Week 12 GI Secretion Flashcards
Histamine 2 Antagonist prototype drug
CIMETIDINE
Antacid prototype drug
Sodium bicarbonate
Protein pump inhibitors prototype drug
omperazole
what neutralizes or reduces gastric acidity, resulting in an increase in gastric pH
Antacid
Therapeutic action: Histamine 2 antagonist
Inhibits the actions of histamine at H2 receptor sites of the stomach, inhibiting gastric acid secretion and reducing total pepsin output
- acts before gastric acids are secreted
indications: Histamine 2 antagonist
Short term; duodenal or benign gastric ulcers
- Pathological hypersecretory conditions
- prophylaxis; stress ulcers
- erosive GERD
- relief of heartburn/ indigestion
pharmacokinetics: Histamine 2 antagonist
- oral, IV & IM
- metabolized in liver, excreted in urine
- can cross placenta/ breastmilk
adverse effects: Histamine 2 antagonist
- dizziness, confusion, headache, somnolence, cardiac arrhythmias, cardiac arrest, diarrhea, impotence, gynecomastia, rash
contraindications: Histamine 2 antagonist
- Allergy
- caution; pregnancy/ breastfeeding & hepatic/renal dysfunction
- prolonged use may mask underlying condition
drug-drug interaction: Histamine 2 antagonist
Slows metabolism of certain drugs, increases risk for toxicity
- warfarin
- phenytoin
- Beta-adrenergic blockers
- benzodiazepines
- tricyclic antidepressants
nursing considerations: Histamine 2 antagonist
- Administer w/ or before meals & at HS
- use increased safety measures when ambulating d/t dizziness
- monitor liver & renal function
- get a detailed description of the GI problem & determine underlying medical problem
- perform physical exam to get baseline data, determine drug effectiveness, & evaluate for adverse effects
Therapeutic action: antacids
Neutralizes or reduces gastric acidity, resulting in an increase in gastric pH
indications: antacids
- Systemic relief of upset stomach from hyperacidity
- prophylaxis of GI bleed & stress ulcers
- adjunctive of severe diarrhea
- metabolic acidosis
pharmacokinetics: antacids
oral & IV
- readily available in may preparations
- excreted unchanged in the urine
- crosses placenta/ breastmilk
adverse effects: antacids
Related to acid/base & electrolyte imbalance
- fluid retention & HF
- systemic alkalosis; headache, weakness, confusion, tetany
- hypokalemia
contraindications: antacids
- Allergy
- caution use with the following instances; electrolyte imbalances, GI obstruction, renal dysfunction, acid-base imbalance, pregnancy/ lactation
nursing considerations: antacids
- Watch for acid rebound!
- Pts should seperate taking antacids and other oral med by 1-2hrs
-Ensure pts chew tablets thoroughly & follows w/ water - continually assess sign of acid/ base or electrolyte imbalances
- monitor serum electrolyte levels & renal function test
- inspect & auscultate abdomen
Therapeutic action: PPI’s
Blocks the final step of acid production and decreases gastric acid levels in the stomach
indications: PPI’s
Short term; duodenal ulcers, benign gastric ulcers, s/s of GERD
Long term; pathological hypersecretory conditions
Combo therapy; w/ amoxicillin & clarithromycin for treatment of H. Pylori
pharmacokinetics: PPI’s
- oral med
- metabolized in the liver, excreted in the urine & bile
- unknown if crosses placenta/ breastmilk
adverse effects: PPI’s
- headache, dizziness, vertigo, insomnia, rash, diarrhea, abdominal pain, n/v, upper resp infection s/s, cough
contraindications: PPI’s
Allergy
- caution should NOT be used in pregnant women
- Be cautious when using in patients younger than 18 years old
drug-drug interactions: PPI’s
Slows metabolism of certain drugs, increases risk for toxicity
- Benzodiazepine
- phenytoin
- warfarin
nursing considerations: PPI’s
- Administer before meals, and DO NOT open, chew or crush
- inspect & palpate abdomen to r/o underlying conditions
- perform physical exam to get baseline data, determine drug effectiveness, & evaluate for adverse effects
- assess change in bowel elimination & GI upset
- encourage small frequent meals
- follow up 4-8wks if s/s have not resolved
children considerations
- Dose should be determined by the weight and age of the child
- Proton pump inhibitors have been used to successfully decrease ulcer formation related to stress or drug therapy in children
- Antacids may be used in children who complain of upset stomach or who are receiving therapy known to increase avid production
- Use caution in order to prevent electrolyte disturbances or any interference with nutrition, which could be especially detrimental to children
adult considerations
Caution adults not to overuse any of these agents and check with a healthcare provider if GI discomfort continues after repeated use
Monitor for electrolyte disturbances
Safety during pregnancy and lactation has not been established
older adult considerations
Frequently prescribed one or more of these drugs
More likely to develop adverse effects
Due to GI tract changes that occur with aging, absorption of nutrients is more likely to be impacted with use of these medications
Start at a lower dose, monitor renal and hepatic impairment
Alerted to OTC preparations that may contain the same ingredients
inhibits the actions of histamine at H2 receptor sites of the stomach, inhibiting gastric acid secretions and reducing total pepsin output
Histamine 2 Antagonist (cimetidine)
Blocks the final step of acid production and decreases gastric acid levels in the stomach
PPI (omeprazole)
