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Alterations in GI Chapter 51


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Antidiarrheal: Diphenoxylate HCL with Atropine Sulfate
Treats Diarrhea Contraindicated in Obstructive Jaundice Adverse Effects: Drowsiness and dizziness, nausea, vomitting, abdominal discomfort, paralytic ileus, toxic megacolon, pancreatitis, sedation, headache, malaise, lethargy, restlessness, depression
Saline Laxatives: Magnesium Hydroxide Milk of Magnesia, Dulcolax
*Used for acute or chronic constipation, preoperatively to prepare the bowel for surgery Adverse Effects: Overactive bowel:marked by cramps, diarrhea, or nausea *Follow magnesium hydroxide with a full glass of water to prevent dehydration and to promote a more rapid effect
Stimulant (Irritant) Laxatives
Direct stimulatory effect on the intestianl mucosa or nerve and increase peristalsis Chronic use may induce loss of normal bowel function and laxative dependency Contraindicated for use in fecal impaction or obstipation
Bulk-Forming Laxatives
Fibers attract water and swell to form a soft, bulky stool; bulky mass stimulates the intestinal muscles and increase peristalsis *Will not work without increased fluid intake and can complicate constipation
Stool Softeners(Docusate-Surfactant)
Facilitates the addition of fat and water into the stool to soften it: does NOT stimulate peristalsis Preven contipation in at risk patients
Emollient (Lubricant) Laxatives
Used as an enema in fecal impaction Lubricates teh intestine and retards colonic absorption of water Decreases absorption of fat-soluble vitamins-important in patients receivng warfin
Bowel Evacuants
Not used to treat constipation but for bowel cleansing in preparation for GI examinations Common adverse effects: Anal irritation, bloating, epigastric fullness, nause, stomach cramps, and vomiting
Irritable Bowel Syndrome: Alosetron
Only drug approved in the United States for treatment of women with IBS-D Blocks 5HT3 receptors Should not be administered to anyone with IBS-C Contraindicated for anyone with a history of chronic or severe constipation or with a history of sequelae for constipation; a history of intestinal obstruction, stricture, toxic megacolon Patient teaching: Instruct patients to report any constipation or signs of ischemic colitis (rectal bleeding, bloody diarrhea, or new or worsening abdominal pain. Encourage patients to drink sufficient fluids daily
Dicyclomine(Bentyl)- Different from Alosetron
Antispasmodic: works by blocking the action of acetylcholine at parasympathetic sites in secretory glands, smooth muscles, and the CNS. Contraindicated in: Obstructive uropathy, myasthenia gravis, glaucoma, GI tract obstruction, paralytic ileus, and toxic megacolon Give cautiously in patients with hepatic or renal insufficiency, cardiovascular disease, hyperthyroidism, or hypertension Causes sedation, constipation, urinary retention, tachycardia, blurred vision, dry mouth, or dizziness. Children 3 months or younger have been reported to experience respiratory distress, seizures, syncope, asphyxia, pulse rate fluctuation
Selective Chloride Channel Activator- Lubiprostone(Amitiza)
Used in treatment of chronic idiopathic constipation Works by activating chloride channels on the apical part of the small bowel epithelium that results in a secretion of chloride ions
Tricyclic Antidepressants Imipramime(Trofranil) and amitriptyline (Elavil)
Provide visceral analgesia by increasing the pain threshold in the GI system, reducing abdominal pain, mucorrhea, and stool frequency
5-ASA Preparations- Asacol, Pentasa, Lialda- Mesalamine Treat Inflammatory bowel disease
Used in patients with ulcerative colitis and proctosigmoiditis Adverse effects: Diarrhea, abdominal pain, cramps, flatulence, nausea, and headache: Serious/Rare effects: Blood dyscrasia, exacerbation of colitis, pericarditis, renal impairment, and hepatotoxicity *Explain the importance of retaining the ENEMA for 8 HOURS and the SUPPOSITORY for 3 HOURS
Ifliximab(Remicade)- Different from Mesalamine
Immune response modulator used to treat moderate to severe Crohn disease or ulcerative colitis Reduces signs and symptoms of IBD, induces and maintains clinical remission in patient with moderate to severe IBD, and reduces the number of draining entercutaneous fistulas

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