Acid-Controlling Drugs

Question 1

Peptic Ulcer Disease

Answer 1

Gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin

Question 2

H. Pylori

Answer 2

Bacterium found in the GI tract in 90% of patients with duodenal ulcers and 70% of those with gastric ulcers

First-line therapy includes a 10 to 14 day course of a proton pump inhibitor and antibiotics

Question 3

Stress-Related Mucosal Damage

Answer 3

GI lesions are common in ICU patients

Factors include decreased blood flow, mucosal ischemia, hypoperfusion, and reperfusion injury

NG tubes and ventilators predispose patients to GI bleeding

Histamine receptor-blocing drug or a proton pump inhibitor are given for prevention

Question 4

Antacid Mechanism of Action

Answer 4

Do not prevent overproduction of acid but instead help to neutralize stomach acid secretions

Promote gastric mucosal defense mechanisms

Stimulate secretion of mucus, bicarbonate, and prostaglandins

Question 5

Antacid Drug Effects

Answer 5

Reduction of pain

Increases resistance of stomach lining, increases tone of cardiac sphincter, inhibits the protein-digestion ability of pepsin

Question 6

Aluminum Salt Antacids

Answer 6

HAVE CONSTIPATING EFFECTS

Often used with magnesium to counteract constipation

Often recommended for patients with renal disease

MAALOX, MYLANTA

Question 7

Magnesium Salt Antacids

Answer 7

COMMONLY CAUSE DIARRHEA

DANGEROUS WHEN USED WITH RENAL FAILURE (failing kidney cannot excrete extra magnesium)

Question 8

Calcium Salt Antacids

Answer 8

MAY CAUSE CONSTIPATION, kidney stones

Not recommended for patients with renal disease

Long duration of action

TUMS (CALCIUM CARBONATE)

Question 9

Sodium Bicarbonate Antacids

Answer 9

Highly soluble, buffers the acidic properties of HCl

Quick onset, short duration

May cause metabolic alkalosis

May cause problems in patients with heart failure, hypertension, or renal insufficiency

Question 10

Antiflatulents

Answer 10

Used to relieve painful symptoms associated with gas

SIMETHICONE (MYLICON)

Question 11

Antacid Drug Interactions

Answer 11

Reduces the ability of the other drug to be absorbed in the body

Chelation (chemical binding/inactivation of other drug, produces insoluble complexes –> reduced drug absorption)

Question 12

Histamine 2 Receptor Antagonists

Answer 12

Reduce acid secretion

Most popular drugs for treatment of acid-related disorders

CIMETIDINE (TAGAMET), FAMOTIDINE (PEPCID)

Question 13

Histamine 2 Antagonist Mechanism of Action

Answer 13

Block the H2 receptor of acid-producing parietal cells

Increase the pH of the stomach

Question 14

Indications for Histamine 2 Antagonists

Answer 14

GERD, peptic ulcer disease, erosive esophagitis, adjunct therapy to control upper GI bleeding, Zollinger-Ellison syndrome

Question 15

Adverse Effects of H2 Antagonists

Answer 15

CENTRAL NERVOUS SYSTEM ADVERSE EFFECTS IN ELDERLY PATIENTS INCLUDE CONFUSION AND DISORIENTATION (ESPECIALLY CIMETIDINE)

Question 16

Proton Pump Inhibitors

Answer 16

Parietal cells release positive hydrogen ions (protons) during HCl production

H2 BLOCKERS AND ANTIHISTAMINES DO NOT STOP THE ACTION OF THIS PUMP

OMEPRAZOLE (PREVACID) AND PANTOPRAZOLE (PROTONIX)

Question 17

Mechanism of Action of Proton Pump Inhibitors

Answer 17

Irreversibly bind to H+/K+ ATPase enzyme to prevent movement of hydrogen ions from the parietal cell into the stomach

ALL GASTRIC ACID SECRETION IS TEMPORARILY BLOCKED

Question 18

Indications for Proton Pump Inhibitors

Answer 18

GERD, erosive esophagitis, short-term treatment of GI bleeding, Zollinger-Ellison syndrome, NSAID-induced ulcers, stress ulcer prophylaxis, H. pylori ulcers

Question 19

Adverse Effects of Proton Pump Inhibitors

Answer 19

OSTEOPOROSIS AND RISK OF WRIST, HIP, AND SPINE FRACTURES IN LONG-TERM USERS

Question 20

Miscellaneous Acid-Controlling Drugs

Answer 20

SUCRALFATE (CARAFATE)
MISOPROSTOL (CYTOTEC)

Cytotec is useful in the treatment of NSAID-induced ulcers and should not be given to pregnant women, but can be used at term pregnancy to help induce labor

Question 21

Sucralfate (Carafate)

Answer 21

Cytoprotective drug used for stress ulcers and peptic ulcer disease

FORMS A PROTECTIVE BARRIER OVER BASE OF ULCERS

MAY IMPAIR ABSORPTION OF OTHER DRUGS (GIVE OTHER DRUGS AT LEAST TWO HOURS BEFORE)

Question 22

Nursing Implications for Antacids

Answer 22

LONG-TERM SELF-MEDICATION WITH ANTACIDS MAY MASK SYMPTOMS OF SERIOUS UNDERLYING DISEASES, SUCH AS MALIGNANCY OR BLEEDING ULCERS

Question 23

Nursing Implications for H2 Antagonists

Answer 23

Assess for impaired renal or liver function

Take 1-2 hours before antacids

Use with caution in those who are confused, disoriented, or elderly

Question 24

Nursing Implications for Proton Pump Inhibitors

Answer 24

MAY INCREASE SERUM LEVELS OF DIAZEPAM AND PHENYTOIN

May increase chance for bleeding with Warfarin