Questions and Answers
What is a common side effect of cimetidine in the elderly?
When should H2 receptor antagonists be taken for optimal results?
What is the MOA of proton pump inhibitors?
What is a potential interaction between warfarin and proton pump inhibitors?
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What is the indication for sucralfate?
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What is the MOA of sucralfate?
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What is a contraindication for misoprostol?
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What is the indication for simethicone?
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What is a potential risk of long-term proton pump inhibitor use?
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What should patients take proton pump inhibitors with?
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What percentage of patients with duodenal ulcers have Helicobacter pylori (H.Pylori) in their GI tract?
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What is the first-line therapy for Helicobacter pylori (H.Pylori) infection?
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What is the Mechanism of Action (MOA) of Antacids?
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What is the indication for Antacids?
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What is the effect of Antacids on pain associated with acid-related disorders?
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What is the contraindication for Antacids in patients with renal failure?
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What is the Mechanism of Action (MOA) of Histamine 2 (H2) Receptor Antagonists?
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What is the indication for Histamine 2 (H2) Receptor Antagonists?
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What is the adverse effect of Cimetidine?
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What is the effect of Antacids on the absorption of other drugs?
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What is a preexisting condition that may restrict the use of antacids?
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Why should patients with HF or hypertension be cautious with antacids?
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What should be done to ensure effective absorption of antacids?
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What is a potential interaction between antacids and other medications?
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Why should H2 antagonists be taken 1 to 2 hours before antacids?
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What should be assessed before administering PPIs?
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What is a special consideration for administering pantoprazole capsules via NG tubes?
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What is a potential consequence of long-term medication with antacids?
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Why should patients with ongoing symptoms seek medical evaluation?
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What should be done to ensure effective administration of chewable antacid tablets?
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Histamine 2 (H2) receptor antagonists increase the pH of the stomach by reducing acid secretion.
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Antacids can be used as a long-term treatment for acid-related disorders.
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Helicobacter pylori (H.Pylori) is found in the GI tract of 50% of patients with duodenal ulcers and 30% of those with gastric ulcers.
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Proton pump inhibitors (PPIs) block acid secretion in the stomach.
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Antacids can cause rebound hyperacidity.
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Simethicone is used to relieve the symptoms associated with heartburn and acid indigestion.
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Cimetidine is still used to treat certain allergic reactions and causes confusion in the elderly.
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Proton pump inhibitors block the acid in the stomach to treat GERD.
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Sucralfate is a cytoprotective drug that forms a protective barrier over the ulcers in the stomach.
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Misoprostol is used to treat painful gas and is an antiflatulent medication.
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Simethicone is used to treat GERD and erosive esophagitis.
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Long-term use of proton pump inhibitors may increase the risk of osteoporosis and fractures.
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Patients with HF or hypertension should use antacids with high sodium contents.
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Antacids can cause premature dissolving of enteric-coated medications, resulting in stomach upset.
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Long-term medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.
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H2 antagonists should be taken 1 to 2 hours after antacids.
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PPIs are available for parental administration.
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The granules of pantoprazole capsules can be given via NG tubes without any restrictions.
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Fluid imbalances are a contraindication for antacids.
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Patients with ongoing symptoms should not seek medical evaluation.
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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
Acid-Related Diseases
- 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.
