ATI Pharm Book Ch. 28 Peptic Ulcer Disease Flashcards
Pharmacological management of Peptic Ulcer disease addresses
the imbalance between gastric mucosal defenses, including mucus and bicarbonate, and antagonistic factors and use of NSAIDS
Antibiotic Prototype Medications
Amoxicillin Bismuth Clarithromycin Metronidazole Tetracycline Tinidazole
Expected Pharmacologic Action - Antibiotics - GI
Eradication of H. Pylori bacteria
Therapeutic Uses - Antibiotics - GI
Combination of two-three antibiotics for 14 days to increase effectiveness and minimize development of medication resistance
Nursing Administration - Antibiotics - GI
Administer metronidazole with food to decrease GI disturbances
Client Education - Antibiotics - GI
- Nausea and diarrhea are common adverse affects
- take full course of prescribed medications
Histamine2-Receptor Agonists Prototypes
Cimetidine
Other Meds:
Famotidine &
Nizatidine (PO only)
Histamine2-Receptor Agonists - Cimetidine - Expected Pharmacological Action
Block H2 receptors, suppresses the secretion of gastric acid and lowers the concentration of hydrogen ions in the stomach
Histamine2-Receptor Agonists - Cimetidine -Therapeutic Uses
- Prescribed to prevent or treat gastric and duodenal ulcers, GERD, hypersecretory conditions such as Zollinger Ellison Syndrome, heartburn, and acid indigestion
- used in conjunction with antibiotics to treat H. pylori
- management of urticaria
Histamine2-Receptor Agonists - Cimetidine - Complications -Blocked androgen receptors - results in; education
results in decreased libido, gynecomastia, and impotence.
Adverse effects stop when dosing stops
Histamine2-Receptor Agonists - Cimetidine - CNS Effects - Effects & Nursing Actions
- lethargy
- hallucinations
- confusion
- restlessness
Usually seen more often in older adults who have kidney or liver dysfunction
Histamine2-Receptor Agonists - Cimetidine - Effects to report to provider
- constipation
- diarrhea
- nausea
Histamine2-Receptor Agonists - Cimetidine - Contraindications/precautions
- Pregnancy Risk Category B
- Older adults are more likely to experience adverse CNS effects and can require decreased dosage
- H2 receptor antagonists decrease gastric acidity, which promotes bacterial colonization of stomach and respiratory tract.
- USe cautiously in those high risk for pneumonia, including COPD patients
- Dosages should be reduced in clients with moderate to severe kidney impairment
Histamine2-Receptor Agonists - Cimetidine - Interactions
- can inhibit medication-metabolizing enzymes and thus increase levels of
- warfarin
- phenytoin
- theophylline
- lidocaine - Concurrent use of antacids can decrease absorption of H2 receptor antagonists
- Smoking can decrease effectiveness of histamine receptor antagonists
Histamine2-Receptor Agonists - Cimetidine - Nursing actions & Client Education specifically for Interactions
- In clients taking warfarin, monitor for indications of bleeding, INR, and PT levels, adjust warfarin dosages accordingly
- In clients taking phenytoin, theophylline, and lidocaine, monitor blood levels and adjust dosages accordingly
- Educate: Do not take antacids within 1 hour of H2 antagonist
- Educate: Stop smoking or avoid smoking after last dose of the day.
Histamine2-Receptor Agonists - Nursing Administration
- Famotidine can be administered IV in acute situations
- Clients should avoid smoking, delayed healing
- Encourage clients to see provider if manifestations persist with OTC use of these medications
- Famotidine can be taken with or without food
- Treatment is usually 1-2 doses per day until ulcer healed followed by once at bedtime for maintenance
Histamine2-Receptor Agonists - Client Education
- Treatment of peptic ulcer is usually one dose twice daily until healed then one dose at bedtime for maintenance
- notify provider of any obvious or occult GI bleeding (coffee ground emesis)
- avoid alcohol and foods that increase GI irritation, limit aspirin or NSAIDS
- increase fiber and fluid intake to prevent and manage constipation
- several medications can be required several times a day, follow full treatment regimen
Proton Pump Inhibitors Prototype and other medications
Omeprazole
- pantoprazole
- lansoprazole
- dexlansoprazole
- rabeprazole
- esomeprazole
Proton Pump Inhibitors - Omeprazole - Expected Pharmacological Action
Block basal and stimulated acid production, and reduce gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid
Proton Pump Inhibitors - Omeprazole - Therapeutic Uses
- short-term therapy of gastric and duodenal ulcers, erosive esophagitis, and GERD. Limited to 4-8 weeks.
- Long term therapy of hypersecretory conditions
- prevention of stress ulcers for at-risk clients experiencing acute events
Proton Pump Inhibitors - Omeprazole - Complications
- Pneumonia
- Osteoporosis and fractures
- Rebound acid hypersecretion
- hypomagnesemia
- CDIFF
Proton Pump Inhibitors - Omeprazole - Report to Provider
-manifestations of respiratory infection
-manifestations of hypomagnesemia
—tremors
—muscle cramps
—seizures
manifestations of CDAD
—fever
—diarrhea
—abdominal pain or cramping
—bloody stools
