JC Pharmacology Wk 7 Chapter 37

• Drug therapy is essential for peptic ulcer disease and hyperacidity.

Peptic Ulcer Disease

• This is characterized by ulcer formation in the esophagus, stomach, or duodenum.
• Ulcers occur in areas of the gastrointestinal (GI) mucosa exposed to gastric acid and pepsin.
• Most cases are due to Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
• Stress can contribute to ulcer formation.
• Gastric and duodenal ulcers are more common than esophageal ulcers.
• Gastric ulcers are more common in older adults and are typically chronic.
• Duodenal ulcers are strongly linked to H. pylori and NSAID usage; they can occur at any age.

Gastroesophageal Reflux Disease (GERD)

• GERD is the most common disorder of the esophagus.
• Characteristics include regurgitation of gastric contents into the esophagus and exposure of the esophageal mucosa to gastric acid and pepsin.
• Acid reflux often occurs after evening meals and decreases during sleep.
• Pyrosis (heartburn) is a main symptom that worsens in a recumbent position or when bending over.
• Common during pregnancy and in those over 40 years old.
• Indicative signs are effortless regurgitation of acidic fluid into the mouth, especially after meals and at night.
• An incompetent lower esophageal sphincter (LES) typically causes GERD.
• Factors contributing to reflux include foods, fluids, medications, gastric distention, cigarette smoking, and a recumbent posture.

Medications for Upper GI Disorders

• Medications promote healing of lesions.
• Medications prevent recurrence of lesions through both cell-destructive and cell-protective efforts.
• Several types of medications can be used alone or in combination.

Antacids

• People commonly take over-the-counter (OTC) antacids to offset the effects of GI acids.
• Antacids vary in their ability to neutralize gastric acid (50-80 mEq of acid is produced hourly), onset of action, and adverse effects.
• Common antacids are mixtures of aluminum hydroxide and magnesium hydroxide.
• Other ingredients include calcium salts (like Mylanta; aluminum hydroxide-magnesium hydroxide-simethicone mixture).
• Calcium compounds may cause hypercalcemia and acid rebound.
• Aluminum-containing antacids, like Mylanta, can cause constipation.
• Hypophosphatemia and osteomalacia may develop with long-term use of aluminum-based antacids.
• Aluminum compounds alone are rarely used for acid-peptic disorders.
• Mylanta also contains magnesium.
• Antacids with magnesium may cause diarrhea and hypermagnesemia.
• Older adults may experience neuromuscular effects.

Histamine₂ Receptor Antagonists (H₂RA)

• They inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin.
• Common adverse effects of cimetidine (prototype) include diarrhea, dizziness, drowsiness, headache, confusion, and gynecomastia, but occur infrequently.
• Adverse effects are more likely with prolonged use of high doses, increasing age, and with abnormal kidney or impaired hepatic function.

Histamine₂, Proton Pump Inhibitors (PPIs)

• PPIs (Omeprazole [prototype]) are strong inhibitors of gastric acid secretion.
• PPIs are similar to H₂RAs (Cimetidine) in terms of effects but have a different mode of action.
• PPIs suppress gastric acid more strongly and for longer periods than H₂RAs. This provides faster symptom relief and faster healing in acid-related diseases.
• Rates of ulcer recurrence are similar with PPIs and H2RAs, but PPIs are more popular.
• Nausea, diarrhea, and headache are the most frequently reported adverse effects.
• Long-term or high-dose PPIs may increase chances of bone fractures due to hypocalcemia.
• Long-term use can affect absorption of dietary vitamin B12 and magnesium which can lead to deficiencies.

Adjuvant Medications

• Naturally occurring prostaglandin E, produced in mucosal stomach and duodenum cells, inhibits gastric acid secretion.
• Prostaglandin E increases mucus and bicarbonate secretion and mucosal blood flow for mucosal repair.
• It inhibits mucosal damage from gastric acid, aspirin, and NSAIDs.
• Erosion and ulceration of gastric mucosa may occur when prostaglandin E synthesis is inhibited.
• Misoprostol is approved for usage with NSAIDs for gastric mucosa protection from NSAID-induced erosion and ulceration.
• Sucralfate is a preparation of sulfated sucrose and aluminum hydroxide that binds to normal and ulcerated mucosa.
• It prevents and it treats peptic ulcer disease.
• For ulcer treatment, it requires usage for 4 to 8 weeks until healing is confirmed via radiologic or endoscopic examination.
• Dosage reduction becomes necessary when there is long term use for ulcer recurrence prevention.
• Combination drug therapy includes at least two antibiotics and an acid reducer (triple therapy).
• Sometimes bismuth subsalicylate(quadruple therapy) is recommended for peptic ulcer disease patients infected with H. Pylori.
• Health care providers use bismuth subsalicylate to coat ulcers protecting them from stomach acid when treating with H.pylori
• Bismuth treatments include diarrhea and nausea.
• Bismuth subsalicylate can cause bleeding problems when used alone in patients with ulcers.

Assessment

• Contributing risk factors for peptic ulcer disease include cigarette smoking, which increases gastric acid secretion and decreases blood supply to the gastric mucosa.
• Nicotine’s effects constrict blood vessels.
• Patients with peptic ulcers who continue to smoke heal more slowly and have more recurrent ulcers.
• Stress, like physiologic stress (shock, sepsis, burns, surgery, head injury, severe trauma, and medical illness) and psychological stress, can be contributing factors.
• Stress activates the sympathetic nervous system, causing vasoconstriction in organs not needed for “fight or flight”.
• This reaction can cause Ischemia in the gastric mucosa.
• Drug therapy with aspirin and other NSAIDs, corticosteroids, and antineoplastic may cause ulcers.
• Signs and Symptoms of ulers depend on the cause and location of ulcer.
• Periodic epigastric pain, 1 to 4 hours after eating or during the night, described as burning or gnawing, are symptoms of a chronic duodenal ulcer.
• GI bleeding occurs with acute or chronic ulcers when corrosion appears in blood vessels.
• GERD leads to heartburn.

Nursing Interventions

• Prevent or minimize peptic uler disease and gastric acid-induced esophageal disorders.
• Helpful interventions include general health measures like a well balanced diet, adequate rest and regular exercise.
• Avoidance of cigarrete smoking and gastric irratants.
• Gastric irratants are alcohol, aspirin and NSAIDs, and caffine.
• Decrease the amount of psychological stress by changing the enviroment or learning a healthy way to manage stress.
• Healthy stratergies include relaxation tecniques as well as physical exercise.
• There is no practical way to avoid stress because it is a part of everyday life..
• The strategy of long-term drug therapy includes small doses of H2RAs, antacids, or sucralfate.
• Therapeutic regimins like active peptic ulcer follow presriptions to promote healing and prevent complications.
• Diet therapy has little impotance in treatment and prevention of peptic disease.
• Phyisicans perscribe no dietary restrictions, while others suggest minimizing or avoiding spiced foods, gas-forming foods and caffine containg beveranges.
• Helpful measures with heartburn and esophagitis are those that prevent of decrease gastroesophageal reflux of gastric contents.
• Preventative measures include avoiding irratants , higley spiced of fatty foods, eating small meals, and not laying down one to two hours after eating.
• Other measures include elevating the head, avoiding obesity, constipation, or anyother condition that increases intra-abdominal pressure.

Explore GERD, its causes, and lifestyle factors. Understand the role and mechanisms of antacids, including their effects on gastric acid production and potential adverse effects. Learn about the use of aluminum and calcium compounds in treating acid-peptic disorders.