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Acid controlling drugs Flashcards

1
Q

the stomach secretes

A

hcl, bicarbonate, pepsinogen, intrinsic factor, mucus, prostaglandins

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2
Q

3 glands of the stomach

A

cardiac, pyloric, gastric

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3
Q

cells in the gastric gland

A

parietal, chief, mucous, endocrine, enterochromaffin

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4
Q

parietal cells

A

produce and secrete hcl
site of action for many drugs to treat acid related disorders

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5
Q

chief cells

A

secretes pepsinogen which becomes pepsin which breaks down proteins

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6
Q

mucous cells

A

provide a protective mucus coat to protect against self digestion by hcl and digestive enzymes

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7
Q

hydrochloric acid

A

secreted from parietal cells when stimulated by food, caffeine, chocolate and alcohol

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8
Q

hydrochloric acid maintains stomach pH of..

A

1-4

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9
Q

what does acidity do for the GI tract

A

aids in proper digestion and defenses against microbial infection via the GI tract

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10
Q

hcl secretion is also stimulated by

A

large fatty meals and emotional stress

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11
Q

peptic ulcer disease

A

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

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12
Q

helicobacter pylori

A

bacterium found in the GI tract of 90% of pts with duodenal ulcers and 70% of those with gastric ulcers

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13
Q

triple therapy for h.pylori (in red)

A

7-14 day course of a proton pump inhibitor 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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14
Q

stress-related mucosal damage

A
  • GI lesions in CCU pts within 24 hours after admission
  • factors include decreased blood flow, mucosal ischemia, hypoperfusion and reperfusion activity
  • NG tubes and ventilators predispose for GI bleeding
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15
Q

what is given for the prevention of stress-related mucosal damage

A

histamine receptor blocking drug or a PPI (proton pump inhibitor)

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16
Q

types of acid controlling drugs

A

antacids, H2 antagonists, PPIs

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17
Q

antacids are used to

A

neutralize stomach acid

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18
Q

antacids are made of

A

salts of Al, Mg, Ca or Na bicarbonate or all of these

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19
Q

many antacid preparations contain

A

antiflatulent (antigas) drug simethicone

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20
Q

magnesium in Al and Ca based antacids contributes to

A

the acid neutralizing capacity and counteracts the constipating effects of Al and Ca

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21
Q

Ca antacids may lead to the development of

A

kidney stones and increases gastric acid secretions

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22
Q

avoid antacids with Mg in ppl with

A

renal failure

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23
Q

which is a highly soluble antacid form with a quick onset and short duration of action

A

sodium bicarbonate

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24
Q

antacids MOA

A
  • doesn’t help acid overproduction but helps neutralize acid secretions
  • promotes mucosal defensive mechanisims
  • stim secretions of mucous, bicarbonate and prostaglandins (which prevents activation of proton pump)
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25
Q

antacids drug effects

A
  • reduction of pain and reflux associated with acid-related disorders
  • raising the gastric pH. Neutralizes 90% of the gastric acids
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26
Q

reducing acidity reduces pain as a result of

A
  • 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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27
Q

antacid indications

A

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

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28
Q

antacid contraindications

A

-allergy
- sever renal failure or electrolyte disturbances
- GI obstruction: tumour or stricture. (antacids may stimulate GI motility)

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29
Q

antacids OTC formulations available as

A
  • capsules and tablets
  • powders
  • chewable tablets
  • suspension
  • effervescent granules and tablets
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30
Q

antacids types

A

used alone or in combination
- aluminum hydroxide
- magnesium hydroxide
-simethicone
- combination of aluminum hydroxide and magnesium hydroxide contain a local anesthetic (mucaine)

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31
Q

aluminum salts have a ___ effect

A

constipating

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32
Q

aluminum salts are often used with ___ to

A

magnesium

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33
Q

aluminum salts are recommended for pts with

A

renal disease

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34
Q

examples of aluminum salts (combination products)

A

antacid plus, diovol, gelusil, maalox, multiaction

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35
Q

magnesium salts commonly cause

A

diarrhea. use with other drugs to counteract this efect

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36
Q

magnesuim salts are dangerous when used for pts with

A

renal failure. the kidney cant excrete extra magnesium resulting in accumulation

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37
Q

magnesium salts examples

A

magnesium hydroxide and mineral oil (magnolox)

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38
Q

calcium salts most common form

A

carbonate

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39
Q

calcium salts may cause

A

constipation and kidney stones

40
Q

calcium salts are not recommended for pts with

A

renal disease (toxicity)

41
Q

calcium salts have a __ duration of action that may cause

A

-long duration of action that may cause increased gastric acid secretion

42
Q

ex of calcium salts

A

calcium carbonate and simethicone (maalox, rolaids)

43
Q

sodium bicarbonate

A
  • highly soluble
  • buffers the acidic properties of hydrochloric acid
  • quick onset and short duration
44
Q

sodium bicarbonate sodium content may cause problems in pts with

A

heart failure, hypertension or renal insufficiency

45
Q

antiflatulents

A
  • used to relieve the painful symptoms associated with gas
  • often combined with antacids
46
Q

antiflatulent example

A

simethicone

47
Q

antacids adverse effects (overuse)

A

metabolic alkalosis

48
Q

adverse effects of aluminum and calcium

A

constipation

49
Q

magnesium adverse effects

A

diarrhea

50
Q

calcium adverse effects

A

kidney stones and rebound hyperacidity

51
Q

calcium carbonate adverse effects

A

produces gas and belching, often combined with simethicone

52
Q
A
53
Q

antacid adsorption of other drugs

A

reduces the ability of the other drug to be observed into the body

54
Q

chelation

A
  • chem binding or inactivation of another drug
  • produces insoluble complexes
  • result= reduced drug absorption
55
Q

antacid increased stomach pH

A
  • increased absorption of basic drugs
  • decreased absorption of acidic drugs
56
Q

antacids increased urinary pH

A
  • increased excretion of acidic drugs
  • decreased excretion of basic drugs
57
Q

H2 receptor antagonists

A
  • reduces acid secretion
  • all available OTC in lower dosage forms
  • most popular drugs for treatment of acid related disorders
58
Q

examples of H2 receptor antagonists

A

ranitidine hydrochloride (Zantac) and famotidine (Pepcid)

59
Q

H2 antagonist MOA

A
  • block H2 receptors of acid producing parietal cells
  • reduce H ion secretion from parietal cells
  • increase pH in stomach
  • relieve symptoms of hyperacidity conditions
60
Q

H2 drug indications

A
  • GERD
  • peptic ulcer disease
  • erosive esophagitis
  • adjunct therapy to control upper GI bleeding
  • zollinger-Ellison syndrome
61
Q

H2 antagonist adverse effects

A
  • very few
  • confusion and disorientation in elderly
  • cimetidine= erectile dysfunction
  • thrombocytopenia= ratidine hcl and famotidine
62
Q

cimetidine drug interactions

A
  • binds with P-450 in liver resulting in inhibited oxidation of drugs and increased drug levels
63
Q

all H2 antagonist drug interactions

A
  • inhibited absorption of drugs that require an acidic gastric environment for absorption
64
Q

due to drug interactions, cimetidine has been largely replaced with

A

ranitidine and famotidine

65
Q

smoking and H2 antagonists

A

smoking decreases effectiveness of H2 blockers

66
Q

when to take H2 antagonists with antacids

A

take H2 antagonists 1 hr before antacids

67
Q

what is the proton pump

A

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

68
Q

T or F antihistamines and H2 antagonists can inhibit proton pump

A

false

69
Q

proton pump inhibitor examples

A

lansoprazole (prevacid), omeprazole (losec), pantoprazole sodium IV (pantoloc)

70
Q

proton pump inhibitors MOA

A
  • irreversibly bind to H+ and K+ ATPase enzyme
  • this bond prevents movement of H= from parietal cells into stomach
  • results in achlorhydria (all gastric acid secretions temporarily blocked)
71
Q

PPI indications

A
  • GERD
  • erosive esophagitis
  • short term treatment of active duodenal and benign gastric ulcers
  • zollinger- ellison syndrome
  • NSAID ulcers
  • stress ulcer prophylaxis
    -treatment of H, pylori-induced infections
72
Q

PPI adverse effects

A
  • generally well tolerated
  • possible predisposition to GI tract infections (clostridium difficile)
  • osteoporosis and risk of wrist, hip and spine fractures in long term users
    -pneumonia
  • depletion of magnesium
73
Q

PPI 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 ( delay absorption of PPIs)
  • food may decrease absorption of PPIs
74
Q

miscellaneous acid controlling drugs

A

sucralfate, misoprostol, simethicone

75
Q

sucralfate is used for

A
  • is a cytoprotective drug
    -used for stress ulcers, peptic ulcer disease
    -attracted to and binds to the base of ulcers and erosions forming a barrier
  • protects these areas from pepsin (which breaks down proteins)
76
Q

sucralfate absorption

A
  • little absorption from the gut
77
Q

sucralfate may cause

A

constipation, nausea and dry mouth

78
Q

when to give sucralfate with other drugs

A

give other drugs 2hrs before sucralfate because of impaired absorption

79
Q

sucralfate binds with

A

phosphate
- can be used in chronic renal failure to reduce phosphate levels

80
Q

misoprostol

A
  • prostaglandin E analogue
  • has cytoprotective activity
  • protects gastric mucosa from injury by enhancing local production of mucous or bicarbonate
  • promotes local cell regeneration
  • maintains mucosal blood flow
81
Q

misoprostol is used for prevention of

A

NSAID-induced gastric ulcers

82
Q

doses that are therapeutic enough to treat duodenal ulcers often produce

A

abdominal cramps and diarrhea

83
Q

simethicone

A
  • antiflatulent drug
  • reduce discomfort of gastric or intestinal gas
  • alters elasticity of mucous-coated gas bubbles breaking them into smaller ones
  • result= decreased gas pain and increased expulsion via mouth or rectum
84
Q

pre-existing conditions that restrict the use of antacids

A
  • fluid imbalance
  • renal disease
  • GI obstruction
  • heart failure
  • pregnancy
85
Q

pts with ____ or ____ shouldnt use antacids with high sodium content

A

heart failure or hypertension

86
Q

when to administer antacids

A

take other meds 1-2 hours before the antacid.

87
Q

antacids and enteric coated medications

A

antacids may cause premature dissolving of enteric coated medications resulting in stomach upset

88
Q

give antacids with how much water

A

240 ml to enhance absorption

89
Q

long term self medication of antacids

A

masks symptoms of underlying diseases such as malignancy or bleeding ulcers

90
Q

antacid adverse effects

A

-nausea, vomiting, abd pain, diarrhea,
- constipation and acid rebound with calcium-containing products

91
Q

what to assess before giving H2 antagonists

A

allergies and impaired renal or liver function

92
Q

use H2 antagonists with caution in pts who are

A

confused, disoriented or older adults

93
Q

PPIs may increased serum levels of

A

diazepam and phenytoin
- may increase chance for bleeding with warfarin

94
Q

granules of pantoprazole capsules

A

may be given via nasogastric tubes
- can be mixed with apple juice
- dont crush delayed granules

95
Q

misoprostol and pregnancy

A

dont use with pregnant ppl because it can induce uterine contractions

96
Q

when should you take PPI with food

A

30 -60 mins before meal

nurs 252 (23 decks)

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