Acid-Controlling Drugs Flashcards
what does the STOMACH SECRETE? (6)
- HYDROCHLORIC ACID (HCI)
- BICARB
- PEPSINOGEN
- INTRINSIC FACTOR
- MUCUS
- PROSTAGLANDINS
what are the GLANDS of the STOMACH?
- CARDIAC
- PYLORIC
- GASTRIC
[names based after relative locations within the STOMACH]
what are the CELLS of the GASTRIC GLANDS?
- PARIETAL
- CHIEF
- MUCOUS
describe HCI ACID
- is secreted by the PARIETAL CELLS
- keeps stomach pH around 1 - 4
- helps with the PROPER DIGESTION OF FOOD + fights against MICROBIAL INFECTION in the GI TRACT
what STIMULATES HCI SECRETION?
- FOOD, CHOCOLATE, CAFFEINE, ALCOHOL
- LARGE FATTY MEALS
- EMOTIONAL STRESS
what are the TYPES OF ACID-CONTROLLING DRUGS?
- ANTACIDS
- H2 ANTAGONISTS
- PPIs
describe ANTACIDS
- work simply by NEUTRALIZING STOMACH ACID
- contains your SALTS; Al, Mg, Cal, Na
- often has ANTI-FLATULENT DRUG SIMETHICONE
calcium antacids can develop into what?
- KIDNEY STONES
- can also INCREASE gastric acid secretions
antacids that contain MAGNESIUM are contraindicated for which demographic of patients?
renal failure patients
sodium bicarb is a __________ antacid with a _________ onset but a __________ duration of action
- HIGHLY SOLUBLE
- QUICK
- SHORT
describe the MOA of antacids
- NEUTRALIZES ACID SECRETIONS
- aids in PROMOTING GASTRIC MUCOSAL DEFENSE MECHANISMS
antacids stimulate the secretion of? (3)
- MUCUS
a PROTECTIVE BARRIER vs. HCI - BICARB
keeps proper BUFFER against HCI - PROSTAGLANDINS
prevents the ACTIVATION of PROTON PUMP
indications for ANTACIDS
- PEPTIC ULCERS
- GASTRITIS
- GASTRIC HYPERACIDITY
- HEARTBURN
contraindications for ANTACIDS
- allergies
- SEVERE RENAL FAILURE
- ELECTROLYTE DISTURBANCES
- GI OBSTRUCTION
adverse effects of ANTACIDS
- LONG TERM USE; METABOLIC ALKALOSIS
- Mg; DIARRHEA
- Al & Cal; CONSTIPATION
- Cal; KIDNEY STONES/REBOUND HYPERACIDITY
- Calcium carbonate; GAS & BELCHING **due to combo with SIMETHICONE
what type of OTC FORMULATIONS are available for antacids?
- Capsules and tablets
- Powders
- Chewable tablets
- Suspensions
- Effervescent granules and tablets
magnesium salts
- HYDROXIDE SALT (MILK OF MAG)
- CARBONATE SALT (GAVISCON)
- MAALOX + MYLANTA (Al & Mg)
- causes DIARRHEA typically
- XX RENAL FAILURE; kidneys cannot remove extra mag
calcium salts
- most common; CARBONATE
- long term use can cause HYPERACIDITY REBOUND
- can cause CONSTIPATION & KIDNEY STONES
- XX RENAL DISEASE/FAILURE
- seen often as an extra source of dietary calcium!
ex. TUMS :)
sodium bicarbonate
- is HIGHLY SOLUBLE
- acts as a BUFFER vs. HCI
- can cause METABOLIC ALKALOSIS
- use caution with HF, HT, or RENAL INSUFFICIENCY patients (due to SODIUM CONTENT)
examples;
ALKA-SELTZER
SEGERID
aluminium salts
- can have CONSTIPATION
(to counteract often used with Mg) - BETTER METHOD for RENAL DX PATIENTS due to easier excretion
examples;
ALUMINUM CARBONATE; BASALIJEL
HYDROXIDE SALT; ALTERNAGEL
**combined with MAALOX/MYLANTA/GAVISCON
drug interactions with antacids
- ABSORPTION
- CHELATION
- INCREASED STOMACH PH
- INCREASED URINARY PH
absorption
reduces ability of the other’s drugs absorption
chelation
can chemically INACTIVATE other drugs
- production of INSOLUBLE COMPLEXES > reduced drug absorption
increased stomach pH
increases ABSORPTION of BASIC DRUGS/decreases ABSORPTION of ACIDIC DRUGS
increased URINARY pH
increases the EXCRETION of acidic drugs/decreases the EXCRETION OF BASIC DRUGS
describe HISTAMINE 2 RECEPTOR ANTAGONISTS
- work by REDUCING ACID SECRETION
- all are available OTC - in LOW DOSAGE FORMS
- very popular drugs for treatment of acid-related disorders
what are our H2 RECEPTOR ANTAGONISTS?
- CIMETIDINE (TAGAMET)
- NIZATIDINE (AXID)
- FAMOTIDINE (PEPCID)
- RANITIDINE (ZANTAC) **taken off the market
MOA of H2 ANTAGONISTS
- blocks the H2 RECEPTOR of the ACID-PRODUCING PARIETAL CELLS
- reduces H ION SECRETIONS
- increases pH in the STOMACH
indications for H2 ANTAGONISTS
- GERD
- PUD
- EROSIVE ESOPHAGITIS
- control for UPPER GI BLEEDING
- ZOLLINGER-ELLISON SYNDROME
adverse effects for H2 ANTAGONISTS
- CNS effects - elderly patients
ex. CONFUSION and DISORIENTATION - CIMENTIDINE; can cause IMPOTENCE & GYNECOMASTIA
- FAMOTIDINE; can cause THROMBOCYTOPENIA
cimetidine (tagamet) and its DRUG INTERACTIONS
- binds to the P-450 microsomal oxidase sys within the LIVER; can cause INHIBITED OXIDATION of drugs + INCREASE DRUG LEVELS
- can inhibit DRUG ABSORPTION
- main reason to why CIMETIDINE is know widely replaced by FAMOTIDINE
drug interactions for H2 ANTAGONISTS
- smoking; decreases efficacy
- can cause absorption issues if taken with ANTACIDS at the same time; take H2 1 - 2 hours before
nursing implications - H2 ANTAGONISTS
- assess for ALLERGIES/IMPAIRED RENAL or LIVER FXN
- CNS effects - confusion or disorientation?
describe PPIs (PROTON PUMP INHIBITORS)
- inhibits the PROTON PUMP that the PARIETAL CELLS use to release HYDROGEN IONS (PROTONS) during HCI PRODUCTION
- unique as H2 BLOCKS or ANTIHISTAMINES cannot do this
MOA of PPIs
- binds to H+/K+ ATPase enzyme
- prevents the MOVEMENT of HYDROGEN IONS from PARIETAL CELLS to the STOMACH
indications for PPs
- EROSIVE ESOPHAGITIS
- SYMPTOMATIC GERD - if there is poor response to H2 blockers
- ACTIVE DUODENAL ULCERS/BENIGN GASTRIC ULCERS
- ZOLLINGER-ELLISON SYNDROME
- NSAID-INDUCED ULCERS
- STRESS ULCER PROPHYLAXIS
- H. PYLORI ULCERS
[often given with ANTIBIOTICS]
adverse effects of PPIs
- C. diff infections
- wrist, hip, or spine fractures
- pneumonia
- depletion of magnesium
- systemic lupus erythematous
drug interactions for PPis
- can increase levels of DIAZEPAM & PHENYTOIN
- increased chance of bleeding - PPI + WARFARIN
- given with CLOPIDOGREL
- can decrease the effectiveness of clopidogrel due to dependency on CYP-450 ENZYME SYSTEM
- can cause issues of ABSORPTION for KETOCONAZOLE, AMPICILLIN, IRON SALTS or DIGOXIN
- best to take on an EMPTY STOMACH - food can decrease absorption of PPI
what are our PPIs?
- LANSOPRAZOLE (PREVACID)
- OMEPRAZOLE (PRILOSEC)
- RABEPRAZOLE (ACIPHEX)
- PANTOPRAZOLE (PROTONIX)
- ESOMEPRAZOLE (NEXIUM)
- DEXLANSOPRAZOLE (DEXILANT)
sulcralfate (carafate)
- used as a MUCOSAL PROTECTANT
- used for the TREATMENT OF ACTIVE STRESS ULCERATIONS + LONG-TERM THERAPY for PEPTIC ULCER DISEASE
- binds to bases of ULCERS; creates PROTECTIVE BARRIER
- decreases PEPSIN ACCESS (can break down proteins - causes exacerbation of ulcers)
implications for sucralfate
- can cause LITTLE ABSORPTION for the gut; causing CONSTIPATION, N/V, or DRY MOUTH
- DO NOT ADMINSTER with other meds
- can be USED in CHRONIC RENAL FAILURE due to phosphate binding ability
- give other drugs AT LEAST 2 HOURS BEFORE
misoprostol (cytotec)
- type of PROSTAGLANDIN E ANALOGUE [important to inhibit gastric acid/mucus production/cell regen]
- reduces the INCIDENCE OF GASTRIC ULCERS with patients who are taking NSAIDs
simethicone
- used to REDUCE the DISCOMFORTS of GASTRIC OR INTESTINAL GAS
- known as an ANTIFLATULENT DRUG
- works by altering the ELASTICITY OF MUCUS-COATED GAS BUBBLES > causes the bubbles to break into smaller ones
- reduces GAS PAIN/expulsion of GAS via mouth or rectum
nursing implications for ANTACIDS
assess for PREEXISTING CONDITIONS;
- FLUID IMBALANCES
- RENAL Dx
- GI OBSTRUCTION
- HF **do not use due to antacid sodium content
- PREGNANCY
- other meds should be given 1 - 2 hours PRIOR to antacid
- can cause EARLY DISSOLVING OF ENTERIC-COATED MEDS
- adminster with at LEAST 8 OZ of WATER for better absorption
