Acid-Controlling Drugs

Question 1

What are the classes of acid-controlling drugs?

Answer 1

Antacids
Histamine (H2) antagonists
Proton pump inhibitors (PPI)

Question 2

What is the mechanism of action of antacids?

Answer 2

Increases gastric pH to neutralize gastric acidity

Antacids DO NOT prevent overproduction of acid

Question 3

What is the drug effect of antacids?

Answer 3

Reduction of pain associated with acid-related disorders (heartburn)

Question 4

What are the indications for antacids?

Answer 4

Symptoms associated with: 
PUD
Gastritis
Heartburn
Hyperacidity

Question 5

What are the contraindications for antacids?

Answer 5

Allergy
Renal failure
Electrolyte disturbances
Gastrointestinal obstruction

Question 6

What are examples of magnesium-containing antacids?

Answer 6

Gaviscon liquid

Milk of magnesium

Question 7

What are examples of aluminum-containing antacids?

Answer 7

Amphogel

Question 8

What are examples of magnesium and aluminum combo antacids?

Answer 8

Maalox

Mylanta

Question 9

What are examples of sodium-containing antacids?

Answer 9

Alka-seltzer

Question 10

What are examples of calcium-containing antacids?

Answer 10

Tums

Question 11

What are the adverse effects of antacids?

Answer 11

Magnesium - diarrhea
Aluminum and calcium - constipation
Calcium - kidney stones
Sodium bicarbonate - alkalosis

Question 12

What are the interactions concerning antacids?

Answer 12

Adsorption of other drugs to antacids reduces ability of other drugs to be absorbed into body
Chelation (chemical inactivation of other drugs)
Increased stomach pH increases absorption of basic drugs and decreases absorption of acidic drugs
Increased urinary pH increases excretion of acidic drugs and decreases excretion of basic drugs

Question 13

What are nursing implications for antacids?

Answer 13

Long-term self medication may mask symptoms of serious underlying diseases (cancer, bleeding ulcers)
Do not take within 1 - 2 hours of taking other medications (affects absorption)
Take tablets with 8 oz of water to enhance absorption
Seek medical evaluation if symptoms remain ongoing

Question 14

What is the mechanism of action of H2 antagonists?

Answer 14

Block histamine at H2 receptors of acid-producing parietal cells, reducing production of hydrogen ions, resulting in decreased production of HCl

Question 15

What is the drug effect of H2 antagonists?

Answer 15

Suppresses acid secretion in stomach

Relieves symptoms associated with hyperacidity disorders

Question 16

What are the indications for H2 antagonists?

Answer 16

GERD
PUD
Zollinger-Ellison syndrome

Question 17

What are the contraindications for H2 antagonists?

Answer 17

Allergy
Liver dysfunction
Kidney dysfunction

Question 18

What are examples of H2 antagonists?

Answer 18

Cimetidine (Tagamet)
Nizatidine (Axid)
Famotidine (Pepcid)
Ranitidine (Zantac)

Question 19

What are the adverse effects of H2 antagonists?

Answer 19

Low incidence of adverse effects

May cause some CNS effects in geriatric patients (lethargy, depression, confusion)

Question 20

What are the nursing implications for H2 antagonists?

Answer 20

Smoking reduces effectiveness

Take 1 hour before taking other medicaitons

Question 21

What is the mechanism of action of proton pump inhibitors?

Answer 21

Binds to the proton pump (hydrogen-potassium-ATPase), preventing movement of hydrogen ions out of parietal cell, blocking al gastric acid secretion

Question 22

What is the drug effect of proton pump inhibitors?

Answer 22

Reduces amount of gastric acid

Question 23

What are the indications for proton pump inhibitors?

Answer 23

GERD not responsive to H2 blockers
Erosive esophagitis
Active gastric/duodenal ulcers
Zollinger-Ellison syndrome
Stress ulcer prophylaxis
Treatment of H. pylori

Question 24

What are the contraindications of proton pump inhibitors?

Answer 24

Allergy

Question 25

What are some examples of proton pump inhibitors?

Answer 25

``` Lansoprazole (Prevacid) Omeprazole (Prilosec) Rabeprazole (Aciphex) Pantoprazole (Protonix) Exomeprazole (Nexium) ```

Question 26

What are the adverse effects of proton pump inhibitors?

Answer 26

Generally well tolerated | Concerns of predisposing patients to GI tract infections

Question 27

What are nursing implications for proton pump inhibitors?

Answer 27

Work best before breakfast Do not crush or chew sustained-release capsules Long-term use may increase risk of osteoporosis Notify provider for any signs of GI bleeding (coffee-grind emesis, tarry stool)

Question 28

What are some miscellaneous acid-controlling drugs?

Answer 28

Sucralfate (Carafate) Misoprostol (Cytotec) Simethicone (Mylicon)

Question 29

What are the indications for sucralfate (Carafate)?

Answer 29

Long-term therapy for PUD

Question 30

What is the mechanism of action of sucralfate (Carafate)?

Answer 30

Binds directly to surface of ulcer and forms protective barrier

Question 31

What are the indications for misoprostol (Cytotec)?

Answer 31

Gastric ulcers in patients taking NSAIDs

Question 32

What is the class of misoprostol (Cytotec)?

Answer 32

Prostaglandin E analogue

Question 33

What are the nursing implications for misoprostol (Cytotec)?

Answer 33

Pregnancy category X

Question 34

What is the mechanism of action of simethicone (Mylicon)?

Answer 34

Alters the elasticity of mucus-coated gas bubbles, causing them to break down into smaller ones

Question 35

What is the drug effect of simethicone (Mylicon)?

Answer 35

Reduce the discomforts of flatulence and aid in its release

Question 36

What are the indications for simethicone (Mylicon)?

Answer 36

Pain associated with post-operative gaseous distention