drug therapy for PUD and hyperacidity Flashcards
stomach acid is made up of two groups of cells, what are they?
chief cells and parietal cells
what do chief cells make
make pepsinogen and pepsin
what do parietal cells make
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
what is the pH range for stomach acid
1.5-3.5
what two layers does the stomach have for protection of the stomach surface
-mucosal layer (has the goblet cells)
-bicarbonate layer (neutralizer)
what is peptic ulcer disease (PUD)
-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
what are some risk factors of PUD
-smoking, caffiene
-kidney or pulmonary disease (can increase acidity of blood)
-stress
-drugs (NSAIDS)
-H. pylori
what is H. pylori
-bacteria that can lead to ulcers
-spread fecal-oral
what are some causes of GERD
-weak/incompetent loser esophageal sphincter (LES) (lets gastric acif leak up to esophagus)
-pyloric stenosis
-hiatal hernia
-motility disorder
-obesity
-age-related illness
when does GERD usually cause symptoms
after meals and at bedtime
what are some long term complications of GERD
-esophagitis (inflammation of esophagus, if untreated leads to barrett’s esophagus)
-barretts esophagus (scar tissue builds up, harder to swallow)
-strictures
-esophageal cancers
what are some lifestyle changes used to treat PUD/GERD
-ETOH and tobacco use cessation
-weight management
-reducing stress
-eliminate causitive food
what drugs should be eliminated/changed if feasible to help treat PUD/GERD
-NSAIDs
-corticosteroids
-platelet inhibitors
-caffeine
name some examples of antacids
mylanta
tums
what are antacids used for
-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
what are some adverse effects of antacids
-constipation
-hypophosphatemia
-osteomalacia
-diarrhea
-hypermagnesemia
give an example of histamine-2 antagonists
cimetidine
what are histamine-2 antagonists used for
-block H-2 receptors, blocks production of HCL
-prevent and treat PUD, GERD, heartburn, stress
-IV and PO
-OTC
what are some adverse effects of histamine-2 antagonists
-diarrhea
-dizziness
-high IV doses -> heart arrythmias
give an example of proton pump inhibitors (PPI)
omeprazole
what are proton pump inhibitors (PPI) used for
-prevent the release of gastric acid
-most potent acid inhibitor
-treatment of PUD, GERD, H pylori
-IV and PO
-OTC
what are some adverse effects of proton pump inhibitors (PPI)
-osteoporosis
-nausea
-diarrhea
describe the administration of proton pump inhibitors (PPI)
-take before food
-swallow whole
-do not crush/chew
what are some nursing considerations for drugs that decrease stomach acid
-give 1-2hrs before or after other meds
-usually given before meals and at bedtime
-avoid PPIs with clopidogrel
whats some stuff to include in patient education for drugs that decrease stomach acid
-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
give an example of a prostaglandin E
misoprostol
what is prostaglandin E used for
-inhibits mucosal damage from NSAIDs
-prevention of GI bleeding in NSAID use
what is the black bow warning for prostaglandin E
med is an abortifacient
causes abortion
give an example of a GI protectant
sucralfate
what are GI protectants used for
-prevents and treats peptic ulcers
-binds to normal and ulcerated mucosa (liquid bandaid)
-no effect on acid
describe administration of GI protectants
-prevents absorption of other drugs
-give 2hrs after other meds taken
what type of treatment is required for H pylori
combination therapy
-usually 14 day treatment
-triple or quadruple therapy
describe triple therapy for H pylori
2 antibiotics (amoxicillin and clarithromycin) and acid reducer (PPI or histamine antagonists)
escribe quadruple therapy for H pylori
2 antibiotics (amoxicillin and clarithromycin), acid reducer, and bismuth subsalicylate (also a liq bandaid, protects ulcer from acid)
true or false
peptic ulcers are found in the esophagus, stomach, and duodenum
true
peptic ulcers are found in the esophagus, stomach, and duodenum. gastric and duodenal ulcers are more common than esophageal ulcers
a hemodialysis patient asks which antacid would be a good choice. the nurse knows the renal failure patient should avoid which antacid?
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
