Acid Controlling Drugs Flashcards
The stomach secretes what?
HCL
bicarbonate
pepsinogen
intrinsic factor
mucus
prostaglandins (anti inflammatory)
What are the three glands of the stomach
Cardiac
Pyloric
Gastric
Name the Cells of the Gastric Glands
Parietal
Chief
Mucous
Endocrine
Enterochromaffin
What do Parietal cells produce?
HCL
What do chief cells do?
break down proteins
What do Mucous cells do?
protects the stomach from acidity of the stomach environment
What is Peptic Ulcer diseasae?
Ulcers that involve the digestion of the GI mucosa caused by pepsin; can be casues by bacteria (H. pylori)
What is the treatment regime of Peptic Ulcer disease?
Triple therapy: 7-14 days, of proton pump inhibitors, clarithromycin, amoxicillin, metronidazole, or Quadruple therapy of the previous drugs + bismuth subsalicylates
What is Stress related Mucosal damage?
Due to high stress environment of hospital it causes GI lesions, GI ischemia
What are the types of Acid controlling drugs?
Antacids
H2 antagonists
PPIs
What do Antacids do?
neutralize the stomach acidity, may contian an antiflatulant, and amgnesium to prevent contipation,
What elements are constipating?
aluminum and calcium
What are the Antacids you need to know for the exam?
calcium
containing magnesium
Sodium bicarbonate
MOA of Antacids?
Stimulate mucus, bicarbonate, prostaglandins. these all buffer and neutralize acid secretions
How do Antacids effect the body
Stops the irritation of the stomach lining, neutralizes 90% of gastric acid, raises pH 1.3-2.3 points
Who needs antacids?
acute relief of peptic ulcers, gastritis, gastric hyperacidity, heart burn
what are the contraindications of antacids?
allergy
severe renal failure
accumulation of electrolytes
obstruction (tumor, stricter)
What are the types of Antacids?
Aluminum hydroxide
Magnesium hydroxide
Simethicone
Combination aluminum hydroxide and magnesium hydroxide contain a local anesthetic
Describe Aluminum salts?
are very constipating
recommended for renal disease
Describe Magnesium salts?
cause diarrhea
very dangerous when pt is in renal failure
Describe Calcium salts
may cause constipation and kidney stones
not recommended for renal disease
have a long duration
Describe Sodium bicarbonate
Highly soluble
buffers acidic properties
may cause metabolic alkalosis
fast onset short duration
contains sodium may cause fluid overload
Which Antacid can a pt. with renal failure use?
Aluminum salt antacid
What are Antiflatulets?
Helps relive painful symptoms with gas
what is the Antiflatulents drug on the exam?
simethicone
Antacids AEs
overuse= metabolic acidosis
contipation
diarrhea
rebound hyperacididty
Interactions of Antacids
reduce ability to absorb meds
When should other medications be taken if pt is taking antacids?
the drugs should be taken 2 hours before or after antacids
What are H2 receptor antagonist?
Drugs that reduce acid secretion
inhibit 90% of acid production
What are the H2 antagonists drugs you need to know for the exam?
ranitidine hydrochloride (Zantac®)
famotidine (Pepcid®)
Cimetidine
what is the MOA of H2 Receptor antagonist’s
block acid producing cells,
incresas pH of stomach
relive many sympotooms of hyperacidity
Indications of H2 receptor antagonists
GERDs
peptic ulcers
Erosive esophagitis
control upper GI bleeds
Zollinger Ellison syndrome
What are the AE of H2 receptor antagonists?
in the elderly can cause confusion/disorientation
ED
gynecomastia
Thrombocytopenia
H2 receptor antagonists Interactions
Cimetidine: affect absorption of other meds
All H2 antagonists may inhibit the absorption of drugs that require an acidic gastrointestinal environment for absorption
What activity decreases the effectiveness of H2 Antagonists?
smoking, taking antacids at the same time
What are Proton Pump Inhibitors?
They totally block the secretion of H+ ions from the parietal cells
What Proton Pump Inhibitors drugs do you need to know for the exam?
lansoprazole (Prevacid®)
omeprazole (Losec®)
pantoprazole sodium (Pantoloc®) (only IV med)
What is the MOA of Proton Pump Inhibitors?
Bind to ATPase enzyme to prevent movement of H+ ion and blocks there secretions
What are the Indications of Proton Pump Inhibitors?
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
What are the AE of Proton Pump Inhibitors?
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
What are the interactions of Proton Pump Inhibitors?
Increase serum levels of diazepam and phenytoin
Warfarin: increased chance of bleeding
Absorption of ketoconazole, ampicillin, iron salts, and digoxin
Copidogrel (Plavix): risk of MI, death
Sucralfate: may delay the absorption of PPIs
Food may decrease absorption of the PPIs
Name the miscellaous Acid controlling drugs
sucralfate
misoprostol
Simethicone (Ovol®)
Explain Sucralfate
must give 2 hrs before meds and 1 hr before meals with empty stomach
cytoprotective e drug
used for stress and peptic ulcers
attaches and binds to base of ulcers and erosions to form a barrier over them to protect them from pepsin
Explain Misoprostol
Is a prostaglandin (cytoprotective)
not as effective as H2 antagonist or PPIs
used for NSAID gastric ulcers
may induce labor (don’t use of pregnant women)
Explain Simethicone
is an antiflatulet
alter elasticity of mucous gas bubles
results in decreased gas pain
What is an Example of Antacid Magnesium salt?
Magnesium hydroxide and mineral oil (Magnolox®)
What is an example of Antacid Aluminum salts?
Magnesium hydroxide and mineral oil (Magnolox®)
What is an example of Antacid Calcium salts?
Example: calcium carbonate and simethicone (Maalox, Rolaids®)
Many antacids also contain what drug?
Simethicone (antiflatulent)
What element counteracts the constipating effects of aluminum and calcium?
magnesium
______ May lead to the development of kidney stones and increased gastric acid secretion
Calcium antacids
_______ Must be avoided in patients with renal failure
Magnesium Antacids
______ is highly soluble, has a quick onset and short DOA
Sodium bicarbonate
What needs to be assessed prior to and when administering antacids?
Fluid disease
allergies
Renal disease
GI obstruction
HF or HTN (no sodium antacids)
Pregnancy
When should Antacids be adminstred?
1-2 hours before other medications
How can Antacids effect enteric coated medications?
they may cause the premature dissolving of the coating causing an upset stomach and possible decreased effect of the medication
Why do chewable meds need to be chewed thoroughly?
To ensure they are broken down when they arrive in the stomach to ensure they are effective
Antacids should be administered with _____ to ensure absorption
240 mL of water (except with rapid dissolve meds)
What are the AEs of Antacids?
NVD, abdominal pain
Calcium products: constipation, acid rebound
What needs to be assessed during and prior to administering H2 antagonists?
Allergies
Liver function
confusion
disorientation
When should H2 antagonists be administer if the patient is also taking antacids?
1-2 hours before similar to all other medications
What needs to be assessed during and prior to administration of a PPI?
Allergies
liver function
PPIs may increase serum levels of what?
diazepam, phenytoin,
Granules of what med may be given via NG tube?
pantoprazole
