ANTIULCER Flashcards
Peptic Ulcers
Mucosal lining erosion
-esophageal
-gastric
-duodenal
hypersecretion
-hcl
-pepsin
-ph of 2 to 5
esophageal ulcer
results from reflux of acidic gastric secretions into esophagus due to incompetent cardiac sphincter
gastric ulcer
results from a breakdown of the gastric mucosal barrier
duodenal ulcer
results in acid that passes into the duodenum
stress ulcer
results from trauma, burns, or major surgery
Ulcer predisposing factors
h pylori
mechanical
genetic
environmental
drugs
stress ulcers following critical situations
Ulcer symptoms
gnawing aching pain after eating
gastric- .5 to 1.5 hours after eating
duodenal- 2 to 3 hours after eating
Gastroesophageal Reflux Disease
GERD (reflux esophagus)
- inflammation of the esophageal mucosa caused by reflux of gastric acid content into the esophagus
-main cause- incompetent lower esophageal sphincter
- smoking accelerates the disease process
- TX is an antiulcer drug (same for peptic ulcers)
Non- Pharm measures for GERD
avoid alcohol and tobacco
weight loss
avoid how spicy foods
take NSAIDs and glucocorticoids with food or in decreased dosages
sit upright
do not eat before bedtime
wear loose-fitting clothes
anti-ulcer drugs
traquilizers
anticholinergics
antascids
h2 blockers
proton pump
pepsin inhibitor
prostaglandin E1 analog
Antacids
ACTION: neutralize HCL and reduce pepsin activity
SE/ AR: sodium bicarb (alka seltzer)- hypernatremia, water retention, metabolic alkalosis, acid rebound
calcium carb (tums)- acid rebound, hypercalcemia
mag hydroxide (maalox) - diarrhea
aluminum hydroxide (amphogel)- consipation
H2 blockers
Histamine2 blockers
ACTION: reduce gastric acid by blocking the h2 receptors of parental cells in stomach
promote healing of ulcers by eliminating the cause
SE: headaches, dizziness, diarrhea or constipation, reversible impotence, gynecomastia, decreased libido
ROUTE: mostly oral some iv
MEDS: cimetidine (tagamet), ranitident (zantac), famotidine (pepcid), nizatidine (axid)
DRUG INTERACTIONS: cimetidine increases the effects of oral anticoagulants, theophylline, caffeine, phenytoin (Dilantin), diazepam (valium), Propranolol (Inderal), phenobarbital, and calcium channel blockers
cimetidine causes increase in BUN, serum creatine, serum alkaline phosphate
CONTRA: cimetidine nor ranitidine should be taken with antacids
proton pump inhibitors
ACTION: redoce gastirc acid by inhibiting hydrogen potassium ATPase
MEDS: omeprazole ( prilosec)
Lansoprazole (prevacid)
raberprazole (aciphex)
pantoprazole (protnix)
esomeprazole (nexium)
dexlansoprazole (dexilant)
SE: headache
dizziness
dry mouth
rash
fatigue
gi distress
appetite changes
diarrhea
constipation
pepsin inhibitors
ACTION: combines with protein to form thick paste covering ulcer and protects it from acid and pepsin
SE: main side effect is constipation
INTERVENTIONS: 30 mins before meals and bedtime
MEDS: sucralfate (carafate)
prostaglandin analog
ACTION: supress gastric acid secretion
cause moderate decrease in pepsin secretion
protect mucosa
SE: diarrhea
abdominal pain
chills
shivering
hyperthermia
MEDS: misoprostol (cytotec)
