Chapter 46: Antiulcer Drugs Flashcards
What is gastric ulcers? Like where?
Ulcers in the stomach
Where is esophageal ulcers?
In the esophagus
Where is duodenal ulcers?
In the early part of the small intestine
What are reason why we get peptic ulceration? (3)
Mucosal lining erosion
Hyper secretions
( hycrocholirc acid or pepsin )
Gastric ph too low
What are some factors that cause or predisposed a patient to peptic ulcers?
Main bacteria?
H.pylori
Mechanism disturbances
( how food flows their your gut, genetic influence )
Genetic influence
Environmental influence
What 2 medication increases ulcers?
NSAIDs and steroids
What are the 2 main symptoms of peptic ulcers?
Gnawing and aching pain
What is the definition of peptic ulcer disease?
Gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin
H. Pylori is the found in almost all ulcers, so what’s the first line therapy for these patients?
10-14 day course of PPI and antibiotics
Why does esophageal ulcers occur?
Due to reflux of acid gastric secretions into the esophagus from an incompetence cardiac spichter
( GERD )
Why does gastric ulcer occur?
Due to breakdown of gastric mucosal barrier
Why does duodenal ulcers occur?
Due to hypersecretion of acid
What is stress ulcers usually caused by?
It’s in the name itself
However mainly from trauma, burns and major surgery
Usually what is the first finding of a stress ulcers after a patient in the ICU comes back from surgery 24 hours after?
GI lesions
What are some symptoms we can see with stress ulcers ? (3)
Decreased blood flow
Mucosal ischemia
Hypo perfusion and repefusion of inury
Does an NG tube and ventilator cause GI bleeding?
Yess it can
Usually what do we want to do for these patients, for stress ulcers, like how do we prevent?
Usually using PPI
And or histamine receptor
What is GERD?
Inflammation or erosion of the esophageal mucosa caused by reflux or gastric acid content into the esophagus
What causes GERD?
Incompetent lower esophageal spincter
Does GERD have ulcers?
No
They can lead to ulcers tho!
What can aggravate GERD?
Smoking
Spicy foods
Citrus stuff
What is the 3 treatment we use to help GERD?
Antiulcer drugs
H2 blockers
PPIs
What are some Nonpharmacologic measure for ulcers?
Avoid tobacco and alcohol
Weight loss
Avoid hot spicy greasy foods
Take nsaids and steroids with food
Don’t eat before bedtime
Wear loose fitting clothing
Elevate HOB
What are the 7 anti ulcer drug options we are going to talk about?
Tranquilizers
Anticholinergic
Antacids
H2 blockers
Proton pump inhibitors
Pepsin inhibitors
Prostaglandin analogue
What are tranquilizers mix with?
Anxiety medication and anticholinergic
What is the action of tranquilizers and how it places a role in helping with ulcers?
So it reduces the Vegas nerve which runs right by our stomach by reducing the amount of acid producing & the anti cholinergic helps dry up gastric secretions
What are the side effects of tranquilizers? (3)
Edema
Ataxia ( unsteady movement )
Confusion
What does anticholinergic drugs do?
Pretty much help reduce the amount of acid in the body and helps dry it out
What are anticholinergic drug side effects?
Same dry mouth
Headache
Dizziness
Blurred vision
Urinary rention and constipation
( no glaucoma !
What is the first line of treatment for ulcers ? Usually OTC?
Antacids
What are the 4 antacids?
Sodium bicarbonate
Calcium carbonate
Magnesium hydroxide
Aluminum hydroxide
What is our biggest concern of sodium bicarbonate? ( baking soda )
Hypernatremia !!( too much sodium )
Water rentetion
Metabolic alkalosis
What is the effect or action of sodium bicarbonate we tell patients about?
It’s quick onset but it doesn’t last long
And you can have that rebound again
In which patients should be careful with the administer of sodium bicarbonate?
Caution in patients with heart failure
Hypertension
Renal insufficiency
Calcium carbonate ( tongs )
Help reduce the acid in the stomach
What are the 4 side effects?
Acid rebound
Constipation
Hyper calcium
Hypo phosphorus
What’s important to remember is that whenever we see high calcium what do we think?
Low phosphors
Or vise versa
What is a complication of calcium carbonate ? (3)
Burnett syndrome alkalosis
Hypercalcemia
Crystalluria& renal failure
What is the side effect of magnesium hydroxide?
Diarrhea - often mixed with alminium hydroxide
Magnesium hydroxide is very dangerous against which type of patients?
Renal failure
( failing kidney cannot excrete extra magnesium )
Aluminum hydroxide side effects? (4)
Constipation
Anoriexa
Weakness
Impaired cognition
What are your aluminum hydroxide complication?
Hypo phoso
Hyper calcium
Osteroposories
Neprhotlithaid
GI constipation
Usually again that magnesium causing diarrhea and aluminum causing constipation what do we do?
Mix them together so it levels out
What is the function behind antacids?
Neutralize HCI and reduced pepsin activity
Increasing PH in the stomach and bladder
If the ph is not where it needs to be in the stomach, usually because antacids increase it, what happens with other drugs?
Usually will not be absorbed
What drug binds with calcium and should be avoided with antacids?
Tetracyclines
Most medication should be administered _ to _ hours after an antacids?
1-2
Educate patients that long term use of antacids can what?
Hide underlying causes or bleeding
Now onto histamine blockers 2
What is the action of histamine blockers 2?
These block h2 receptors that is released
What are the 3 histamine blockers 2?
Cimetidine ( Tagamet )
Nizatidine ( axid )
Famotidine ( Pepcid (
What are some side effects of h2 blockers? (3)
Erectile dysfunction
Vitamin b12 deficiency
Theombocytopenia
Remmeber H1 is for allergies
H2 is for ulcers
Proton pump inhibitors!!
What is the action of PPI?
So in our body, we have this enzyme hydrogen/potassium ATPase enzyme in the parietal cells that release this protons causing that heavy secretions of acid
But the PPI literally shuts that down! And restarts it to a better level of acid
What is PPI side effects? (3)
Vitamin B12 deficiency
Hypomagenseima
Blood dyscrasias
PPI are highly protein bound
So if you give this to another protein bound medication, like digoxin, it’ll have a more effect on which one?
Digoxin!
Pepsin inhibitors!!
What is pepsin inhibitors action?
Combined with protein to form thick paste covering ulcer protecting ulcer from acid and pepsin
Covers stomach lining and protecting its from the acid
What is the pepsin side effect?
Constipation !
Pepsin
Given 1 hour before meals and bedtime
Do not give other medication at the same time
Drug interactions
Decrease the absorption of tetracycline, phenytoin, fat double vitamins, cipro, norfloxacin
Hour of antacids separation
Prostaglandins analogue
What are the two medication of prostaglandin analogue?
Cytotec
Misoprostol
What is the action of prostaglandin analogue?
Decrease acid secretions
Protects gastric mucosa
Usually given for NSAIDS
Prostaglandin analogue contraindication??????
Abortion pill !!!!!!!!!
( either for abortion or cervix dilation )
