Acid+Controlling+&+Bowel+Disorder+Drugs

=Acid Controlling Drugs =

(Acid Related Pathophysiology)

 * -Th e stomach secretes several substances with various physiologic function- **
 * ** Hydrochloric acid, and acid that aids digestions and also serves as a barrier to infection **
 * ** Bicarbonate, a base that is a natural mechanism to prevent hyper-acidity **
 * ** Pepsinogen, an enzymatic precursor to pepsin (an enzyme that digests dietary proteins) **
 * ** Intrinsic factor, a glycoprotein that facilitates gastric absorption of vitamin B12 **
 * ** Mucous, which protects the stomach lining from both hydrochloric acid and digestive enzymes **
 * ** Prostaglandins, which have a variety of anti inflammatory and protective functions **
 * Hint-Remember Cox 1

Glands of The Stomach: Named by Location!

 * **Cardiac** || **Pyloric** || **Gastric Glands** ||
 * ** *Around cardiac Sphincter ** || ** * Pyloric Region ** || ** * Fundus ** ||
 * *The cells of the gastric **** gland are the largest **
 * in number of primary **** importance when discussing **
 * acid control **

Cells of the Gastric Gland
I. ** Parietal cells ** = = =Keeping the Cells Balanced!=
 * ** *Produce and secrete hydrochloric acid (HCL) **
 * ** *Primary site of action for many acid-controller drugs **
 * II. Cheif cells **
 * ** *Secrete pepsinogen which is a proenzyme that becomes pepsin **
 * (pepsin is activated by exposure to acid)[[image:http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/digestive_disorders/digestive_diseases_heartburn_gastroesophageal_reflux_disease_GERD.jpg width="285" height="284" align="right" caption="What causes heartburn"]] **
 * III. Mucoid cells **
 * (also called surface epithelial) **
 * ** * Mucous secreting cells **
 * ** * Protect against self-digestion by HCL **
 * ** * Provides protective mucous coat **


 * -When the balance of the cells and their secretions is impaired, acid-related diseases**
 * can occur. The effcts of cell imbalance leads to:**
 * 1. Hypersecretion **
 * ** *Most common condition is mild to moderate hypersecretion (indigestion, **
 * sour stomach, heartburn, acid stomach) **
 * ** *GERD (Gastroesophageal Reflux Disease) which is excessive **
 * stomach acid backup into the lower esophagus which can lead to Barrett's Esophagus **
 * 2. Peptic Ulcer Disease (PUD) **
 * 3. Esophageal Cancer **
 * - Hydrochloric Acid **
 * ** Is an acid that is secreted by the parietal cells in the lining of the stomach **
 * ** It is the primary substance secreted in the stomach that maintains the environment of the stomach that maintains the environment of the stomach at a pH of 1-4 **
 * ** Body's defense against microbial infection via the GI tract **
 * ** Aids in the proper digestion of food **
 * ** Hydrochloric acid secretions stimulated by: **


 * **Excessve Alcohol**

|| **Emotional stress** || **Large Fatty Meals** || **Caffeine** || **Chocolate**

||

**Antacids are basic compound used to neutralize stomach acid. (Most commonly they are nonprescription salts of aluminum, magnesium, calcium and sodium.**

 * **Mechanism of Action** || **Drug Effects** || **Formulations** || **Indications** ||
 * -** Secretion of mucous, bicarbonate and prostaglandins **
 * -They DO NOT prevent **
 * overproduction of acid. Instead **
 * they neutralize acid once its in the stomach **
 * -Increases the resistance of the stomach lining **
 * -Increases the tone of the cardiac sphincter > **
 * which reduces reflux of the stomach ** || ** -Reducing acidity reduces pain **
 * -can be used alone or in combination **
 * with aluminum salts, calcium salts, **
 * magnesium salts, and sodium bicarbonate **
 * -It raises 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 gastric acid **

** ﻿Contraindications **
**-Effervescent granules** || ** -Relief of pain associated with **
 * -Severe renal failure ** || **- Capsules **
 * -Tablets **
 * -Powders **
 * -Chewable tablets **
 * -Suspensions **
 * PUD, gastritis, heartburn **

** Secretions **
Used for discomfort associated with hyperacidity S/E-Diarrhea. DO NOT USE WITH RENAL FAILURE of HF *Failing kidney cannot excrete extra magnesium resulting in accumulation Indication- Buffers the acidic properties of HCL and it is used for dicomfort associated with hyperacidity The most rapidly acting antacid (Quick onset, but short duration) S/E- Metabolic alkalosis, irritability, muscle twitching, numbness and tingling, cyanosis, and slow/shallow respirations
 * -Mucus creates a protective barrier **
 * -Bicarbonate helps buffer acidic **
 * properties of HCL **
 * -Prostaglandins prevent activation **
 * of proton pump ** ||
 * Aluminum Salts**
 * **Aluminum Carbonate: Basaljel**
 * **Hydroxide salt: AlternaGEL**
 * Used for discomfort associated with hyperacidity **
 * Dissovles slowly in the stomach **
 * S/E- Constipation and acid rebound **
 * Caffeine, alcohol, harsh spices and black pepper may aggrevate condition **
 * Important: with impaired renal function, aluminum is retained **
 * Magnesium Salts**
 * **Hydroxide salt: Magnesium hydroxide (Milk of Magnesia)**
 * **Combination products: Maalox, Mylanta (aluminum and magnesium)**
 * Calcium Salts**
 * **Tums-Calcium**
 * Used for discomfort associated with hyperacidity **
 * S/E- Constipation, gas/belching, kidney stones, rebound hyperacidity **
 * Sodium Bicarbonate**
 * ** Alka-Seltzer **
 * ** Baking Soda **

Antiflatulents: Used to relieve painful symptoms associated with gas

 * ===** Simethcone **===
 * Used for excessive gas production **
 * Used often, but there are limited data to support effectiveness **
 * *Often added to antacid combination products **
 * Nursing Implications **
 * 1) ** Give medications 1-2 hours after giving an antacid **
 * 2) ** Give with at least 8 ounces of water **
 * 3) ** Monitor side effects: Nausea, vomiting, abdominal pain, diarrhea **
 * 4) ** Caffiene, alcohol, harsh spices and black pepper may aggravate the underlying GI condition **
 * Pathophysiology Part 2 **
 * Proton Pump **
 * ** Moves Potassium ions into the cell and hydrogen ions out of the proton pump **
 * ** Responsible for release of Intrinsic factor B12 **
 * Why is Hydrochloric acid so important? **
 * 1) ** We need B12 for RBC production, Maintenence of CNS and PNS and cognitive functions **
 * 2) ** We need acid to digest food **
 * 3) ** We need it to zap food-borne pathogens **
 * 4) ** we need it to help absorb calcium **
 * H2 Antagonists (Most popular drug) **
 * What they do? Reduce acid secretion **
 * Drugs: Cimetidine, Famotidine, Ranitidine **
 * Are they available? Yes, they are available in lower doses for OTC brands **
 * **Mechanism of action** || **Indications** || **Side Effects** || **Drug Interactions** || **Nursing Implications** ||
 * -** Block histamine 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 ** || ** Headache, lethargy, confusion, diarrhea, urticaria, sweating, flushing **


 * Cimetidine: Impotence and Gynecomastia ** || ** Smoking decreases effectiveness ** || ** -Take an hour before or after antacids **
 * -Decreases absorption of drugs that require an acidic GI environment **
 * -Use with caution in patients who are confused, disoriented or elderly ** ||

** Proton Pump Inhibitors **
= References = = = Lilley, Collins, R., Harringtoon, & Snyder. (2011). //Pharmacology and the Nursing Process.// St. Louis: Elsevier. Maton, P. N., & Burton, M. (1999). Antacids Revisited. //Adis INternational Limited//, 855-867.
 * Drugs: **
 * Prevacid, Prilosec, Aciphex, Protonix, Nexium **
 * Indications: **
 * GERD, Erosive esophagitis, short term treatment of active duodenal and benign gastric ulcers, NSAID induced ulcers **
 * Side Effects: **
 * Safe for short term therapy, good prevention for stress ulcers **
 * Nurse Implications: **
 * May increase serum levels, take before meals, may be given with antacids, Treatment is SHORT TERM **

__﻿ACID-CONTROLLING DRUGS﻿﻿ __  -Duodenal & gastric ulcers, GERD, upper ﻿ GI hemorrhage. -Works by inhibiting histamine action at the histamine H(2) receptors of the parietal cells, thus lowering basal gastric acid secretion. ||< Gynecomastia, headache, agranulocytosis, leukopenia, seizure, psychotic disorder. ||< Oral. Monitor CBC. Drug interactions: Metformin & Roflumilast. Large potential to cause drug interactions; has been largely replaced by ranitidine and famotidine. || -Duodenal & gastric ulcers, gastric hypersecretion, H. Pyloria GI tract infection, indigestion. ||< Abdominal pain, constipation, diarrhea, headache, bradycardia, thrombocytopenia, hepatitis, abnormal liver function tests. ||< IV or oral. Monitor CBC. Drug interactions: Didanosine. Most widely-used H2 antagonist. || -Duodenal ulcer disease, GERD, gastric hypersecretion, indigestion, gastiric ulcer. -Primarily inhibits both the concentration and volume of gastric secretion. ||< Constipation, diarrhea, dizziness, headache. ||< IV, oral tablet, oral powder. Monitor CBC. Drug interactions: Atazanavir, Dasatinib. || -Reduces the incidence of gastric ulcers in patients taking NSAIDs. <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">-Inhibit gastric acid secretion and protect the gastric mucosa. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Headache, GI distress, and vaginal bleeding. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Misoprostol must be used in dosages that usually produce adverse effects such as abdominal cramps and diarrhea. Usual dose is 200 mcg QID with meals. || <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">-Used to reduce discomforts of gastric or intestinal gas and aid in its release via the mouth or rectum. <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">-It works by altering the elasticity of mucus-cated gas bubbles, which causes them to break into smaller ones. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">No listed adverse effects. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">No listed drug interactions or pharmacokinetic parameters. Available only for oral use; usually 1-2 tablets 4-6 times daily PRN. ||
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">**Drug Name** ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">**Indication / Mechanism of Action** ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">**Side Effects / Adverse Effects** ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">**Nursing Implications** ||
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Cimetidine (Tagamet) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">H2 Antagonist.
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Ranitidine (Zantac) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">H2 Antagonist.
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Famotidine (Pepcid) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">H2 Antagonist.
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Omeprazol (Prilosec) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Proton Pump Inhibitor. GERD, Zollinger-Ellison syndrome, various types of ulcers, heartburn. Blocks the hydrogen/potassium ATP enzyme system, AKA proton pump; directly responsible for secreting H+ ions into the gastric lumen; decreases the amount of acid in the stomach. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Stomach pain, N/V/D, constipation, flatulence, headache, fever, rash, hives, itching, swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs, difficulty breathing or swallowing, and hoarseness. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Orally administered PPIs work best when taken 30-60 minutes before meals. ||
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Lansoprazole (Prevacid) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Proton Pump Inhibitor. Ulcers, GERD, Zollinger-Ellison syndrome, heartburn. Blocks the hydrogen/potassium ATP enzyme system, AKA proton pump; directly responsible for secreting H+ ions into the gastric lumen; decreases the amount of acid in the stomach. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Stomach pain, N/D, constipation, flatulence, headache, dizziness, rash, hives, blistering or peeling skin, swelling of the eyes, face, lips, mouth, tongue, or throat, difficulty breathing or swallowing, and hoarseness. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Available in a delayed-release capsule, granules for oral suspension, and orally disintegrating tablets. ||
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Pantoprazole (Protonix) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Proton Pump Inhibitor. GERD, Zollinger-Ellison syndrome. Blocks the hydrogen/potassium ATP enzyme system, AKA proton pump; directly responsible for secreting H+ ions into the gastric lumen; decreases the amount of acid in the stomach. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Headache, dizziness, diarrhea, stomach pain, N/V, gas, joint pain, blistering or peeling skin, rash, hives, itching, swelling of the eyes, face, lips, mouth, throat, or tongue, difficulty breathing or swallowing, hoarseness. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">For NG tube administration, the tube must be at least a size 16 due to large granules. ||
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Sucralfate (Carafate) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">-Used as a mucosal protectant in the treatment of active stress ulcerations and long-term therapy for peptic ulcer disease. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Uncommon, but include nausea, constipation, and dry mouth. ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Acts locally, not systemically. Drug interactions can be avoided by taking other medications 2 hours before sucralfate. Give 1 hour before meals and at bedtime. ||
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Misoprostol (Cytotec) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Prostaglandin E Analogue.
 * < <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Simethicone (Mylicon) ||< <span style="color: #ff00bf; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Antiflatulent Drug.

<span style="display: block; font-family: 'Times New Roman',Times,serif; font-size: 150%; text-align: center;">__Bowel Disorder Drugs__

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- Sudden onset in a previously healthy individual
===<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 10pt 0.75in; text-indent: -0.25in;">- Causes: drugs, bacteria, viruses, nutritional factors, and protozoa ===

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 10pt;">Chronic Diarrhea:
===<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- Lasts for longer than 3 to 4 weeks and is associated with recurrent passage of diarrheal stools, possible fever, loss of appetite, nausea, vomiting, weight reduction and chronic weakness === ===<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 10pt 0.75in; text-indent: -0.25in;">- Causes: tumors, AIDS, diabetes mellitus, hyperthyroidism, Addison’s disease, and irritable bowel syndrome ===

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- divided into groups based on mechanism of action:
===<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 0pt 1in; text-indent: -0.25in;">o adsorbents: coat the walls of the GI tract and bind to problem causing agent to remove it === ===<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 0pt 1in; text-indent: -0.25in;">o anticholingeric drugs: slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract === ===<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; line-height: 150%; margin: 0in 0in 0pt 1in; text-indent: -0.25in;">o intestinal flora modifiers: suppress the growth of diarrhea-causing bacteria ===

<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- obtain a thorough health and history report
===<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- listen to bowel sounds in all four quadrants before and after medication administration === ===<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 10pt 0.75in; text-indent: -0.25in;">- complaints of abdominal pain, bloody stools, confirmation of hypoactive to no bowel sounds, and/ or fever should be reported to prescriber ===

<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- constipation related to improper diet and fluid intake
===<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- diarrhea related to GI irritation from food, bacteria or viruses, or pathology === ===<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- Fluid volume deficit related to excessive diarrhea and loss of fluids and electrolytes caused by frequent, loose stools ===

<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 0pt 0.75in; text-indent: -0.25in;">- Risk for injury related to the adverse effects of medication
===<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 10pt 0.75in; text-indent: -0.25in;">- Noncompliance related to lack of knowledge about and/or experience with the medication regimen ===

=
<span style="color: #12bc20; font-family: Times New Roman; line-height: 150%; margin: 0in 0in 10pt 0.75in; text-indent: -0.25in;">Lilley, L., Collins, S., Harrington, S., & Snyder, J. (2011). //Pharmacology and the [|nursing process]//. St Louis, MO: Mosby Elsevier =====

<span style="color: #ff00bf; font: 150% 'Times New Roman',Times,serif; margin: 0px; min-height: 14px;">__Bowel Disorder Drugs__ <span style="color: #ff00bf; display: block; font: 110% 'Times New Roman'; letter-spacing: 0px; margin: 0px; text-align: center;">**& Drug Class** || <span style="color: #ff00bf; display: block; font: 110% 'Times New Roman'; letter-spacing: 0px; margin: 0px; text-align: center;">**Indication & Mechanism of Action** || <span style="color: #ff00bf; display: block; font: 110% 'Times New Roman'; letter-spacing: 0px; margin: 0px; text-align: center;">**Side Effects &** <span style="color: #ff00bf; display: block; font: 110% 'Times New Roman'; letter-spacing: 0px; margin: 0px; text-align: center;">**Adverse Effects** || <span style="color: #ff00bf; display: block; font: 110% 'Times New Roman'; letter-spacing: 0px; margin: 0px; text-align: center;">**Nursing Implications** || //Adsorbent// || -Diarrhea, Heartburn, H. Pylori GI infection, Indigestion, Nausea, Upset Stomach. -Exact mechanism has not been determined. May exert its antidiarrheal action by stimulating absorption of fluid and electrolytes across the intestinal wall and inhibiting synthesis of a prostaglandin responsible for intestinal inflammation and hypermotility. || Constipation, Diarrhea, Nausea, Stool color abnormal, Grayish-black, Tongue discoloration, Grayish-black, Vomiting, Neurotoxicity (rare) || -Contraindicated: Children or teens with or recovering from influenza or varicella; hypersensitivity to the bismuth subsalicylate or salicylates. || //Anticholinergic// || -Irritable bowel syndrome and ulcers in the intestine. -Reduced muscle spasms in the digestive or urinary tract and reduced secretions from certain glands or organs. || Diarrhea, Painful or difficult urination, Fast or pounding heartbeats, Blurred vision with eye pain or seeing halos around lights, Feeling faint, Mouth sores, Red or bleeding gums, Tooth decay, Drowsiness, Dry Mouth, Decreased taste sensation, Decreased sweating or urination, HA, Dizziness, Weakness, Insomnia, N/V, Constipation, Bloating, Restlessness, Impotence, Loss of interest in sex, trouble having an orgasm. || -Take with a full glass of water. -This medication can case unusual results with certain medical tests. -Drug of abuse. -Contraindicated: blockage in intestines or digestive tract, paralytic ileus, active bleeding, severe ulcerative colitis or toxic megacolon, myasthenia gravis, hiatal hernia or reflux disease, and porphyria. || //Opiate// || -Diarrhea, Adjunct. -Probably acts both locally and centrally to reduce intestinal motility. || Abd discomfort, N/V, Dizziness, Sedation, Somnolence, Euphoria, Malaise, Pancreatitis, Toxic megacolon, Anaphylaxis || -Atropine has anticholinergic activity; however, in this preparation atropine is included in doses below the therapeutic level in an attempt to prevent abuse by deliberate overdosages. -Contraindicated: Diarrhea associated with eterotoxin-producing bacteria or psudomembranous enterocolitis, may prolong and/or worsen diarrhea; hypersensitivity to diphenoxylate or atropine products; obstructive jaundice, may precipitate hepatic coma. || //Opiate// || -Diarrhea, acute or chronic, High output ileostomy, Traveler's diarrhea, Proctocolectomy || Hyperglycemia, Abd pain, N/V, Xerostomia, Dizziness, Somnolence, Fatigue, Necrotizing enterocolitis in fetus OR newborn (rare). || -Available OTC. -Periodic F&E status determinations in long term therapy. CNS toxicity in pts with hepatic impairment. -Contraindicated: Abd pain in the absence of diarrhea, bacterial enterocolitis, dystenery (acute), hypersensitivity to loperamide or to any of the excipients, infants <24 months, pseudomembranous colitis, ulcerative colitis. || //Intestinal Flora Modifier// || -Yeast infections, UTIs. -Helps maintain an acidic environment in the body, which can prevent the growth of harmful bacteria. || Allergic reaction: hives, difficulty breathing, swelling of face, lips, tongue, throat. Less serious S/E may be more likely, but there may be none at all. || -Has not been approved by the FDA to treat any disease and should not be substituted for prescription medications. -Talk to MD if any other medical conditions, allergies, other medications or herbal supplements. -Talk to MD first if you are/may become pregnant or breastfeeding. || //Bulk-Forming Laxative// || -Constipation -Absorbs liquid in the intestines and makes a bulky, softer stool which is easier to pass. || Uncommon but serious: allergic reaction (dyspnea, closing of throat), chest pain, dysphagia, rectal bleeding, severe abdominal pain, N/V. || -Take with at least 8oz of liquid. Mix methylcellulose powder with at least 8oz of noncarbonated beverage, mix briskly and drink promptly || //Bulk-Forming Laxative// || -Constipation -It absorbs liquid in the intestines, swells, and forms a bulky stool, which is easy to pass. || Difficulty breathing, Stomach pain, Difficulty swallowing, Skin rash, Itching, N/V || -Powder, granules, capsule, liquid, and wafer. Usually taken TID. -Powder and granules must be mixed with 8 oz of liquid. Do not take for longer than 1 week unless approved by MD. || //Emollient Laxative// || -Constipation -Stool softener laxative used for temporary relief of constipation by actively drawing water into the stool, thus softening the stool and achieving ease in bowel movement. || Abnormal taste in mouth, Bitter, Diarrhea, Nausea, Cramp, Hepatotoxicity (rare) || -BM in 12-72 hours. Reassess if rectal bleeding or no BM after laxative. -Contraindicated: Hypersensitivity to docusate products, concomitant use of mineral oil, intestinal obstruction, acute abd pain, N/V || //Emollient Laxative// || -Constipation, stool softener, hemorrhoids or anal fissures. || -May allow absorption of mineral oil and some medications from the intestine, which collects in the tissues of the body (lymph nodes and liver). || -Slow onset of action (24-48 hours). Do not use longterm. -Do not use with Docusate. -May also increase absorption of other medications. -Risk of hepatotoxicity. -May take a week or more to be effective. || //Hyperosmotic Laxative// || -Relieving occasional constipation. -Irritates the lining of the intestine and increases the amount of fluid, making it easier for stools to pass. || -Anal irritation; burning sensation; diarrhea; gas; nausea; stomach cramps. -Severe allergic reactions (rash; hives; difficulty breathing; tightness in chest; swelling of mouth, face, lips, or tongue); rectal bleeding. || Do not use if: allergic to any ingredients in Fleet Babylax Enema, blockage in digestive system, or undiagnosed abdominal pain. || //Hyperosmotic Laxative// || -Constipation -Synthetic sugar. It is broken down in the colon into products that pull water out from the body and into the colon, which softens stools. || -Diarrhea, Gas, Nausea, Stomach pain or cramps, Vomiting. || -Keep in original container, tightly closed, at room temperature away from excess heat and moisture. -Tell MD: prescription and nonprescription meds, diabetes, pregnant, plan to become pregnant, breastfeeding, surgery or tests on colon or rectum. || //Hyperosmotic Laxative// || -Used to clean the bowel before colonoscopy, a barium x-ray, or other intestinal procedures. -Increases the amount of water in the intestinal tract to stimulate bowel movements. || -Allergic reaction: hives, difficulty breathing, swelling of face, lips, tongue, or throat. -Other serious S/E: severe stomach pain or bloating, no BM within 2 hours after use, gagging, choking, or vomiting. -Less serious S/E: mild stomach cramps, gas, or bloating, rectal pain or irritation, nausea, or passing gas. || -This medication contains potassium, sodium, and other minerals to replace electrolytes that are passed from the body in the stool. -Do not use if you have: a perforated bowel, a bowel obstruction or severe constipation, colitis or toxic megacolon, an eating disorder. -Tell MD if you have: N/V, trouble swallowing, or a history of: bowel obstruction, diverticulitis, ulcerative colitis, or other chronic bowel disease. || //Saline Laxative// || -Short-term basis to treat constipation. || -Stomach cramps, Upset stomach, Vomiting, Diarrhea. || -Comes as a tablet & a liquid. -Before taking, tell MD: if allergic, any prescription or nonprescription meds, if hx of kidney disease, if pregnant, plan to become pregnant, or breastfeeding. || //Stimulant Laxative// || -Short-term basis to treat constipation. Empty bowels before surgery and examinations such as X-rays using barium enemas. || -Stomach cramps, Upset stomach, Diarrhea, Stomach and intestinal irritation, Faintness, Irritation or burning in the rectum (from suppositories). || -PO or suppository. To empty the bowels, PO at night and rectally the morning of the surgery. -Tablets normally cause a BM in 6-8 hours, suppositories in 15-60 minutes, and eema in 3-5 minutes. || //Stimulant Laxative// || -Used to treat constipation or before rectal or bowel examinations or surgery. -Work by increasing the movement in the bowel. || -Yellow-brown discoloration of urine, Diarrhea, N/V, Irritation, Stomach cramping, Bloody stools, Severe cramping, Pain, Weakness, Dizziness, Unusual tiredness, Rectal bleeding. || -Liquids, powders, granules, tablets, and suppositories. -Take on empty stomach with 8oz of water. Food slows the effect. || <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">__//**QUIZ**//__ <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">1. The nurse will teach patients that antacids are effective in treatment of hyperaciditiy because they: <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">A) Neutralize gastric acid. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">B) Decrease stomach motility. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">C) Decrease gastric pH. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">D) Decrease duodenal pH.
 * <span style="color: #ff00bf; display: block; font: 110% 'Times New Roman'; letter-spacing: 0px; margin: 0px; text-align: center;">**Drug Name**
 * Bismuth Subsalicylate (Pepto-Bismol)
 * Donnatal (Belladonna Alkaloid)
 * Diphenoxylate with atropine (Lomotil, Lonox)
 * Loperamide (Imodium A-D)
 * Lactobacillus acidophilus (Bacid)
 * Methylcellulose (Citrucel)
 * Psyllium (Metamucil)
 * Docusate Salts (Calcium and Sodium)
 * Mineral Oil (Kondremul Plain)
 * Glycerin (Fleet Babylax)
 * Lactulose (Chronulac)
 * Polyethylene Glycol 3350 (GoLYTELY)
 * Magnesium Salts (Milk of Magnesia)
 * Bisacodyl (Dulcolax)
 * Senna (Senokot)

<span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">2. Which drug category blocks the hydrogen/potassium ATP enzyme system? <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">A) H2 Antagonists. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">B) Proton Pump Inhibitors <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">C) Antiflatulent Drugs. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">D) Opiate

<span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">3. Which statemtn demonstrates understanding of patient teaching regarding the use of histamine 2-receptor antagonists? <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">A) "Since I am taking this medication, it is okay for me to eat spicy foods." <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">B) "Smoking decreases the effects of this medication, so I should look into cessation programs." <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">C) "I should take this medication 1 hour after each meal in order to maximally decrease gastric acidity." <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">D) "I should decrease bulk and fluids in my diet to prevent diarrhea."

<span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">4.Which drug would be most effective in treating yeast infections or urinary tract infections (UTIs)? <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">A)Pepto-Bismol <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">B) Mineral Oil <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">C) Bacid <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">D) Senokot

<span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">5. Bismuth subsalicylate (Pepto-Bismol), as an adsorbent, has which mechanism of action? <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">A)Decreased GI motility <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">B) Decreased gastric secretions <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">C) Increased fluid absorption <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">D) Binding to diarrhea-causing bacteria for excretion

<span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">6. Milk of Magnesia alleviates constipation by which action? <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">A) Increasing water absorption into the colon. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">B) Lubricating the passage of stool. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">C) Increasing bulk within t he colon. <span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">D) Stimulating nerves that regulate defecation.

<span style="color: #000080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 110%;">7. **T/F**: To avoid fecal impaction, Metamucil should be administered with at least 8 oz of fluid.

<span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">Answers <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">1. A <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">2. B <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">3. B <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">4. C <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">5. D <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">6. A <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 90%;">7. T