GERD Flashcards
Contraindication and what client should used H2 receptor antagonist cautiously?
Contraindicated: Hypersensitivity
Use cautiously: Impaired renal and hepatic function
Action and indication of H2 Receptor Antagonist
-Suppresses gastric acid secretion
-Alleviate Heartburn sx
-Promote healing of GERD
Route of Cimetidine (Tagamet) and Ranitidine (Zantac)
PO, IV and IM
What H2 Receptor antagonist should NOT be taken with food?
Cimetidine (Tagamet)
Rationale: it can delay the drug absorption
What is the effect of antacids while taking Cimetidine (Tagamet) ?
-Taking antacid decrease absorption of oral Cimetidine (Tagamet)
-when taking both Cimetidine (Tagamet) and antacid, at least 1 HOUR apart
What are the possible s/e of Cimetidine (Tagamet) ?
M- mental confusion
A - agitation
P - psychosis
D -depression
A -anxiety
D- disorientation
When and Why was Cimetidine (Tagamet) dosage is reduced in pt with GERD?
-if client have impaired renal fx (causes nephrotoxicity)
-When drug is administered with Warfarin Na, Phenytoin, Theophylline and Lidocaine ( to prevent drug interaction)
Taking Ranitidine is not affected by food?
T or F
True
What H2 receptor antagonist doesn’t need to be administered with food?
Famotidine (Pepcid) and Nizatidine (Acid)
5 overall consideration in H2 Receptor Antagonist:
- If prescribed OD, take drug at bedtime
- Take the drug 1 hour before and after taking ANTACID
- Avoid cigarette smoking, alcohol and NSAIDS
- Long term use: M-drug can lead to gynecomastia and impotence and F- lead to breast tenderness
- A/E:
Diarrhea, Rashes and bruises, Confusion, Fatigue and Malaise
At least 5 PPI drugs?
P- Pantoprazole (Protonix)
R- Rabeprazole ( Aciphex)
O- Omeprazole ( Prilosec)
L- Lansoprazole (Prevacid)
E- Esomeprazole ( Nexium)
Common S/E of PPI:
H- headache
A- abdominal pain
N- nausea
D- diarrhea
Nursing responsibility on PPI:
- If prescribed TID, instruct to take before breakfast and at bedtime; but if OD, take it at bedtime
- Monitor the liver function test (AST, ALT, Bilirubin) since its nephrotoxic
3.Avoid cigarette smoking, alcohol, aspirin and NSAIDs to promote healing
4.Do not chew the tablet to prevent to reduce the drug potency - Report black tarry stool (GI bleeding), diarrhea and abdominal pain
What are the extrapyramidal effects of Metoclopramide?
-Dysarthria -Twitching movements
-Dysphagia -Weakness of A and L
-Loss of balance -Tardive Dyskinesia
-Gait disturbances
Nsg. Responsibility of Metoclopramide?
- TID, 30 mins before breakfast and at bedtime
- by direct IVP over 1-2 mins or
Slow infusion over 15-30 mins - Avoid alcohol or CNS depressants
Nutrition and Lifestyle Mng. of client with GERD
- Eliminate acidic foods like spicy, caffeine, tomato products and citrus
- Avoid peppermint, chocolate, alcohol and fatty foods.
- Eat smaller meal, refrain eating 3 hrs before bedtime
- Stay upright (Semi fowler’s position) for 2 hrs after meal
- Elevate HOB 6-8 inch blocks
- Avoid smoking
- Avoid tight clothing and bending
- Avoid very hot and cold beverages
- Avoid salicylates (Aspirin) , phenylbutazone (NSAIDs)
Other term of GERD
Reflux esophagitis
Other name of Lower esophageal Sphincter
Cardiac sphincter
Causes of GERD:
-Decreased pressure / incompetent LES (relaxed)
-Pyloric stenosis
-Nicotine
-High Fatty Foods
-Xanthine Derivatives ( Theophylline and Aminophylline)
-Ganglionic Stimulants ( Pilocarpine,
-Acetylcholine, Lobeline and Lidocaine)
-Beta adrenergic agents (Propranolol and Metoprolol)
-Elevated estrogen/progesterone level
Assessment of GERD:
How n Dude?
H- heartburn D- Dysphagia
O- odynophagia U- Upp. adm dc
W- water brash D- Dyspepsia
E- Eructation
N- N/V E- Epigastric Pain
What are avoided in GERD?
-P 4C A 2F
-A N A
- eating 2 hrs before bedtime and tight clothing
Diet in GERD
Low fat
Hight Protein
Hight Fiber
Surgery done in GERD
Nissen fundoplication
AKA “Gastric Wrap Around”
Indication/ Purpose of aluminum hydroxide
To treat hyperphosphatemia
