drug therapy for peptic ulcer disease and hyperacidity

Question 1

stomach acid produced by

Answer 1

chief cells and parietal cells

Question 2

chief cells make

Answer 2

pepsin and pepsinogen

Question 3

parietal cells make

Answer 3

hydrochloric acid (HCL), intrinsic factor (B vitamins)

Question 4

stomach acid pH

Answer 4

1.5-3.5

Question 5

gastric acid protects

Answer 5

stomach surface (mucous layer(thickness) & bicarbonate layer(neutralize gastric acid))

Question 6

peptic ulcer disease (PUD)

Answer 6

erosion of mucosal layer & results in peptic ulcers

Question 7

you can see peptic ulcers in

Answer 7

esophagus, stomach, duodenum

Question 8

gastric ulcers (in the stomach) normally cause

Answer 8

painless bleeding and take a long time to heal because you’re always eating

Question 9

duodenal ulcers you see

Answer 9

heart burn, stomach pain (usually worse when stomach is empty or at bedtime)

Question 10

PUD risk factors

Answer 10

smoking & caffeine, kidney or pulmonary disease(can increase the acidity of the blood, you can have respiratory acidosis), stress, drugs(NSAIDs), H. Pylori(bacteria/ ex. spread by not washing hands (put to the mouth))

Question 11

gastroesophageal reflux disease (GERD) caused by

Answer 11

weak or incompetent lower esophageal sphincter (LES)(lets gastric content creep up when its weak/ doesn’t close tight), pyloric stenosis, hiatal hernias, motility disorder, obesity, age related changes

Question 12

long term complications of GERD

Answer 12

esophagitis, Barretts esophagus, strictures, esophageal cancers

Question 13

untreated esophagitis can lead to

Answer 13

barrets esophagus and later esophageal cancers

Question 14

PUD/ GERD non pharmacological treatment

Answer 14

lifestyle changes (ETOH, tobacco, weight management, reducing stress, eliminate causative foods) & eliminate/ change drugs (NSAIDs, corticosteroids, platelet inhibitors, caffeine)

Question 15

foods that are bad for acid reflux

Answer 15

coffee, wine, fatty food, pop, chocolate, garlic, onion, tomatoes, citrus, peppermint, spices, diary

Question 16

foods that are good for acid reflux

Answer 16

ginger, leafy greens, rice, coconut, celery, berries, melon, banana, fennel, avocado, apple, pear

Question 17

PUD/ GERD pharmacologic treatment

Answer 17

proton pump inhibitors, pancreatic enzymes, histamine 2 antagonists, prostaglandin, antacids, antiseptic agent

Question 18

example medications of antacids

Answer 18

mylanta, tums (available OTC)

Question 19

use of antacids

Answer 19

prevent or treat PUD, GERD, heartburn; neutralize or reduce gastric acid; increase gastric pH; DO NOT USE MAGNESIUM BASED ANTACIDS IN RENAL FAILURE

Question 20

adverse effects of antacids

Answer 20

constipation, hypophosphatemia, osteomalacia, diarrhea, hypermagnesemia

Question 21

example medications of histamine 2 antagonists

Answer 21

cimetidine

Question 22

uses for histamine 2 antagonists

Answer 22

blocks H-2 receptors, blocks production of HCL; prevents & treats PUD, GERD, heartburn, stress ulcers; given IV & PO; available OTC

Question 23

adverse effects of histamine 2 antagonists

Answer 23

diarrhea, dizziness, high IV doses heart arrhythmias

Question 24

example medications of proton pump inhibitor (PPI/ big dogs)

Answer 24

omeprazole

Question 25

uses for proton pump inhibitors

Answer 25

prevent the release of gastric acid; most potent acid inhibitor; treatment of PUD, GERD, H Pylori ; given IV and PO; OTC

Question 26

adverse effects of proton pump inhibitor

Answer 26

osteoporosis, nausea, diarrhea

Question 27

administration of proton pump inhibitors

Answer 27

take before food, swallow whole, do not crush or chew

Question 28

nursing considerations when giving medications that decrease stomach acid (antacids, histamine 2 antagonists, proton pump inhibitors)

Answer 28

give 1-2 hours before or after other meds, usually given before meals & at bedtime, AVOID PPI WITH CLOPIDOGREL

Question 29

patient education when taking medications that decrease stomach acid

Answer 29

elevate HOB, eat small frequent meals, do not lie down for 1-2 hours after meals, avoid: fats, chocolate, citrus juice, coffee, alcohol, smoking; seek tx if used more than 2 weeks

Question 29

patient education when taking medications that decrease stomach acid

Answer 29

elevate HOB, eat small frequent meals, do not lie down for 1-2 hours after meals, avoid: fats, chocolate, citrus juice, coffee, alcohol, smoking; seek tx if used more than 2 weeks

Question 30

example medications for Prostaglandin E

Answer 30

misoprostol

Question 31

uses for prostaglandin E medications

Answer 31

inhibits mucosal damage from NSAIDs, prevention on Gi bleeding in NSAID use

Question 32

black box warning for prostaglandin E (misoprostol)

Answer 32

medication is an abortifacient (will cause an abortion)

Question 33

example medication for GI protectant

Answer 33

sucralfate

Question 34

uses for GI protectant

Answer 34

prevents and treats peptic ulcers, binds to normal and ulcerated mucosa, no effect on acid

Question 35

administration for GI protectant

Answer 35

prevents absorption of other drugs, ***give 2 hours after other meds taken

Question 36

treatment for H pylori

Answer 36

combo therapy, usually a 14 day treatment (triple therapy: 2 antibiotics & acid reducer) or (quadruple therapy: 2 antibiotics, acid reducer and bismuth subsalicylate(pepto bismo))

Question 37

the two antibiotics uses in H pylori treatment

Answer 37

amoxicillin & clarithromycin

Question 38

what acid reducers can be used in H pylori treatment

Answer 38

PPI or histamine 2 antagonists

Question 39

summary of pharmacotherapy: proton pump inhibitor

Answer 39

bind to the enzyme H+, K+ ATPase and prevent acid from being secreted

Question 40

summary of pharmacotherapy: H2 receptor antagonists

Answer 40

occupy the histamine receptors and prevent secretion

Question 41

summary of pharmacotherapy: antibiotics

Answer 41

eradicate H pylori, the primary cause of peptic ulcers

Question 42

summary of pharmacotherapy: antacids

Answer 42

chemically combine with acids to lower stomach pH

Question 43

T or F. peptic ulcers are found in the esophagus, stomach and duodenum

Answer 43

true

Question 44

a hemodialysis patient asks which antacid would be a good choice. the nurse knows the renal failure patient should avoid which antacid

Answer 44

mylanta; because it is a magnesium based antacid and may lead to hypermagnesemia in dialysis patients. (Tums are made from calcium carbonate and safe for renal failure, cimetidine and misoprostol are safe to be used with caution in renal failure patients)