ATI Pharm Book Ch. 28 Peptic Ulcer Disease

Question 1

Pharmacological management of Peptic Ulcer disease addresses

Answer 1

the imbalance between gastric mucosal defenses, including mucus and bicarbonate, and antagonistic factors and use of NSAIDS

Question 2

Antibiotic Prototype Medications

Answer 2

Amoxicillin
Bismuth
Clarithromycin
Metronidazole
Tetracycline
Tinidazole

Question 3

Expected Pharmacologic Action - Antibiotics - GI

Answer 3

Eradication of H. Pylori bacteria

Question 4

Therapeutic Uses - Antibiotics - GI

Answer 4

Combination of two-three antibiotics for 14 days to increase effectiveness and minimize development of medication resistance

Question 5

Nursing Administration - Antibiotics - GI

Answer 5

Administer metronidazole with food to decrease GI disturbances

Question 6

Client Education - Antibiotics - GI

Answer 6

• Nausea and diarrhea are common adverse affects

- take full course of prescribed medications

Question 7

Histamine2-Receptor Agonists Prototypes

Answer 7

Cimetidine
Other Meds:
Famotidine &
Nizatidine (PO only)

Question 8

Histamine2-Receptor Agonists - Cimetidine - Expected Pharmacological Action

Answer 8

Block H2 receptors, suppresses the secretion of gastric acid and lowers the concentration of hydrogen ions in the stomach

Question 9

Histamine2-Receptor Agonists - Cimetidine -Therapeutic Uses

Answer 9

• 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

Question 10

Histamine2-Receptor Agonists - Cimetidine - Complications -Blocked androgen receptors - results in; education

Answer 10

results in decreased libido, gynecomastia, and impotence.

Adverse effects stop when dosing stops

Question 11

Histamine2-Receptor Agonists - Cimetidine - CNS Effects - Effects & Nursing Actions

Answer 11

• lethargy
• hallucinations
• confusion
• restlessness

Usually seen more often in older adults who have kidney or liver dysfunction

Question 12

Histamine2-Receptor Agonists - Cimetidine - Effects to report to provider

Answer 12

• constipation
• diarrhea
• nausea

Question 13

Histamine2-Receptor Agonists - Cimetidine - Contraindications/precautions

Answer 13

• 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

Question 14

Histamine2-Receptor Agonists - Cimetidine - Interactions

Answer 14

1. can inhibit medication-metabolizing enzymes and thus increase levels of
   - warfarin
   - phenytoin
   - theophylline
   - lidocaine
2. Concurrent use of antacids can decrease absorption of H2 receptor antagonists
3. Smoking can decrease effectiveness of histamine receptor antagonists

Question 15

Histamine2-Receptor Agonists - Cimetidine - Nursing actions & Client Education specifically for Interactions

Answer 15

• 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.

Question 16

Histamine2-Receptor Agonists - Nursing Administration

Answer 16

• 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

Question 17

Histamine2-Receptor Agonists - Client Education

Answer 17

• 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

Question 18

Proton Pump Inhibitors Prototype and other medications

Answer 18

Omeprazole

• pantoprazole
• lansoprazole
• dexlansoprazole
• rabeprazole
• esomeprazole

Question 19

Proton Pump Inhibitors - Omeprazole - Expected Pharmacological Action

Answer 19

Block basal and stimulated acid production, and reduce gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid

Question 20

Proton Pump Inhibitors - Omeprazole - Therapeutic Uses

Answer 20

• 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

Question 21

Proton Pump Inhibitors - Omeprazole - Complications

Answer 21

• Pneumonia
• Osteoporosis and fractures
• Rebound acid hypersecretion
• hypomagnesemia
• CDIFF

Question 22

Proton Pump Inhibitors - Omeprazole - Report to Provider

Answer 22

-manifestations of respiratory infection
-manifestations of hypomagnesemia
—tremors
—muscle cramps
—seizures
manifestations of CDAD
—fever
—diarrhea
—abdominal pain or cramping
—bloody stools