Peptic Ulcer Drugs

Question 1

Parietal Cells

Answer 1

•Produce and secrete HCl to keep stomach at pH of 1 to 2
•Primary site of action for many acid-controller drugs

Question 2

ECL Cells

Answer 2

•Secrete histamine
•stimulate parietal cells

Question 3

Inhibitors of gastric acid secretion/action

Answer 3

•H2 antagonist
•Proton pump inhibitors
•Antacids

Question 4

H2 Antagonists

Answer 4

•Reduce acid secretion: Blocks H2 receptors of acid-producing parietal cells
•Reduce HCl production
•Most popular for Tx of acid-related disorders

DRUG: Cimetidine

INDICATIONS: GERD, PUD,

CONSIDERATIONS:
•inhibits liver CYP-450
•Care in pts with renal impairment
•Caution in pts who are confused, disoriented, elderly
•Take 1 hr before or after antacids (important) - affects absorption

Question 5

Proton Pump Inhibitors

Answer 5

•Inhibition of the pump that moves H+ into stomach lumen
•More effective than H2 antagonist
•Irreversibly bind to H+/K+ ATPase enzyme (proton pump)
•Normal acid secretion requires parietal cell to synthesize new H+/K+ ATPase

DRUG: Omeprazole
•Enteric coated, PO

INDICATIONS: GERD, short-term Tx of duodenal and gastric ulcers

CONSIDERATIONS:
•can increase bleeding with warfarin
•do not crush or break capsule
•can be taken with antacids

Question 6

Antacids

Answer 6

•Neutralize acid
•DO NOT prevent acid production

Aluminum salts
Magnesium salts
Calcium salts
Sodium bicarbonate

Aluminum salts
May cause constipation
Aluminum hydroxide

Magnesium salts
Commonly cause diarrhea
Dangerous for renal failure pt

Aluminum salts + magnesium salts = normal bowel function

Calcium salts
May cause constipation
Possible kidney stones
Calcium carbonate (TUMS)

Sodium Bicarbonate
Highly soluble
Quick onset, short duration
High Sodium can cause issues

Question 7

Antacid Adverse Effects

Answer 7

Minimal

Aluminum and calcium: constipation

Magnesium: diarrhea

Question 8

Antacid Drug Interactions

Answer 8

Absorption of other drugs
•May reduce absorption of other drugs given at same time

Chelation
•Chemical binding, or inactivation, of another drug
•Produces insoluble complexes
-Reduced drug absorption

Question 9

Antacid Care Implications

Answer 9

Assess for conditions that can restrict antacid use such as:
-Fluid imbalance, renal disease, HF, pregnancy, GI obstruction

•Clients with HF or hypertension should use low-sodium antacids
•Most medications should be given 1 to 2 hours after giving an antacid
•Antacids may cause premature dissolving of enteric coated medications
•Administer with at least 240 mL of water to enhance dispersion,

Question 10

Other Agents - protect mucosa

Answer 10

Sucralfate
•bind directly to ulcer surface

Misoprostol (Cytotec)
•Prostaglandin agent

Question 11

Sucralfate

Answer 11

•Cytoprotective agent
•Used for intestinal erosions
•Forms gel with mucus in low pH
•Do not administer with antacids
•Attracted to and binds to the base of ulcers and erosions, forming a protective barrier
•May cause constipation

Question 12

Misoprostol

Answer 12

•Reduce gastic effects of NSAIDs e.g. ASA, diclofenac
•Therapeutic doses for duodenal ulcers often produce abdominal cramps, diarrhea