McKenna's Pharmacology for Nursing, 2e

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P A R T 1 1  Drugs acting on the gastrointestinal system

■ ■ Inspect the skin for colour and evidence of lesions or rash that might indicate adverse drug effects. ■ ■ Assess the person’s neurological status, including level of orientation, affect and reflexes, to monitor for CNS effects of the drug. ■ ■ Examine the abdomen; auscultate bowel sounds to evaluate GI motility ; evaluate bowel elimination pattern or changes that could suggest possible adverse effects. ■ ■ Assess mucous membrane status to evaluate potential problems with absorption. ■ ■ Monitor the results of laboratory tests such as renal function studies to identify the need for possible dose adjustments and toxic effects. ■ ■ Administer the drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure the therapeutic effectiveness of the drug. ■ ■ Monitor the person for GI pain, and arrange to administer antacids to relieve pain if needed. ■ ■ Administer antacids or antibiotics, if ordered, between doses of sucralfate, not within 30 minutes ■ ■ Provide comfort and safety measures if CNS effects occur to prevent injury. ■ ■ Provide frequent mouth care, including sugarless lozenges to suck, to alleviate dry mouth . if diarrhoea occurs ; institute bowel training as needed and provide small, frequent meals if GI effects are uncomfortable. ■ ■ Offer support and encouragement to help the person cope with the disease and the drug regimen. ■ ■ Provide thorough teaching, including the drug name and prescribed dosage; schedule for administration; importance of taking the drug on an empty stomach; use of antacids if ordered and the need to separate doses by at least 2 hours; signs and symptoms of possible adverse effects and measures to minimise or prevent their occurrence; danger signs that need to be reported to the healthcare provider immediately; safety measures, such as avoiding driving and asking for help with ambulation, to minimise injury secondary to CNS effects ; dietary measures such as small, frequent meals to minimise diarrhoea ; increased fluid and fibre in the diet to reduce the risk of constipation ; small, frequent meals to help with GI upset ; comfort measures, such as mouth care and use of sugarless lozenges, to alleviate dry mouth ; the importance of compliance with therapy to achieve the intended effects ; measures to help avoid adverse ■ ■ Ensure ready access to bathroom facilities Implementation with rationale of a sucralfate dose, because sucralfate can interfere with absorption of oral agents.

effects; warning signs that may indicate problems; and the need for periodic monitoring and evaluation to evaluate the effectiveness of therapy , enhance knowledge about therapy and promote compliance.

Evaluation

■■ The GI protectant sucralfate forms a protective coating over the eroded stomach lining to protect it from acid and digestive enzymes to aid healing. ■■ Constipation is a common occurrence with this drug. P rostaglandin Prostaglandins are used to protect the stomach lining. The prostaglandin available for this use is the synthetic prostaglandin E 1 analogue misoprostol ( Cytotec ). Therapeutic actions and indications Prostaglandin E 1 inhibits gastric acid secretion and increases bicarbonate and mucus production in the stomach, thus protecting the stomach lining (see Figure 57.1). Misoprostol is primarily used to prevent NSAID-induced gastric ulcers in people who are at high risk for complications from a gastric ulcer (e.g. elderly or debilitated people, people with a past history of ulcer). See Table 57.1 for more information and indications about this drug. Pharmacokinetics Miosprostol is given orally. It is rapidly absorbed from the GI tract, metabolised in the liver and excreted in urine. Misoprostol crosses the placenta and enters breast milk. Contraindications and cautions Misoprostol is contraindicated with allergy to any part of the drug to prevent hypersensitivity reactions. ■ ■ Monitor the response to the drug (relief of GI symptoms; healing of erosive GI lesions). ■ ■ Monitor for adverse effects (GI effects, CNS changes, dermatological effects). ■ ■ Monitor the effectiveness of comfort and safety measures and compliance with the regimen. ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug and dosage and describe the adverse effects to watch for, specific measures to avoid them and measures to take to increase the effectiveness of the drug). KEY POINTS