Lower GIT medications

Question 1

Lower GIT includes:

Answer 1

• large intestine
• small intestine
• rectum
• anus

Question 2

Disorders affecting the Lower GIT are:

Answer 2

• diarrhoea
• constipation
  -diverticular disease
• irritable bowel syndrome
  -irritable bowel disease
• carcinoma
• haemorrhoids

Question 3

2 major types of of Lower GIT drugs:

Answer 3

1. laxatives
2. antidiarrhoeals

Question 4

What are laxatives?

Answer 4

• laxatives are used enable and ease elimination of constipation

Question 5

There are different types of laxatives:

Answer 5

• faecal softeners
• bulk-forming (high fiber) agents
• stimulants
• Osmotics
• lubricants /facael softeners
• combination of stool softener and stimulant

Question 6

Faecal softeners:

Answer 6

• used to treat acute constipation and to prevent straining
• examples - Coloyxl, Docusate
  Nursing considerations
• may cause mild cramping or diarrhoea
• should not be used with other laxatives -

Question 7

Bulk forming agents:

Answer 7

• safest form
• high fibre
• absorbs water and increase volume, bulk and moisture
• examples - Psyllium hydrophilic muciloid (Metamucil
  Nursing considerations:
• must be followed with a large amount of fluid
• may cause abdominal cramps and diarrhoea
• nausea and vomiting
  -prevents calcium absorption

Question 8

Stimulants (irritant laxatives):

Answer 8

• increase peristalsis
• stimulation of colon nerves (senna)
• stimulation of sensory nerves in intestinal mucosa (durolox)
• stimulation of smooth muscle and inhibition of water and electrolyte reabsorption (castor oil)
• useful in neuromuscular disease/spinal disorders
• used in preparation for surgery
  Nursing considerations:
• not recommended for regular use
• oral preparations act between 6-12 hours
• suppositories and enemas work more quickly
• may cause rebound constipation as the intestines adapt to being strongly stimulated

Question 9

Osmotic laxatives:

Answer 9

3 groups of osmotic laxatives:
- non absorbable inorganic salts (Epsom salts)
- non absorbable sugars (lactulose, glycerol, sorbitol, duphalac)
- polyethylene glycol (colonlytely)
Nursing considerations:
- ensure adequate water is consumed
- contraindicated in intestinal obstruction
- non absorbable salts can cause bowel movement 3-4 hours post ingestion
- non absorbable sugars needs to be monitored with patients with diabetes
- polyethylene glycol used to completely evacuate bowel prior to surgery or colonoscopy

Question 10

Lubricants/faecal softeners:

Answer 10

• creates a barrier between the faeces and the colon wall
• prevents reabsorption of faecal fluid to soften stool
• coats surface of faeces facilitating elimination
• used where straining should be avoided
• example - liquid paraffin
  Nursing considerations:
• may produce abdominal cramps, vomiting, decreased absorption of nutrients
• may cause leakage and seepage from rectum

Question 11

Antidiarrhoeals is:

Answer 11

• diarrhoea may be defined as an increase in volume, fluidity or frequency of bowel movements relative to the usual pattern for that individual
• causes include - infectious agents, toxins, drugs anxiety, chronic diseases

Question 12

Managment of diarrhoea:

Answer 12

• determine the cause - stool sample
• prevent treat fluid and electrolyte imbalances
• prevent dehydration
• all antidiarrhoeals are given orally
• diet restricted to clear liquids for 24 hours
• food gradually added as tolerated -

Question 13

2 main groups of antidiarrhoeals:

Answer 13

• Absorbents
• Opioid antidiarrhoeals

Question 14

Absorbents are:

Answer 14

• most commonly used
• clay-like materials administered in tablet or liquid suspension form after each loose bowel movements
• eliminated through stool
• Example - Kaolin-pectin

Question 15

Opioid antidiarrhoeals are:

Answer 15

• narcotic based OTC opioids
• activate opioid receptors in gut wall - reduction of secretions and suppressed GIT motility slowing passage of intestinal contents
• can also be used to decrease volume of discharge in patients with colostomies
• examples - Loperamide (Imodium), Diphenoxylate, Codeine

Question 16

Opioid antidiarrhoeals nursing considerations:

Answer 16

• short term treatment of diarrhoea
• adverse reactions are minimal
• all antidiarrhoeals are given orally
• diet changes are part of treatment plan - clear fluids

Question 17

Other lower GIT Medications include:

Answer 17

• Antispasmodics
• 5-Aminosalycyclates (5-ASA)
• Corticosteroids
• Immunosuppressants
• Antiflatulents
• Anorectal preparations

Question 18

Antispasmodics are:

Answer 18

-used to treat:
- irritable colon
- hypermotility
- biliary colic

• relieves cramps and spasms
• Examples - Hyoscine, peppermint oil capsules, belladonna
• side effects may include dizziness, drowsiness, dry mouth, nausea, and bloating

Question 19

5-Aminosalycyclates (5-ASA) are:

Answer 19

• used to treat - inflammatory bowel disease - ulcerative colitis and Crohn’s disease
• consists of sulfasalazine, olsalazine, balasalazide, and mesalazine
• adverse effects include - unexplained bleeding and bruising, itchy skin rash, difficulties breathing, sore throat, change of colour of tears and urine.
• plenty of water should be drunk while taking 5-ASA medications

Question 20

Corticosteroids are:

Answer 20

• used to treat inflammatory bowel disease
• two most commonly drugs used are
• Prednisolone - Suppository and retention enema
• Budesonide - enteric coated tablet

Question 21

Immunosuppressants are:

Answer 21

• also used to treat inflammatory bowel disease
• examples - Azathioprine, Mercaptopurine and Methotrexate

Question 22

Antiflatulents are:

Answer 22

• used to treat bloating; flatulence and post operative gas pains, chronic air swallowing; functional dyspepsia
• may be used together with antacid therapy
• breaks down mucous surrounding gas bubbles allowing all bubbles to come together
• examples- Simethicone, Charcoal

Question 23

Anorectal preparations are:

Answer 23

• used for symptomatic relief of haemorrhoids
• adverse reactions - sensitisation to the product
• examples - Dibucaine, Hydrocortisone acetate. Zinc sulfate monohydrate, Hydrocortisone foam