Peak Development for ...

Medication Administration

Vol. 16 Issue 1
January 2015

GI Agents: Lubiprostone (Amitiza)

Peak Development Resources
P.O. Box 13267
Richmond, VA 23225
Phone: (804) 233-3707
Fax: (804) 233-3705
Email: editor@peakdev.com

Peak Development for Medication

Administration and Competency
Assessment Tool for Medication
Administration are components of
a site license for the Peak
Development Resources
Competency Assessment System
for Medication Administration
and may be reproduced for this
individual facility only. Sharing
of these components with any
other freestanding facility within
or outside the licensees corporate
entity is expressly prohibited.

The information contained in

Peak Development for Medication
Administration is intended only as
a guide for the practice of
licensed nursing personnel who
administer medications. Every
effort has been made to verify the
accuracy of the information
herein. Because of rapid changes
in the field of drug therapy, the
reader is advised to consult the
package insert, facility pharmacist
or patients physician for relevant
information. This is particularly
important for new or seldom used
drugs. Use of professional
judgment is required in all patient
care situations. It is the readers
responsibility to understand and
adhere to policies and procedures
set forth by the employing
institution. The editor and
publisher of this newsletter
disclaim any liability resulting
from use or misuse of
information contained herein.
Copyright 2015

After completion the learner should be able to:

1. Identify appropriate indications for use of
lubiprostone.
2. Relate general characteristics of
lubiprostone to specific patient situations.
3. Apply nursing process considerations for
lubiprostone to specific patient situations.
Constipation is a very common condition,
affecting over 40 million Americans each year,
with many suffering from chronic constipation.
The National Institutes of Health (NIH) defines
constipation as fewer than 3 spontaneous
bowel movements per week, and/or the
passage of hard, dry, stool that is low in
volume. This is often accompanied by
symptoms such as abdominal pain, difficult
expulsion, straining, bloating and a feeling of
incomplete emptying. Rectal bleeding may
also occur. Normal frequency of bowel
movements typically ranges from 23 per
day, to 3 per week. Normal stool is soft,
formed, and expelled without straining or
discomfort.
Laxatives are substances that promote
effective bowel elimination, and are in common
use in the US and worldwide. In an attempt to
obtain relief from constipation, an estimated
$725 million is spent annually in the US on
laxative products. There are a number of
different laxative types, such as osmotic,
stimulant, lubricant, bulk-forming, and
surfactant laxatives. Lubiprostone (Amitiza) is
a miscellaneous laxative drug, not included in
these standard drug classes. It is a chloride
channel activator, the first and only in its class.
Indications
Lubiprostone is indicated for treatment of
adults with chronic idiopathic constipation and
opioid-induced constipation in patients with

chronic non-cancer pain. It is also indicated for

treatment of irritable bowel syndrome (IBS)
with constipation in adult women. During
clinical trials, drug effectiveness in men with
IBS was not demonstrated.
Pharmacodynamics
Lubiprostone is a metabolite of
prostaglandin, and activates the chloride
channels in the wall of the intestine. Chloride
ions move into the intestinal lumen, followed
by sodium and water. This action causes fluid
secretion into the lumen of the bowel,
increasing the water content of the stool and
enhancing intestinal motility. Lubiprostone
does not affect serum electrolyte levels.
Pharmacokinetics
Absorption: The drug is administered orally,
and remains primarily in the GI tract; systemic
absorption is very low
Distribution: Highly protein bound; it is not
known whether lubiprostone is excreted in
breast milk
Metabolism: Rapidly metabolized within the
stomach and small intestine
Elimination: Metabolites of lubiprostone are
eliminated in the urine and feces
Major Interactions
Because lubiprostone has low systemic
availability, there are few interactions with
other drugs. Concurrent use of methadone
may decrease the effects of lubiprostone.
Adverse Effects/Toxicity
The most common adverse drug effects are
nausea, diarrhea, abdominal pain, headache,
abdominal distention and flatulence. Less
commonly, heartburn, fecal incontinence,
vomiting, sweating, anxiety and edema have
been reported. Some patients experience
sensations of chest tightness and difficulty

breathing shortly after taking the first dose, commonly within

one hour. These sensations usually last for several hours, and
may recur with subsequent doses. This effect is usually mild
and self-limiting, requiring no intervention or change in dosage.
Precautions/Contraindications
As with all laxative-type drugs, lubiprostone should not
be administered to patients with undiagnosed abdominal pain
or obstruction of the GI tract. No dosage adjustment is
required for patients with renal impairment. Patients with
moderate to severe liver impairment tend to experience
increased adverse drug effects. A lower starting dosage is
recommended for patients with idiopathic and opioid-induced
constipation who have moderate liver impairment. All patients
with severe liver impairment should receive a decreased
starting dose.
Nursing Process
Assessment
Determine baseline status: Prior to laxative use for
treatment of constipation, a thorough assessment of the
patients GI status, current pattern of elimination, and typical
dietary intake should be conducted. Any abnormalities, such
as abdominal pain, distention, nausea, or hypo or hyperactive
bowel sounds should be noted, as well as frequency, amount,
color and consistency of bowel movements. Any related
symptoms, such as straining to defecate, difficult expulsion or
feelings of incomplete emptying should also be documented.
Dietary intake should be assessed to identify patterns that
either promote or prevent constipation, including intake of
water and other fluids and high-fiber foods, such as fruits,
vegetables and whole grains. In addition, a current medication
history is important to identify factors promoting constipation,
such as use of opioids or laxative abuse. Laxative abuse is
common, particularly among the elderly and those with
anorexia, bulimia and chronic constipation. The patients
current activity level should also be assessed, as lack of
physical activity is a significant risk factor for constipation.
Identify risk factors: In patients with symptoms of bowel
obstruction (such as abdominal pain, distention, vomiting, and
diarrhea), this condition must be ruled out before laxative use.
Liver function tests should be assessed prior to therapy.
Age-specific considerations: FDA pregnancy category
C should be used during pregnancy only if the benefits
outweigh the risks. Due to its low systemic availability and high
protein binding, risk to nursing infants from maternal use of
lubiprostone is considered low. Nursing infants should be
monitored for diarrhea during treatment. The safety and
effectiveness for use of lubiprostone in the pediatric population

have not been established. There are no age-related concerns

in the geriatric population, and dosage reduction based on age
is not required.
Planning and Analysis
The goal of therapy with lubiprostone is to relieve
constipation and promote normal bowel function.
Intervention
Medication administration: Lubiprostone is administered
orally, and should be taken with food and water to decrease
nausea. Dosing is usually twice daily. Capsules should be
swallowed whole, and not crushed, chewed or broken.
Observe for therapeutic effects: For approximately 80%
of patients, lubiprostone produces a bowel movement within
2448 hours. However, drug effects may take several days to
a week. Relief of constipation is assessed by the patients
report of improved comfort, and more frequent, softer bowel
movements.
Observe for adverse effects: Assess for effects such as
nausea, diarrhea, abdominal pain and dyspnea. Hold the
medication and notify the prescribing physician if nausea,
diarrhea or difficulty breathing are severe.
Patient/Family teaching:
Take the medication as prescribed, with food and water. Do
not increase the dosage without medical guidance.
Allow several days for the medication to produce a bowel
movement do not take additional laxatives during this time
without medical guidance.
Go to the bathroom as soon as the urge occurs.
A sensation of chest tightness and/or difficulty breathing
may occur with the first dose. This usually goes away within
several hours, and may or may not occur with future doses.
Stop taking the drug and notify the doctor if nausea, diarrhea
or difficulty breathing are severe.
If nursing, watch your baby for diarrhea and contact a
healthcare provider if it occurs.
Explain that it is not necessary to have a bowel movement
every daypatients should develop a pattern that is normal
and comfortable for them.
Patient education should also include dietary and lifestyle
factors to promote bowel function, including regular daily
exercise, 20-25 gm of fiber per day, increased fruits,
vegetables, and whole grains, and at least 6-8 glasses of
fluid daily (unless contraindicated).
Evaluation
The nurses role in assessment, monitoring and effective
patient education promotes the successful use of lubiprostone
to promote normal bowel function and the relief of constipation.

Peak Development for Medication Administration

GI Agents: Lubiprostone (Amitiza)

Page 2

Peak Development for ...

Medication Administration
Competency Assessment Tool

Vol. 16 Issue 1
January 2015

GI Agents: Lubiprostone (Amitiza)

NAME:

DATE:

UNIT:

Directions: Place the letter of the one best answer in the space provided.
_____1. Which of the following is MOST characteristic of constipation? A patient complains that he:
A. has hard, dry stools
B. has 3 bowel movements per week
C. does not have a bowel movement every day, like he used to
D. has soft, semi-formed stools
_____2. Lubiprostone is included in which of the following classes of laxatives:
A. bulk-forming
B. stimulant
C. serotonin receptor agonist
D. chloride channel activator
_____3. Lubiprostone is indicated for the treatment of:
A. irritable bowel syndrome with constipation in adult women
B. chronic idiopathic constipation in adults
C. opioid-induced constipation in patients with chronic non-cancer pain
D. all of the above
_____4. Concurrent use of which of the following drugs may decrease the effects of lubiprostone:
A. morphine
B. oxycodone
C. methadone
D. fentanyl
_____5. Common adverse effects of lubiprostone include all of the following EXCEPT:
A. diarrhea
B. hyponatremia
C. abdominal distention
D. headache

_____6. Which of the following patients should NOT receive lubiprostone:

A. Mrs. R, who has liver impairment
B. Mr. H, who recently had a heart attack
C. Mr. Y, who has renal impairment
D. Mrs. S, who has undiagnosed abdominal pain
_____7. A patient who has been prescribed lubiprostone for relief of constipation asks the nurse
how long it will take to work. The nurse appropriately responds:
A. It works quickly, you should expect to have a bowel movement within a few hours.
B. Most people have a bowel movement within 1 to 2 days.
C. You should have a bowel movement in 12 weeks.
D. Theres no way to know, all of these laxatives act differently on people.
_____8. The nurse should instruct patients starting on lubiprostone to take the drug:
A. with food and water
B. on an empty stomach
C. either with food or on an empty stomach, but do so consistently
D. whenever they desire, as food has no effect on drug absorption or adverse effects
_____9. Thirty minutes after the nurse administers a patients first dose of lubiprostone, the patient
complains of slight tightness in her chest. The nurse should:
A. reassure the patient that this is a common side effect
B. request an EKG
C. place a note on the chart to request a change to another medication
D. hold any further doses of the medication and notify the physician
_____10. Patient education for lubiprostone should include all of the following EXCEPT:
A. do not increase the dosage or take additional laxatives without medical guidance
B. capsules may be crushed and mixed with applesauce or pudding
C. a daily bowel movement is not necessary
D. call the doctor if nausea, diarrhea or difficulty breathing are severe

Competency Assessment Tool

GI Agents: Lubiprostone (Amitiza)

Page 2

Peak Development for ...

Medication Administration

Month: January 2015

Issue: GI Agents: Lubiprostone
(Amitiza)

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GI Agents: Lubiprostone (Amitiza)

January 2015

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