Acid-Related Diseases and Stress-Related Mucosal Damage
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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?

    <p>Calcium-based antacids</p> Signup and view all the answers

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

    <p>Buffering excess acid</p> Signup and view all the answers

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

    <p>Ciprofloxacin</p> 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?

    <p>As a second-line therapy</p> Signup and view all the answers

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

    <p>Magnesium toxicity</p> Signup and view all the answers

    What is the primary mechanism of action of MOA?

    <p>Neutralizing acid secretions</p> Signup and view all the answers

    Which of the following is NOT a contraindication for antacids?

    <p>Gastroesophageal reflux disease (GERD)</p> Signup and view all the answers

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

    <p>Increases gastric acid secretion</p> Signup and view all the answers

    Why are magnesium salts dangerous when used with renal failure?

    <p>The failing kidney cannot excrete extra magnesium</p> Signup and view all the answers

    What is the mechanism of action of H2 antagonists?

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

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

    <p>Metabolic alkalosis</p> Signup and view all the answers

    What is the indication for H2 antagonists in adjunct therapy?

    <p>All of the above</p> Signup and view all the answers

    Why is smoking a concern for H2 blockers?

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

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

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

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

    <p>Confusion and disorientation</p> Signup and view all the answers

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

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

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

    <p>Osteoporosis and risk of fractures</p> Signup and view all the answers

    What is the main mechanism of action of Sucralfate?

    <p>Form a protective barrier over ulcers and erosions</p> Signup and view all the answers

    What is a potential interaction between Cimetidine and other drugs?

    <p>Inhibited oxidation of many drugs</p> Signup and view all the answers

    What is a contraindication for the use of Sodium Bicarbonate?

    <p>All of the above</p> Signup and view all the answers

    When should H2 receptor antagonists be taken for optimal results?

    <p>1 to 2 hours before antacids</p> Signup and view all the answers

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

    <p>1 to 2 hours before antacids</p> Signup and view all the answers

    What is a common side effect of aluminum salts?

    <p>Constipation</p> Signup and view all the answers

    What is the mechanism of action of PPIs?

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

    What is a potential complication of achlorhydria caused by PPIs?

    <p>Bacterial overgrowth</p> Signup and view all the answers

    What is a contraindication for the use of PPIs?

    <p>Known drug allergy</p> Signup and view all the answers

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

    <p>Renal disease</p> Signup and view all the answers

    What is a side effect of calcium salts?

    <p>Kidney stones</p> Signup and view all the answers

    What is the purpose of antiflatulents?

    <p>To relieve painful symptoms associated with gas</p> Signup and view all the answers

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

    <p>Its abortifacient properties</p> Signup and view all the answers

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

    <p>Because of the risk of further compromising their cardiovascular condition</p> Signup and view all the answers

    What is the primary mechanism of action of Simethicone?

    <p>Breaking down gas bubbles in the gastrointestinal tract</p> Signup and view all the answers

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

    <p>To prevent premature dissolving of enteric-coated medications</p> Signup and view all the answers

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

    <p>Masking of symptoms of underlying diseases</p> Signup and view all the answers

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

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

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

    <p>Increased risk of gastrointestinal bleeding with warfarin</p> Signup and view all the answers

    What should be done when administering chewable antacid tablets?

    <p>Chew the tablet thoroughly before swallowing</p> 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.

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