Week 13 : Acid controlling drugs (5 mueller) Flashcards
Antacids are usually NOT administered how?
Antacids are usually NOT administered simultaneously with other medications
or even within 1-2 hours of other medications!!!!!!
What 2 medications together at same time are WRONG?
Antacid + Levothyroxine
Ciprofloxin followed by what 30 minutes later is WRONG?
Antacid
Antacids: Aluminum Salts
Has what?
Often used with?
**Can be used to in…to treat…?
Has constipating effects
Often used with magnesium to counteract constipation
Can be used in CKD to treat hyperphosphatemia!!!!
Antacids: Magnesium Salts
Commonly causes?
DO NOT GIVE IF?
Commonly cause diarrhea; usually used with other drugs to counteract this effect
* renal failure*
the failing kidney cannot excrete extra magnesium, resulting in accumulation
Antacids: Calcium Salts
May cause? 4
Don’t give with?
Constipation
Kidney stones
Milk Alkali Syndrome (don’t give with milk!)
Rebound Hypersecretion of Acid
Antacids: Sodium Bicarbonate
may causes problems in patients with?
** heart failure (HF)
renal insufficiency
hypertension**
Simethicone
Used for?
Gas
Many antacid combinations include Simethicone
NURSING CONSIDERATIONS:
Antacids: aluminum, magnesium and calcium, sodium bicarbonate
What two can cause Constipation?
What causes Diarrhea?
What to avoid for Kidneys?
What’s okay for kidneys?
What to avoid for Heart Failure?
Constipation: Aluminum/Calcium
Diarrhea: Magnesium
Kidneys: Avoid Magnesium! Aluminum is given for CKD (hyperphosphatemia)
Heart Failure: Avoid any that have SODIUM (Sodium Bicarb)
ADMINISTRATION of Antacids
Generally take when?
DO NOT?
minimum time window?
Generally 1 to 3 hours after a meal bedtime too
DO NOT give with other drugs
(minimum 1-2 hour window- both directions)!!!!! for other drugs
Antibiotics
Levothyroxine
Antacid Summary
Commonly used for?
Investigate if?
Avoid?
Seperate all other drugs by?
Commonly used for occasional GERD/Heartburn, NOT PUD
If someone is using chronically, we need to investigate!
Avoid co-administration with other drugs
Separate ALL other drugs by 1 to 2 hours (30 minutes too short!)
H2RA
1st generation?
2nd generation?
- Cimetidine
-Anti-androgen
-Liver Enzyme Inhibition - Ranitidine, Famotidine
Cleaned up version (no androgen/liver issues)
H2RAS:
cimetidine, ranitidine and famotidine
ADVERSE EFFECTS? 2
- Can accumulate in renal impairment
-What will this act like?- Can be a problem in geriatrics! - Change pH in the gut
-Higher risk for Pneumonia and C.diff
CIMETIDINE- ANTI-ANDROGEN:
may cause?
Cimetidine blocks? educate about?
Impotence and Gynecomastia.
Cimetidine blocks androgen
Educate patients to monitor for libido changes, gynecomastia, impotence
What has been reported with ranitidine and famotidine?
Administration- H2RAs and antacids should be administered?
Thrombocytopenia and Hepatotoxicity
At least 1-2 hours apart
H2RA SUMMARY (dine)
Increased risk for?
Whats rare?
Be careful in?
what is cimetidine?
Administration?
Intended outcome?
Increased risk for C.diff and Pneumonia
Hepatotoxicity and Thrombocytopenia are RARE
Be careful in renal impairment (begins to act like Benadryl-H1RA)
Cimetidine- liver enzyme inhibitor + anti-androgen
Administration: Usually at bedtime
Intended Outcome: Reduced heartburn/dyspepsia/healing of ulcers
Proton Pump Inhibitor (prazole)
used to treat? 4
When is it taken?
Why should u taper off?
GI. Bleed
Peptic Ulcer Disease
GERD
Stress Ulcer Prophylaxis
Patients should take first thing in the morning 30 minutes before their first meal
Taper off, sudden stoppage can cause rebound hypersecretion of stomach acid
Proton Pump Inhibitor (prazole)
Omeprazole
Adverse effects? 3
Long terms? 2
- Diarrhea
- Change in gut pH
-c.diff and pneumonia - Change in absorption of electrolytes
-long term –hypomagnesemia
-Long term- hypocalcemia
-Fractures and Osteoporosis (due to hypocalcemia)
PPI: Omeprazole
Nursing considerations
monitor for?
Osteoporosis (Vitamin D + Calcium intake)
Pneumonia/C.Diff (patients monitor S/S)
Magnesium (monitor for muscle cramps, more dangerously- seizures)
Anti-Ulcer: Sucralfate (BAND AID)
Used to treat?
Patients may develop?
Remember?
Administer?
Separate?
Peptic Ulcer Disease
constipation- encourage fiber intake
Remember, it works for several hours at a time.
Administer on empty stomach for best mechanism
Separate administration of other drugs (2 hours before/after)
Bismuth Subsalicylate (pepto bismol)
Used for?
Adverse effects
Avoid in?
Not for?
-Diarrhea (traveler’s diarrhea)
-Indigestion/Heartburn
May stain tongue, bowel movements green/black
Avoid in children with viral infection
> risk for Reye’s Syndrome
NOT for Chronic use- risk for salicylism
H. Pylori Treatment
How many antibiotics for how many days?
Minimum of two antibiotics prescribed FOR 2 WEEKS (14 days)
2 antibiotics + PPI
Misoprostol
used for?
Don’t use?
can cause?
-Ulcers
-Promotes Cervical Ripening
-Can be used for termination of Pregnancy
Dont use during pregnancy
Dont touch the drug
DiarrheaSpotting/Dysmenorrhea
