drug therapy for PUD and hyperacidity

Question 1

stomach acid is made up of two groups of cells, what are they?

Answer 1

chief cells and parietal cells

Question 2

what do chief cells make

Answer 2

make pepsinogen and pepsin

Question 3

what do parietal cells make

Answer 3

HCL

this is not only an aid in digestion but it is also the intrinsic factor which means it is needed for the basorption of B12 in the small intestine

Question 4

what is the pH range for stomach acid

Answer 4

1.5-3.5

Question 5

what two layers does the stomach have for protection of the stomach surface

Answer 5

-mucosal layer (has the goblet cells)
-bicarbonate layer (neutralizer)

Question 6

what is peptic ulcer disease (PUD)

Answer 6

-erosion of the mucosal layer
-peptic ulcers in the esophagus, stomach, and duodenum
-usually causes painless bleeding and they take a long time to heal

-duodenum ulcers may cause heart burn and stomach pain usually when stomach is empty or at bedtime

Question 7

what are some risk factors of PUD

Answer 7

-smoking, caffiene
-kidney or pulmonary disease (can increase acidity of blood)
-stress
-drugs (NSAIDS)
-H. pylori

Question 8

what is H. pylori

Answer 8

-bacteria that can lead to ulcers
-spread fecal-oral

Question 9

what are some causes of GERD

Answer 9

-weak/incompetent loser esophageal sphincter (LES) (lets gastric acif leak up to esophagus)
-pyloric stenosis
-hiatal hernia
-motility disorder
-obesity
-age-related illness

Question 10

when does GERD usually cause symptoms

Answer 10

after meals and at bedtime

Question 11

what are some long term complications of GERD

Answer 11

-esophagitis (inflammation of esophagus, if untreated leads to barrett’s esophagus)
-barretts esophagus (scar tissue builds up, harder to swallow)
-strictures
-esophageal cancers

Question 12

what are some lifestyle changes used to treat PUD/GERD

Answer 12

-ETOH and tobacco use cessation
-weight management
-reducing stress
-eliminate causitive food

Question 13

what drugs should be eliminated/changed if feasible to help treat PUD/GERD

Answer 13

-NSAIDs
-corticosteroids
-platelet inhibitors
-caffeine

Question 14

name some examples of antacids

Answer 14

mylanta
tums

Question 15

what are antacids used for

Answer 15

-prevent or treat PUD, GERD, heartburn
-neutralize or reduce gastric acid
-increase gastric pH
-do NOT use magnesium based antacids (mylanta) in renal failure
-OTC

Question 16

what are some adverse effects of antacids

Answer 16

-constipation
-hypophosphatemia
-osteomalacia
-diarrhea
-hypermagnesemia

Question 17

give an example of histamine-2 antagonists

Answer 17

cimetidine

Question 18

what are histamine-2 antagonists used for

Answer 18

-block H-2 receptors, blocks production of HCL
-prevent and treat PUD, GERD, heartburn, stress
-IV and PO
-OTC

Question 19

what are some adverse effects of histamine-2 antagonists

Answer 19

-diarrhea
-dizziness
-high IV doses -> heart arrythmias

Question 20

give an example of proton pump inhibitors (PPI)

Answer 20

omeprazole

Question 21

what are proton pump inhibitors (PPI) used for

Answer 21

-prevent the release of gastric acid
-most potent acid inhibitor
-treatment of PUD, GERD, H pylori
-IV and PO
-OTC

Question 22

what are some adverse effects of proton pump inhibitors (PPI)

Answer 22

-osteoporosis
-nausea
-diarrhea

Question 23

describe the administration of proton pump inhibitors (PPI)

Answer 23

-take before food
-swallow whole
-do not crush/chew

Question 24

what are some nursing considerations for drugs that decrease stomach acid

Answer 24

-give 1-2hrs before or after other meds
-usually given before meals and at bedtime
-avoid PPIs with clopidogrel

Question 25

whats some stuff to include in patient education for drugs that decrease stomach acid

Answer 25

-elevate head of bed
-small frequent meals
-dont lie down for 1-2hrs after meals
-avoid: fats, chocolate, citrus juice, coffee, alcohol, smoking
-seek tx if used more than 2 weeks

Question 26

give an example of a prostaglandin E

Answer 26

misoprostol

Question 27

what is prostaglandin E used for

Answer 27

-inhibits mucosal damage from NSAIDs
-prevention of GI bleeding in NSAID use

Question 28

what is the black bow warning for prostaglandin E

Answer 28

med is an abortifacient

causes abortion

Question 29

give an example of a GI protectant

Answer 29

sucralfate

Question 30

what are GI protectants used for

Answer 30

-prevents and treats peptic ulcers
-binds to normal and ulcerated mucosa (liquid bandaid)
-no effect on acid

Question 31

describe administration of GI protectants

Answer 31

-prevents absorption of other drugs
-give 2hrs after other meds taken

Question 32

what type of treatment is required for H pylori

Answer 32

combination therapy
-usually 14 day treatment
-triple or quadruple therapy

Question 33

describe triple therapy for H pylori

Answer 33

2 antibiotics (amoxicillin and clarithromycin) and acid reducer (PPI or histamine antagonists)

Question 34

escribe quadruple therapy for H pylori

Answer 34

2 antibiotics (amoxicillin and clarithromycin), acid reducer, and bismuth subsalicylate (also a liq bandaid, protects ulcer from acid)

Question 35

true or false

peptic ulcers are found in the esophagus, stomach, and duodenum

Answer 35

true

peptic ulcers are found in the esophagus, stomach, and duodenum. gastric and duodenal ulcers are more common than esophageal ulcers

Question 36

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

Answer 36

mylanta

mylanta 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