DRUGS THAT AFFECT THE UPPER

GASTROINTESTINAL SYSTEM
ATI Pharmacology

Drugs That Affect the Upper Gastrointestinal
System
Antacids drugs that neutralize HCl and protect
mucosal lining
Histamine H2 antagonists, proton pump inhibitors,
and miscellaneous acid reducing agents drugs that
reduce the production and release of HCl acid
GI stimulants drugs that facilitate stomach emptying
Antiemetics drugs that prevent nausea and vomiting
Antacids
Drugs that neutralize or reduce the acidity of the stomach and
duodenum by combining with hydrochloric acid and producing
salt and water
Effective when burning is relieved
Used to treat the hyperacidity caused by: heartburn, acid
indigestion, sour stomach, Gastroesophageal reflux disease
(GERD), and peptic ulcer
Antacids
May be used to treat non GI conditions
Aluminum carbonate is a phosphate binding agent
that may be used in treating hyperphosphatemia, a
condition that is associated with chronic renal
failure
Aluminum carbonate may also be given to prevent
the formation of phosphate based urinary stones
Calcium may be used to treat calcium deficiency
Magnesium may be used to treat magnesium
deficiency
Antacids
Magnesium and sodium containing antacids may
cause diarrhea
Milk of Magnesia (MOM)
Magnesium oxide (Mag-Ox)
Sodium Bicarbonate (baking soda)
Aluminum and calcium containing antacids may cause
constipation
Aluminum carbonate (Basaljel)
Aluminum hydroxide (Amphojel, Alternagel)
Calcium carbonate (Tums)
Antacids
Aluminum containing antacids may cause:
constipation, intestinal impaction, anorexia,
weakness, tremors, and bone pain
Magnesium containing antacids may cause: severe
diarrhea, dehydration, and hypermagnesemia
Calcium containing antacids may cause: rebound
hyperacidity, metabolic alkalosis, hypercalcemia,
vomiting, confusion, headache, renal calculi,
neurologic impairment
Antacids
Sodium bicarbonate may cause: systemic alkalosis and
rebound hyperacidity
Sodium containing antacids are contraindicated in clients with
cardiovascular problems and those on sodium restricted diets
Calcium containing antacids are contraindicated in clients with
renal calculi or hypercalcemia
Antacids
Aluminum containing antacids are used cautiously in
gastric outlet obstruction or those with upper GI
bleeding.

All antacids are contraindicated in clients with
severe abdominal pain of unknown cause, and
during lactation.
Antacids
Nursing interventions and client education
Tablets should be chewed thoroughly and taken with a full glass of water
Other drugs should be taken 2 hours before or 2 hours after antacids
Antacids may cause white streaks in the stool which is normal
Liquid antacids must be shaken thoroughly before administration and
followed by a small amount of water
Antacids may be taken hourly for the first 2 weeks when treating acute
peptic ulcer
Histamine H2 Antagonists
Inhibits the action of histamine at the H2 receptor
which reduces secretion of gastric acid and pepsin
Used to treat : heartburn, acid indigestion, sour
stomach, GERD, gastric or duodenal ulcer, gastric
hypersecretory conditions
May cause dizziness, somnolence (excessive
drowsiness), headache, confusion (especially the
elderly), hallucination, diarrhea, and reversible
impotence
Histamine H2 Antagonists
Used cautiously in clients with renal or hepatic impairment
Used cautiously in severely ill, elderly, or debilitated clients
Cimetidine (Tagamet) is used cautiously in clients with diabetes
Used cautiously during pregnancy and lactation

Histamine H2 Antagonists

Maybe given prophylactically to prevent
recurrence of ulcers
Many of these drugs come in IM and IV forms
Rapid IV infusion may cause arrhythmias
Examples:
Tagamet (Cimetidine) PO, IM, IV
Pepcid (Famotidine) PO, IV
Zantac (Rantidine) PO, IM, IV
Axid (Nizatidine) PO
Histamine H2 Antagonists
Nursing interventions and client education
Monitor the elderly for confusion and dizziness
Avoid hazardous tasks if drowsiness occurs
Give IM injections deep into muscle to minimize irritation and harm
Cigarette smoking may decrease the effects of Tagamet
Oral doses usually given BID or at HS for maintenance
Proton Pump Inhibitors
Suppress gastric acid secretion by inhibition of the hydrogen-
potassium adenosine triphosphate (ATPase) enzyme system of
the gastric parietal cells
The ATPase enzyme system is called the proton pump system
These drugs inhibit gastric secretion by blocking the final step
in the production of gastric acid by the gastric mucosa
Proton Pump Inhibitors
Used to treat: gastric and duodenal ulcers
(specifically associated with H. pylori infections),
GERD, erosive esophagitis, and pathological
hypersecretory conditions
These drugs are used in combination therapy for the
treatment of H. pylori; triple drug therapy uses 1
proton pump inhibitor with 2 anti-infective drugs
Another triple drug therapy consists of bismuth plus
2 anti-infective drugs
Proton Pump Inhibitors
Helidac therapy (bismuth, metronidazole, and
tetracycline) may be given with a histamine H2
antagonist to treat H. pylori
Common adverse reactions include: headache,
nausea, diarrhea, and abdominal pain
Used cautiously in older adults and in clients with
hepatic impairment
Prolonged therapy may bodys ability to absorb
B12 pernicious anemia
Proton Pump Inhibitors
Prevacid, Protonix, and Aciphex are contraindicated in
pregnancy
Think prazole
Nexium (Esomeprazole)
Prevacid (Lansoprazole)
Prilosec (Omeprazole)
Protonix (Pantoprazole)
Aciphex (Rabeprazole)
Proton Pump Inhibitors
Nursing interventions
and client education
Administer 1 hour
before meals and
swallow tablets whole
Nexium and Prevacid
capsules maybe
sprinkled on food

Anticholinergic Drugs
Reduce gastric motility and decrease the amount of
hydrochloric acid produced by the stomach
Occasionally used for the treatment of peptic ulcer
disease
May be used to dry up secretions in clients with
tracheostomies
Side effects include dry mouth, blurred vision,
urinary hesitancy, urinary retention, constipation,
nausea, vomiting, palpitations, and headache
Anticholinergics
May cause drowsiness, dizziness, and photophobia; confusion
in the elderly
Examples
Belladona for PUD
Bentyl (Dicyclomine) for IBS
Robinul (Glycopyrrolate) for PUD
Probanthine (Propantheline) for PUD

Belladonna
Anticholinergics
Nursing interventions and client education
Offer sips of water to decrease dry mouth
Monitor for urinary retention and hesitancy
Do not administer to clients with BPH
Keep room semi-dark if photophobia occurs,
sunglasses if outside
Supervise ambulation if dizziness occurs
Encourage fluids to prevent constipation
Pepsin Inhibitor
Sucralfate (Carafate) is a mucosal protective drug;
do not administer with other drugs
The drug binds with protein molecules to form a
viscous substance that buffers acid and protects the
mucosal lining
Used in the short term treatment of duodenal ulcers
Most common adverse reaction is constipation
Given on an empty stomach
Miscellaneous Drugs
Carafate (Sucralfate)
Forms a protective
layer (paste) over a
duodenal ulcer aiding
in healing
Take on an empty
stomach 1 hour before
meals
Therapy will continue
for 4 to 8 weeks
Prostaglandin Drug
Misoprostol (Cytotec) has been used to reduce the
risk of nonsteroidal anti-inflammatory drug (NSAID)
induced gastric ulcers in high risk clients such as
older adults or the critically ill
Inhibits production of gastric acid and has mucosal
protective properties
Can cause abortion or birth defects
Adverse reactions include: headache, nausea,
diarrhea, and abdominal pain
Prostaglandin Drug
Misoprostol (Cytotec) is
pregnancy category X
Instruct client to use
effective contraception if
taking this drug
Instruct client to notify
the physician if pregnant
Gastrointestinal Stimulants
Used to treat delayed gastric emptying and emesis by
increasing the motility of the upper GI tract without
increasing production of secretions
Used to treat: GERD, gastric stasis
Contraindicated in GI obstruction, gastric perforation
or hemorrhage and epilepsy
Examples
Ilopan (Dexpanthenol) given IM
Reglan (Metroclopramide) given IM or IV
Gastrointestinal Stimulants
Ilopan (Despanthenol) maybe given IV immediately
after major abdominal surgery to reduce risk of
paralytic ileus
Ilopan may cause itching, difficulty breathing, and
urticaria
Reglan (Metoclopramide) in high doses or when
given for prolonged administration may cause CNS
symptoms such as restlessness, drowsiness,
dizziness, EPS effects, facial grimacing, and
depression
Gastrointestinal Stimulants
Nursing interventions and client education
After administration of Ilopan auscultate bowel
sounds
Administer Reglan 30 minutes before meals
Monitor and report s/s of EPS tremors,
involuntary movements of the limbs, muscle
rigidity, difficulty speaking or swallowing, mask like
face, shuffling gait, facial twitching or grimacing
Antiemetics
Used to treat or prevent nausea
Individuals may experience nausea due to motion
sickness or a condition called vertigo
Many of the drugs used to treat motion sickness
may be purchased over the counter
Vomiting may be caused by drugs, radiation, and
metabolic disorders due to stimulation of the
chemoreceptor trigger zone (CTZ), a group of nerve
fibers in the brain
Antiemetics
These drugs appear to inhibit the CTZ and the brains
primary neurotransmitters dopamine and
acetylcholine
The 5-hydroxytryptamine type 3 (5-HT3) receptor
antagonists, target serotonin receptors at the CTZ and
at the nerve endings in the stomach
Antiemetics may be used before surgery to prevent
vomiting during surgery; after surgery when the client
is recovering from anesthesia; during chemotherapy
and radiation therapy
Antidopaminergic Antiemetics
Chlorpromazine (Thorazine) PO, PR, IM, IV, may
cause hypotension, dry mouth, drowsiness, nasal
congestion, twitching, tremors, restlessness.
Perphenazine PO, IM, IV, S/E as above
Prochlorperazine (Compazine) PO, PR, IM, IV, S/E as
above
Promethazine PO, PR, IM, IV, S/E as above
Thiethylperazine (Torecan) PO, S/E as above
Triflupromazine IM, IV, S/E as above
Anticholinergic Antiemetic
Trimethobenzamide (Tigan) PR, IM, IV,
May cause hypotension, parkinson-like symptoms,
blurred vision, drowsiness, dizziness
Safety is an issue
Instruct client to change position slowly
Instruct client not to drive or perform other tasks
requiring alertness and clear vision if blurred
vision, drowsiness, or dizziness occurs
5-HT3 Receptor Antagonist Antiemetics
Dolasetron (Anzemet) PO, IV, may cause headache,
fatigue, fever, abdominal pain
Palonesetron (Aloxi) IV, S/E as above
Granisetron (Kytril) PO, IV, transdermal, may cause
headache, asthenia, diarrhea, constipation
Ondasetron (Zofran) PO, IV, may cause headache,
fatigue, drowsiness, sedation, constipation, hypoxia
Antiemetics
Most common adverse reactions are varying degrees
of drowsiness
Take drug for motion sickness 1 hour before travel
Contraindicated with severe CNS depression
5-HT3 receptor antagonists should not be used in
clients with heart block or prolonged QT intervals
Not recommended during pregnancy
Dronabinol (Marinol) is the only medically available
cannabinoid (marijuana derivative)
Emetics
Drugs that induce vomiting by exerting a local
irritating effect on the stomach and stimulation of the
vomiting center of the medulla
Used to cause rapid vomiting in accidental or
intentional poison or drug overdose
Do not use in clients who are not fully conscious, or
have an altered mental status
Do not use if turpentine, corrosives, such as alkalis
(lye) or strong acids, or petroleum distillates, such as
kerosene, paint thinner, cleaning fluid, or furniture
polish has been ingested
Emetics
Examples
Apomorphine, Ipecac
Nursing interventions and client education
Identify the substance ingested, time of ingestion, and symptoms
exhibited
Monitor the client for s/s of drug overdose
Position client on side before or immediately after drug is given
Suction as needed, VS every 5-10 minutes
Digestive Enzymes
Used to supplement or replace pancreatic enzymes
Breakdown fats, starches, and proteins
Necessary for the breakdown and digestion of food
Replacement therapy for those with pancreatic
enzyme insufficiency such as cystic fibrosis,
pancreatitis, pancreatic cancer, malabsorption
syndrome, gastrectomy and pancreatectomy
Digestive Enzymes
No adverse reactions
High doses may cause abdominal cramps or pain,
nausea, and diarrhea
Contraindicated in clients allergic to hog or cow
proteins
Calcium and magnesium products interfere with
action of the medication
Contraindicated in acute pancreatitis
Used cautiously in asthma, hyperuricemia, and during
pregnancy and lactation
Can decrease the absorption or oral iron
Digestive Enzymes
Examples:
Creon (Pancreatin)
Cotazym (Pancrelipase)
Nursing interventions and client education
Do not bite or chew capsules or tablets
Capsules can be sprinkled on food
Administered with meals or a snack to buffer the stomach acid
Note each stool for undigested food
Cholelithiasis Medications
Chenodiol (Chenix)
Decreases cholesterol production lowering content of bile
dissolution of gallstones
May cause diarrhea and possible hepatotoxicity
Monitor baseline LFTs: AST and ALT
Instruct client to report abdominal pain, sudden RUQ pain, nausea, or
vomiting
Administer with food or milk
Avoid aluminum containing antacids
Cholelithiasis Medications
Ursodiol (Actigall)
Naturally occurring bile salt
Suppresses hepatic synthesis and secretion of cholesterol and inhibits
intestinal absorption of cholesterol
Requires months of therapy; US obtained within 6 months to determine
efficacy
Instruct client to report nausea, vomiting, diarrhea or rash
Administer with food or milk
Avoid aluminum containing antacids
Cholelithiasis Medications
Monoctanoin (Moctanin)
Used when stones made of calcium are resistant to dissolution by Chenix
Administered through a T-tube, nasal biliary catheter, or percutaneous
transhepatic catheter
Effective only when in contact with the stone
Major side effects include: diarrhea, nausea, and abdominal pain
DRUGS THAT AFFECT THE
LOWER GASTROINTESTINAL
SYSTEM
ATI Pharmacology

Aminosalicylates
Used to treat inflammatory bowel disease: Crohns
disease and ulcerative colitis
Aspirin like compounds with anti-inflammatory action
These drugs exert a topical inflammatory effect in the
bowel
Exact mechanism of action is unknown
May cause abdominal pain, nausea, diarrhea,
headache, dizziness, fever, and weakness
Aminosalicylates
Contraindicated in clients with hypersensitivity to
salicylates, sulfites, and sulfonamides
Contraindicated in intestinal obstruction and children
< 2 years
Used cautiously in pregnancy and lactation
Assess the abdomen prior to administration
Evaluate effectiveness of drug therapy by daily
comparison of symptoms
Take medication whole, dissolves in intestine
Aminosalicylates
Balsalazide (Colazal) PO TID for 8 weeks
Mesalamine (Asacol, Pentasa, Rowasa) PO and
suspension enema (Rowasa)
Olsalazine (Dipentum) 1g/day PO in 2 doses
Sulfasalazine (Azulfidine) 3-4g/day PO in divided
doses, then 2 g PO QID push fluids to prevent
crystalluria from sulfa; monitor BUN and serum
Creatinine for kidney damage
Miscellaneous Drugs for Bowel Disorders
Alosetron (Lotronex) second line treatment of
female IBS with severe diarrhea
May cause GI distress, hemorrhoids, constipation
Requires special permission for therapy
Remicade (Infliximab) for Crohns disease, ulcerative
colitis, and RA
May cause sore throat, cough, sinus infection, GI distress; given IV every
2-8 weeks
Antidiarrheals
Used to treat diarrhea
Difenoxin (Motofen) and diphenoxylate (Lomotil) are
chemically related to opioid drugs and decrease
intestinal peristalsis
Motofen and Lomotil may have sedative and
euphoric effects, but no analgesic effects
Motofen and Lomotil are combined with atropine
(anticholinergic) to cause dry mouth and other mild
adverse reactions to reduce potential for abuse
Antidiarrheals
Loperamide (Imodium) acts directly on the muscle
of the bowel to slow motility, and is not related to
the opioids
Loperamide is used in treating chronic diarrhea
associated with IBD
May cause anorexia, nausea, vomiting, constipation,
abdominal discomfort, abdominal pain, and
distention
May cause dizziness, drowsiness, headache,
sedation, euphoria, and rash
Drug is administered after each loose stool
Antidiarrheals
Contraindicated in diarrhea associated with
organisms that cause harm to the intestinal mucosa,
pseudomembranous colitis, abdominal pain of
unknown origin, and obstructive jaundice
Contraindicated in children < 2 years
Used cautiously in clients with severe hepatic
impairment or IBD
Instruct client that if diarrhea persists for > 2 days
when OTC antidiarrheal drugs are being used, to
discontinue use and see the primary health care
provider

Antidiarrheals
Bismuth subsalicylate (Pepto-Bismol)
May temporarily cause stools and tongue to turn
dark
May cause salicylate toxicity such as tinnitus,
rapid respirations
Difenoxin with atropine (Motofen)
May cause dry skin and mucous membranes,
nausea, constipation, lightheadedness
Antidiarrheals
Diphenoxylate with atropine (Lomotil)
May cause dry skin and mucous membranes,
nausea, constipation, urinary retention,
lightheadedness
Loperamide (Imodium)
May cause dry skin and mucous membranes,
nausea, constipation, lightheadedness
Tincture of opium (Paregoric)
May cause somnolence, constipation
Antidiarrheals
Instruct the client not to exceed the recommended
dosage
Instruct the client to use caution when driving or
performing other hazardous tasks because the
Motofen and Lomotil may cause drowsiness
Avoid the use of alcohol or other CNS depressants
and other nonprescription drugs unless use has
been approved
Notify the primary health care provider if diarrhea
persists or becomes more severe
Antiflatulents
Simethicone (Mylicon) and charcoal are used to
reduce flatus (gas) in the intestinal tract
These drugs do not absorb or remove gas; they act
to help the body release the gas by belching or
flatus
Used to relieve painful excess gas caused by
postoperative gaseous distention and air
swallowing, dyspepsia, peptic ulcer, IBS or
diverticulosis

Antiflatulents
Charcoal may be used in the prevention of nonspecific
pruritus associated with kidney dialysis treatment and
as an antidote in poisoning
Simethicone is in some antacid products: Mylanta
liquid and Di-Gel liquid
Simethicone tablets must be chewed thoroughly
No averse reactions
There may be a decreased effectiveness of other
drugs because of absorption by charcoal

Laxatives
There are various types of laxatives
Prescribed for the short term relief of constipation
Constipation may occur as an adverse reaction
May cause diarrhea, and a loss of water and
electrolytes, abdominal pain or discomfort, nausea,
vomiting, perianal irritation, fainting, bloating,
flatulence, cramps, and weakness
Prolonged use can dependence
Laxatives
Some of these products contain tartrazine (a yellow
food dye) which may cause allergic type reactions
Bulk forming laxatives (most natural) may cause
obstruction of the esophagus (monitor dysphagia),
stomach, small intestine, and colon if not
administered with adequate fluid or in clients with
intestinal stenosis
The very young, the elderly, and debilitated clients are
at greatest risk for aspiration of mineral oil when
taken for constipation
Laxatives
Contraindicated in persistent abdominal pain,
nausea or vomiting of unknown cause, signs of
appendicitis, fecal impaction, intestinal obstruction
and acute hepatitis
Contraindicated in pregnancy and lactation: may
cause labor; can cross the placental barrier
Magnesium is used cautiously in clients with renal
impairment
Laxatives are used cautiously in clients with rectal
bleeding

Laxatives
Stimulant, emollient, and saline laxatives evacuate
the colon for rectal and bowel examinations
Stool softeners or mineral oil used for prevention
of strain during defection
Psyllium and polycarbophil used for IBS and
diverticular disease
Hyperosmotic (lactulose) agents used to reduce
blood ammonia levels in hepatic encephalopathy
Bulk Producing Laxatives
Methylcellulose (Citrucel, Unifiber) for
constipation, IBS, and severe watery diarrhea; take
with 8 ounce glass of water followed by another 8
ounce glass of water
Psyllium (Metamucil, Fiberall) for constipation, IBS,
and severe watery diarrhea; take with 8 ounce glass
of water followed by another 8 ounce glass of water
Polycarbophil (FiberCon) for constipation, IBS, and
severe watery diarrhea; take with 8 ounce glass of
water followed by another 8 ounce glass of water
Laxatives
Emollients
Mineral oil used to
relieve constipation
and fecal impaction
May impair absorption
of vitamins A, D, E, K
Take at HS on empty
stomach
Stool Softeners
(Surfactants)
Docusate (Colace,
Surfak) used to
relieve constipation,
and prevent straining

Hyperosmotic Agents
Glycerin (Colace suppositories) used to relieve constipation,
and prevent straining; store suppositories in the refrigerator
Lactulose (Cephulac, Chronulac) used to relieve constipation,
and in the treatment of hepatic encephalopathy
Lubiprostone (Amitiza) used to relieve constipation and
prevent straining
Irritant or Stimulant Laxatives
Cascara sagrada (Aromatic Cascara) used for relief of
constipation; may cause brownish color to the urine
Sennosides (Ex-Lax, Senokot) used for relief of constipation;
may cause brownish color to the urine, yellow-green color to
the stool
Bisacodyl (Dulcolax, Modane, Correctol) used for relief of
constipation
Laxatives
Saline Laxatives
Magnesium
preparations (Milk of
Magesia) to evacuate
colon for endoscopy,
relieve constipation
May cause diarrhea,
nausea, vomiting,
bloating, cramping
Bowel Evacuants
Polyethylene glycol
(Miralax) relieves
constipation
Polyethylene
glycolelectrolyte
solution (GoLYTELY)
for colon evacuation
before surgery or
procedures
Laxatives
Long term use dependence; electrolyte imbalance
Do not use these products in the presence of
abdominal pain, nausea, or vomiting
Notify the primary health care provider if constipation
is not relieved or if rectal bleeding or other symptoms
occur
Drink plenty of fluids, get exercise, and eat foods high
in bulk or roughage
Cascara sagrada or senna pink-red, red-violet, red-
brown, yellow-brown, or black discoloration of urine