Drugs affecting GI motility Ch 58

Question 1

What are drugs affecting motility?

Answer 1

Used to speed up or improve motility
 Used to increase tone/ stimulate motility
 Used to decrease GI tract movement
 Categories:
 Bulk Stimulants
 Stool Softeners
 Stimulants
 Antidiarrheals

Question 2

Describe constipation

Answer 2

Slower emptying of large intestine
 Symptom, not a disease
 Can be caused by a variety of diseases or drugs
 Treatment determined by patient condition and reason
for use

Question 3

What is psyllium (Metamucil)?

Answer 3

Laxative bulk stimulate

Question 4

What is therapeutic action of psyllium (Metamucil)?

Answer 4

Laxative bulk stimulate
 Bulk forming fiber/ increases
water
 Cause fecal matter to increase in
bulk  turn gel like
 Distend bowel to initiate reflex
bowel activity

Question 5

What are adverse effects of psyllium (Metamucil)?

Answer 5

Laxative bulk stimulate
Diarrhea, cramps, F/E imbalances,
dehydration

Question 6

What are contras of psyllium (Metamucil)?

Answer 6

Laxative bulk stimulate
-Acute abd process
- Intestinal obstruction; fecal impaction

Question 7

What are cautions of psyllium (Metamucil)?

Answer 7

Laxative bulk stimulate
Cardiac disease due to F/E imbalance

Question 8

What are Nursing considerations with psyllium (Metamucil)?

Answer 8

Laxative bulk stimulate
Take 30 minutes before/after other meds
take with generous amount of water

Question 9

What is lactulose and magnesium citrate?

Answer 9

Osmotic laxative

Question 10

What are therapeutic actions of lactulose and magnesium citrate?

Answer 10

Osmotic laxative
Pulls fluid in GI tract  increases pressure GI tract  stimulate motility

Question 11

What are adverse effects of lactulose and magnesium citrate?

Answer 11

Osmotic laxative
-GI  diarrhea, abdominal cramping and bloating
- Dehydration

Question 12

What is docusate (Colace)?

Answer 12

Stool softeners

Question 13

What are therapeutic actions of docusate (Colace)?

Answer 13

Stool softeners
-Promote more water and fat in the stools
- Lubricate the fecal material and intestinal walls
Usually act within 1-3 days

Question 14

What are contras of docusate (Colace)?

Answer 14

Stool softeners
Acute abd process, allergy

Question 15

What are cautions of docusate (Colace)?

Answer 15

Stool softeners
Cardiac disease
 Can decrease absorption of fat soluble vitamins A, D, E, K

Question 16

What is bisacodyl (Ducolax)?

Answer 16

Laxatives: chemical stimulants

Question 17

What are therapeutics of bisacodyl (Ducolax)?

Answer 17

Laxatives: chemical stimulants
Directly stimulates the nerve plexus in intestinal wall

Question 18

What are contras of bisacodyl (Ducolax)?

Answer 18

Laxatives: chemical stimulants
Acute abd. process

Question 19

What are cautions of bisacodyl (Ducolax)?

Answer 19

Laxatives: chemical stimulants
-Cardiac disease – stimulation of vagus nerve with PR administration
-Bleeding precautions with PR administration

Question 20

What are nursing considerations with laxatives

Answer 20

 Obtain a thorough history of presenting
symptoms, elimination patterns, and
allergies
 Assess fluid and electrolytes
 Hold for nausea, vomiting, and/or
abdominal pain, s+sx of obstruction,
post-op
 Fecal impaction – suppository/enema
first
 Children/ infants – glycerin PR; older
children –lactulose – not long term
 Caution with pregnancy as stimulation
could induce premature labor
 A healthy, high-fiber diet and increased
fluid intake should be encouraged as an
alternative to laxative use
 Long-term use of laxatives often results
in decreased bowel tone and may lead to
dependency
 All laxative tablets should be swallowed
whole, not crushed or chewed, especially
if enteric coated
 Take tablets with 6-8 oz. of water
 When to notify PCP

Question 21

What is **metoclopramide (Reglan)?

Answer 21

Gastrointestinal stimulants

Question 22

What are therapeutic actions of metoclopramide (Reglan)?

Answer 22

Gastrointestinal stimulants
Stimulate parasympathetic activity

Question 23

What are contras of metoclopramide (Reglan)?

Answer 23

Gastrointestinal stimulants
GI obstruction or perforation

Question 24

What are cautions of metoclopramide (Reglan)?

Answer 24

Gastrointestinal stimulants
 Pregnancy
 Can cause extra-pyramidal effects, Parkinson like symptoms
 Monitor N/V/D and spasm

Question 25

What is loperamide (Imodium)?

Answer 25

Antidiarrheals

Question 26

What are therapeutic actions of loperamide (Imodium)?

Answer 26

Antidiarrheals
Block stimulation of GI tract, slow motility

Question 27

What are adverse effects of loperamide (Imodium)?

Answer 27

Antidiarrheals
Constipation, distension, CNS effects with opium

Question 28

What are contras of loperamide(Imodium)?

Answer 28

Antidiarrheals
Acute abd process, infectious process

Question 29

What are cautions of loperamide(Imodium)?

Answer 29

Antidiarrheals
Pregnancy

Question 30

What is lomotil diphenoxylate with atropine?

Answer 30

antidiarrheals combination products

diphenoxylate – chemically related to meperidine
 diphenoxylate is combined with sub-therapeutic amounts of atropine
 Combo may discourage recreational opiate drug use
 Large dosages will result in extreme anticholinergic effects (dry mouth,
abdominal pain, tachycardia, blurred vision)

Question 31

What are nursing considertions of antidiarrheals?

Answer 31

Obtain thorough history of bowel
patterns, general state of health,
and recent history of illness or
dietary changes, and assess for
allergies
 DO NOT give bismuth
subsalicylate to children or
teenagers with chickenpox
because of the risk of Reye’s
syndrome
 Rule out acute abd, infectious
process before administering
 Teach patients to take
medications exactly as
prescribed and to be aware of
their fluid intake, dietary and
medication changes
 Assess fluid volume status, I&O,
and mucous membranes before,
during, and after initiation of
treatment
 Monitor for therapeutic effect