Antiulcer Flashcards
describe GERD
aka: reflux esophagitis
- chronic inflammation of the esophageal mucosa
- caused by reflux of gastric acidic content into the esophagus
- related to:
a) an incompetent lower-esophageal sphincter (cardiac sphincter)
b) hiatal hernia
c) smoking tends to accelerate the disease process
describe PUD
Mucosal lining erosion of:
- Esophageal
- Gastric
- Duodenal- most common
antacid drugs (3)
- calcium-carbonate
- magnesium-hydroxide
- magnesium-hydroxide / aluminum-hydroxide
- –> no constipation or diarrhea b/c Mg = diarrhea but Al = constipation
antacid nursing (5)
- Take up to 7 doses/day (1 & 3 hrs after meals & at HS)
- take other drugs at least 1 hr before or 4 hrs after antacids
- Monitor for diarrhea as a sign of infection (low acidity => opportunistic infections)
- Chewable (must chew), suspension (must shake well)
- take with 8 oz water, just enough to ensure the drug reaches stomach
antacid side effect (1)
- OD of electrolytes (Mg, Ca, Al)
- –> especially with history of RF
histamine2 receptor blockers drugs (3)
- *famotidine IV/PO
- cimetidine IV/PO
- nizatidine PO
histamine2 receptor blockers MOA (2)
- reduce gastric acid by blocking H2 receptors on the stomach wall
- Promote healing of ulcer by reducing hydrochloric acid production
histamine2 receptor blockers side effects
- B12-deficiency (take supplement)
- Blocking androgen receptors
- impotence, decreased libido, gynecomastia
- CNS effects
- lethargy, depression, confusion (take at bedtime)
- caution: geriatric population
- Low gastric acidity: may cause bacterial colonization (precautions)
histamine2 receptor blockers nursing (6)
- Take right before meals to decrease food-induced acid secretion
- Take at HS for lethargy, depression, confusion side effects
- Monitor I&Os
- RF is a side effect & contraindication
- monitor Lab: renal panel, CMP - Don’t take with antacids (lower absorption) take separately 1-2 hrs
- May cause toxicity with warfarin, phenytoin, theophylline, lidocaine
- Older adults need smaller dose d/t less gastric acid
proton pump inhibitors (PPI) drugs
- pantoprazole IV/PO
2. omeprazole PO
PPI MOA (2)
- Reduce gastric acid
2. Oral peak effect after several days
predisposing factors for PUD that we need to know in this class
- NSAIDs, ASA, corticosteroids
- take drugs with food
- preferred: enteric-coated medication - avoid caffeine, ETOH, nicotine, greasy foods, spices
- educate to eat a bland diet
PPI side effects
- diarrhea
- insomnia
- dizziness
- dry mouth
- flatulence
- liver failure
- C-diff
- Long-term use = osteoporosis
PPI -prazole nursing (2)
- Take at least an hour before meal/drugs (to avoid poor digestion/absorption)
- Taper off to avoid rebound acid hypersecretion
pepsin inhibitor drug (1)`
sucralfate PO tablet or oral suspension
pepsin inhibitor MOA (2)
- reacts with gastric acid and forms a thick paste
2. selectively adheres to the ulcer protecting it from acid and pepsin for up to 6 hrs
CN X is what nerve
vagus nerve is a cholinergic nerve (sleepy chicken) so antiulcer drugs work as anticholinergics and stop GI motility and GI secretions
pepsin inhibitor side effects
- constipation
- hyperglycemia (sugar content of the drug)
pepsin inhibitor nursing interventions
- Given 30 minutes AC & HS (qid)
- Avoid taking with other drugs
- at least 2 hrs apart from other drugs to prevent poor absorption
- Finish the course even if feeling better
- Increase activity, water, fiber to avoid constipation
helicobacter pylori
- 1-2 weeks of treatment; combination of multiple antibiotics to reduce risk of resistance, followed by 6 weeks of acid suppression therapy
- Antibiotics (multi-agent abx therapy)
= metronidazole, amoxicillin, tetracycline - Proton pump inhibitor (PPI)
= omeprazole, pantoprazole - Antacid
= magnesium-hydroxide / aluminum-hydroxide - H2 receptor blocker
= famotidine
**Side effect of abx and acid suppression: opportunistic infection (C.diff)
