Questions and Answers
What percentage of patients with gastric ulcers have Helicobacter pylori in their GI tract?
Which of the following is NOT a factor contributing to stress-related mucosal damage?
What is the primary purpose of giving a histamine receptor–blocking drug or a PPI to ICU patients?
Which of the following antacids may lead to the development of kidney stones?
Signup and view all the answers
What is the mechanism of action of antacids in neutralizing acid?
Signup and view all the answers
Which of the following antibiotics is NOT part of the first-line therapy for Helicobacter pylori infection?
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?
Signup and view all the answers
Which of the following is a common complication of using antacids containing magnesium in patients with renal failure?
Signup and view all the answers
What is the primary mechanism of action of MOA?
Signup and view all the answers
Which of the following is NOT a contraindication for antacids?
Signup and view all the answers
What is the effect of calcium salts on gastric acid secretion?
Signup and view all the answers
Why are magnesium salts dangerous when used with renal failure?
Signup and view all the answers
What is the mechanism of action of H2 antagonists?
Signup and view all the answers
Which of the following is a side effect of sodium bicarbonate?
Signup and view all the answers
What is the indication for H2 antagonists in adjunct therapy?
Signup and view all the answers
Why is smoking a concern for H2 blockers?
Signup and view all the answers
What is the main mechanism of action of Histamine 2 (H2) Receptor Antagonists?
Signup and view all the answers
What is a common adverse effect of Cimetidine in elderly patients?
Signup and view all the answers
What is the main mechanism of action of Proton Pump Inhibitors?
Signup and view all the answers
What is a potential complication of long-term use of Proton Pump Inhibitors?
Signup and view all the answers
What is the main mechanism of action of Sucralfate?
Signup and view all the answers
What is a potential interaction between Cimetidine and other drugs?
Signup and view all the answers
What is a contraindication for the use of Sodium Bicarbonate?
Signup and view all the answers
When should H2 receptor antagonists be taken for optimal results?
Signup and view all the answers
What is the optimal timing for taking H2 receptor antagonists in relation to antacids?
Signup and view all the answers
What is a common side effect of aluminum salts?
Signup and view all the answers
What is the mechanism of action of PPIs?
Signup and view all the answers
What is a potential complication of achlorhydria caused by PPIs?
Signup and view all the answers
What is a contraindication for the use of PPIs?
Signup and view all the answers
What is the primary indication for the use of antacids containing aluminum salts?
Signup and view all the answers
What is a side effect of calcium salts?
Signup and view all the answers
What is the purpose of antiflatulents?
Signup and view all the answers
What is the primary reason why Misoprostol is classified as a pregnancy category X drug?
Signup and view all the answers
Why should patients with HF or hypertension avoid using antacids with high sodium content?
Signup and view all the answers
What is the primary mechanism of action of Simethicone?
Signup and view all the answers
Why should medications be administered 1 to 2 hours after an antacid?
Signup and view all the answers
What is a potential complication of long-term self-medication with antacids?
Signup and view all the answers
What should be done before administering capsules of pantoprazole through a nasogastric (NG) tube?
Signup and view all the answers
What is a potential drug interaction with proton pump inhibitors (PPIs)?
Signup and view all the answers
What should be done when administering chewable antacid tablets?
Signup and view all the answers
Study Notes
Acid-Related Diseases
- 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
Stress-Related Mucosal Damage
- 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
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Learn about peptic ulcer disease, Helicobacter pylori, and stress-related mucosal damage in the GI tract, including their causes, symptoms, and treatment options.