Acid-Related Diseases and Stress-Related Mucosal Damage

Questions and Answers

What percentage of patients with gastric ulcers have Helicobacter pylori in their GI tract?

50%

80%

90%

70% (correct)

Which of the following is NOT a factor contributing to stress-related mucosal damage?

Reperfusion injury

Mucosal ischemia

Decreased blood flow

Increased oxygen supply (correct)

What is the primary purpose of giving a histamine receptor–blocking drug or a PPI to ICU patients?

To treat underlying GI disease

To prevent GI bleeding (correct)

To reduce stress

To improve oxygen supply

Which of the following antacids may lead to the development of kidney stones?

Calcium-based antacids Signup and view all the answers

What is the mechanism of action of antacids in neutralizing acid?

Buffering excess acid Signup and view all the answers

Which of the following antibiotics is NOT part of the first-line therapy for Helicobacter pylori infection?

Ciprofloxacin Signup and view all the answers

What is the primary indication for using a combination of a PPI, bismuth subsalicylate, and antibiotics in the treatment of Helicobacter pylori infection?

As a second-line therapy Signup and view all the answers

Which of the following is a common complication of using antacids containing magnesium in patients with renal failure?

Magnesium toxicity Signup and view all the answers

What is the primary mechanism of action of MOA?

Neutralizing acid secretions Signup and view all the answers

Which of the following is NOT a contraindication for antacids?

Gastroesophageal reflux disease (GERD) Signup and view all the answers

What is the effect of calcium salts on gastric acid secretion?

Increases gastric acid secretion Signup and view all the answers

Why are magnesium salts dangerous when used with renal failure?

The failing kidney cannot excrete extra magnesium Signup and view all the answers

What is the mechanism of action of H2 antagonists?

Competitively block the H2 receptor of acid-producing parietal cells Signup and view all the answers

Which of the following is a side effect of sodium bicarbonate?

Metabolic alkalosis Signup and view all the answers

What is the indication for H2 antagonists in adjunct therapy?

All of the above Signup and view all the answers

Why is smoking a concern for H2 blockers?

Smoking has been shown to decrease the effectiveness of H2 blockers Signup and view all the answers

What is the main mechanism of action of Histamine 2 (H2) Receptor Antagonists?

Competitively block the H2 receptor of acid-producing parietal cells Signup and view all the answers

What is a common adverse effect of Cimetidine in elderly patients?

Confusion and disorientation Signup and view all the answers

What is the main mechanism of action of Proton Pump Inhibitors?

Irreversibly bind to H+/K+ ATPase enzyme Signup and view all the answers

What is a potential complication of long-term use of Proton Pump Inhibitors?

Osteoporosis and risk of fractures Signup and view all the answers

What is the main mechanism of action of Sucralfate?

Form a protective barrier over ulcers and erosions Signup and view all the answers

What is a potential interaction between Cimetidine and other drugs?

Inhibited oxidation of many drugs Signup and view all the answers

What is a contraindication for the use of Sodium Bicarbonate?

All of the above Signup and view all the answers

When should H2 receptor antagonists be taken for optimal results?

1 to 2 hours before antacids Signup and view all the answers

What is the optimal timing for taking H2 receptor antagonists in relation to antacids?

1 to 2 hours before antacids Signup and view all the answers

What is a common side effect of aluminum salts?

Constipation Signup and view all the answers

What is the mechanism of action of PPIs?

Irreversibly binding to H+/K+ ATPase enzyme Signup and view all the answers

What is a potential complication of achlorhydria caused by PPIs?

Bacterial overgrowth Signup and view all the answers

What is a contraindication for the use of PPIs?

Known drug allergy Signup and view all the answers

What is the primary indication for the use of antacids containing aluminum salts?

Renal disease Signup and view all the answers

What is a side effect of calcium salts?

Kidney stones Signup and view all the answers

What is the purpose of antiflatulents?

To relieve painful symptoms associated with gas Signup and view all the answers

What is the primary reason why Misoprostol is classified as a pregnancy category X drug?

Its abortifacient properties Signup and view all the answers

Why should patients with HF or hypertension avoid using antacids with high sodium content?

Because of the risk of further compromising their cardiovascular condition Signup and view all the answers

What is the primary mechanism of action of Simethicone?

Breaking down gas bubbles in the gastrointestinal tract Signup and view all the answers

Why should medications be administered 1 to 2 hours after an antacid?

To prevent premature dissolving of enteric-coated medications Signup and view all the answers

What is a potential complication of long-term self-medication with antacids?

Masking of symptoms of underlying diseases Signup and view all the answers

What should be done before administering capsules of pantoprazole through a nasogastric (NG) tube?

Check that the NG tube is at least 16 gauge to prevent clogging Signup and view all the answers

What is a potential drug interaction with proton pump inhibitors (PPIs)?

Increased risk of gastrointestinal bleeding with warfarin Signup and view all the answers

What should be done when administering chewable antacid tablets?

Chew the tablet thoroughly before swallowing Signup and view all the answers

Study Notes

Peptic ulcer disease (PUD) involves digestion of the GI mucosa by the enzyme pepsin
Helicobacter pylori (H.pylori) is a bacterium found in 90% of patients with duodenal ulcers and 70% of those with gastric ulcers
First-line therapy for H.pylori includes a 10- to 14-day course of a proton pump inhibitor (PPI) and antibiotics

GI lesions are common in ICU patients, especially within the first 24 hours after admission
Factors contributing to stress-related mucosal damage include:
- Decreased blood flow
- Mucosal ischemia
- Hypoperfusion
- Reperfusion injury
Nasogastric (NG) tubes and ventilators predispose patients to GI bleeding
Histamine receptor–blocking drugs or PPIs are used for prevention

Antacids

Types of antacids:
- Salts of aluminum, magnesium, calcium, and/or sodium
- Many antacid preparations also contain simethicone
Mechanism of action (MOA):
- Basic compounds used to neutralize stomach acid
- Do not prevent overproduction of acid but instead help to neutralize acid secretions
- Promote gastric mucosal defense mechanisms
Indications:
- Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn
Effects:
- Reduction of pain associated with acid-related disorders
- Raising the gastric pH 1 point (1.3 to 2.3) neutralizes 90% of gastric acid
Contraindications:
- Known allergy to a specific drug product
- Severe renal failure or electrolyte disturbances
- GI obstruction

Aluminum Salts

Have constipating effects
Often used with magnesium to counteract constipation
Examples: Basaljel, AlternaGEL, and combination products (Gaviscon, Maalox, Mylanta, Di-Gel)

Magnesium Salts

Commonly cause diarrhea
Often used with other drugs to counteract this effect
Examples: magnesium hydroxide (Milk of Magnesia), carbonate salt (Gaviscon), and combination products (Maalox, Mylanta)

Calcium Salts

May cause constipation and kidney stones
Long duration of acid action may cause increased gastric acid secretion (hyperacidity rebound)
Example: Tums (calcium carbonate)

Sodium Bicarbonate

Highly soluble
Buffers acidic properties of HCl
Quick onset but short duration
May cause metabolic alkalosis
Sodium content may cause problems in patients with heart failure, hypertension, or renal insufficiency

H2 Antagonists

Mechanism of action (MOA):
- Competitively block the H2 receptor of acid-producing parietal cells
- Reduced hydrogen ion secretion from the parietal cells
- Increase in the pH of the stomach
Indications:
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease
- Erosive esophagitis
- Adjunct therapy to control upper GI bleeding
- Zollinger-Ellison syndrome
Examples: Cimetidine (Tagamet), Nizatidine (Axid), Famotidine (Pepcid)

Proton Pump Inhibitors

Mechanism of action (MOA):
- Inhibit acid production
- Irreversibly bind to H+/K+ ATPase enzyme
- Prevent movement of hydrogen ions from the parietal cell into the stomach
Indications:
- GERD
- Erosive esophagitis
- Short-term treatment of active duodenal and benign gastric ulcers
- Zollinger-Ellison syndrome
- Nonsteroidal antiinflammatory drug (NSAID)-induced ulcers
- Stress ulcer prophylaxis
- Treatment of H.pylori-induced ulcers
Examples: Lansoprazole (Prevacid), Omeprazole (Prilosec), Rabeprazole (AcipHex), Pantoprazole (Protonix), Esomeprazole (Nexium), Dexlansoprazole (Dexilant)

Antiflatulents

Used to relieve painful symptoms associated with gas
Examples: Simethicone (Mylicon)

Miscellaneous Acid-Controlling Drugs

Sucralfate (Carafate):
- Cytoprotective drug (mucosal protectant)
- Used for stress ulcers, peptic ulcer disease
- Attracted to and binds to the base of ulcers and erosions, forming a protective barrier
Misoprostol (Cytotec):
- Used for prevention of NSAID-induced gastric ulcers
- May induce labor
- Classified as a pregnancy category X drug

Nursing Implications

Focus on timing, drug interactions, and patient education
Assess for allergies and preexisting conditions that may restrict the use of antacids
Use with caution in patients with heart failure, hypertension, or renal disease
Monitor for adverse effects and therapeutic response

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Description

Learn about peptic ulcer disease, Helicobacter pylori, and stress-related mucosal damage in the GI tract, including their causes, symptoms, and treatment options.