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Drugs for gastrointestinal, respiratory and muscular disorders
- 1. Drugs for Gastrointestinal, Respiratory and Musculoskeletal Disorders
- 2. Objectives Identify common symptoms of gastrointestinal , respiratory and musculoskeletal systems Recall classifications of medications used for gastric disorders Explain how probiotics work Recall classifications of medications used for respiratory disorders Recall classifications of medications used for musculoskeletal disorders Identify signs of anaphylaxis
- 3. Gastrointestinal Disorders/Medications Common Symptoms of Gastrointestinal Disorders Loss of appetite & weight loss Abdominal pain Nausea & vomiting Change in bowel habits (diarrhea, constipation) Flatulence Blood or mucus in feces Fever Heartburn, indigestion, difficulty swallowing Diaphoresis Gastrointestinal Medication Actions Increase or decrease function of GI tract by changing muscle tone, and change secretions of or into GI tract Increase or decrease rate of peristalsis Replace enzyme deficiencies
- 4. Drugs Used for Gastric Disorders Antacids Mucosal protectants Antibiotics Antisecretory agents Antispasmodics Prokinetic agents
- 5. Other Gastrointestinal Drugs Pancreatic enzyme replacements Gallbladder treatment Drugs for emesis Laxatives and Cathartics Antidiarrheal agents Anti-inflammatory agents (ulcerative colitis)
- 6. Alternative Treatment - Probiotics Helpful microorganism groups: Lactobacillus and Bifidobacterium Used to promote digestive health by helping to regulate movement of food through the intestines
- 7. Respiratory Conditions/Medications Common Symptoms of Respiratory System Disorders Pain (in respiratory tract) Difficulty breathing (dyspnea, wheezing, rales) Acute or chronic cough Dysphonia Fatigue and malaise Chills, fever, headaches Hemoptosis and epistaxis Respiratory Medication Actions Vascular dilation and contraction of smooth muscles of the bronchial tree (vasodilator) Vasoconstriction of mucous membranes (vasoconstrictor) Suppress symptoms of allergic rhinitis (antihistamine) Elevate cough threshold & suppress cough (antitussives)
- 8. Drugs Used for Respiratory Disorders Antihistamines Decongestants Glucocorticoids Antitussives: Opioid and Nonopioid cough suppressants Inhalation Medications
- 9. Musculoskeletal Conditions/Medications Common Symptoms of Musculoskeletal System Disorders Inflammation Redness Decreased range of motion. Loss of function Tingling Numbness Stiffness Pain/tenderness Muscle weakness Fatigue Decreased grip strength Musculoskeletal Medication Actions Muscle Relaxants Steroids Salicylates NSAIDS
- 10. Musculoskeletal Pain Pain is the chief symptom of most musculoskeletal disorders. The pain may be mild or severe, local or widespread (diffuse). Although pain may be acute and short-lived, as is the case with most injuries, pain may be ongoing with chronic illnesses, such as rheumatoid arthritis. Dangers of NSAIDS
- 11. Anaphylaxis (Anaphylactic Shock) Severe adverse reaction; medical emergency Potentially fatal Symptoms include hives, reddened skin, bronchospasm, elevated blood pressure followed by drop in blood pressure, cyanosis, dyspnea, vascular collapse, loss of consciousness, cardiac arrhythmias and cardiac arrest.
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- When food enters stomach, it is mixed with hydrocholoric acid and enzymes. The acidic environment of the stomach is necessary for enzymes to work and to inhibit or kill microorganisms found in food or other materials that are ingested. Sometimes the acid becomes so strong that it eats away at the stomach wall. The stomach usually has a mucous covering, but when excessive secretions occur the gastric surface may break down. Worry and stress increase the secretions of the stomach making the wall more sensitive to the acid, causing ulcers and sloughing of the gastric tissue. If the lesion is found in the duodenum, duodenal ulcer is used. The microorganism Helicobacter pylori is present in 90% of ulcers (opportunistic infection)Antacids: neutralize hydrochloric acid to protect mucosal lining (because antacids interfere with the absorption of many medications, especially antibiotics, other medications should not be given with antacids. The ideal time to give antacids is 2 hours after meals, when acid rebound occurs [increase in gastric acid secretions])Mucosal protectants:Sucralfateprotects gastric mucosa; misoprostol used in prevention of NSAID-induced gastric ulcers [side effects sucralfate: constipation; misoprostol: diarrhea, nausea)Antibiotics: use of 2 antibiotics (to reduce risk of drug resistance) in combination with bismuth salts (Pepto-Bismol). Examples: amoxicillin, tetracycline, Flagyl, Biaxin)Antisecretory agents:cimetidine (Tagamet) ranitidine (Zantac) H2-receptors inhibit acid secretions & pepsin. Proton pump inhibitors inhibit chemicals used to produce hydrocloric acid; such as omeprazole (Prilosec) and lansoprazole (Prevacid) (side effects: headaches, abdominal pain, diarrhea, nausea, constipation, rash)Antispasmodics: actually anticholinergicsthat decrease secretions and slow peristalsis for treatments of IBS, ulcerative colitis, diverticulitis, ulcers and biliary spasm such as belladonna alkaloids (Bellafoline, Donnatal). Side effects include dizziness, headache, insomnia, drowsiness, visual disturbances, changes in heart rhythm.Prokinetic agents: stimulate GI motility by lowering esophageal sphincter pressure and accelerating gastric emptying and movement of food through intestines. Used for GERD symptoms such as metoclopramide (Reglan)
- Pancreatic enzyme replacements:Pancreas produces 4 digestive enzymes (lipase, amylase, chymotrypsin and trypsin). 2 enzyme replacements (pancreatin and pancrelipase) are taken with meals.Gallbladder treatment: Telepaque or Bilopaque are oral radiopaque drugs to enable visualization of the gallbladder. Drugs used to dissolve gallstones include chenodiol (Chenix) and ursodiol (Catigall).Drugs for Emesis:antiemetics used to suppress nausea and vomiting and include the different classes of serotonin antagonists (ondansetron hydrochloride (Zofran) and granisetron (Kytril); dopamine antagonists are the largest group (subdivided to phenothiazines (promethazine = Phenergan) and butyrophenones; benzodiazepines (lorazepam (Ativan) and diazepam (Valium) for chemo patients; anticholinergics used for motion sickness; phosporated carbohydrate solution (Emetrol) relieves hyperactivity of smooth muscle of gastric wall and trimethobenzamide hydrochloride (Tigan).Laxativesinduce defecation and can be abused. Constipation is related to hardness of stools (not frequency of bowel movements) and laxatives can be used for short-term use. Use of stool softening agents. Types of laxatives include osmotic saline laxatives (MOM), bulk forming laxatives (Citrucel), stimulant laxatives such as biscodyl (Dulcolax), cascara sagrada (Ex-Lax), castor oil and lubricant laxatives and stool softeners (docusate (Colace)Antidiarrheal include adsorbents (activated charcoal, bismuth salts, PeptoBismol) and opioid /synthetic opioidmedications such as lopermide (imodium) and atropine (Lomotil).Antiinflammatory agents for the treatment of ulcerative colitis includes the sulfonamide Azulfidine and salicylatesDipentum and Colazal
- What Are Probiotics?Probiotics are living microscopic organisms, or micro-organisms, that scientific research has shown to benefit your health. Most often they are bacteria, but they may also be other organisms such as yeasts. In some cases they are similar, or the same, as the “good” bacteria already in your body, particularly those in your gut. The most common probiotic bacteria come from two groups, Lactobacillus or Bifidobacterium, and many other types of bacteria classified as probiotics. Each group of bacteria has different species and each species has different strains. This is important to remember because different strains have different benefits for different parts of your body. In general, not all probiotics are the same, and they don’t all work the same way. Scientists are still sorting out exactly how probiotics work. They may:Boost your immune system by producing antibodies for certain viruses. Produce substances that prevent infection. Prevent harmful bacteria from attaching to the gut wall and growing there. Send signals to your cells to strengthen the mucus in your intestine and help it act as a barrier against infection. Inhibit or destroy toxins released by certain “bad” bacteria that can make you sick. Produce B vitamins necessary for metabolizing the food you eat, warding off anemia caused by deficiencies in B-6 and B-12, and maintaining healthy skin and a healthy nervous system. Common UsesProbiotics are most often used to promote digestive health.Nevertheless, probiotics have been shown to help regulate the movement of food through the intestine. They also may help treat digestive disease. Some of the most common uses for probiotics include the treatment of the following:Irritable Bowel Syndrome Inflammatory Bowel Disease Infectious Diarrhea Traveler’s Diarrhea Antibiotic-Related Diarrhea
- Antihistamines Prevent histamine from reaching exposed tissue than causes edema, inflammation and itching (blocks H1 receptor sites); provides palliative relief with greatest therapeutic effect on nasal allergic reactions with examples like: diphenahydramine (Benedryl), certirzine (Zyrtec) and loratadine (Claritin)Decongestants used to relieve nasal congestion; they are vasoconstricting in that theyshrink swollen mucous membranes of nasal airway or upper respiratory tract. Example of topical medications: ephedrine (Vick’s, Vatronel), epinephrine (Primatene mist); oral decongestants pseudoephedrine (Sudafed) and pseudoephedrine/chorpheramine (Chlor-Trimeton).Glucocorticoids are used for prolonged seasonal rhinitisand include fluticasone (Flonase) and triamcinolone (Nasacort)Antitussives Codeine and hydrocodine used to elevate the cough threshold and suppress cough; decreases both the frequency and intensity of the cough. Example: Tussionex. Nonopioids do not have gastrointestinal side effects (constipation, nausea) like codeine and are non-addicting. Diphenhydramine (Benadryl) and benzonatate (Tessalon).Inhalation Medications promote bronchodilation and include the beta-adrenergic agents albuterol (Proventil, Ventolin), and anticholinergic agents tiotropium (Spiriva).
- Musculoskeletal disorders (abbreviation: MSD) is a term that refers to soft tissue injuries that occur gradually over time and can affect muscles, tendons, ligaments, joints and nerves. These injuries can develop when the same muscles are used over long periods without adequate rest. Some common examples of MSDs include carpal tunnel syndrome, tendonitis, bursitis and epicondylitis (tennis and golfer’s elbow), trigger finger (gamer’s finger). Muscle Relaxants Actions: By acting on the brain this medication helps relax the skeletal musclesMajor side effects or toxic effects: Dizziness, weakness, drowsiness, GI distress, and numbness to extremities.Nursing Care: To help with GI distress give with milk or food, patient teaching is vital so patient does not take medication with alcohol and over the counter medications without discussing with the patients physician.SteroidsActions: Very portent anti-inflammatory medication that overrides the body's normal response to inflammatory.Major side effects or toxic effects: decrease in healing time, GI distress, masking of infections, electrolyte imbalance, osteoporosis, if abruptly stopped can cause an adrenal crisis.Nursing Care: It is very important to teach your patient that they must taper off steroid medications to avoid adrenal crash, take with milk or food for any GI distress, and take as ordered.SalicylatesActions: Anti-inflammatory, analgesicMajor side effects or toxic effects: GI irritations and GI bleedingNursing Care: watch for signs of bleeding, give with antacid, milk or foods for GI irritationsNon-steroidal anti-inflammatory (NSAIDs)Actions: Anti-inflammatory, analgesicMajor side effects or toxic effects: dizziness, GI irritations, GI Bleeding and headacheNursing Care: patient is important to teach your patient not to take aspirin or aspirin products, give with milk or food and watch for signs of GI bleeding.Slow Acting Anti-inflammatoryAntimalarials - anti-inflammatory (action unknown) S/E - GI distress, retinal edema that can lead to blindness. Nursing Care: patient teaching on the importance of exam every 6 months.Gold Salts- anti-inflammatory. S/E - hepatic disturbances or damage. Nursing Care: monitor patient's complete blood count and UA.Anti-Gout MedicationsColchicines, butazolidine, allopurinol, probenecidActions: anti-inflammatory, analgesicSide effects or toxic effects: hematologic changes and GI irritationsNursing Care: administer medication with food or milk and keep in mind that Anti-Gout medications are used only on a short term basis.
- What Causes Musculoskeletal Pain?The causes of musculoskeletal pain are varied. Muscle tissue can be damaged with the wear and tear of daily activities. Trauma to an area (jerking movements, auto accidents, falls, fractures, sprains, dislocations, and direct blows to the muscle) also can cause musculoskeletal pain. Other causes of pain include postural strain, repetitive movements, overuse, and prolonged immobilization. Changes in posture or poor body mechanics may bring about spinal alignment problems and muscle shortening, therefore causing other muscles to be misused and become painful.What Are the Symptoms of Musculoskeletal Pain?People with musculoskeletal pain sometimes complain that their entire bodies ache. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch or burn. Symptoms vary from person to person, but the common symptoms are:PainFatigueSleep disturbancesYour doctor will conduct a thorough physical examination and medical history. In addition, your doctor may perform diagnostic studies to confirm the diagnosis.How Is Musculoskeletal Pain Diagnosed?Your doctor will conduct a thorough physical examination and medical history. In addition, your doctor may perform diagnostic studies to confirm the diagnosis.How Is Musculoskeletal Pain Treated?Different types of manual therapy, or mobilization, can be used to treat people with spinal alignment problems. For acute musculoskeletal pain, these techniques have been shown to speed recovery.In patients with musculoskeletal disorders such as fibromyalgia, medications to increase the body's level of serotonin and norepinephrine (neurotransmitters that modulate sleep, pain, and immune system function) are prescribed in low doses. Some of the medicines used to aid sleep include Ambien, Klonopin, and Desyrel.Other treatments may include:Injections with anesthetic or anti-inflammatory medications in or around the painful sitesExercise that includes muscle strengthening and stretchingPhysical or occupational therapyAcupuncture or acupressureRelaxation/biofeedback techniquesOsteopathic manipulation (a whole system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body)Chiropractic careTherapeutic massage
- Occurs most often after administration of antibiotics (penicillin and derivatives), and dyes used in diagnostic studies (iodine) or with any medications. Also occurs with insect stings, and foods (shellfish, peanuts, eggs)Anaphylaxis treatment can begin while you are waiting for medical help. Using an EpiPen, if the person has one, may alleviate symptoms, and even save a life. If there is no EpiPen, using an inhaler with Albuterol or another rescue inhaler, or taking an allergy medication with the ingredient Diphenhydramine, such as Benadryl, can help cut down on the severity of the symptoms.No matter what sort of anaphylaxis treatment you use, there is still the need for medical intervention. The possibility is there that symptoms could return a few hours after the initial attack. Being prepared and getting help can prevent it from getting out of control