McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 5 7 Drugs affecting gastrointestinal secretions

This drug is also contraindicated during pregnancy because it is an abortifacient. Women of childbearing age should be advised to have a negative serum preg- nancy test within 2 weeks of beginning treatment, and they should begin the drug on the second or third day of their next menstrual cycle. In addition, they should be instructed to use barrier contraceptives during therapy. Caution should be used during breastfeeding because of the potential for adverse effects on the newborn. Caution also is necessary in people with hepatic or renal impairment, which could interfere with the effective metabolism and excretion of the drug. Adverse effects The adverse effects associated with this drug are pri- marily related to its GI effects—nausea, diarrhoea, abdominal pain, flatulence, vomiting, dyspepsia and constipation. Genitourinary effects, which are related to the actions of prostaglandins on the uterus, include miscarriages, excessive bleeding, spotting, cramping, hypermenorrhoea, dysmenorrhoea and other menstrual disorders. Women taking this drug should be notified, both in writing and verbally, of these potential effects of this drug. Prototype summary: Misoprostol Indications: Prevention of NSAID- or aspirin- induced gastric ulcers in people at risk for complications of gastric ulcers. Actions: Inhibits gastric acid secretion and increases bicarbonate and mucus production, protecting the lining of the stomach; increases stimulatory effects in the uterus. Pharmacokinetics: Route Onset Peak Oral Rapid 12–15 mins T 1/2 : 20 to 40 minutes; metabolised in the liver and excreted in urine. Adverse effects: Nausea, diarrhoea, abdominal pain, flatulence, vomiting, excessive bleeding or spotting, hypermenorrhoea, dysmenorrhoea, miscarriage.

potential for adverse effects on the fetus or breastfeeding infant . ■ ■ Perform a physical examination to establish baseline data before beginning therapy, and during therapy to determine the effectiveness of the drug and to evaluate for the occurrence of any adverse effects associated with drug therapy. ■ ■ Examine the abdomen for possible changes to rule out medical conditions. ■ ■ Perform a pregnancy test and assess normal menstrual activity to make sure that the woman is not pregnant. ■ ■ Monitor the results of laboratory tests, including renal and hepatic function tests, to determine the need for possible dose adjustment and identify toxic effects. ■ ■ Administer to people at high risk for NSAID- induced ulcers during the full course of NSAID therapy to prevent the development of gastric ulcers. Administer four times a day, with meals and at bedtime, to ensure maximum benefit of the drug . ■ ■ Arrange for a serum pregnancy test within 2 weeks before beginning treatment, and begin therapy on the second or third day of the menstrual period, to ensure that women of childbearing age are not pregnant and to prevent abortifacient effects associated with this drug. ■ ■ Provide the woman with both written and oral information regarding the associated risks of pregnancy to ensure that the woman understands the risks involved ; advise the use of barrier contraceptives during therapy to ensure the prevention of pregnancy. ■ ■ Evaluate nutritional status if GI effects are severe to arrange for appropriate measures to relieve discomfort and ensure nutrition , such as small, frequent meals, and increased fluid intake if appropriate . ■ ■ Explain the risk of menstrual disorders and pain, miscarriage and excessive bleeding related to the drug effects on prostaglandin activity in the uterus. ■ ■ 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; the need to take the drug with meals and at bedtime; signs and symptoms of adverse effects and measures to minimise or prevent them; the importance of avoiding pregnancy while taking drug; the use of barrier contraceptives to prevent pregnancy; dietary Implementation with rationale

Care considerations for people receiving prostaglandin

Assessment: History and examination

■ ■ Assess for possible contraindications or cautions : any history of allergy to misoprostol to prevent hypersensitivity reactions , and current status of pregnancy or breastfeeding because of the