LESSON 4

GASTROINTESTAL TRACT
(GIT) DRUGS

ANTIEMETICS

A. Description
1. Diminish the sensitivity of the chemoreceptor trigger zone (CTZ) to irritants.
2. Alleviate nausea and vomiting
3. Prevent and control emesis and motion sickness
4. Available in oral, parenteral (IM, IV), rectal, and transdermal preparations

B. Examples
1. Centrally-acting agents: ondansetron HCl (Zofran);
prochlorperazine (Compazine);
trimethobenzamide HCl (Tigan)

2. Agents for motion sickness control: dimenhydrinate (Dramamine);

mechlizine HCl (Antivert, Bonine);
promethazine HCl (Phenergan)

3. Agents that promote gastric emptying: cisapride (ProPULSID);

metoclopramide (Reglan)

C. Major side effects: drowsiness (CNS depression);

hypotension (vasodilation via central mechanism);
dry mouth (decreased salivation from anticholinergic effect);
incoordination (an extrapyramidal symptom due to dopamine
antagonism)

D. Nursing Care
1. Observe occurrence and characteristics of vomitus
2. Eliminate noxious substances from the diet and environment
3. Provide oral hygiene
4. Caution client to avoid engaging in hazardous activities
5. Offer sugar-free chewing gum or hard candy to promote salivation
6. Instruct client to change positions slowly

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EMETICS
A. Description
 Stimulate the vomiting center & induce vomiting
 Used to treat acute poisoning

B. Examples
1. Apomorphine
Controlled substance
Given subq
Emesis occurs 5-15 mins after subq. administration
DO NOT GIVE to patients who are allergic to morphine or other opiates
AE: depression, euphoria, respiratory depression, orthostatic hypotension

2. Ipecac syrup
 30 cc or less cause no systemic, adverse effects
 Emesis occurs after 20-30 mins
 200-300 mL of water may facilitate the emetic action
 DO NOT GIVE to patients who:
a) Have altered LOC
b) Have seizures
c) Ingested corrosives
d) Ingested petroleum
distillates

ANOREXIANTS

A. Description

1. suppress the desire for food at the hypothalamic appetite centers;

generally produce CNS stimulation
2. Available in oral preparations

B. Examples:
1. amphetamine sulphate (Bezedrinea)
2. dextroamphetamine sulphate (Dexedrine)

C. Major side effects: nausea, vomiting (irritation of gastric mucosa); constipation (delayed
passage of stool in GI tract); tachycardia (sympathetic stimulation); CNS stimulation
activation

D. Nursing care

1. Educate client regarding:

a. Drug misuse(controlled substances)
b. Concurrent exercise and diet therapy
c. Need for medical supervision during therapy
d. Possibility of affecting ability to engage in hazardous activities

2. Monitor weight

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 ANTACID

A. Description

1. Provide a protective coating on the stomach lining and lower the gastric acid level; allows
more rapid movement of stomach contents into the duodenum
2. Inactivate pepsin & enhance mucosal protection but do not coat the ulcer crater
3. Neutralize gastric acid; effective in the treatment of ulcers
4. Available in oral preparations

B. Examples:
1. aluminum hydroxide gel (Amphojel)
2. Al & MgOH (Maalox)
3. Aluminum phosphate gel (Phosphaljel)
4. sodium bicarbonate - may cause alkalosis;
5. Calcium carbonate (Tums) – may cause hypercalcemia & hypophosphatemia
6. Milk of Magnesia

C. Major side effects

1. Constipation (aluminum compounds) (aluminum delays passage of stool in GI tract)
2. Diarrhea (magnesium antacid) magnesium stimulates peristalsis in GI tract
3. Alkalosis (systemic antacids) (absorption of alkaline compound into the circulation)
4. Reduce absorption of calcium and iron (increase in gastric pH)

D. Nursing care

1. Instruct the client regarding

a. Prevention of overuse of antacids which can result in rebound hyperacidity
b. Need for continued supervision
c. Dietary restrictions related to gastric distress
d. Foods high in calcium and iron

2. Caution client on a sodium-restricted diet that many antacid contains sodium

3. Shake oral suspensions well before administration
4. Administer with small amount of water to ensure passage to stomach
5. Can interfere with sucralfate

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 ANTICHOLINERGICS

A. Description

1. Inhibit smooth muscle construction in the GI tract

2. Alleviate pain associated with peptic ulcer
3. Available in oral and parenteral (IM, SC, IV) preparations

B. Examples:
1. atropine sulphate
2. dicyciomine HCI (Bentryl)
3. glycopyrrolate (Robinul)
4. propantheline bromide (Pro-Banthine)
5. methaneline bromide (Banthine)
6. Belladona

C. Major side effects (all related to decreased parasympathetic stimulation)

1. Abdominal distention and constipation (decrease peristalsis)
2. Dry Mouth (decreased salivation )
3. Urinary retention (decreased parasympathetic stimulation)
4. CNS disturbances (direct CNS toxic effect) –confusion
5. Blurred vision

D. Nursing care

1. Provide dietary counseling with emphasis on bland foods

2. Provide oral hygiene

ANTISECRETORY AGENTS

A. Description

1. Inhibit gastric acid secretion

2. Act at the H2 receptors of the stomach parietal cells to limit gastric secretion (H 2)
antagonists)
3. Inhibit hydrogen/ potassium ATPase enzyme system to block acid production (proton pump
inhibitors)
4. Available in oral and parental (IM, IV) preparations

B. Examples
1. H2 antagonists
a) famotidine (Pepcid)
b) ranitidine (Zantac)
c) cimetidine (Tagamet)
d) nizatidine (Axid) – for GERD

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 2. Proton pump inhibitors
a) omeprazole (Prevacid) – for esophagitis, GERD, ulcer
3. misoprostol (Cytotec) – suppresses gastric acid secretion; promotes secretion of HCO 3
& cytoprotective mucus; maintains submucosal blood flow through vasodilation

C. Major side effects

1. CNS disturbances (decreased metabolism of drug because of liver or kidney impairment)
2. Blood dyscrasias (decreased RBCs, WBCs , platelet synthesis)
3. Skin rash (hypersensitivity)

D. Nursing care

1. Do not administer at the same time as antacids; allow 1 to 2 hour between drugs
2. Administer oral preparation with meals
3. Assess for potentiation of oral anticoagulant effect
4. Instruct client to follow prescription exactly
5. Administration should not exceed 8 weeks without medical supervision

SUCRALFATE (Carafate)
 Forms a highly-condensed, paste-like substance after reacting with gastric acid that
binds to gastric & duodenal ulcers, forming a protective barrier to pepsin, acid, bile –
allowing ulcers to heal
 Wait for 2 hrs after other drugs

ANTIDIARRHEALS

A. Description

1. Promote the formation of formed stools

2. Alleviate diarrhea
3. Available in oral and parental (IM) preparations

B. Examples

1. Fluids adsorbents: decrease the fluid content of stool: bismuth carbonate; kaolin and
pectin (Kaopectate)

2. Enteric bacteria replacements: enhance production of lactic acid from carbohydrates in

intestinal lumen; acidity suppresses pathogenic bacterial over growth: Lactobacillus
acidophilus (Bacid); Lactobacillus bulgaricus (Lactin-ex)

3. Motility suppressants: decrease GI tract motility so that more water will be absorbed
from the large intestine: diphenoxylate HCI (Lomotil); Loperamide HCI (Imodium)

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C. Major side effects

1. Fluid adsorbents: GI disturbance (local effect); CNS disturbance (direct CNS toxic effect)

2. Enteric bacteria replacements: excessive flatulence (increased microbial gas

production); abdominal cramps (increased microbial gas production)

3. Motility suppressants: urinary retention (decreased parasympathetic stimulation);

tachycardia (vagolytic effect on cardiac conduction); dry mouth (decreased salivation
from anticholinergic effect); sedation (CNS depression); paralytic ileus (decreased
peristalsis); respiratory depression (depression of medullary respiratory center)

D. Nursing care
1. Monitor bowel movement for color, characteristics, and frequency
2. Assess for fluid/electrolyte imbalance
3. Assess and eliminate cause of diarrhea
4. Motility suppressants
a. Warn client of interference with ability to perform hazardous activities and risk of
physical dependence with long-term use
b. Offer sugar free chewing gum and hard candy to promote salivation

CATHARTICS/LAXATIVES

A. Description

1. Alleviate or prevent constipation and promote evacuation of stool

2. Available in oral and rectal preparations

B. Examples
1. Intestinal lubricants: decrease dehydration of feces, lubricate intestinal tract: mineral
oil; olive oil

2. Fecal softeners: lower surface tension of feces, allowing water and fats to penetrate;
dicotyl calcium sulfosuccinated (Surfak); dicotyl sodium (Colace)

3. Bulk – forming laxatives: increase bulk in intestinal lumen, which stimulates propulsive
movements by pressure on mucosal lining: methylcellulose (Cellothyl); psyllium
hydrophilic mucilloid (Metamucil)

4. Colon irritant: stimulate peristalsis by reflexive response to irritation of intestinal lumen

bisacodyl (Dulcolax); senna (Senokot)

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 5. Saline cathartics: increase osmotic pressure within intestine, drawing fluid from blood
and bowel wall, thus increasing bulk and stimulating peristalsis: effervescent
sodiumphosphate (Fleet Phospho-Soda); magnesium citrated solution; Milk of Magnesia

C. Major side effects

1. Laxative dependence with long term use (loss of normal defecation mechanism)
2. GI disturbances (local effect)
3. Intestinal lubricants: inhibit absorption of fat soluble vitamins A, D, E, K; can cause anal
leaking of oil (accumulation of lubricant near rectal sphincter)
4. saline cathartics: dehydration (fluid volume depletion resulting from hypertonic state in
GI tract); hypernatremia (increased sodium absorption into circulation; shift of fluid from
vasculature to intestinal lumen)

D. Nursing care
1. Instruct the client regarding: overuse of cathartics and intestinal lubricants; increasing
intake of fluids and dietary fiber; increasing activity level; compliance with vowel-
retraining program.
2. Monitor bowel movements for consistency and frequency of stool
3. Intestinal lubricants: use peripad to protect clothing
4. Bulk-forming laxatives: mix thoroughly in 8 oz of fluid and follow with another 8 oz of
fluid to prevent obstruction
5. administer at bedtime to promote defection in the morning

PANCREATIC ENZYMES

A. Description

1. Replace natural endogenous pancreatic enzymes (protease, lipase, amylase); promote the
digestion of proteins, fats and carbohydrates
2. Available in oral preparations

B. Examples: pancreatin (donnazyme);

pancrelipase (Cotazym,
Pancrease, Viokase)

C. Major side effect: nausea and diarrhea (GI irritation)

D. Nursing care

1. Administer with meals

2. Avoid crushing preparations that are enteric coated
3. Provide a balanced diet to prevent indigestion

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 BILE ACID SEQUESTRANTS

A. Description
 Treat pruritus associated with biliary disease
 Act by absorbing & combining with intestinal bile salts – secreted in the feces
 Take with flavored products or juice to mask bad taste
 Abate GI effects through stool softeners

B. Examples
1. Cholestyramine (Questran, Prevalite)
2. Colestipol (Colestid)

C. Side effects
1. Constipation
2. Bloating
3. Flatulence
4. Nausea
5. Decreased vitamin absorption

HEPATIC ENCEPHALOPATHY

A. Lactulose (Duphalac)
 Reduces ammonia level
 Improves protein tolerance in clients with advanced hepatic cirrhosis
 Lowers colonic pH from 7 t0 5: acidification pulls ammonia into the bowel to be
excreted in the feces, thus lowering the ammonia level

B. Neomycin (Mycifradin)
Reduces the number of colonic bacteria that normally convert urea & amino
acids into ammonia

ANTISPASMODICS

A. Description
 Relax smooth muscle of the GI
B. Side effects
 Constipation
 Rash
 Euphoria
 dizziness
C. Examples
1. HNBB - Buscopan

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 ANTIHELMINTHICS
Medicines that rid the body of parasitic worms
The body has no natural means of getting rid of parasitic worms – antihelminthics do the job
Kill, starve, or paralyze
Can be transferred from person to person through contaminated food, drinking glasses, clothing
or linens – pinworms
May be present in undercooked meat or fish – tapeworm
TYPES:
A. INTESTINAL WORMS

I. NEMATODES/ROUNDWORMS

1. PINWORMS
Perianal/vaginal itching
Most common among school-age children
2. WHIPWORMS
o Attach to colon wall
o Cause colic & bloody diarrhea
o Intestinal prolapsed & anemia due to blood loss
3. THREADWORMS
 Burrow itself in the wall of SI lay eggs  invade tissues – lungs, liver, heart 
death
4. ASCARIS
 May reach the lungs  cough & fever
 May grow in the intestine to as big as earthworm
 Abdominal distention, pain, obstruction
5. HOOKWORMS
Suck blood from the walls of the intestines  anemia, malabsorption

II. FLATWORMS

1. CESTODES/TAPEWORMS
o Segmented with a head or scolex
o Grow yards long
o May come out the mouth or nose

2. FLUKES/SCHISTOSOMES

B. TISSUE-INVADING WORMS
1. TRICHINOSIS
 Caused by ingestion of Trichinella spiralis present in undercooked meat
 Larvae pass into the blood stream  skeletal muscle, cardiac muscle, brain  inflammatory
reaction
 Fatal pneumonia, heart failure, encephalitis
 Prevention is the best treatment

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2. FILARIASIS
 Infection of blood & tissues  skin bites  inflammatory reactions  swelling of hands,
feet, scrotum, arms, legs, breast
 Elephantiasis

3. SCHISTOSOMIASIS
 Infection by a fluke carried by a snail
 Larvae skinbloodstream & lymphatics  lungs & liver  mature & mate 
migrate to intestine & urinary bladder  urine & feces
 s/s : Swimmer’s itch, fever, chills, h/a, abdominal pain, diarrhea, spleen & liver
enlargement

AVAILABLE DRUGS:
1. PYRANTEL (Antiminth)
 Single oral dose
 Pinworms & roundworms
2. THIABENDAZOLE (Mintezol)
 Roundworm, hookworm, pinworm
 Not as effective as others & has more adverse effects
3. ALBENDAZOLE (Albenza)
Effective against active lesions caused by pork tapeworm & cystic disease of the
liver, lungs, & peritoneum caused by dog tapeworm
RF & BMD – adverse effects
4. IVERMECTIN (Stromectol)
 threadworm
5. PRAZIQUANTIL (Biltricide)
 Schistosomiasis & flukes
 3 doses with 4-6 hours interval

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 ANTIPROTOZOAL AGENTS
 Infections caused by insect bites (malaria, trypanosomiasis, leishmaniasis)
 Infections caused by ingestion or contact with the causal organism (amoebiasis, giardiasis,
trichomoniasis)

MALARIA
 Spread via the bite of Anopheles mosquito
 The plasmodium parasites:
1. P. Falciparum
- Most dangerous
- Fever, hypotension,swelling, of limbs, RBC loss, death

2. P. Vivax
- Milder & seldom results in death
3. P. Malariae
- Very mild s/s
- Acute disease in travellers to endemic areas
4. P. Ovale
- Rare; on the verge of eradication

Combination of drugs attack the plasmodium at various stages

a) QUININE – first to be discovered

- Reserved for chloroquine resistant infections
- May lead to severe diarrhea & CINCHONISM (n/v, tinnitus, vertigo)
b) CHLOROQUINE (Aralen)
- Mainstay of antimalarial therapy
- Hepatotoxic, eye damage, blindness
c) HYDROXYCHLOROQUINE (Plaquenil)
- Combined with PREMAQUINE for greater effectiveness
d) PRIMAQUINE
- Prevent relapse of vivax & malariae infections
e) MEFLOQUINE (Lariam)
- Prevention & treatment
f) PYRIMETHAMINE (Daraprim)
- Combined with other drugs

AMEBIASIS
 Caused by Entamoeba histolytica
 Aka amebic dysentery
 Transmitted while in the cystic stage in fecal matter  water, ground
 Ideal environment is large intestine – TROPHOZOITE
 Eat away tissues vascular area  liver, lungs, heart, etc.

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
LEISHMANIASIS
 Passed from sand flies to humans
 Can cause serious lesions in the skin, viscera, mucous membranes

TRYPANOSOMIASIS
 African sleeping sickness – tsetse fly – lethargy, prolonged sleep, death
 Chaga’s disease – cardiomyopathy

TRICHOMONIASIS
 Spread during sexual intercourse by asymptomatic men to women vaginitis – reddened,
inflamed, itching, burning, yellowish-green discharge

GIARDIASIS
 Most common intestinal parasite in the US
 Contaminated water or food
 Diarrhea, rotten egg-smelling stool, pale-mucoid stool

PNEUMOCYSTIS CARINII PNEUMONIA

 PC does not usually cause illness in humans
 Most common opportunistic infection in AIDS patient

DRUGS AVAILABLE:
1. ATOVAQUONE (mepron)
- Active against PCP
2. METRONIDAZOLE (flagyl)
- Amebiasis, trichomoniasis, giardiasis
3. PENTAMIDINE (Pentam 300)
- Inhalation agent for PCP
4. TINIDAZOLE (Tindamax)
- Amebiasis, trichomoniasis, giardiasis

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University