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The upper GI tract consists of what?
mouth, oropharynx, esophagus, stomach, and duodenum
Where does digestion begin?
In the mouth
Peristalsis
a rhythmic movement of contractions and expansions of the smooth muscle that propels food toward the stomach
What regulates gastric secretions?
Parasympathetic Nervous System
What controls vomiting?
The vomit center (VC) in the medulla of the brain
Symptoms of:
gastroesophageal reflux disease
1. heartburn
2. regurgitation
3. dysphagia
4. waterbrash
What causes gastroesophageal reflux?
Helicobacter pylori infection
(H. pylori) is a gram - bacterium that weakens the protective mucous lining of the stomach and duodenum.
How to test/treat gastroesophageal reflux
Tests: breath test or serum

Treatment: Two antibiotics are prescribed.
- Clarithromycin
- Amoxicillin
- Tetracycline
- Metronidazole
+ Bismuth Compounds*
Peptic Ulcer
a general term that refers to ulcer formation in the esophagus, stomach, or duodenum
Pancreatitis
Occurs when the digestive enzymes production is reduced or no longer occurs.
Obesity
is where the BMI exceeds the normal range.
Nausea and Vomiting (n/v)
caused by the stimulation of the chemoreceptors in the brain and GI tract
Proton Pump Inhibitors
These drugs block the final step of gastric acid production for GERD

Prototype: omeprazole (Prilosec)
Omeprazole (Prilosec)

Treatment of heartburn/GERD.
-> Blocks the last phase of gastric acid production by suppressing the H+/K+/ATPase enzyme system.

Adverse effects:
-headache
-diarrhea

*Dont use other drugs that are also metabolized through the cytochrome P-450 pathway.

Assess lifestyle habits like diet and smoking
(longer duration of action in asians)

Take med daily. Do not crush or chew tablet. Take 1 Hour before meals. Contact physician immediately if they experience persistent diarrhea.*

*Suggest Calcium citrate for elderly patients on long term therapy.

Omeprazole therapy is effective when the symptoms of GERD, or hypersecretory conditions are controlled or the duodenal ulcer is healed.
What is the most common adverse effects of omeprazole?
A. Headache
B. Dizziness
C. Diarrhea
D. A&C
E. All of the above
D. A&C

The most common adverse effects of omeprazole is headache and diarrhea.
Other Proton Pump Inhibitors:
- esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Pantoprazole (Protonix)
Least expensive
- Rabeprazole (Aciphex)
Histamine 2 Receptor Antagonists
H2RA's block the effect of histamine at h2 receptors (particularly those in the parietal cells of the stomach).

These drugs inhibit Gastric acid secretions as well as secretions by food, insulin, and caffeine.

These drugs also reduce the volume and concentration of gastric secretions.

Prototype: ranitidine (Zantac)



Ranitidine (Zantac)
Treatment of ulcers. Inhibits both daytime and nocturnal basal gastric acid secretions.

Adverse Effects:
Headache, blood count changes, GI affects, hepatocellular, Cholestatic, or mixed hepatitis

Favorable because it does not interact with the cytochrome P-450 system


Assess diet and smoking habits

*If both ranitidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of ranitidine.

-monitor serum trough levels in patients with renal or hepatic impairment.
-Administer IV ranitidine slowly to prevent hypotension and cardiac arrhythmias.


*Do not take double dose if missed!!
**Monitor blood count on patients with longterm therapy to detect changes!
Ranitidine is metabolized by the cytochrome P-450 system.
A. True
B. Flase
False.

Ranitidine is favorable because it does not use the P-450 cytochrome system.
Antacids
Antacids are drugs that increase the gastric pH.

These preparations are used for various upper GI disorders including symptoms of GERD, esophagitis, hiatal hernia and gastritis.

Antacids are Inorganic salts


Prototype: Aluminum hydroxide with Magnesium hydroxide. (Maalox, Mylanta)
Aluminum Hydroxide
Relieves symptoms associated with GERD.

Raises the pH in the stomach and duodenal bulb.

Caution patients with recent GI bleed.

Adverse effects:
Osteomalacia, encephalopathy, and rebound increased gastric acid production. Diarrhea/Constipation


**Liquid preparations are usually preferred because of their rapid action. SHAKE WELL.

Administer 2 hours after other drugs to prevent drug interactions.

Caution patients not to take max dose longer than 2 weeks!

Therapy is considered effective if the patients pain is decreased or eliminated, electrolytes remain at normal levels, elimination patterns remain normal, and GI symptoms are controlled.
Prokinetic Agents
The prokinetic agents increase the effect of acetylcholine on the GI system.

Acetylcholine is responsible for normal GI function.

Prokinetic agents increase peristalsis and gastric empying.

Prototype: Metoclopramide (Reglan)
metoclopramide (Reglan)
Relieves symptoms of diabetic gastroparesis (decreases motility, or paralysis)

Adverse effects:
restlessness, drowsiness, depression, insomnia, headache, anxiety, dizziness, and confusion.

Parkinson-like symptoms


Monitor for evidence of depression
withhold the dose and notify the prescriber if parkinson-like symptoms occur.

Take metaclopramide (reglan) 30 minutes BEFORE meals.
To promote optimal effectiveness of drug, metoclopramide should be given:
A. 30 minutes before meals
B. at the start of a meal
C. 30 minutes after a meal
d. three times per day
A. Metoclopramide should be given 30 minutes before eating a meal.
Digestive Enzymes
Digestive enzymes are responsible for breaking down food into forms that can be absorbed easily in the the GI tract.

Many drug preparations of digestive enzymes are combinations of various enzymes, frequently paired with anticholinergics, barbiturates, or antacids.

Prototype: Pancrelipase (Pancrease MT, Vuijasem Creon, Lipram, Pancrecarb, Panocaps)
Pancrelipase
Replacement therapy for patients with deficient exocrine pancreatic secretions.

Adverse Effects:
Nausea, abdominal cramps, and diarrhea

Drug Interactions:
Antacids, calcium carbonate and magnesium hydroxide, iron preparations

*Brands of Pancrelipase should not be changed!
*Administer antacids, or H2 receptors antagonists if prescribed.

Prevent excessive over dosing by taking med EXACTLY as prescribed.
-Tell patients to take drug every time they eat.
- Call physician if abdominal pain, diarrhea, nausea, or return of steatorrhea (Fatty stools)
Drugs for Weight Management
Lipase inhibitors and anorexiants are drug classes for the management of obesity.

Used specifically for long-term weight reduction.

Prototype: Orlistat (Xenical)
Orlistat
Manages Obesity

Reversible lipase inhibitor.

Oily spotting with discharge or stool, increased defecation, and fecal incontinence.

Drug interactions: Fat-soluable vitamins.

*Ensure that the patient taken orlistat with all meals that contain fat.
*Encourage exercise
*Take multivitamin that contains fat-soluable vitamins to prevent imbalances from drug therapy.
Antiemetics
Nausea and vomiting related to oncologic therapy is frequently difficult to manage.

-Antiemetics, which suppress stimulation of the CTZ and VC, used to treat nausea and vomiting.

1. Selective serotonin receptor antagonists
2. Antidopaminergic drugs
3. anticholinergic drugs

Selective Serotonin Receptor Antagonists
-prevents the stimulation of type 3 serotonin receptors in the CTZ.

Prototype drug: Ondansetron (Zofran)
Ondansetron
Prevents nausea and vomiting associated with cancer chemotherapy.

Blocks receptor sites

Adverse Effects:
Headache, constipation, and malaise.

Interacts with drugs metabolized in the cytochrome P-450 system**

DO NOT mix with alkaline solutions (decreases effectiveness)


Teach patients to move slowly to decrease dizziness or weakness.

Ondansetron therapy is considered effective if nausea and vomiting are controlled and adverse effects are controlled or do not occur.
Ondansetron should be given:
A. Rapid IV push
B. IV over 15 minutes
C. IV over 30 minutes
D. IV over 1 hour
B. IV over 15 minutes.

Drugs for motion sickness
1. Scopolamine

side effects:
-dry mouth
-blurred vision
-drowsiness

2. Antihistamines
In what part of the colon are the majority of fluids and electrolytes reabsorbed?
A. Proximal Colon
B. Mid-segment of the colon
C. Distal Colon
D. Rectum
A. Proximal Colon

Absorption of fluid and electrolytes occur primarily in the proximal colon
Large Intestine

5ft long. 2.5 inches in diameter.
Composed of:

1. Cecum
2. Colon
3. Rectum
4. Anal Canal

Contents from the small intestine enter the cecum through the ileocecal valve.

Peristalsis moves contents through the small and large intestines.

Large amounts of mucus are secreted by goblet cells in the epithelial layer of large intestine.
Flatus
normal biproduct of digestion
Diarrhea
frequent passage of loose or liquid stool
Constipation
infrequent or incomplete passage of hard stools resulting from a decrease in peristaltic activity.
Irritable bowel syndrome (IBS)
common disorder of the intestines characterized by altered bowel habits and pain.
Inflammatory bowel disease (IBD)
general term that includes both ulcerative colitis and Crohn Disease
Antiflatulents
decreases gas production

Prototype: Simethicone (Mylicon)
Simethicone
Relieves discomfort of excessive gas.

Defoaming action that alters the action of surface tension and gas bubbles.

Assess bowel sounds and abdominal pain
Assess dietary choices
*Give after meals and at bedtime to increase its effectiveness
**Must shake the drug before use.

DO NOT increase dosage.

Assess abdominal pain/distention
Antidiarrheals
Slows intestinal motility allowing time for fluid reabsorption and better stool formation.

Prototype: Diphenoxylate HCl with atropine sulfate (Lomotil, Lonox)
Diphenoxylate (Lomotil)

Antidiarrheal
Adverse effects:
drowsiness/dizziness

Drug Interactions:
MAOIs, alcohol, barbiturates, and tranquilizers.

Assess for substance abuse!!
Will enhance effects

Decrease dosage when number of stools decrease.

Assess for signs of Atropine sulfate toxicity

Notify physician if diarrhea persists longer than 2 days.

**It is important to Assess skin turgor and mucous membranes for loss of moisture because these signs indicate dehydration**
Signs of atropine toxicity include:
A. Dry mouth
B. Hypothermia
C. Tachycardia
D. Urinary retention
E. All of the above
E. All of the above

Signs of dehydration
Laxatives
Drugs used to treat constipation

Act directly on the intestines to promote peristalsis and evacuation of the bowel.

Classified as saline, hyperosmotic, stimulant, and bilk forming

Saline laxatives:
-Attract or retain water in the intestinal lumen, resulting in an increased intraluminal pressure that stimulates peristalsis.

Prototype: Magnesium hydroxide (MOM)
Magnesium Hydroxide (MOM), Milk of Magnesia
Used for treatment of constipation. Prepares bowels for surgery.

2-6 hours (early morning/late evening)

*shake well*

Retains water in intestines.

Contraindications:
Abdominal pain

Adverse Effects:
Overactive bowel and fluid and electrolyte imbalance.

May decrease or increase the effects of drugs
Alosetron
Take with full glass of water.

What is it for??

Assess for signs of constipation or ischemic colitis
What is the major adverse effect of Alosetron?
A. Diarrhea
B. Constipation
C. Tachycardia
D. Nephrotoxicity
B. Constipation

Alosetron's major adverse effect
Drugs used to treat inflammatory Bowel Disease
Can not cure IBD.

Drugs used to treat IBD include:
5-aminosalicylic acid (5-ASA)
Corticosteroids
and drugs that suppress the immune system

5-ASA preparations
-Aminosalicylates are the anti inflammatory drugs most commonly prescribed for IBD

Prototype: Mesalamine (Asacol, Pentasa, Lialda)
Mesalamine
Ulcerative collitis and proctosigmoiditis

Suppository

Adverse effects:
diarrhea, abdominal pain, cramps, flatulence, nausea, and headache

**Shake before administering**
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