Pharmacology, part 39: Gastrointestinal Medications - IBS Meds, GI Anti-inflammatory, Pancreatic Enzymes
by Cathy Parkes September 10, 2021 Updated: December 29, 2021 6 min read
This article wraps up our coverage of gastrointestinal medications, including IBS medications, gastrointestinal anti-inflammatory medications, and pancreatic enzymes.
The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
IBS (irritable bowel syndrome)
IBS medications include alosetron and lubiprostone.
Alosetron is for “loose” stools. Lubiprostone is for stone-like poop.
Alosetron mode of action
Alosetron is used for IBS with diarrhea. It works by blocking 5HT3 receptors, which increases the firmness of the stool and decreases the sense of urgency to defecate.
Alosetron side effects
The key side effect of alosetron is constipation. This medication has a black-box warning due to the complications of constipation as well as the risk for ischemic colitis, a temporary reduction in blood flow to part of the large intestine (colon).
Lubiprostone is an IBS medication used for IBS with constipation.
Lubiprostone mode of action
Lubiprostone works by increasing fluid secretion in the intestine and increasing intestinal motility.
Lubiprostone side effects
Side effects of lubiprostone can include diarrhea, nausea, and headache.
GI anti-inflammatory: sulfasalazine (Azulfidine)
Sulfasalazine is a GI anti-inflammatory medication that can be used to treat irritable bowel syndrome and other irritable bowel diseases, such as Crohn's disease (a chronic inflammatory bowel disease that affects the lining of the digestive tract) and ulcerative colitis (a chronic inflammatory bowel disease that causes inflammation in the digestive tract).
Sulfasalazine mode of action
Sulfasalazine works by inhibiting prostaglandin synthesis, which helps to decrease inflammation in the colon.
Sulfasalazine side effects
Other side effects can include GI upset, rash, headache, crystalluria (cloudy urine caused by crystals found in the urine), and fever.
Sulfasalazine nursing care
It is important to teach a patient on sulfasalazine that this medication may cause orange-yellow discoloration of their urine and/or skin. It's also important to monitor the patient's CBC levels during therapy due to the risk of blood dyscrasias.
Antiflatulent: simethicone (Gas-X)
Now that you ate an ice cream cone, you sure are gassy! Better go take some simethicone.
Simethicone is a medication that can offer relief from painful gas in the GI tract.
Simethicone mode of action
Simethicone causes the coalescence (merging) of gas bubbles. The medication works by reducing the surface tension of gas bubbles, allowing them to be expelled via flatulence or belching.
Simethicone side effects
Simethicone has no significant side effects.
Administer simethicone after meals and at bedtime.
Pancreatic enzymes for digestion: pancrelipase (Pancrease)
Pancrelipase helps break down food when your pancreas isn’t getting the job done.
The pancreas plays an important role in digestion, bringing digestive enzymes into the intestine. If the pancreas isn't working properly, then the intestines are not getting those digestive enzymes.
Pancrelipase mode of action
Pancrelipase is a pancreatic enzyme that can be administered when a patient has pancreatic insufficiency due to a disorder such as cystic fibrosis or pancreatitis, or if they've had GI bypass surgery. It contains lipase (a protein that helps the body absorb fats), amylase (an enzyme that catalyzes the hydrolysis of starch into sugars), and protease (an enzyme that helps break down protein in food into amino acids), which facilitate the digestion of fat, carbohydrates, and proteins in the GI tract.
Pancrelipase side effects
The side effects of this medication can include diarrhea, nausea, and abdominal pain.
Patients should be instructed to take pancrelipase immediately before or with their meals and snacks to allow for digestion. Also, it is important to advise patients to swallow the pills whole — they should not crush them. If they have difficulty swallowing the pills, open up the capsules and sprinkle the medication on applesauce, to make it easier (and tastier) to administer.
Hi, I'm Cathy with Level Up RN. In this video, I'm going to wrap up my coverage of gastrointestinal medications, including IBS medications, gastrointestinal anti-inflammatory medications, and pancreatic enzymes. At the end of the video, I'm going to provide you guys a quick quiz to test your knowledge of some of the facts I'll be covering in this video, so definitely stay tuned for that. If you have our pharmacology, second edition flashcards, definitely pull those out, so you can follow along. I won't be covering every single medication or fact in these flashcards, but I'll definitely try to hit the highlights.
Let's begin with our irritable bowel syndrome medications or IBS medications. IBS can cause diarrhea or constipation or sometimes a combination of both.
So one IBS medication to know is Alosetron. Alosetron is used for IBS with diarrhea, and it works by increasing the firmness of the stool and decreasing the sense of urgency to defecate. The key side effect with this medication is constipation. And in fact, this medication has a black-box warning due to the complications of constipation and the risk for ischemic colitis. Another IBS medication is lubiprostone. And lubiprostone is used for IBS with constipation. So it works by increasing fluid secretion in the intestine and increasing intestinal motility. Side effects can include diarrhea, nausea, and headache. So the way I remember these medications and our little cool chicken hint here on the card is that Alosetron, which is spelled A-L-O-S-E is for loose stools, and lubiprostone, which ends in that stone is for stone-like poop, so constipation. So hopefully that tip is helpful for you as well.
Next, we have sulfasalazine, which is a GI anti-inflammatory medication. It can be used to treat irritable bowel syndrome. It can also be used to treat irritable bowel diseases such as Crohn's disease and ulcerative colitis. It works by inhibiting prostaglandins synthesis, which helps to decrease inflammation in the colon. Side effects can include blood dyscrasias. So this includes anemia as well as agranulocytosis. So agranulocytosis is where we have a decrease in the number of granulocyte, which are a type of white blood cell. Other side effects can include GI upset, rash, headache, crystal urea, and fever. So some important patient teaching we want to do for a patient on sulfasalazine is that this medication may cause orange-yellow discoloration of their urine and or skin. Also, we're going to want to monitor their CBC levels during therapy due to that risk of blood dyscrasias.
Next, we have pancreatic enzymes, including pancrelipase. Pancrelipase is used when a patient has pancreatic insufficiency due to a disorder such as cystic fibrosis or pancreatitis, or if they've had GI bypass surgery. So the pancreas plays an important role in digestion, right? It brings digestive enzymes into the intestine. So if our pancreas isn't working well, then our intestines are not getting those digestive enzymes. So this is where this medication comes in. It is there to help with digestion of fat, carbohydrates, and protein. So side effects of this medication can include diarrhea, nausea, and abdominal pain. We want to provide teaching for our patients because they need to take this medication immediately before or with their meals and snacks to allow for that for that digestion. Also, we want to advise our patients to swallow the pills whole, so they should not crush them. If they have difficulty swallowing the pills, you can open up the capsules and kind of sprinkle them on applesauce, and they can take it that way.
So our cool chicken hint for remembering this medication. If you look at the medication name, it is pancrelipase, and it starts with that pancre, which helps you to remember the pancreas, and that this medication is used when the pancreas isn't getting its job done right. All right, so that is it for our GI medications, and are you guys ready for your quiz? I have three questions for you.
First question. What IBS medication carries the risk for constipation and ischemic colitis? The answer is Alosetron. Second question. What medication is used to improve digestion in patients with cystic fibrosis? The answer is pancrelipase. Third question. When should pancrelipase be taken? Answer is should be taken immediately before or with meals and snacks. Okay. I hope this video has been helpful. Hope you're enjoying these little quizzes at the end of the video. If so, be sure to leave me a comment and be sure to like this video as well. Take care.
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