Lilley Chapter 39 - Acid Controlling Drugs Flashcards
The nurse will teach patients that antacids are effective in the treatment of hyperacidity because they do which of the following?
Decrease gastric pH
Decrease duodenal pH
Neutralize gastric acid
Decrease stomach motility
C. Neutralize gastric acid
Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.
The nurse will monitor a patient taking an aluminum-containing antacid, such as aluminum hydroxide, for which adverse effect?
Gastrointestinal upset
Constipation
Diarrhea
Fluid retention
B. Constipation
Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.
For a patient with chronic renal failure, the nurse most likely will question a prescription for which type of antacid?
Calcium-containing antacids
Sodium-containing antacids
Magnesium-containing antacids
Aluminum-containing antacids
C. Magnesium-containing antacids
Magnesium-containing antacids can cause hypermagnesemia in patients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic renal failure. Sodium- and aluminum-containing antacids are chemically more easily excreted in patients with renal compromise. Although calcium-containing antacids may accumulate in the bloodstream of patients with renal failure, they may also be appropriate because these patients may be hypocalcemic.
What condition will the nurse monitor for with a patient using sodium bicarbonate to treat gastric hyperacidity?
Hyperkalemia
Metabolic acidosis
Hypercalcemia
Metabolic alkalosis
D. Metabolic alkalosis
Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serum calcium would decrease, not increase, with alkalosis.
Which nursing diagnosis is appropriate for a patient receiving famotidine (Pepcid®)?
Impaired urinary elimination related to retention
Risk for injury related to thrombocytopenia
Risk for infection related to immunosuppression
Ineffective peripheral tissue perfusion related to hypertension
B. Risk for injury related to thrombocytopenia
A serious adverse effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding. The patient receiving famotidine may experience hypotension as an adverse effect, not hypertension. Famotidine does not cause immunosuppression or urinary retention.
What is the mechanism of action of famotidine?
It forms a protective coating against gastric acid, pepsin, and bile salts.
It competes with histamine for binding sites on the parietal cells.
It irreversibly binds to the hydrogen–potassium–adenosine triphosphatase (ATPase) pump.
It causes a decrease in stomach pH, reducing stomach acidity.
B. It competes with histamine for binding sites on the parietal cells.
Histamine receptor–blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.
Which patient statement demonstrates a patient’s understanding of the nurse’s teaching in regard to the use of histamine2-receptor antagonists?
“I should increase bulk and fluids in my diet to prevent constipation.”
“I should take this medication 1 hour after each meal to maximally decrease gastric acidity.”
“Smoking decreases the effects of this medication, so I should look into cessation programs.”
“Because I am taking this medication, it is okay for me to eat spicy foods.”
C. “Smoking decreases the effects of this medication, so I should look into cessation programs.”
Patients taking histamine2-receptor–blocking drugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking. Diarrhea, not constipation, is a gastrointestinal adverse effect. Whereas cimetidine should be taken with meals, famotidine can be taken without regard to meals.
What will the nurse tell patients about the action of proton pump inhibitors (PPIs)?
They compete with histamine for binding sites on the parietal cells.
They help to neutralize acid secretions to promote gastric mucosal defensive mechanisms.
They irreversibly bind to the hydrogen–potassium–ATPase pump.
They form a protective barrier that can be thought of as a liquid bandage.
C. They irreversibly bind to the hydrogen–potassium–ATPase pump.
PPIs work to block the final step in the acid-secreting mechanisms of the proton pump. They do this by irreversibly binding to the ATPase pump, H+/K+ ATPase, the enzyme for this step.
PPIs have the ability to almost totally inhibit gastric acid secretion. Because of this possibility, the use of PPIs can lead to what condition?
Diverticulosis
Gastroesophageal reflux disease (GERD)
Achlorhydria
Gastric ulcer formation
C. Achlorhydria
Because PPIs stop the final step of acid secretion, they can block up to 90% of acid secretion, leading to achlorhydria (lack of acid).
The nurse will question a prescription for misoprostol for which patient?
A 64-year-old man with hypertension
A 32-year-old pregnant woman with a urinary tract infection
A 45-year-old woman with GERD
A 21-year-old man with Zollinger-Ellison syndrome
B. A 32-year-old pregnant woman with a urinary tract infection
Misoprostol is a prostaglandin E analogue and is believed to inhibit gastric acid secretion and protect the gastric mucosa from injury by enhancing the local production of mucus. However, it is also an abortifacient and therefore is contraindicated in pregnancy. The drug may be useful in treating patients with Zollinger-Ellison syndrome (a hypersecretory syndrome) and GERD. Hypertension is not a contraindication for its use.
The nurse would teach a patient prescribed simethicone to avoid which substances?
Histamine2-receptor antagonists
Over-the-counter antacids
Milk and dairy products
Carbonated beverages
D. Carbonated beverages
Simethicone is used to decrease gas and belching, both of which can be aggravated or caused by ingesting carbonated beverages. It may be given in combination with other medications used to decrease acidity.
How does sucralfate achieve a therapeutic effect?
By forming a protective barrier over the gastric mucosa
By inhibiting the production of gastric acid secretion
By neutralizing gastric acid
By enhancing gastric absorption
A. By forming a protective barrier over the gastric mucosa
Sucralfate has a local effect only on the gastric mucosa. It forms a protective barrier that can be thought of as a liquid bandage in the stomach. This liquid bandage adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.
