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Antispasmodics (GI spasms): Nursing Pharmacology

Notes

Notes

GASTROINTESTINAL ANTISPASMODICS
DRUG NAME
dicyclomine (Bentyl); 
hyoscyamine (Symax, HyoMax, Anaspaz)
CLASS
Gastrointestinal antispasmodics; Anticholinergics
MECHANISM OF ACTION
  • Bind to the muscarinic receptors on the gastrointestinal smooth muscles and block acetylcholine from binding to them
  • Decrease smooth muscle contraction and relieve spasm
INDICATIONS
  • Irritable bowel syndrome
  • Biliary colic
  • Pancreatitis
ROUTE(S) OF ADMINISTRATION
  • Dicyclomine: PO
  • Hyoscyamine: PO, SL
SIDE EFFECTS
  • Blurred vision
  • Dry mouth
  • Decreased sweating
  • Urinary retention
  • Constipation
  • Headaches
  • Dizziness
  • Tachycardia
CONTRAINDICATIONS AND CAUTIONS
  • Severe ulcerative colitis
  • Stenosing peptic ulcer
  • Paralytic ileus
  • Gastrointestinal obstruction
  • Toxic megacolon
  • Prostatic hypertrophy
  • Bladder obstruction
  • Narrow-angle glaucoma
  • Myasthenia gravis
  • Cardiovascular disease
  • Hypertension
  • Pregnancy and breastfeeding
  • Elderly clients
  • Hepatic and renal disease
NURSING CONSIDERATIONS: GASTROINTESTINAL ANTISPASMODICS
ASSESSMENT AND MONITORING
Assessment
  • Vital signs, fluid intake and output, current gastrointestinal symptoms
  • Laboratory test results: renal and hepatic function
  • Diagnostic test results: endoscopy, colonoscopy, or CT scan

Monitoring
  • Side effects
  • Therapeutic response: decrease in symptoms of irritable bowel syndrome
CLIENT EDUCATION
  • Purpose of medication: relieve gastrointestinal spasms
  • Self-administration
    • Take four times a day with plenty of water; at same time each day
  • Side effects
    • Urinary retention
      • Empty bladder before taking their medication
      • Empty their bladder regularly
      • Report: pain or burning during urination; flank pain, frequent need to urinate with small output
    • Dry mouth
      • Sugar-free candy or gum
      • Frequent sips of water
    • Decreased ability to sweat
      • Caution when exercising or during hot weather
    • Immediately seek medical attention for an increased temperature with flushed or red skin; altered mental status; rapid or pounding heartbeat; extremely dry mucous membranes, blurry vision
  • Lifestyle modifications
    • Increase dietary fiber
    • Avoid common gas-producing foods
    • Keep a diary to identify IBS triggers
Transcript

Gastrointestinal antispasmodics are medications used to treat spasms of the gastrointestinal tract muscles, which can occur in diseases like irritable bowel syndrome, or IBS for short, biliary colic, and pancreatitis.

The most commonly used gastrointestinal antispasmodics include antimuscarinic medications like dicyclomine, which can be administered orally, as well as hyoscyamine, which can be given orally and sublingually.

Once administered, these medications bind to the muscarinic receptors on gastrointestinal smooth muscles. As a result, they block acetylcholine from binding to these receptors, which ultimately decreases smooth muscle contraction and relieves the spasm.

Now, gastrointestinal antispasmodics may cause anticholinergic side effects, such as blurred vision, dry mouth, decreased sweating, urinary retention, and constipation. Some clients may also present with headaches, dizziness, and tachycardia.

Now, contraindications of gastrointestinal antispasmodics include severe ulcerative colitis, stenosing peptic ulcer, paralytic ileus, gastrointestinal obstruction, and toxic megacolon.

In addition, these medications are contraindicated in clients with closed- or narrow-angle glaucoma, myasthenia gravis, cardiovascular disease, prostatic hypertrophy, and bladder obstruction.

Finally, gastrointestinal antispasmodics should be used with caution during pregnancy and breastfeeding, in elderly clients, as well as in clients with hypertension, and hepatic or renal disease.

Okay, if a client with irritable bowel syndrome or IBS is prescribed a gastrointestinal antispasmodic like dicyclomine, first perform a baseline assessment, including vital signs, fluid intake and output, and gastrointestinal status.

Be sure to make note of their current IBS symptoms, such as diarrhea, abdominal pain, or bloating, as well as stool characteristics and frequency.

Then, review recent laboratory test results, specifically renal and hepatic function; and diagnostic test results, including endoscopy, colonoscopy, or CT scans.

Then, explain to your client how the medication will help relieve their gastrointestinal spasms. Instruct them to take their medication four times daily with plenty of water, with or without food, and at the same time consistently each day.

Next, let your client know about some of the side effects they could experience during treatment. To help manage urinary retention, instruct them to empty their bladder before taking their medication and remind them to empty their bladder regularly, at least every 3-4 hours, even if they don’t feel the need.