickness.Phenothiazines: Prochlorperazine (Compazine)Antihistamines: Diphenhydramine (Benadryl)Meclizine (Antivert & Bonin)Trimethobenzamide (Benzacot, Tigan & Ticon)CannabinoidsPhosphorated Carbohydrate Solution (Emetrol)Serotonin Ondansetron (Zofran)00Nausea: Caused by unusual smells, pregnancy hormones, or emptiness of stomach.Emesis: (Vomiting) Ejection of stomach contents.Antiemetics: Decrease nausea, vomiting & motion sickness.Phenothiazines: Prochlorperazine (Compazine)Antihistamines: Diphenhydramine (Benadryl)Meclizine (Antivert & Bonin)Trimethobenzamide (Benzacot, Tigan & Ticon)CannabinoidsPhosphorated Carbohydrate Solution (Emetrol)Serotonin Ondansetron (Zofran)MEDICATIONS TO TREAT NAUSEA & VOMITING (ANTIEMETICS)PHENOTHIAZINES:Block dopamine receptors that stimulate vomit.Chlorpromazine (Thorazine) & Prochlorperazine (Compazine) to control vomiting in CHEMOTHERAPY.Tend to produce sedation while treating.By RX only.5-HYDROXYTRYPTAMINE-3 RECEPTOR ANTAGONISTS:“Serotonin”Serotonin antagonists: Commonly used to treat nausea and vomiting in CHEMOTHERAPY.Block chemical serotonin in brain and stomach.Dolasetron (Anzemet)Ondansetron (Zofran)Granisetron (Kytril)RX onlyANTIHISTAMINES:Blocks signals to brain’s movement center.Works best with motion sickness nausea.Dramamine (Dimenhydrinate)Diphenhydramine (Benadryl)Meclizine (Antivert & Bonine)Promethazine (Adgan, Phenergan & Promethacon)ANTICHOLINERGICS:Blocks effects of acetylcholine & acts on medulla that initiates vomiting.Trimethobenzamide (Benzacot, Tigan & Ticon)Scopolamine (Maldemar, Scopase & Transderm-Scop)Can be used as transdermal disc placed behind ear before motion-sickness event.CANNABINOIDS:Marijuana is herbal form.Nabilone (Cesamet)Affects area of brain that controls nausea & vomit impulses.High level of addiction.Only when other antiemetics are unsuccessful.Used in CHEMOTHERAPY.Altered thinking: Take with care.Taken before, during & after CHEMOTHERAPY.Cesamet & Marijuana are controlled substances.Check your states laws.Qualifying illnesses: Cancer, Glaucoma, HIV/AIDS, Hep C, Amyotrophic Lateral Sclerosis, Chron’s Disease, Alzheimer’s Disease, PTSD, Peripheral Neuropathy, Severe Arthritis, Chronic or debilitating diseases or treatments causing: Wasting or Severe Pain.PHOSPHERATED CARBOHYDRATE SOLUTION:Emetrol: Contains dextrose, fructose & phosphoric acid.Decreases hyperactivity of smooth muscle in gastric mucosa.Contraindicated in DM.MEDICATIONS TO TREAT GERD:Cardiac sphincter loose: Stomach acid can move back into esophagus.Gastroesophageal Reflux Disease (GERD) (Heartburn)ANTACIDS:Decrease amount of HCl in stomach. Creates more alkaline environment. (Neutralizes acid)Not readily absorbed & don’t alter pH of entire body.Contain aluminum, calcium, magnesium, sodium or combo of them.Woman with osteoporosis: Benefit from calcium-based antacid.Calcium-based kidney stone: Avoid dietary calcium.Take before food.Chewable tabs with glass of water or milk.30 mins – 3 hours.H2-Receptor blockers: 1 hour before or 3 hours after meals.Long term use can increase acid secretion.Used to lower elevated acid levels resulting from spicy foods.Decrease nausea with pregnancy hormones.Mild: Tums & RolaidsPROTON PUMP INHIBITORS:Reduce acidity of stomach. (Bind to stomach enzymes)Block enzymes that cause acid production.Protects stomach longer.Inhibit hydrogen & potassium ions as short term for GERD & benign peptic ulcers.S/E: Abdominal pain, headache, constipation, diarrhea & nausea.Esomeprazole (Nexium)Lansoprazole (Prevacid)Omeprazole (Prilosec)Pantoprazole (Protonix)Rabeprazole (Aciphex)GASTRIC STIMULANTS:Prokinetic agents stimulate gastric activity in pt with decreased peptic activity.Decrease esophageal sphincter pressure.Increase gastric emptying (improves peristalsis).Given to decrease amount of time food is in stomach & reduces risk for aspiration pneumonia/choking.Metoclopramide (Reglan)S/E: Drowsiness, restlessness, headache, dry mouth, menstrual period changes & diarrhea.MEDICATIONS TO TREAT PEPTIC ULCERS:HCl breaks down food. Allows easy absorption.Stomach can create too much acid and can lead to peptic ulcer (perforation of mucosa)Acid can spill into duodenum & erode mucosa.Pts @ high risk for ulcers:Type O bloodCig smokersInfected with H PyloriDon’t cope well with stressAlcoholCaffeinated foods & drinksCertain drugs: Corticosteroids, Aspirin & NSAIDSH pylori associated with:75% of gastric ulcers90% of duodenal ulcersANTIBIOTICS:Fight H Pylori.Amoxicillin (Amoxil, Trimox)Clarithromycin (Biaxin)Metronidazole (Flagyl)TetracyclineNever used alone, usually in combo.7-14 day regimenBismuth to stop H Pylori from sticking to mucosa.MUCOSAL PROTECTANTS:Cover & protect ulcer to promote healing.Must be taken on empty stomach.Sucralfate (Carafate) [Aluminum & Sulfated Sucrose]Allowing healing.S/E: Constipation & Vitamin DeficiencyPROSTAGLANDINS:Hormone-like substances with wide range of effects on body.Contraction & relaxation of smooth muscleModeration of inflammation Control of BPPeptic Ulcers: Misoprostol (Cytotec)Inhibits gastric acid secretion: Decreases amount of acid in stomach.Protects lining of stomach.Used to reduce for NSAID induced ulcers.S/E: Diarrhea, stomach cramps, nausea during first weeks of treatment.Take with food.NOT during pregnancy: Risk for miscarriage, premature labor or possible birth defects.ANTISPASMODICS: (Anticholinergics)Decrease secretions & gastric mobility.Reduce gastric spasm.Slow gastric motility.Decrease exposure of gastric mucosa to HCl by keeping food in stomach & reducing amount of acid produced.Treats: GERD, Ulcerative Colitis, Diverticulitis, Biliary spasms & IBS.Dicyclomine (Bentyl) & Glycopyrrolate (Robinul).H2-RECEPTOR ANTAGONISTS:Block histamine from binding to parietal cells & prevent them from secreting HCl.Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid), Ranitidine (Taladine, Zantac)With or without meals (Most effective 30 mins before)NOT within one hour of antacid.S/E: Nausea, vomiting, diarrhea, dry mouth, dizziness, weakness, headache & muscle cramps.PROTON PUMP INHIBITOR:Reduce acidity of stomach & decrease exposure of ulceration to acid.Antacids & GI stimulants are also often used in treatment of ulcers.MEDICATIONS TO TREAT GALLSTONES:Cholelithiasis: When cholesterol or calcium forms calculus (stones).Calcium stones seen on radiograph.Symptoms: Bloating, gas & nausea.Ursodiol (Actigall, Urso)Naturally occurring bile acid: Decreases production of cholesterol & inhibits absorption of cholesterol by intestines.Therapy can take up to 2 years. S/E: Flulike symptoms, stomach pain, dizziness, back pain & headache.center8509000MEDICATIONS TO TREAT OBESITY:Factors that cause obesity: Metabolic abnormalities, overeating, insulin resistance & sedentary lifestyle.Morbidly Obese: Over 20% above ideal body weight.Increases workload of pancreas, liver & circulatory system.Lifestyle changes are best.Anorexiants are sometimes necessary.APPETITE SUPPRESSANTS:Give a feeling of fullness.Used with caution to decrease food intake & potential obesity.Mimic sympathetic nervous system.Short-term use only.Phentermine (Zantryl, T-Diet)Taking with other diet meds: Can cause pulm HTN.Can be habit forming.Affects cognitive function.Sometimes creates nausea.LIPASE INHIBITORS:Orlistat (Alli, Xenical)Used to manage obesity.Bind to lipase so intestines can’t break down the fat.Fats out in feces.Reduces amount of fat absorbed in body and reduces serum lipids.NOT for children or pts with chronic health problems without supervision by HCP.NOT more than 3X day or with meal that does not contain fat.Vitamins to supplement sometimes.MEDICATIONS TO TREAT HEMORRHOIDS:Hemorrhoids: Swollen varicose veinsFissures: Cracks Anorectal preparation used to decrease swelling & soothe cracks.Pramoxine, phenylephrine, glycerin & petrolatum (Preparation H)Pramoxine & zinc oxide: Anusol, Tronalone & Tucks.Pramoxine: Anesthetic to numb pain & itching.Zinc Oxide: Promotes healing.Contain lanolin or mineral oil (Act as emollient to lubricate anus and makes stool less traumatic.Anal fissures & hemorrhoids can be treated with rectal suppositories: Hydrocortisone acetate (Anusol-HC)By suppressing inflammation.-61595104775MEDICATIONS TO TREAT FLATULENCE:Flatulence: Gas released by GI tract.Caused by foods. Decrease consumption of cabbage, onions, beans & use straws.More common from swallowing air, diverticulitis, peptic ulcer, IBS & dyspepsia.Antiflatulents can be used with gastroscopy & bowel radiography.Simethicone: Flatulex, Gas-X, Genasyme, Mylicon)No S/Eright0MEDICATIONS TO TREAT FUNGAL INFECTIONS OF GI TRACT:Oral Candidiasis (thrush): Fungal infection of mucous membranes in mouth.Symptoms: Thick, white patches on tongue & cheeks.Nystatin (Bio-statin, Mycostatin, Milstat)Also as troche (lozenge)Keep in mouth as long as possible to coat affected area.Troches: Do NOT swallow whole.Intestinal candidiasis: Swallow whole.-3333753340MEDICATIONS TO TREAT INTESTINAL PARASITES:Anthelmintics kill intestinal parasites: Roundworms (ascariasis, hookworms, pinworms, strongyloidiasis, trichinosis & whipworms) & tapeworms.Prevent newly hatched from thiriving.Albendazole (Albenza)Praziquantel (Biltricide)Ivermectin (Stromectol)Mebendazole (Vermox)Pyrantel (Antiminith, Ascarel, Pin-X)Praziquantel (Biltricide)Laxative to rid body of dead parasites.S/E: Abd cramps, headaches, anorexia, nausea & vomiting.MEDICATIONS TO INDUCE VOMIT AND TREAT DRUG OVERDOSE:Antiemetics stop vomiting.Emetics promote vomiting.Syrup of ipecac: Induce vomiting in 80-90% of pts within 20-30 mins.Most poisonings & drug overdoses are treated with activated charcoal.Charcoal attracts toxins and inactivates poison then excretes it into stool.Naloxone (Narcan) is standard med for overdose & blocks effects of opioids & reverses overdose.right109537NUTRITIONAL SUPPLIMENTS:Poor nutrition = Poor healthMalnutrition: From lack of availability of food, excessive dieting, poor dietary choices or illnesses that reduce appetite.Multivitamin for lack in food.More easily tolerated in pt who is weak and has compromised immune system.Boost & Ensureright94615DIGESTANTS:Pts have difficulty digesting foods, most commonly because of food allergy or genetic disorder (cystic fibrosis).Lactaid: To help tolerate dairy.Cystic Fibrosis: Don’t produce enough enzymes to digest any food.Digestive enzymes: Enzymatic Digestant Oral with every meal & snack they ingest.right85090MOUTHWASHES & OTHER ORAL TREATMENTS:Decrease halitosis (bad breath)Decrease stomatitis (inflammation of mouth)Fluoride preparation can prevent tooth decay & hardens tooth enamel.Hydrogen Peroxide: Weak antibacterial agent in mouth.Substitutes for pts who don’t produce enough saliva.Dentifrices/toothpastes: Clean teethDecrease plaquePrevent gum diseaseWhiten ................
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