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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
Antacids: 4 Types Used alone or in combination
Aluminum hydroxide Magnesium hydroxide simethicone Combination aluminum hydroxide and magnesium hydroxide contain a local anaesthetic (Mucaine®).
26
Antacids: Aluminum Salts
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®
27
Antacids: Magnesium Salts
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®)
28
Antacids: Calcium Salts
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
Antacids: Sodium Bicarbonate
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
Antiflatulents
used to relieve the painful symptoms associated with gas
31
simethicone
antacid and antiflatulents used to bind or alter intestinal gas and are often added to antacid combination products.
32
Antacids: Adverse Effects
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
Antacids: Drug Interactions
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
Increased stomach pH
-Increased absorption of basic drugs -Decreased absorption of acidic drug
35
Increased urinary pH
-Increased excretion of acidic drugs -Decreased excretion of basic drugs
36
H2 Receptor Antagonists 2 drugs
ranitidine hydrochloride (Zantac®) famotidine (Pepcid®)
37
H2 Receptor Antagonists facts
Reduce acid secretion All available OTC in lower-dosage forms Most popular drugs for treatment of acid-related disorders
38
H2 Antagonists: Mechanism of Action
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
H2 Antagonists: Drug Effect: Indications
Gastroesophageal reflux disease (GERD) Peptic ulcer disease Erosive esophagitis Adjunct therapy to control upper gastrointestinal bleeding Zollinger-Ellison syndrome
40
H2 Antagonists
Drug effect: Suppressed acid secretion in the stomach
41
H2 Antagonists: Adverse Effects
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
H2 Antagonists: Drug Interactions cimetidine:
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
All H2 antagonists may inhibit the absorption of drugs that require an?
acidic gastrointestinal environment for absorption.
44
H2 Antagonists: Drug Interactions
Smoking has been shown to decrease the effectiveness of H2 blockers. For optimal results, H2 receptor antagonists are taken 1 hour before antacids.
45
Proton Pump Inhibitors
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
Proton Pump Inhibitors medications
lansoprazole (Prevacid®) omeprazole (Losec®) pantoprazole sodium (Pantoloc®)
47
Proton Pump Inhibitors: Mechanism of Action
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
Proton Pump Inhibitors: Indications
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
Proton Pump Inhibitors: Adverse Effects
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
Proton Pump Inhibitors: Drug Interactions
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
Miscellaneous Acid-Controlling Drugs
sucralfate misoprostol simethicone (Ovol®)
52
Sucralfate
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
Sucralfate effects
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
Misoprostol
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
Misoprostol is used for?
Used for prevention of NSAID-induced gastric ulcers Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps and diarrhea.
56
Simethicone
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
Nursing Implications: Antacids
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
Nursing Implications: Antacids Adverse effects
Nausea, vomiting, abdominal pain, diarrhea With calcium-containing products: constipation, acid rebound
59
Nursing Implications: H2 Antagonists
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
Nursing Implications: Proton Pump Inhibitors
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
The granules of ______ capsules may be given via nasogastric tubes
pantoprazole Capsules may be opened and their contents mixed with apple juice, but delayed-release granules are not to be crushed or chewed.
62
simethicone
excessive flatus causes mucus coated gas bubbles to break into smaller ones
63
H2 receptor antagonist drug interaction
ketoconazole
64
How to administer sucralfate
give drug on an empty stomach
65
antacid if pt has kidney problems
aluminum-based antacids
66
oral tetracycline complains of heartburn and requested antacid
give tetracycline but delay antacid for 1-2 hours
67
PPI
give on empty stomach make sure pt does not crush/ chew capsules
68
1st dose of misoprostol, what is a contraindication?
pregnancy

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