Chapter 50 test review
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Questions and Answers

What is a common side effect of cimetidine in the elderly?

  • Confusion (correct)
  • Dizziness
  • Headache
  • Nausea

    • When should H2 receptor antagonists be taken for optimal results?

  • 1 to 2 hours before meals
  • 1 to 2 hours before antacids (correct)
  • Before bedtime
  • With meals

    • What is the MOA of proton pump inhibitors?

  • Increases stomach motility
  • Blocks acid secretions (correct)
  • Enhances local production of mucus or bicarbonate
  • Forms a protective barrier over the ulcers in the stomach

    • What is a potential interaction between warfarin and proton pump inhibitors?

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

    What is the indication for sucralfate?

    <p>Stress ulcers and peptic ulcer disease</p> Signup and view all the answers

    What is the MOA of sucralfate?

    <p>Forms a protective barrier over the ulcers in the stomach</p> Signup and view all the answers

    What is a contraindication for misoprostol?

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

    What is the indication for simethicone?

    <p>Painful gas</p> Signup and view all the answers

    What is a potential risk of long-term proton pump inhibitor use?

    <p>Osteoporosis and risk of wrist, hip, and spine fractures</p> Signup and view all the answers

    What should patients take proton pump inhibitors with?

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

    What percentage of patients with duodenal ulcers have Helicobacter pylori (H.Pylori) in their GI tract?

    <p>90%</p> Signup and view all the answers

    What is the first-line therapy for Helicobacter pylori (H.Pylori) infection?

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

    What is the Mechanism of Action (MOA) of Antacids?

    <p>Neutralize acid in the stomach</p> Signup and view all the answers

    What is the indication for Antacids?

    <p>Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperactivity, and heartburn</p> Signup and view all the answers

    What is the effect of Antacids on pain associated with acid-related disorders?

    <p>Reduce the pain</p> Signup and view all the answers

    What is the contraindication for Antacids in patients with renal failure?

    <p>Antacids containing magnesium</p> Signup and view all the answers

    What is the Mechanism of Action (MOA) of Histamine 2 (H2) Receptor Antagonists?

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

    What is the indication for Histamine 2 (H2) Receptor Antagonists?

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

    What is the adverse effect of Cimetidine?

    <p>Impotence and gynecomastia</p> Signup and view all the answers

    What is the effect of Antacids on the absorption of other drugs?

    <p>Reduce the absorption of other drugs</p> Signup and view all the answers

    What is a preexisting condition that may restrict the use of antacids?

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

    Why should patients with HF or hypertension be cautious with antacids?

    <p>Because of the high sodium content</p> Signup and view all the answers

    What should be done to ensure effective absorption of antacids?

    <p>Take with 8 oz of water</p> Signup and view all the answers

    What is a potential interaction between antacids and other medications?

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

    Why should H2 antagonists be taken 1 to 2 hours before antacids?

    <p>To reduce the risk of drug interactions</p> Signup and view all the answers

    What should be assessed before administering PPIs?

    <p>Allergies and history of liver disease</p> Signup and view all the answers

    What is a special consideration for administering pantoprazole capsules via NG tubes?

    <p>The NG tube must be at least 16 gauge</p> Signup and view all the answers

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

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

    Why should patients with ongoing symptoms seek medical evaluation?

    <p>To rule out underlying diseases</p> Signup and view all the answers

    What should be done to ensure effective administration of chewable antacid tablets?

    <p>Chew them thoroughly</p> Signup and view all the answers

    Histamine 2 (H2) receptor antagonists increase the pH of the stomach by reducing acid secretion.

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

    Antacids can be used as a long-term treatment for acid-related disorders.

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

    Helicobacter pylori (H.Pylori) is found in the GI tract of 50% of patients with duodenal ulcers and 30% of those with gastric ulcers.

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

    Proton pump inhibitors (PPIs) block acid secretion in the stomach.

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

    Antacids can cause rebound hyperacidity.

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

    Simethicone is used to relieve the symptoms associated with heartburn and acid indigestion.

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

    Cimetidine is still used to treat certain allergic reactions and causes confusion in the elderly.

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

    Proton pump inhibitors block the acid in the stomach to treat GERD.

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

    Sucralfate is a cytoprotective drug that forms a protective barrier over the ulcers in the stomach.

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

    Misoprostol is used to treat painful gas and is an antiflatulent medication.

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

    Simethicone is used to treat GERD and erosive esophagitis.

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

    Long-term use of proton pump inhibitors may increase the risk of osteoporosis and fractures.

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

    Patients with HF or hypertension should use antacids with high sodium contents.

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

    Antacids can cause premature dissolving of enteric-coated medications, resulting in stomach upset.

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

    Long-term medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.

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

    H2 antagonists should be taken 1 to 2 hours after antacids.

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

    PPIs are available for parental administration.

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

    The granules of pantoprazole capsules can be given via NG tubes without any restrictions.

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

    Fluid imbalances are a contraindication for antacids.

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

    Patients with ongoing symptoms should not seek medical evaluation.

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

    Study Notes

    Helicobacter Pylori (H.Pylori)

    • Found in GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers
    • First-line therapy: 10-14 day course of PPI, clarithromycin, and either amoxicillin or metronidazole, or a combination of PPI, bismuth subsalicylate, and antibiotics tetracycline and metronidazole

    Acid-Controlling Drugs

    Antacids

    • MOA: Neutralize acid in the stomach
    • Indications: Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperactivity, and heartburn
    • Drug Effects: Reduction of pain associated with acid-related disorders, raising the gastric pH, and reducing acidity
    • Contraindications: Known allergy to a specific drug product, severe renal failure or electrolyte disturbances, GI obstruction
    • Adverse Effects: Minimal, depend on the compound used, overuse: metabolic alkalosis, aluminum and calcium: constipation, magnesium: diarrhea, calcium: kidney stones, rebound hyperacidity

    Antacids: Aluminum Salts

    • Indications: Relief of symptoms associated with acid-related disorders
    • Contraindications: Severe renal failure or electrolyte disturbances
    • Examples: Aluminum carbonate (Basaljel), Hydroxide salt (AlternaGEL), Combination products (Gaviscon, Maalox, Mylanta, Di-Gel)

    Antacids: Magnesium Salts

    • Indications: Relief of symptoms associated with acid-related disorders
    • Contraindications: Severe renal failure or electrolyte disturbances
    • Examples: Hydroxide salt (Milk of Magnesia), Carbonate salt (Gaviscon), Combination products (Maalox, Mylanta)

    Antacids: Calcium Salts

    • Indications: Relief of symptoms associated with acid-related disorders
    • Side Effects: Constipation, kidney stones
    • Contraindications: Patients with renal disease, may accumulate to toxic levels
    • Examples: Calcium carbonate (Tums)

    Antiflatulents

    • Simethicone: Used to relieve painful symptoms associated with gas

    Antacids: Sodium Bicarbonate

    • Indications: Heartburn, upset stomach, acid indigestion
    • Contraindications: Sodium content may cause problems in patients with heart failure, hypertension, or renal insufficiency
    • Patient education: Take 30 minutes before meals with water, may cause heart failure in patients with renal insufficiency, do not chew or crush

    Histamine 2 (H2) Receptor Antagonists

    • MOA: Reduce acid secretion by competitively blocking H2 receptors of acid-producing parietal cells
    • Indications: GERD, PUD, Erosive esophagitis, Adjunct therapy to control upper GI bleeding, Zollinger-Ellison syndrome
    • Adverse effects: Confusion and disorientation, Cimetidine: impotence and gynecomastia, Thrombocytopenia (Famotidine)
    • Drug interactions: Cimetidine (Tagamet), Nizatidine (Axid), Famotidine (Pepcid)

    Proton Pump Inhibitors (PPIs)

    • MOA: Blocks acid secretion
    • Indications: GERD, Erosive esophagitis, Short-term treatment of active duodenal and benign gastric ulcers, NSAID-induced ulcers, Stress ulcer prophylaxis, Treatment for H.pylori-induced ulcer
    • Patient education: PPIs block acid in the stomach to treat GERD, take medication before eating, do not take with warfarin, possible predisposition to C.diff infection, risk for osteoporosis
    • Adverse effects: Possible predisposition to GI tract infections, osteoporosis, pneumonia
    • Drug interactions: Increase serum levels of diazepam and phenytoin, warfarin: increased chance of bleeding, absorption of ketoconazole, ampicillin, iron salts, and digoxin, clopidogrel, sucralfate, food may decrease absorption of PPIs

    Miscellaneous Acid-Controlling Drugs

    • Sucralfate (Carafate): Cytoprotective drug (mucosal protectant), used for stress ulcers and peptic ulcer disease
    • MOA: Forms a protective barrier over the ulcers in the stomach
    • Patient education: May cause constipation, nausea, and dry mouth, may impair absorption of other drugs, do not administer with other medications
    • Misoprostol (Cytotec): Protects gastric mucosa from injury, patient education: if pregnant, cannot take this medication, used for prevention of NSAID-induced gastric ulcers, take with water
    • Simethicone (Mylicon): Used to treat painful gas, antiflatulent medication
    • H. pylori is a bacterium found in the GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers.
    • First-line therapy for H. pylori infection includes a 10-to-14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole.

    Types of Acid-Controlling Drugs

    • Antacids: neutralize acid in the stomach.
    • H2 antagonists: reduce acid in the stomach.
    • PPIs: block acid in the stomach.

    Indications

    • Antacids: acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperactivity, and heartburn.
    • H2 antagonists: gastroesophageal reflux disease (GERD), PUD, erosive esophagitis, adjunct therapy to control upper GI bleeding, and Zollinger-Ellison syndrome.
    • PPIs: GERD, erosive esophagitis, short-term treatment of active duodenal and benign gastric ulcers, nonsteroidal anti-inflammatory drug-induced ulcers, stress ulcer prophylaxis, and treatment for H. pylori-induced ulcer.

    Antacids

    • Mechanism of action (MOA): neutralize acid in the stomach.
    • Effects: reduction of pain associated with acid-related disorders, raising the gastric pH, and reducing acidity.
    • Contraindications: known allergy, severe renal failure, or electrolyte disturbances, GI obstruction, and patients with renal failure.
    • Adverse effects: minimal, overuse can lead to metabolic alkalosis, aluminum and calcium can cause constipation, magnesium can cause diarrhea, calcium can cause kidney stones and rebound hyperacidity, and calcium carbonate can produce gas and belching.

    Antacids: Sodium Bicarbonate

    • Indications: relief of heartburn, upset stomach, or acid indigestion.
    • Contraindications: sodium content may cause problems in patients with heart failure, hypertension, or renal insufficiency.

    H2 Receptor Antagonists

    • MOA: reduce acid secretion by competitively blocking the H2 receptor of acid-producing parietal cells.
    • Adverse effects: confusion, disorientation, cimetidine may induce impotence and gynecomastia, thrombocytopenia has been reported with famotidine.
    • Drug interactions: cimetidine can cause confusion in the elderly, smoking, and interactions with other medications.

    Proton Pump Inhibitors (PPIs)

    • MOA: block acid secretions.
    • Adverse effects: possible predisposition to C. diff infection, osteoporosis and risk of wrist, hip, and spine fractures in long-term users, pneumonia, and increased serum levels of diazepam and phenytoin.
    • Drug interactions: warfarin, clopidogrel, sucralfate, and food may decrease absorption of PPIs.

    Miscellaneous Acid-Controlling Drugs

    • Sucralfate (Carafate): cytoprotective drug, used for stress ulcers and peptic ulcer disease.
    • Misoprostol (Cytotec): protects gastric mucosa from injury, used for prevention of NSAID-induced gastric ulcers.
    • Simethicone (Mylicon): antiflatulent medication, used to treat painful gas.

    Nursing Implications

    • Focus on timing, interactions, and patient education.
    • Assess for allergies and pre-existing conditions that may restrict the use of antacids.
    • Use with caution with other medications due to many drug interactions.
    • Administer medications according to specific guidelines.

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    Description

    Learn about the bacterium Helicobacter pylori and its relation to acid-related diseases, including duodenal and gastric ulcers. Understand the first-line therapy and types of acid-controlling drugs.

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