Skip to main content

Medications Used for the Gastrointestinal System

  • Chapter
  • First Online:
Understanding Pharmacology in Nursing Practice

Abstract

Gastrointestinal disturbances such as constipation, increased stomach acidity, nausea and vomiting are common place occurrences. Medications effective for these conditions are frequently obtained ‘over-the-counter’ (OTC). Use of these medications is, however, associated with several inherent risks. This chapter examines the basic mechanism of action of commonly used medications used for constipation, gastric acidity and nausea and vomiting. This discussion is related to clinical practice and the adverse reactions that may occur.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alliët P, Devos E (1994) Ranitidine-induced bradycardia in a neonate—secondary to congenital long QT interval syndrome? Eur J Pediatr 153(10):781

    Article  PubMed  Google Scholar 

  • Arbex MA, Varella Mde C, Siqueira HR, Mello FA (2010) Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 1: first-line drugs. J Bras Pneumol 36(5):626–640

    Article  PubMed  Google Scholar 

  • Arnestad M, Eldor KB, Stray-Pedersen A, Bachs L, Karinen R (2014) Suicide due to cyclizine overdose. J Anal Toxicol 38(2):110–112

    Article  CAS  PubMed  Google Scholar 

  • Ba-Bai-Ke-Re MM, Wen NR, Hu YL, Zhao L, Tuxun T, Husaiyin A, Sailai Y, Abulimiti A, Wang YH, Yang P (2014) Biofeedback-guided pelvic floor exercise therapy for obstructive defaecation: an effective alternative. World J Gastroenterol 20(27):9162–9169

    PubMed  PubMed Central  Google Scholar 

  • Bailey F, Davies A (2008) The misuse/abuse of antihistamine antiemetic medication (cyclizine) by cancer patients. Palliat Med 22(7):869–871

    Article  CAS  PubMed  Google Scholar 

  • Botch-Jones SR, Johnson R, Kleinschmidt K, Bashaw S, Ordonez J (2014) Diphenhydramine’s role in death investigations: an examination of diphenhydramine prevalence in 2 US geographical areas. Am J Forensic Med Pathol 35(3):181–185

    Article  PubMed  Google Scholar 

  • Buffery PJ, Strother RM (2015) Domperidone safety: a mini-review of the science of QT prolongation and clinical implications of recent global regulatory recommendations. N Z Med J 128(1416):66–74

    PubMed  Google Scholar 

  • Christofaki M, Papaioannou A (2015) Ondansetron: a review of pharmacokinetics and clinical experience in postoperative nausea and vomiting. Expert Opin Drug Metab Toxicol 10(3):437–444

    Article  CAS  Google Scholar 

  • Costilla VC, Foxx-Orenstein AE (2014) Constipation: understanding mechanisms and management. Clin Geriatr Med 30(1):107–115

    Article  PubMed  Google Scholar 

  • Crauwels H, Van Heeswijk RPG, Stevens M, Buelens A, Vanveggel S, Boven K, Hoetelmans R (2013) Clinical perspective on drug-drug interactions with the non-nucleoside reverse transcriptase inhibitor rilpivirine. AIDS Rev 15(2):87–101

    PubMed  Google Scholar 

  • De Ruigh A, Roman S, Chen J, Pandolfino JE, Kahrilas PJ (2014) Gaviscon Double Action Liquid (antacid & alginate) is more effective than antacid in controlling post-prandial oesophageal acid exposure in GERD patients: a double-blind crossover study. Aliment Pharmacol Ther 40(5):531–537

    PubMed  PubMed Central  Google Scholar 

  • Del Rosso JQ (2009) Oral antibiotic drug interactions of clinical significance to dermatologists. Dermatol Clin 27(1):91–94

    Google Scholar 

  • Doggrell SA, Hancox JC (2014) Cardiac safety concerns for domperidone, an antiemetic and prokinetic, and galactogogue medicine. Expert Opin Drug Saf 13(1):131–138

    Article  CAS  PubMed  Google Scholar 

  • Ehrenpreis ED, Roginsky G, Alexoff A, Smith DG (2017) Domperidone is commonly prescribed with QT-interacting drugs: review of a community-based practice and a postmarketing adverse drug event reporting database. J Clin Gastroenterol 51(1):56–62

    Article  CAS  PubMed  Google Scholar 

  • Erbe S, Bschor T (2013) Diphenhydramine addiction and detoxification. A systematic review and case report. Psychiatr Prax 40(5):248–251

    Article  PubMed  Google Scholar 

  • Eslick GD, Talley NJ (2016) Prevalence and relationship between gastrointestinal symptoms among individuals of different body mass index: a population-based study. Obes Res Clin Pract 10(2):143–150

    Article  PubMed  Google Scholar 

  • Farhat K, Iqbal J, Waheed A, Mansoor Q, Ismail M, Pasha AK (2015) Association of anti-emetic efficacy of ondansetron with G2677T polymorphism in a drug transporter gene ABCB1 in Pakistani population. J Coll Physicians Surg Pak 25(7):486–490

    PubMed  Google Scholar 

  • Geboes K, Spiessens C, Nijs G, De Witte P (1993) Anthranoids and the mucosal immune system of the colon. Pharmacology 47(Suppl 1):49–57

    Article  CAS  PubMed  Google Scholar 

  • Gochfeld M (2017) Sex differences in human and animal toxicology: toxicokinetics. Toxicol Pathol 45(1):172–189

    Article  PubMed  Google Scholar 

  • Gordon M, Naidoo K, Akobeng AK, Thomas AG (2012) Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev 11(7):CD009118

    Google Scholar 

  • Gray JR (2011) What is chronic constipation? Definition and diagnosis. Can J Gastroenterol 25(Suppl B):7B–10B

    Article  PubMed  PubMed Central  Google Scholar 

  • Guijarro P, Viqueira A, Alonso-Babarro A, Fernandez G (2010) Health-related quality of life in opioid induced constipation patients in Spain. Value in health. In: Conference: ISPOR 13th Annual European Congress, Prague, Czech Republic, vol 13(7), p A373

    Google Scholar 

  • Hatting NP, Hansen PM (2017) Intentional suicide with cyclizine. Ugeskr Laeger 179(14):V01170022

    PubMed  Google Scholar 

  • Huybrechts KF, Hernández-Díaz S, Straub L, Gray KJ, Zhu Y, Patorno E, Desai RJ, Mogun H, Bateman BT (2018) Association of maternal first-trimester ondansetron use with cardiac malformations and oral clefts in offspring. J Am Med Assoc 320(23):2429–2437

    Article  CAS  Google Scholar 

  • Ikarashi N, Baba K, Ushiki T et al (2011) The laxative effect of bisacodyl is attributable to decreased aquaporin-3 expression in the colon induced by increased PGE2 secretion from macrophages. Am J Physiol Gastrointest Liver Physiol 01:G887–G895

    Article  CAS  Google Scholar 

  • Kang HJ, Loftus S, Taylor A, DiCristina C, Green S, Zwaan CM (2015) Aprepitant for the prevention of chemotherapy-induced nausea and vomiting in children: a randomised, double-blind, phase 3 trial. Lancet Oncol 16(4):385–394

    Article  CAS  PubMed  Google Scholar 

  • Kaplan YC, Richardson JL, Keskin-Arslan E, Erol-Coskun H, Kennedy D (2019) Use of ondansetron during pregnancy and the risk of major congenital malformations: a systematic review and meta-analysis. Reprod Toxicol 5(86):1–13

    Article  CAS  Google Scholar 

  • Khalid U, Thomas K, Lalji A, Andreyev J (2009) The use and efficacy of sterculia for patients with defaecatory disorders. In: Annual meeting of the British Society of Gastroenterology, Glasgow, United Kingdom. Conference publication, pp A86–A87

    Google Scholar 

  • Khan EU (2010) Medicine management: pharmacokinetic update for community nurses. Br J Community Nurs 15(9):436–444

    Article  PubMed  Google Scholar 

  • Krammer H, Thomann AK, Rustemeyer T, Ehehalt R (2014) Constipation and myth of laxative abuse. Verdauungskrankheiten 32(3):138–146

    Article  Google Scholar 

  • Lee-Robichaud H, Thomas K, Morgan J, Nelson RL (2010) Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev 7(7):CD007570. https://doi.org/10.1002/14651858.CD007570.pub2

    Article  Google Scholar 

  • Leung L, Riutta T, Kotecha J, Rosser W (2011) Chronic constipation: an evidence-based review. J Am Board Fam Med 24(4):436–451

    Article  PubMed  Google Scholar 

  • Li G, Cheng G, Wu J, Zhou X, Liu P, Sun C (2013) Drug-induced long QT syndrome in women. Adv Ther 30(9):793–802

    Article  CAS  PubMed  Google Scholar 

  • Makari J, Cameron K, Battistella M (2014) Domperidone-associated sudden cardiac death in the general population and implications for use in patients undergoing hemodialysis: a literature review. Can J Hosp Pharm 67(6):441–446

    PubMed  PubMed Central  Google Scholar 

  • Maughan RJ (2012) Hydration, morbidity, and mortality in vulnerable populations. Nutr Rev 70(Suppl 2):S152–S155

    Article  PubMed  Google Scholar 

  • May G, Kumar R (2006) Best evidence topic report. Use of intravenous cyclizine in cardiac chest pain. Emerg Med J 23(1):61–62

    Article  PubMed  PubMed Central  Google Scholar 

  • Mezoff EA, Cohen MB (2013) Acid suppression and the risk of Clostridium difficile infection. J Pediatr 163(3):627–630

    Article  PubMed  PubMed Central  Google Scholar 

  • Mishriky BM, Habib AS (2012) Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis. Br J Anaesth 108(3):374–383

    Article  CAS  PubMed  Google Scholar 

  • Moynihan PJ, Ferrier S, Blomley S, Wright WG, Russell RRB (1998) Acid production from lactulose by dental plaque bacteria. Lett Appl Microbiol 27(3):173–177

    Article  CAS  PubMed  Google Scholar 

  • Nagahara A, Asaoka D, Hojo M, Oguro M, Shimada Y, Ishikawa D, Osada T, Kawabe M, Yoshizawa T, Otaka M, Watanabe S (2010) Observational comparative trial of the efficacy of proton pump inhibitors versus histamine-2 receptor antagonists for uninvestigated dyspepsia. J Gastroenterol Hepatol 25:S122–S128

    Article  CAS  PubMed  Google Scholar 

  • Nath A, Haktanirlar G, Varga Á, Molnár MA, Albert K, Galambos I, Koris A, Vatai G (2018) Biological activities of lactose-derived prebiotics and symbiotic with probiotics on gastrointestinal system. Medicina (Kaunas) 54(2):E18

    Article  Google Scholar 

  • Niebyl JR, Briggs GG (2014) The pharmacologic management of nausea and vomiting of pregnancy. J Fam Pract 63(2 Suppl):S31–S37

    PubMed  Google Scholar 

  • Ogawa R, Echizen H (2010) Drug-drug interaction profiles of proton pump inhibitors. Clin Pharmacokinet 49(8):509–533

    Article  CAS  PubMed  Google Scholar 

  • Ogawa R, Echizen H (2011) Clinically significant drug interactions with antacids: an update. Drugs 71(14):1839–1864

    Article  CAS  PubMed  Google Scholar 

  • Onifer DJ, Butler FK, Gross KR, Otten EJ, Patton R, Russell RJ, Stockinger Z, Burrell E (2015) Replacement of promethazine with ondansetron for treatment of opioid- and trauma-related nausea and vomiting in tactical combat casualty care. J Spec Oper Med 15(2):17–24

    PubMed  Google Scholar 

  • Poluzzi E, Raschi E, Godman B, Koci A, Moretti U, Kalaba M, Wettermark B, Sturkenboom M, De Ponti F (2015) Pro-arrhythmic potential of oral antihistamines (H1): combining adverse event reports with drug utilization data across Europe. PLoS One 10(3):e0119551

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Poluzzi E, Diemberger I, De Ridder M, Koci A, Clo M, Oteri A, Pecchioli S, Bezemer I, Schink T, Pilgaard Ulrichsen S, Boriani G, Sturkenboom MCJ, De Ponti F, Trifirò G (2017) Use of antihistamines and risk of ventricular tachyarrhythmia: a nested case-control study in five European countries from the ARITMO project. Eur J Clin Pharmacol 73(11):1499–1510

    Article  CAS  PubMed  Google Scholar 

  • Roberts RL, Begg EJ, Joyce PR, Kennedy MA (2002) How the pharmacogenetics of cytochrome P450 enzymes may affect prescribing. N Z Med J 115(1150):137–140

    PubMed  Google Scholar 

  • Roila F, Del Favero A (1995) Ondansetron clinical pharmacokinetics. Clin Pharmacokinet 29(2):95–109

    Article  CAS  PubMed  Google Scholar 

  • Ruston T, Hunter K, Cummings G, Lazarescu A (2013) Efficacy and side-effect profiles of lactulose, docusate sodium, and sennosides compared to PEG in opioid-induced constipation: a systematic review. Can Oncol Nurs J 23(4):236–246

    Article  PubMed  Google Scholar 

  • Sahota SS, Bramley PM, Menzies IS (1982) The fermentation of lactulose by colonic bacteria. J Gen Microbiol 128(2):319–325

    CAS  PubMed  Google Scholar 

  • Schmidt FM, Santos VL, Domansky Rde C, Barros E, Bandeira MA, Tenório MA, Jorge JM (2015) Prevalence of self-reported constipation in adults from the general population. Rev Esc Enferm USP 49(3):440–449

    Article  Google Scholar 

  • Shen YD, Chen CY, Wu CH, Cherng YG, Tam KW (2015) Dexamethasone, ondansetron, and their combination and postoperative nausea and vomiting in children undergoing strabismus surgery: a meta-analysis of randomized controlled trials. Pediatr Anesth 24(5):490–498

    Article  Google Scholar 

  • Shi W, Xu X, Zhang Y, Guo S, Wang J, Wang J (2015) Epidemiology and risk factors of functional constipation in pregnant women. PLoS One 10(7):e0133521

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Spears DA, Gollob MH (2015) Genetics of inherited primary arrhythmia disorders. Appl Clin Genet 18(8):215–233

    Google Scholar 

  • Stevens AJ, Woodman RJ, Owen H (2015) The effect of ondansetron on the efficacy of postoperative tramadol: a systematic review and meta-analysis of a drug interaction. Anaesthesia 70(2):209–218

    Article  CAS  PubMed  Google Scholar 

  • Taba Taba Vakili S, Nezami BG, Shetty A, Chetty VK, Srinivasan S (2015) Association of high dietary saturated fat intake and uncontrolled diabetes with constipation: evidence from the National Health and Nutrition Examination Survey. Neurogastroenterol Motil 27(10):1389–1397

    Article  CAS  PubMed  Google Scholar 

  • Talley NJ, Vakil N (2005) Guidelines for the management of dyspepsia. Am J Gastroenterol 100(10):2324–2337

    Article  PubMed  Google Scholar 

  • Teng M, Khoo AL, Zhao YJ, Lin L, Lim BP, Wu TS, Dan YY (2015) Meta-analysis of the effectiveness of esomeprazole in gastroesophageal reflux disease and Helicobacter pylori infection. J Clin Pharm Ther 40(4):368–375

    Article  CAS  PubMed  Google Scholar 

  • Thomas E, Wade A, Crawford G, Jenner B, Levinson N, Wilkinson J (2014) Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action)—a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 39(6):595–602

    Article  CAS  PubMed  Google Scholar 

  • Trottier M, Erebara A, Bozzo P (2012) Treating constipation during pregnancy. Can Fam Physician 58(8):836–838

    PubMed  PubMed Central  Google Scholar 

  • Vazquez RM, Bouras EP (2015) Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging 2(10):919–930

    Google Scholar 

  • Vella-Brincat JW, Begg E, Jensen BP, Chin PK, Roberts RL, Fairhall M, Macleod SA, Reid K (2012) The pharmacokinetics and pharmacogenetics of the antiemetic cyclizine in palliative care patients. J Pain Symptom Manag 43(3):540–548

    Article  CAS  Google Scholar 

  • Waade RB, Hermann M, Moe HL, Molden E (2014) Impact of age on serum concentrations of venlafaxine and escitalopram in different CYP2D6 and CYP2C19 genotype subgroups. Eur J Clin Pharmacol 70(8):933–940

    Article  CAS  PubMed  Google Scholar 

  • Wang ZY, Chen M, Zhu LL, Yu LS, Zeng S, Xiang MX, Zhou Q (2015) Pharmacokinetic drug interactions with clopidogrel: updated review and risk management in combination therapy. J Therap Clin Risk Manag 11:449–467

    CAS  Google Scholar 

  • Wedemeyer RS, Blume H (2014) Pharmacokinetic drug interaction profiles of proton pump inhibitors: an update. Drug Saf 4:201–211

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ehsan Khan .

Editor information

Editors and Affiliations

Appendices

Multiple Choice Questions

  1. 1.

    Laxatives may lead to a number of biochemical abnormalities. Select one abnormality that may be aggravated by a bulk forming laxative:

    1. (a)

      Dehydration

    2. (b)

      Hyperkalaemia

    3. (c)

      Oedema

    4. (d)

      Hypoglycaemia

  2. 2.

    Most laxatives depend upon this principle for their action:

    1. (a)

      Mucosal irritation

    2. (b)

      Receptor antagonism

    3. (c)

      Osmosis

    4. (d)

      Sympathetic agonism

  3. 3.

    Some laxatives share this effect with some antacids:

    1. (a)

      Dehydration

    2. (b)

      Chelation

    3. (c)

      Acidosis

    4. (d)

      Muscle fatigue

  4. 4.

    Proper laxative dose titration and patient hydration can reduce the risk of:

    1. (a)

      Constipation

    2. (b)

      Urinary retention

    3. (c)

      Laxative dependence

    4. (d)

      Laxative tolerance

  5. 5.

    Which form of substance added to antacids neutralises stomach acid?

    1. (a)

      Salt

    2. (b)

      Base

    3. (c)

      Lipophilic solution

    4. (d)

      Milk

  6. 6.

    Antacids are commonly known to bind with which form of medication and reduce its absorption from the intestine?

    1. (a)

      Calcium channel blockers

    2. (b)

      Beta-blockers

    3. (c)

      Broncho-dilators

    4. (d)

      Antibiotics

  7. 7.

    Proton pump inhibitors block the transport of which ion into the gastric lumen?

    1. (a)

      K+

    2. (b)

      Na+

    3. (c)

      Cl

    4. (d)

      H+

  8. 8.

    Medications such as omeprazole should be monitored for drug–drug interactions because they are:

    1. (a)

      Strongly plasma bound

    2. (b)

      Nephrotoxic

    3. (c)

      Metabolised by CYP3A4

    4. (d)

      Hydrophilic

  9. 9.

    Some anti-histamine anti-emetics may increase the risk of which adverse effect?

    1. (a)

      Headache

    2. (b)

      Urinary retention

    3. (c)

      QT prolongation

    4. (d)

      Insomnia

  10. 10.

    The action of cyclizine on these structures enables it to alleviate motion sickness:

    1. (a)

      Eye and nose

    2. (b)

      Basal ganglia

    3. (c)

      Visual cortices

    4. (d)

      Vestibular organs

  11. 11.

    In which trimester of pregnancy are most anti-emetics contraindicated?

    1. (a)

      First

    2. (b)

      Second

    3. (c)

      Third

    4. (d)

      None

  12. 12.

    Domperidone and metoclopramide both work on which receptor for their main anti-emetic function?

    1. (a)

      Cholinergic

    2. (b)

      Serotonin

    3. (c)

      Dopamine

    4. (d)

      NK1

Answers

1. a

2. c

3. b

4. c

5. b

6. d

7. d

8. c

9. c

10. d

11. a

12. c

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Khan, E. (2020). Medications Used for the Gastrointestinal System. In: Hood, P., Khan, E. (eds) Understanding Pharmacology in Nursing Practice . Springer, Cham. https://doi.org/10.1007/978-3-030-32004-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-32004-1_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-32003-4

  • Online ISBN: 978-3-030-32004-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics