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Study cards 2 > Acid controlling drugs > Flashcards

Acid controlling drugs Flashcards

1
Q

The stomach secretes

A

Hydrochloric acid (HCl)
Bicarbonate
Pepsinogen
Intrinsic factor
Mucus
Prostaglandins

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2
Q
  1. Glands of the Stomach
  2. Which gland are the largest in number and of primary importance when discussing acid control?
A

Cardiac
Pyloric
Gastric
-The cells of the gastric gland are the largest in number and of primary importance when discussing acid control.

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3
Q

Cells of the Gastric Gland

A

Parietal
Chief
Mucous
Endocrine
Enterochromaffin

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4
Q

Parietal cells

A

Produce and secrete hydrochloric acid

Primary site of action for many of the drugs used to treat acid-related disorders

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5
Q

Chief cells

A

Secrete pepsinogen, a proenzyme

Pepsinogen becomes pepsin when activated by exposure to acid.

Pepsin breaks down proteins (proteolytic).

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6
Q

Mucous cells

A

Mucus-secreting cells (surface epithelial cells)

Provide a protective mucus coat

Protect against self-digestion by hydrochloric acid and digestive enzymes

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7
Q

Hydrochloric Acid

A

Secreted by parietal cells when stimulated by food, caffeine, chocolate, and alcohol

Maintains stomach at pH of 1 to 4

Acidity aids in the proper digestion of food and defenses against microbial infection via the gastrointestinal tract.

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8
Q

HCL Secretion also stimulated by:

A

Large fatty meals
Emotional stress

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9
Q

Peptic ulcer disease

A

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

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10
Q

Helicobacter pylori (H. pylori)

  1. About
  2. Therapy
A

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

Triple therapy includes a 7- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole or quadruple therapy of a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole.

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11
Q

Stress-related mucosal damage

A

Gastrointestinal lesions are a common finding in Critical Care Unit patients, especially within the first 24 hours after admission.

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

Nasogastric tubes and ventilators predispose patients to gastrointestinal bleeding.

A histamine receptor–blocking drug or a PPI are given for prevention.

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12
Q

3 Types of Acid-Controlling Drugs

A

Antacids
-Calcium antacids
-Antacids with Mg
-Sodium bicarbonate

H2 antagonists
-ranitidine hydrochloride (Zantac®)
-famotidine (Pepcid®)

PPIs
-lansoprazole (Prevacid®)
-omeprazole (Losec®)
-pantoprazole sodium (Pantoloc®)

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13
Q

Antacids

A

Basic compounds used to neutralize stomach acid

Salts of aluminum, magnesium, calcium, or sodium bicarbonate, or all of these

Many antacid preparations also contain the antiflatulent (antigas) drug simethicone.

Many aluminum- and calcium-based formulations also include magnesium, which not only contributes to the acid-neutralizing capacity but also counteracts the constipating effects of aluminum and calcium.

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14
Q

Calcium antacids

A

may lead to the development of kidney stones and increased gastric acid secretion.

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15
Q

Antacids containing magnesium

A

must be avoided in patients with renal failure.

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16
Q

Sodium bicarbonate

A

is a highly soluble antacid form with a quick onset but a short duration of action.

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17
Q

Antacids: Mechanism of Action

A

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

Promote gastric mucosal defensive mechanisms

Stimulate secretion of:
Mucus, Bicarbonate, Prostaglandins

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18
Q

Mucus

A

protective barrier against hydrochloric acid

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19
Q

Bicarbonate

A

helps buffer acidic properties of hydrochloric acid

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20
Q

Prostaglandins

A

prevent activation of proton pump

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21
Q

Antacids: Drug Effects

A

Reduction of pain and reflux associated with acid-related disorders

Raising the gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid.

Reducing acidity reduces pain as a result of:
-Base-mediated inhibition of the protein-digesting ability of pepsin
-Increase in the resistance of the stomach lining to irritation
-Increase in the tone of the cardiac sphincter

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22
Q

Antacids: Indications

A

Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn

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23
Q

Antacids: Contraindications

A

Known allergy to a specific drug product

Severe renal failure or electrolyte disturbances: potential toxic accumulation of electrolytes in the antacids themselves

Gastrointestinal obstruction: Antacids may stimulate gastrointestinal motility when they are undesirable because of the presence of an obstructive process requiring surgical intervention.

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24
Q

Antacids Over-the-counter (OTC) formulations available as:

A

Capsules and tablets
Powders
Chewable tablets
Suspensions
Effervescent granules and tablets

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25
Q

Antacids: 4 Types

Used alone or in combination

A

Aluminum hydroxide

Magnesium hydroxide

simethicone

Combination aluminum hydroxide and magnesium hydroxide contain a local anaesthetic (Mucaine®).

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26
Q

Antacids: Aluminum Salts

A

Have constipating effects

Often used with magnesium to counteract constipation

Often recommended for patients with renal disease (more easily excreted)

Examples
Combination products (aluminum and magnesium): Antacid Plus®, Diovol®, Gelusil®, Maalox®, Multiaction®

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27
Q

Antacids: Magnesium Salts

A

Commonly cause diarrhea; usually used with other drugs to counteract this effect

Dangerous when used with renal failure; the failing kidney cannot excrete extra magnesium, resulting in accumulation

Magnesium hydroxide and mineral oil (Magnolox®)

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28
Q

Antacids: Calcium Salts

A

Many forms but carbonate is most common

May cause constipation, kidney stones

Also not recommended for patients with renal disease—may accumulate to toxic
levels

Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound)

Often advertised as an extra source of dietary calcium
-Example: calcium carbonate and simethicone (Maalox, Rolaids®)

29
Q

Antacids: Sodium Bicarbonate

A

Highly soluble

Buffers the acidic properties of hydrochloric acid

Quick onset but short duration

May cause metabolic alkalosis

Sodium content may cause problems in patients with heart failure, hypertension, or renal insufficiency.

30
Q

Antiflatulents

A

used to relieve the painful symptoms associated with gas

31
Q

simethicone

A

antacid and antiflatulents

used to bind or alter intestinal gas and are often added to antacid combination products.

32
Q

Antacids: Adverse Effects

A

Minimal and depend on the compound used

Overuse: metabolic alkalosis

Aluminum and calcium: constipation

Magnesium: diarrhea

Calcium: kidney stones, rebound hyperacidity

Calcium carbonate: produces gas and belching; often combined with simethicone

33
Q

Antacids: Drug Interactions

A

Adsorption of other drugs to antacids
-Reduces the ability of the other drug to be absorbed into the body

Chelation
-Chemical binding, or inactivation, of another drug
-Produces insoluble complexes
-Result: reduced drug absorption

Increased stomach pH
-Increased absorption of basic drugs
-Decreased absorption of acidic drugs

Increased urinary pH
-Increased excretion of acidic drugs
-Decreased excretion of basic drugs

34
Q

Increased stomach pH

A

-Increased absorption of basic drugs
-Decreased absorption of acidic drug

35
Q

Increased urinary pH

A

-Increased excretion of acidic drugs
-Decreased excretion of basic drugs

36
Q

H2 Receptor Antagonists

2 drugs

A

ranitidine hydrochloride (Zantac®)
famotidine (Pepcid®)

37
Q

H2 Receptor Antagonists facts

A

Reduce acid secretion

All available OTC in lower-dosage forms

Most popular drugs for treatment of acid-related disorders

38
Q

H2 Antagonists: Mechanism of Action

A

Competitively block the H2 receptor of acid-producing parietal cells

Reduce hydrogen ion secretion from the parietal cells

Increase in the pH of the stomach

Relieve of many of the symptoms associated with hyperacidity-related conditions

39
Q

H2 Antagonists: Drug Effect: Indications

A

Gastroesophageal reflux disease (GERD)
Peptic ulcer disease
Erosive esophagitis
Adjunct therapy to control upper gastrointestinal bleeding
Zollinger-Ellison syndrome

40
Q

H2 Antagonists

A

Drug effect:
Suppressed acid secretion in the stomach

41
Q

H2 Antagonists: Adverse Effects

A

Overall, very few adverse effects

Central nervous system adverse effects in elderly patients include confusion and disorientation.

Cimetidine may causes erectile dysfunction and gynecomastia.

Thrombocytopenia has been reported with ranitidine hydrochloride and famotidine.

42
Q

H2 Antagonists: Drug Interactions

cimetidine:

A

cimetidine:

Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels

All H2 antagonists may inhibit the absorption of drugs that require an acidic gastrointestinal environment for absorption.

Because of its potential to cause drug interactions, cimetidine has been largely replaced by ranitidine and famotidine.

Cimetidine is still used to treat certain allergic reactions.

43
Q

All H2 antagonists may inhibit the absorption of drugs that require an?

A

acidic gastrointestinal environment for absorption.

44
Q

H2 Antagonists: Drug Interactions

A

Smoking has been shown to decrease the effectiveness of H2 blockers.

For optimal results, H2 receptor antagonists are taken 1 hour before antacids.

45
Q

Proton Pump Inhibitors

A

The parietal cells release positive hydrogen ions (protons) during hydrochloric acid production.

This process is called the proton pump.

H2 blockers and antihistamines do not stop the action of this pump.

46
Q

Proton Pump Inhibitors medications

A

lansoprazole (Prevacid®)
omeprazole (Losec®)
pantoprazole sodium (Pantoloc®)

47
Q

Proton Pump Inhibitors: Mechanism of Action

A

Irreversibly bind to H+/K+ adenosine triphosphatase (ATPase) enzyme

This bond prevents the movement of hydrogen ions from the parietal cell into the stomach.

Results in achlorhydria—all gastric acid secretion is temporarily blocked.
-To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.

48
Q

Proton Pump Inhibitors: Indications

A

Gastroesophageal reflux disease
Erosive esophagitis
Short-term treatment of active duodenal and benign gastric ulcers
Zollinger-Ellison syndrome
Nonsteroidal anti-inflammatory drug (NSAID)–induced ulcers
Stress ulcer prophylaxis
Treatment of H. pylori–induced infections
Given with an antibiotic

49
Q

Proton Pump Inhibitors: Adverse Effects

A

Protein pump inhibitors (PPIs) are generally well tolerated.

Possible predisposition to gastrointestinal tract infections: Clostridium difficile

Osteoporosis and risk of wrist, hip, and spine fractures in long-term users

Pneumonia

Depletion of magnesium

50
Q

Proton Pump Inhibitors: Drug Interactions

A

Increase serum levels of diazepam and phenytoin

warfarin: increased chance of bleeding

Absorption of ketoconazole, ampicillin, iron salts, and digoxin

clopidogrel

sucralfate: may delay the absorption of PPIs

Food may decrease absorption of the PPIs.

51
Q

Miscellaneous Acid-Controlling Drugs

A

sucralfate
misoprostol
simethicone (Ovol®)

52
Q

Sucralfate

A

Miscellaneous Acid-Controlling Drugs

Cytoprotective drug

Used for stress ulcers, peptic ulcer disease

Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas

Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)

53
Q

Sucralfate effects

A

Little absorption from the gut

May cause constipation, nausea, and dry mouth

May impair absorption of other drugs. Give other drugs at least 2 hours before sucralfate.

Do not administer with other medications.

Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels

54
Q

Misoprostol

A

Miscellaneous Acid-Controlling Drugs

Prostaglandin E analogue

Prostaglandins have cytoprotective activity.
-Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate
-Promote local cell regeneration
-Help to maintain mucosal blood flow

55
Q

Misoprostol is used for?

A

Used for prevention of NSAID-induced gastric ulcers

Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps and diarrhea.

56
Q

Simethicone

A

Miscellaneous Acid-Controlling Drugs

Antiflatulent drug

Used to reduce the discomforts of gastric or intestinal gas (flatulence)

Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones

Result is decreased gas pain and increased expulsion via mouth or rectum.

57
Q

Nursing Implications: Antacids

A

Assess for allergies and pre-existing conditions that may restrict the use of antacids, such as:

-Fluid imbalances
-Renal disease
-Gastrointestinal obstruction
-Heart failure
-Pregnancy

Patients with heart failure or hypertension should not use antacids with high sodium content.

Administer antacids within 1 to 2 hours of other medications.

Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset.

Be sure that chewable tablets are chewed thoroughly and that liquid forms are shaken well before giving.

Administer with at least 240 mL of water to enhance absorption (except for “rapid-dissolve” forms).

Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.

58
Q

Nursing Implications: Antacids Adverse effects

A

Nausea, vomiting, abdominal pain, diarrhea

With calcium-containing products: constipation, acid rebound

59
Q

Nursing Implications: H2 Antagonists

A

Assess for allergies and impaired renal or liver function.

Use with caution in patients who are confused, disoriented, or in older adult patients.

Take 1 to 2 hours before antacids.

For intravenous doses, follow administration guidelines.

60
Q

Nursing Implications: Proton Pump Inhibitors

A

Assess for allergies and history of liver disease.

Not all are available for parenteral administration.

May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin

61
Q

The granules of ______ capsules may be given via nasogastric tubes

A

pantoprazole

Capsules may be opened and their contents mixed with apple juice, but delayed-release granules are not to be crushed or chewed.

62
Q

simethicone

A

excessive flatus

causes mucus coated gas bubbles to break into smaller ones

63
Q

H2 receptor antagonist drug interaction

A

ketoconazole

64
Q

How to administer sucralfate

A

give drug on an empty stomach

65
Q

antacid if pt has kidney problems

A

aluminum-based antacids

66
Q

oral tetracycline complains of heartburn and requested antacid

A

give tetracycline but delay antacid for 1-2 hours

67
Q

PPI

A

give on empty stomach

make sure pt does not crush/ chew capsules

68
Q

1st dose of misoprostol, what is a contraindication?

A

pregnancy

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