GI

• Types of laxatives used for constipation


  • Osmotic (saline)
  • Stimulant (contact or irritants)
  • Bulk-forming
  • Emollient (stool softeners)
• SHOULD ALWAYS BE AVOIDED IF PATIENT HAS AN INTESTINAL OBSTRUCTION
• Osmotic (Saline) Laxatives

  Pull water into the colon and increase water in feces to increase bulk, which stimulates peristalsis and defecation. Produces semi-formed to watery stool
• Osmotic (Saline) Laxatives


  • Lactulose
  • Glycerin
• Stimulant (contact or irritants) Laxatives


  Increase peristalsis by irritating sensory nerve endings in the intestinal mucosa
• Stimulant (contact or irritants) Laxatives


  • Bisacodyl (Dulcolax)
  • Castor Oil
  • Anthraquinones (Senna)
• Stimulant (contact or irritants) Laxatives


  • Bisacodyl (Dulcolax) is the most frequently used and abused laxative (available OTC), PO works in 6-8 hours, Suppositories work in 15-60 min
  • Patient teaching point: change in urine color
• Bulk-forming Laxatives


  Natural fibrous substances that promote large, soft stools by absorbing water into the intestine, fecal bulk and peristalsis, promotes well formed, soft stools
• Bulk-forming Laxatives


  • Polycarbophil
  • Polyethylene glycol (MiraLAX)
  • Methylcellulose
  • Psyllium (Metamucil)
• Emollient stool softeners


  Emollients are lubricants and stool softeners. Promote water accumulation in the intestine and stool. Helps to decrease straining during defecation
• Emollient stool softeners


  • Docusate
• Laxative Contraindications


  • Undiagnosed abdominal pain
  • Inflammatory disorders of the GI tract
  • Appendicitis
  • Diverticulitis
  • Ulcerative colitis
  • Spastic colon
  • Bowel obstruction
  • Pregnancy
• Nursing Considerations for Laxatives


  • Assess history of constipation and possible causes, frequency and consistency of stools
  • Monitor fluid intake and output
  • Note evidence of fluid and electrolyte imbalance resulting from watery stools
  • Encourage patients to increase water intake
  • Advise patients to avoid overuse of laxatives
  • Warn patients that the drug is not for long-term use
  • Inform patients to consume foods high in fiber
• Serotonin Receptor (5- HT3) Antagonist


  Blocks the serotonin (5-HT3) receptors in the CTZ and blocking the afferent vagal nerve terminals in the upper GI tract
• Serotonin Receptor (5- HT3) Antagonist


  • Ondansetron (Zofran)
• Serotonin Receptor (5- HT3) Antagonist


  • Most commonly used antiemetic
  • Side effects: CNS - HA, dizziness, fatigue; CV - hypotension, palpitations, edema
  • Does not block dopamine receptors therefore no EPS
  • Medicate 30 to 60 minutes prior to chemotherapy (PO, IV)
  • More effective when used with glucocorticoids
  • Most effective agents in N/V related to chemo/radiation/anesthesia
• Diagnosis of Peptic Ulcer Disease (PUD)


  • Endoscopy -> biopsy sample
  • Breath test -> urea breath test
  • Serologic test -> igG antibodies specific
• Treatment of Peptic Ulcer Disease (PUD)


  Triple therapy: Metronidazole (flagyl), Omeprazole (prilosec), Clarithromycin (cleocin)
• Histamine -2 (H2) blockers


  Helps decrease/reduce gastric acid secretion, Prevents acid reflux in esophagus, Blocks h2 receptors
• H2 blockers are less effective than Proton Pump Inhibitors (PPIs)
• Proton Pump Inhibitors (PPIs)


  A drug class that suppresses gastric acid secretion by inhibiting the hydrogen/potassium ATPase enzyme located in the gastric parietal cells