Week 13 : Acid controlling drugs (5 mueller)

Question 1

Antacids are usually NOT administered how?

Answer 1

Antacids are usually NOT administered simultaneously with other medications

or even within 1-2 hours of other medications!!!!!!

Question 2

What 2 medications together at same time are WRONG?

Answer 2

Antacid + Levothyroxine

Question 3

Ciprofloxin followed by what 30 minutes later is WRONG?

Answer 3

Antacid

Question 4

Antacids: Aluminum Salts

Has what?
Often used with?
**Can be used to in…to treat…?

Answer 4

Has constipating effects

Often used with magnesium to counteract constipation

Can be used in CKD to treat hyperphosphatemia!!!!

Question 5

Antacids: Magnesium Salts

Commonly causes?

DO NOT GIVE IF?

Answer 5

Commonly cause diarrhea; usually used with other drugs to counteract this effect

* renal failure*

the failing kidney cannot excrete extra magnesium, resulting in accumulation

Question 6

Antacids: Calcium Salts

May cause? 4
Don’t give with?

Answer 6

Constipation
Kidney stones
Milk Alkali Syndrome (don’t give with milk!)
Rebound Hypersecretion of Acid

Question 7

Antacids: Sodium Bicarbonate

may causes problems in patients with?

Answer 7

** heart failure (HF)
renal insufficiency
hypertension**

Question 8

Simethicone

Used for?

Answer 8

Gas

Many antacid combinations include Simethicone

Question 9

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?

Answer 9

Constipation: Aluminum/Calcium

Diarrhea: Magnesium

Kidneys: Avoid Magnesium! Aluminum is given for CKD (hyperphosphatemia)

Heart Failure: Avoid any that have SODIUM (Sodium Bicarb)

Question 10

ADMINISTRATION of Antacids

Generally take when?

DO NOT?

minimum time window?

Answer 10

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

Question 11

Antacid Summary

Commonly used for?

Investigate if?

Avoid?

Seperate all other drugs by?

Answer 11

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!)

Question 12

H2RA

1st generation?
2nd generation?

Answer 12

1. Cimetidine
   -Anti-androgen
   -Liver Enzyme Inhibition
2. Ranitidine, Famotidine
   Cleaned up version (no androgen/liver issues)

Question 13

H2RAS:
cimetidine, ranitidine and famotidine

ADVERSE EFFECTS? 2

Answer 13

1. Can accumulate in renal impairment
   -What will this act like?- Can be a problem in geriatrics!
2. Change pH in the gut
   -Higher risk for Pneumonia and C.diff

Question 14

CIMETIDINE- ANTI-ANDROGEN:

may cause?

Cimetidine blocks? educate about?

Answer 14

Impotence and Gynecomastia.

Cimetidine blocks androgen

Educate patients to monitor for libido changes, gynecomastia, impotence

Question 15

What has been reported with ranitidine and famotidine?

Administration- H2RAs and antacids should be administered?

Answer 15

Thrombocytopenia and Hepatotoxicity

At least 1-2 hours apart

Question 16

H2RA SUMMARY (dine)

Increased risk for?

Whats rare?

Be careful in?

what is cimetidine?

Administration?

Intended outcome?

Answer 16

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

Question 17

Proton Pump Inhibitor (prazole)

used to treat? 4

When is it taken?
Why should u taper off?

Answer 17

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

Question 18

Proton Pump Inhibitor (prazole)

Omeprazole

Adverse effects? 3
Long terms? 2

Answer 18

1. Diarrhea
2. Change in gut pH
   -c.diff and pneumonia
3. Change in absorption of electrolytes

-long term –hypomagnesemia
-Long term- hypocalcemia

-Fractures and Osteoporosis (due to hypocalcemia)

Question 19

PPI: Omeprazole
Nursing considerations

monitor for?

Answer 19

Osteoporosis (Vitamin D + Calcium intake)

Pneumonia/C.Diff (patients monitor S/S)

Magnesium (monitor for muscle cramps, more dangerously- seizures)

Question 20

Anti-Ulcer: Sucralfate (BAND AID)

Used to treat?

Patients may develop?

Remember?

Administer?

Separate?

Answer 20

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)

Question 21

Bismuth Subsalicylate (pepto bismol)

Used for?

Adverse effects

Avoid in?

Not for?

Answer 21

-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

Question 22

H. Pylori Treatment

How many antibiotics for how many days?

Answer 22

Minimum of two antibiotics prescribed FOR 2 WEEKS (14 days)

2 antibiotics + PPI

Question 23

Misoprostol

used for?

Don’t use?

can cause?

Answer 23

-Ulcers
-Promotes Cervical Ripening
-Can be used for termination of Pregnancy

Dont use during pregnancy
Dont touch the drug

DiarrheaSpotting/Dysmenorrhea