Drugs Affecting Gastrointestinal, Endocrine and Renal Systems
Drugs Affecting Gastrointestinal, Endocrine and Renal Systems
Drugs Affecting Gastrointestinal, Endocrine and Renal Systems
SYSTEMS
This learning material deals with different drugs affecting gastrointestinal, endocrine and
renal systems. This module introduces the different classifications of medicines affecting
gastrointestinal, endocrine and renal systems. Emphasis is given on proper drug
administration, assessing drug effects, accurate intervention to achieve its therapeutic effect
and providing health education about the drug regimen to ensure safety in nursing practice as
well as treatment of illness and the promotion, maintenance and restoration of wellness in
diverse individuals across the life span.
Upon completion of this module, the learner is expected to demonstrate the following:
Pre-Test
MULTIPLE CHOICE
1. Which of the following statement from the patient taking Cholestyramine (Prevalite)
indicates further teaching?
a. “I will continue eating fibrous rich foods.”
b. “I will drink the cholestyramine faster for faster absorption.”
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
c. “The medication will help lower my cholesterol level.”
d. “I will continue taking my supplement.”
2. Which condition/s can you safely administer Metoclopramide (Reglan)?
a. Patient with bowel tumor.
b. Patient with gastrointestinal trauma.
c. Patient undergoing radiation.
d. Patients with pheochromocytoma.
3. Which of the following is the therapeutic effect of Misoprostol (Cytotec)?
a. Prevent constipation
b. Stop diarrhea
c. Relief of gastric ulcer
d. Induce vomiting
4. Which of the following is the most common CNS side effect of cimetidine (Tagamet)?
a. Anxiety
b. Agitation
c. Stupor
d. Somnolence
5. When giving a bolus of cimetidine (Tagamet) which of the following parameters
should be closely monitored?
a. Blood pressure
b. Respiratory rate
c. AST and ALT
d. Temperature. Skin turgor.
6. Loperamide hydrochloride is indicated for the following conditions?
a. Dysentery
b. Bloody Diarrhea
c. Pheochromocytoma
d. Patient with ileostomy
7. Ondansetron (Zofran) is given to which of the following conditions?
a. Post-operative pain
b. Post-operative vomiting
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
c. Prevention of infection
d. Prevention of lung collapse
8. When taking prednisolone which of the following food items should be avoided?
a. Canned foods
b. Peanuts
c. Bananas and oranges
d. Beef
9. When taking Glipizide (Glucotrol), which of the following should be avoided?
a. Alcohol
b. Coca cola
c. Milk
d. Juice
10. A nurse is teaching a patient on how to mix regular insulin and NPH insulin in the
same syringe. Which of the following actions, if performed by the patient, indicates
the need for further teaching?
a. Withdraws regular insulin first.
b. Withdraws NPH insulin first.
c. Injects an amount of air equivalent to the desired dose of insulin.
d. Injects air into the NPH insulin first.
Topic 1
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
ANTACIDS
Antacids are used to chemically react with and neutralize the acid in the stomach. They can
provide rapid relief from increased acid levels. They are known to cause GI alterations such
as diarrhea or constipation and can alter the absorption of many drugs.
Therapeutic actions
Adequate drug absorption. Administer the drug apart from any other oral medications
approximately 1 hour before or 2 hours after to ensure adequate absorption of the
other medications.
Ensure therapeutic levels. Have the patient chew tablets thoroughly and follow with
water to ensure that therapeutic levels reach the stomach to decrease acidity.
Perform diagnostic testing. Obtain specimens for periodic monitoring of
serum electrolytes to evaluate drug effects.
Prevent imbalances. Assess the patient for any signs of acid-base or electrolyte
imbalance to ensure early detection and prompt interventions.
Institute a bowel program. Monitor the patient for diarrhea or constipation to institute
a bowel program before severe effects occur.
Ensure adequate nutritional status. Monitor the patient’s nutritional status if diarrhea
is severe or constipation leads to decreased food intake to ensure adequate fluid and
nutritional intake to promote healing and GI stability.
Provide patient support. Offer support and encouragement to help the patient cope
with the disease and the drug regimen.
Educate the patient. Provide thorough patient teaching, including the drug name and
prescribed dose, schedule for administration, signs and symptoms of adverse effects
and measures to prevent or minimize them, warning signs that may indicate possible
problems and the need to notify the health care provider immediately.
HISTAMINE-2 ANTAGONIST
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
cimetidine Tagamet
ranitidine Zantac
Histamine-2 antagonists
famotidine Pepcid
nizatidine Axid
Description
Therapeutic actions
Indication
Ensure therapeutic levels. Administer drug with or before meals and at bedtime (exact
timing varies with product) to ensure therapeutic levels when the drug is most needed.
Prevent serious toxicity. Arrange for decreased dose in cases of hepatic or renal
dysfunction to prevent serious toxicity.
Monitor IV doses carefully. Monitor the patient continually if giving IV doses to
allow early detection of potentially serious adverse effects, including cardiac
arrythmias
Assess for potential drug-drug interactions. Assess the patient carefully for any
potential drug-drug interactions if given in combination with other drugs because of
the drug’s effects on liver enzyme systems.
Provide patient’s comfort. Provide comfort, including analgesics, ready to access
bathroom facilities, and assistance with ambulation, to minimize possible adverse
effects.
Reorient patient thoroughly. Periodically reorient the patient and institute safety
measures if CNS effects occur to ensure patient safety and improve and improve
patient tolerance of the drug and drug effects.
Attend regular follow-ups. Arrange for regular follow-up to evaluate drug effects and
the underlying problems.
Provide support. Offer support and encouragement to help patients cope with the
disease and the drug regimen.
Educate the client. Provide patient teaching regarding drug name, dosage, and
schedule for administration; importance of spacing administration appropriately as
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
ordered; need for readily available access to bathroom; signs and symptoms of
adverse effects and measures to minimize or prevent them.
dexlansoprazole Kapidex
esomeprazole Nexium
pantoprazole Protonix
rabeprazole Aciphex
Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of
the stomach.
Therapeutic actions
Indication
Proper administration. Administer drug before meals to ensure that the patient does
not open, chew, or crush capsules; they should be swallowed whole to ensure the
therapeutic effectiveness of the drug.
Safety and comfort measures. Provide appropriate safety and comfort measures if
CNS effects occur to prevent patient injury.
Institute a bowel program. Monitor the patient for diarrhea or constipation in order to
institute an appropriate bowel program as needed.
Monitor nutritional status. Monitor the patient’s nutritional status; use of small
frequent meals may be helpful if GI upset is a problem.
Ensure follow-up. Arrange for medical follow-up if symptoms are not resolved after 4
to 8 weeks of therapy because serious underlying conditions could be causing the
symptoms.
Provide patient support. Offer support and encouragement to help the patient cope
with the disease and the drug regimen.
Educate the patient and folks. Provide thorough patient teaching, including the drug
name and prescribed dosage; the importance of taking the drug whole without
opening, chewing, or crushing it; signs and symptoms of possible adverse effects and
measures to minimize or prevent them.
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
ADRENOCORTICAL AGENTS
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Adrenocortical agents are drugs used as short-term treatment to suppress immune
system in patients with inflammatory disorders.
They are also used for replacement therapy to maintain hormone levels when adrenal
glands are not functioning adequately. These agents are classified into three:
glucocorticoids, mineralocorticoids, and androgens.
beclomethasone Beclovent
betamethasone Celestone
hydrocortisone Cortef
methylprednisolone Medrol
prednisolone Delta-Cortef
fludrocortisone Florinef
Mineralocorticoids
hydrocortisone Cortef
GLUCOCORTICOIDS
Glucocorticoids are agents that stimulate an increase in glucose levels for energy. They also
increase the rate of protein breakdown and decrease the rate of protein formation from amino
acids to preserve energy. They are also capable of lipogenesis, or the formation and storage
of fat in the body for energy source.
Therapeutic Action
MINERALOCORTICOIDS
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Description
Therapeutic Action
Indications
ANTIDIABETIC DRUGS
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Antidiabetic drugs are a group of drugs structurally unrelated to sulfonylureas and are
effective when used in combination with insulin or sulfonylureas. These drugs include alpha-
glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 (DPP-4) inhibitors, human amylin,
incretin mimetics, meglitinides, and thiazolidinediones.
linagliptin Tradjenta
sitagliptin Januvia
exenatide Baraclude
Incretin mimetics
liraglutide Victoza
nateglinide Starlix
Meglitinides
repaglinide Prandin
pioglitazone Actos
Thiazolidinediones
rosiglitazone Avandia
Therapeutic Action
Indications
Biguanide metformin is approved for use in children 10 years of age and older. It is
also being used in the treatment of women with polycystic ovarian syndrome (PCOS).
Meglitinides nateglinide and repaglinide are used to lower postprandial glucose
levels because they are rapid-acting and with a very short half-life. They are taken
just before meals.
Thiazolidinediones pioglitazone and rosiglitazone are used in combination with
insulin, metformin, and sulfonylureas in patients with insulin resistance.
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Bromocriptine, a dopamine agonist used to treat Parkinson’s disease was approved
in 2009 as a CNS approach to treat type 2 diabetes.
Nursing Considerations
GLUCOSE-ELEVATING AGENTS
Therapeutic Action
Indications
HYPOTHALAMIC AGENTS
Hypothalamic agents can inhibit or stimulate the release of hormones from the
anterior pituitary using hormones or factors. However, not all of these hormones are
available for pharmacological use.
Stimulating factors (agonists) include growth hormone-releasing hormone (GHRH),
thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone
(GnRH), corticotropin-releasing hormone (CRH), and prolactin-releasing hormone
(PRH).
Factors that inhibit (antagonists) include somatostatin (growth hormone-inhibiting
factor) and prolactin-inhibiting factor.
Other drugs acting on the endocrine system include the following: pituitary agents,
adrenocortical agents, thyroid and parathyroid agents, and agents to control blood
glucose levels.
goserelin Zoladex
histrelin Vantas
nafarelin Synarel
tesamorelin Egrifta
degarelix
Antagonists
ganirelix Antagon
Therapeutic Action
Indications
Hypothalamic hormones are not all available for pharmacological use; those that are
available are used mostly for diagnostic testing, for treating some forms of cancer, or
as adjuncts in fertility programs.
Agonists like goserelin, histrelin, leuprolide, and nafarelin are analogues of GnRH.
They decrease production of sex hormones. They are used as treatment for precocious
puberty, endometriosis, and advanced prostate cancer.
Antagonists of GnRH like degarelix and ganirelix are used as treatment for advanced
prostate cancer and inhibition of premature LH surge in women undergoing
controlled ovarian stimulation for fertility.
Nursing Considerations
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
The specific nursing care of patient who is receiving hypothalamic releasing factor is
related to the hormone(s) that the drug is affecting. This will be discussed further as
each drug affecting certain hormones will be covered in this study guide.
INSULIN
Insulin is a drug that is used to control glucose in patients with diabetes mellitus. It is
the only parenteral antidiabetic agent available for exogenous replacement of low
levels of insulin.
Insulin is the hormone produced by the pancreatic beta cells of the islets of
Langerhans. It is released into circulation when the levels of glucose around the cells
arise. Insulin circulates through the body and reacts with specific insulin receptor
sites to stimulate the transport of glucose into cells to be used for energy
(facilitated diffusion).
Originally prepared from pork and beef pancreas, virtually all insulin is prepared by
recombinant DNA technology now. This is a purer form of insulin and is not
associated with sensitivity problems that many patients developed with the animal
products.
Therapeutic Action
Indications
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Ensure that patient has dietary and exercise regimen and using good hygiene
practices to improve the effectiveness of the insulin and decrease adverse effects of
the disease.
Monitor nutritional status to provide nutritional consultation as needed.
Gently rotate the vial containing the agent and avoid vigorous shaking to ensure
uniform suspension of insulin.
Rotate injection sites to avoid damage to muscles and to prevent subcutaneous
atrophy.
Monitor response carefully to avoid adverse effects.
Always verify the name of the insulin being given because each insulin has a different
peak and duration, and the names can be confused.
Use caution when mixing types of insulin; administer mixtures of regular and NPH
insulins within 15 minutes after combining them to ensure appropriate suspension and
therapeutic effect.
Store insulin in a cool place away from direct sunlight to ensure
effectiveness. Predrawn syringes are stable for 1 week if refrigerated.
Monitor patient’s food intake and exercise and activities to ensure therapeutic effect
and avoid hypoglycemia.
Monitor patient’s sensory losses to incorporate his or her needs into safety issues, as
well as potential problems in drawing up and administering insulin.
Provide good skin care and foot care, to prevent the development of serious infections
and changes in therapeutic insulin doses.
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance
patient knowledge and to promote compliance.
PARATHYROID AGENTS
Parathyroid agents are drugs used to treat disorders that affect serum calcium levels.
This can be either anti-hypocalcemic agent or anti-hypercalcemic agent (further
classified into bisphosphonates and calcitonins). The parathyroid glands are four very
small groups of glandular tissue located on the back of the thyroid gland. This
produce PTH and calcitonin to maintain body’s calcium balance. PTH is the most
important regulator of serum calcium levels in the body.
calcitriol Rocaltrol
Antihypocalcemic Agents
teriparatide Forteo
Antihypercalcemic Agents
ANTIHYPOCALCEMIC AGENTS
Therapeutic Action
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
A vitamin D compound that regulates the absorption of calcium and phosphate from
the small intestine, mineral resorption in bone, and reabsorption of phosphate from
renal tubules, increasing the serum calcium level.
Teriparatide stimulates new bone formation leading to increase in skeletal mass. It
increases serum calcium and decreases serum phosphorus.
Indications
ANTIHYPERCALCEMIC AGENTS
Therapeutic Action
Bisphosphonates slow normal and abnormal bone resorption without inhibiting bone
formation and mineralization.
Calcitonin inhibits bone resorption and lowers elevated serum calcium. It also
increases the excretion of filtered phosphate, calcium, and sodium by the kidney.
Indications
Ensure adequate hydration with any of these agents to reduce risk of renal
complications.
Arrange for concomitant vitamin D, calcium supplements, and hormone replacement
therapy if used to treat postmenopausal osteoporosis.
Rotate injection sites and monitor for inflammation if using calcitonins to prevent
tissue breakdown and irritation.
Monitor serum calcium before and periodically during treatment to allow for dose
adjustment.
Arrange for periodic blood tests of renal function if using gallium to monitor for renal
dysfunction.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance
patient knowledge and to promote compliance.
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
PITUITARY AGENTS
Pituitary agents include drugs affecting anterior (further divided into growth hormone
agonists and growth hormone antagonists) and posterior pituitary hormones.
Drugs that affect anterior pituitary hormones mimic or antagonize the effects of
specific pituitary hormones. They are used as replacement therapy, for diagnostic
purposes, and for blocking the effects of anterior pituitary hormones.
The anterior pituitary hormone that is most commonly used pharmacologically
is growth hormone (GH).
Nutropin, Saizen,
Growth Hormone Agonists somatropin
Humatrope
bromocriptine Parlodel
pegvisomant Somavert
corticotropin Acthar
Other Drugs Affecting Anterior
cosyntropin Cortrosyn
Pituitary Hormones
menotropin Pergonal
tolvaptan
Growth Hormone Agonists are responsible for linear skeletal growth, growth of
internal organs, protein synthesis, and stimulation of processes required for normal
growth.
Hypopituitarism is often seen as GH deficiency before any other signs and symptoms
occur. It occurs as a result of the following: developmental abnormalities, congenital
defects of the pituitary, circulatory disturbances (e.g., hemorrhage), acute or chronic
inflammation of the pituitary, and pituitary tumors.
Dwarfism is the GH deficiency in children which results to short stature.
Somatotropin deficiency syndrome (SDS) is a condition in adults with
hypopituitarism caused by pituitary tumors or trauma or may have been treated for
GH deficiency as children, resulting in a shutdown of the pituitary production of
somatotropin.
Therapeutic Action
Replacing human GH and stimulate skeletal growth, growth of internal organs, and
protein synthesis.
Indications
Therapeutic Action
Indications
Therapeutic Action
Pressor and antidiuretic effect by causing the cortical and medullary parts of the
collecting duct to become permeable to water, thereby increasing water reabsorption
and decreasing urine formation.
Increasing levels of clotting factor VIII
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Indications
Monitor patient fluid volume to watch for signs of water intoxication and fluid excess
or excessive fluid loss.
Monitor patient with vascular disease for any sign of exacerbation to provide for
immediate treatment.
Monitor condition of nasal passages if given intranasally to observe for nasal
ulceration, which can occur and could affect drug absorption.
Provide comfort measures to help patient cope with the drug effects.
Provide patient education about drug effects and warning signs to report to enhance
patient knowledge and to promote compliance.
SULFONYLUREAS
Sulfonylureas are another group of agents used to control blood glucose level. These
drugs are only effective in patients who have functioning beta cells. They are not
effective for all diabetics and may lose their effectiveness over time with others.
Sulfonylureas are further classified as first-generation or second-generation
sulfonylureas.
Use of first-generation sulfonylureas is declining as more effective drugs have
become available. Also, they are now thought to possibly cause an increase in
cardiovascular death.
Use of second-generation sulfonylureas have several advantages over first-generation,
including safer for patients with renal dysfunction as they are excreted in urine and
bile, absence of interaction to many protein-bound drugs, and longer duration of
action.
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
All of sulfonylureas can cause hypoglycemia.
chlorpropamide Diabinese
tolbutamide Orinase
glimepiride Amaryl
Therapeutic Action
Sulfonylureas stimulate insulin release from the beta cells in pancreas. They improve
insulin binding to insulin receptors and may actually increase the number of insulin
receptors.
They are also known to increase the effect of antidiuretic hormone on renal cells.
Indications
Sulfonylureas are used as adjunct to diet and exercise for the treatment of type
2 diabetes older than 10 years of age; extended-release form for patients older than 17
years of age; adjunct treatment with polycystic ovary syndrome.
THYROID AGENTS
Thyroid agents either replace or remove hormones to prevent deficiency and excess.
Thyroid agents include thyroid hormones (T3, T4, TSH) and antithyroid drugs
(further classified as thioamides and iodine solution).
Thyroid Agents
liotrix Thyrolar
Antithyroid Agents
methimazole Tapazole
Thioamides
propylthiouracil (PTU) –
THYROID HORMONES
Thyroid hormones are made available to replace the low or absent levels of natural
thyroid hormone and suppress the overproduction of TSH by the pituitary.
These can contain both natural and synthetic thyroid hormone.
Therapeutic Action
This is replacement hormone for hypothyroid states like myxedema coma, goiters,
and thyroid cancer increases the metabolic rate of body tissues, increasing oxygen
consumption, respiration, heart rate, growth and maturation, and the metabolism of
fats, carbohydrates, and proteins.
Levothyroxine, a synthetic salt of T4, is the most frequently used replacement
hormone because of its predictable bioavailability and reliability.
Indications
Replacement hormone for hypothyroid states like myxedema coma, goiters, and
thyroid cancer
Treatment for thyroid toxicity in conjunction with antithyroid drugs
Treatment for thyroid overstimulation during pregnancy
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Administer a single daily dose before breakfast each day to ensure consistent
therapeutic levels.
Administer with a full glass of water to prevent difficulty of swallowing
and esophageal atresia.
Monitor cardiac response to detect cardiac adverse effects.
Arrange for periodic blood tests of thyroid function to monitor the effectiveness of
the therapy.
Provide comfort measures (temperature control, rest as needed, safety precautions) to
help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance
patient knowledge and to promote compliance.
ANTITHYROID AGENTS
Antithyroid agents are drugs used to block the production of thyroid hormone and
treat hyperthyroidism.
This includes thioamides and iodide solutions. These groups of drugs are not
chemically related but they both block the formation of thyroid hormones within the
thyroid gland.
Therapeutic Action
Thioamides lower thyroid hormones by preventing the formation of thyroid hormone
in the thyroid cells. They also partially inhibit the conversion of T4 to T3 at cellular
level. Thioamides include propylthiouracil (PTU) and methimazole.
Iodine solutions in high doses block thyroid function. They cause the cells to become
oversaturated with iodine and stop producing hormones.
Indications
DRUGS AFFECTING GASTROINTESTINAL, ENDOCRINE AND RENAL
SYSTEMS
Treatment of hyperthyroidism
Thyroid blocking in a radiation emergency
Administer PTU three times a day, around the clock to ensure consistent therapeutic
levels.
Give iodine solution through a straw to decrease staining of teeth; tables can be
crushed.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance
patient knowledge and to promote compliance.
Post-Test
Activity
Choose at least five drugs then explain their mechanism of actions to diseases.
Reference
Kee, J., Hayes, E., & McCuistion, L. (2014). Pharmacology: A Patient-Centered Nursing
Process Approach (8th ed.). Elsevier Health Sciences.
Reflection
Reflect on the learning outcomes you have achieved after completing this module. State what
aspects that need to improve to attain the learning outcomes of the course.