(Chapter 52 Acid-controlling drugs) Flashcards
Antacids
Basic compounds composed of different combinations of acid-neutralizing ionic salts
- Neutralizes the acid once it is in the stomach
- Promote gastric mucosal defence mechanisms
- Secretes Mucus: protective barrier against HCl, bicarbonate: helps buffer acidic properties of HCl and prostaglandins: prevent activation of proton pump
- Reduce pain due to acidity and raises the pH
- Used alone or in combination: Aluminum salts, magnesium salts, calcium salts, sodium bicarbonate
- Contraindicated in people with Severe kidney failure or electrolyte disturbances and GI obstruction
Chief cells
Cells in the stomach that secrete the gastric enzyme pepsinogen (becomes pepsin when exposed to acid)
Hydrocholric acid (HCL)
An acid secreted by the parietal cells in the lining of the stomach that maintains the environment of the stomach at a pH of 1 to 4
- Stimulated when we eat, drink caffeine, chocolate, alcohol, smoke
Mucous cells
Cells whose function in the stomach is to secrete mucus that serves as a protective mucous coat against the digestive properties of HCL
- Protects against self-digestion
Parietal cells
- Cells in the stomach that produce and secrete HCL
- Are the primary site of action for many acid-controlling drugs
Types of acid-controlling drugs
Antacids
Histamine-2 (H2) antagonists
Proton pump inhibitors
Aluminum salts
- Have constipating effects
- Are often used with magnesium to counteract constipation
- Are often recommended for patients with renal disease (more easily excreted)
Include - Aluminum hydroxide salt: Almagel (with magnesium hydroxide)
Combination products (aluminum and magnesium): Maalox, Mylanta
Magnesium salts
- Commonly cause diarrhea; usually used with other drugs to counteract this effect
- Are dangerous when used in patients with renal failure— the failing kidney cannot excrete extra magnesium, resulting in accumulation
- Examples include: Carbonate salt: Magmix
Hydroxide salt: milk of magnesia
Oxide salt: magnesium oxide
Trisilicate salt: Gasulsol Tablets
Combination product: Calmax, Maalox
Calcium salts
- Come in many forms, but carbonate is most common
- May cause constipation, kidney stones
- Are not recommended for patients with renal disease—may accumulate to toxic levels
- May cause increased gastric acid secretion (rebound hyperacidity)
- Are often advertised as an extra source of dietary calcium
Example: Tums (calcium carbonate) - Used to prevent or treat calcium deficiency (calcium acetate, calcium liquid, and calcium carbonate)
- Used in patients with kidney failure to bind dietary phosphate
Sodium Bicarbonate
- Is highly soluble
- Buffers the acidic properties of HCl
- Has a quick onset but short duration
- May cause metabolic alkalosis
- May cause problems in patients with heart failure, hypertension, or renal insufficiency because of high sodium content
Antiflatulents
- Antiflatulents are used to relieve the painful symptoms associated with gas
- Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products
- simethicone decreases the amount of gas that is in the gut
Nursing implications for antacids
- Do not give at the same time as other medications (before or after)
- Patients with heart failure or hypertension should not use antacids with a high sodium content
- Use with caution with people who are preganant, cardiac failure, GI obstruction, renal disease, and fluid imbalance
Histamine-2 (H2) Antagonists
- Reduce production of HCL
- suffix is “dine”
- Block histamine at the H2 receptors of acid-producing parietal cells
- Very few adverse effects but include Headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing
- Smoking decreases the effectiveness
Nursing implications for H2 Antagonists
- Assess for allergies and impaired renal or liver function
- Use with caution in patients who are confused or disoriented and in older adults
- Give 1 hour before or after antacids
- For intravenous (IV) doses, follow administration guidelines
Proton Pump Inhibitors (PPI)
- The parietal cells release positive hydrogen ions (protons) during HCl production and This process is called the “proton pump”
- H2 blockers and antihistamines do not stop the action of this pump
- Total inhibition of gastric acid secretion
- Suffix is “zole”
- Adverse effects uncommon. It is safe from short term therapy and some are approved for long term therapy.
