NUR198 Exam 5 · GI Medications Cheat-Sheet

🎯 The whole GI unit in one line: Antibiotics fight infection (appendicitis, diverticulitis, H. pylori) · reduce acid + protect the lining for ulcers/GERD · anti-inflammatories & immunosuppressants calm autoimmune disease (Crohn's/UC) · for IBS, match the drug to the symptom.

🔥 Reduce / Neutralize Acid

GERD · gastritis · PUD — let the lining heal

Drug / class	What it does & key nursing point
PPIs (–prazole)	omeprazole, pantoprazole, esomeprazole. Block the proton pump = strongest, longest acid drop. Take before meals. Long-term: ↓B12/Mg/Ca, ↑C. diff & fracture risk.
H2 blockers (–tidine)	famotidine. Block histamine → less acid. Weaker/shorter than PPIs. Good at bedtime.
Antacids	calcium carbonate (Tums), aluminum/magnesium hydroxide (Maalox). Neutralize acid already there — fast, short. ⚠️ Separate from other meds by 1–2 h (blocks absorption). Aluminum → constipation, magnesium → diarrhea.

🦠 Kill H. pylori

The #1 cause of ulcers — eradicate it and the ulcer heals

Drug / class	What it does & key nursing point
Triple therapy (10–14 days)	PPI + clarithromycin + amoxicillin (use metronidazole if penicillin-allergic). PPI lowers acid so antibiotics + healing work.
Quadruple therapy	PPI + bismuth subsalicylate + metronidazole + tetracycline — used when there's resistance. Bismuth → harmless black stool/tongue.
Teaching	⚠️ FINISH the entire antibiotic course or it comes back / builds resistance. Retest (breath or stool) 4+ weeks after to confirm it's gone.

🛡️ Protect the Mucosa

Coat and shield the ulcer

Drug / class	What it does & key nursing point
Sucralfate (Carafate)	Forms a protective barrier over the ulcer. Take on an empty stomach, and separate from antacids/other meds by ~2 h.
Misoprostol	Prostaglandin analog — protects the lining, prevents NSAID-induced ulcers. ⚠️ Contraindicated in pregnancy (causes uterine contractions).

🤢 Nausea / Vomiting

Antiemetics

Drug / class	What it does & key nursing point
Ondansetron (Zofran)	5-HT3 blocker — very common. ⚠️ Watch QT prolongation.
Metoclopramide (Reglan)	Speeds gastric emptying. ⚠️ Can cause EPS / tardive dyskinesia.
Promethazine (Phenergan)	Effective but sedating; ⚠️ irritating to veins (give slow, diluted).

🌀 IBS — Match the Symptom

No inflammation — you're treating the symptom, not damage

Drug / class	What it does & key nursing point
Diarrhea (IBS-D)	loperamide (Imodium) slows the gut; rifaximin; alosetron (restricted, severe cases).
Constipation (IBS-C)	lubiprostone (Amitiza), linaclotide (Linzess) — pull water into the intestine; plus fiber.
Cramping / pain	Antispasmodics: dicyclomine (Bentyl), hyoscyamine. Low-dose amitriptyline (TCA) for pain/motility.

💊 Infection — Antibiotics

Appendicitis · diverticulitis · peritonitis

Drug / class	What it does & key nursing point
Diverticulitis	metronidazole (Flagyl) + ciprofloxacin, or amoxicillin-clavulanate (Augmentin). ⚠️ Avoid NSAIDs (raise perforation/bleed risk).
Appendicitis (peri-op)	cefoxitin or piperacillin-tazobactam. Support only — surgery removes the cause.
Metronidazole (Flagyl)	⚠️ NO alcohol — disulfiram reaction (severe flushing, vomiting).
Ciprofloxacin	⚠️ Separate from antacids/dairy; tendon-rupture & photosensitivity risk.

🎗️ IBD — Crohn's & Ulcerative Colitis

Calm the immune attack (this is where toxic megacolon comes from)

Drug / class	What it does & key nursing point
Aminosalicylates (5-ASA)	sulfasalazine, mesalamine — first-line anti-inflammatory for mild–moderate. Sulfasalazine: ↑fluids, harmless orange urine, sulfa-allergy caution, add folic acid.
Corticosteroids	prednisone, IV methylprednisolone — for flares, short-term. ⚠️ Watch glucose & infection; don't stop abruptly (taper).
Immunomodulators	azathioprine, 6-MP, methotrexate — monitor CBC & for infection.
Biologics	infliximab (Remicade), adalimumab (Humira) — ⚠️ screen for TB before starting; infection risk.
Toxic megacolon	IV steroids + antibiotics + fluids. ⚠️ STOP antidiarrheals / anticholinergics / opioids — they trigger it. Surgery (colectomy) if no improvement.

🚽 Constipation & Diarrhea

Move it, soften it, or slow it

Drug / class	What it does & key nursing point
Bulk-forming	psyllium (Metamucil) — take with plenty of water.
Stool softener	docusate (Colace).
Osmotic	PEG (MiraLAX), lactulose — pull water into stool.
Stimulant	senna, bisacodyl — ⚠️ short-term only (dependence).
Antidiarrheals	loperamide, diphenoxylate-atropine. ⚠️ Do NOT use in infectious diarrhea, UC flare, or toxic megacolon.

🥤 Nutrition Support

When the gut can't be used

Drug / class	What it does & key nursing point
TPN	Hypertonic nutrition via a central line. ⚠️ Monitor blood glucose, use sterile care (infection = #1 risk), never stop abruptly (rebound hypoglycemia — taper), daily weights.