NURS 3210 CH 50 PPT

Questions and Answers

What is a potential side effect of cimetidine?

Confusion and disorientation

Impotence and gynecomastia (correct)

GI bleed

Thrombocytopenia

Why has cimetidine been largely replaced by famotidine?

Because of its low effectiveness

Because of its potential to cause drug interactions (correct)

Due to its high cost

Due to its limited availability

What can decrease the effectiveness of H2 blockers?

Mucosal protectants

Smoking (correct)

Antacids

PPIs

When should H2 receptor antagonists be taken in relation to antacids?

1 to 2 hours before Signup and view all the answers

What type of drug can cause confusion and disorientation in older adults?

H2 antagonists Signup and view all the answers

What process is inhibited by H2 blockers?

P-450 microsomal oxidase system Signup and view all the answers

What is the mechanism of action of proton pump inhibitors?

Inhibiting the proton pump Signup and view all the answers

What is a potential advantage of famotidine over cimetidine?

Fewer drug interactions Signup and view all the answers

Which of the following medications may have increased serum levels when administered concurrently with proton pump inhibitors?

All of the above Signup and view all the answers

What is a crucial nursing assessment prior to administering proton pump inhibitors?

Assess for allergies Signup and view all the answers

Which of the following administration routes is NOT typically available for all proton pump inhibitors?

Intramuscular Signup and view all the answers

What is the recommended timing for taking proton pump inhibitors in relation to meals?

30 to 60 minutes before eating Signup and view all the answers

Which of the following statements is TRUE about administering pantoprazole capsules via a nasogastric (NG) tube?

The granules of pantoprazole capsules can be given via NG tubes, but the NG tube must be at least 16 gauge. Signup and view all the answers

What is a potential adverse effect associated with the use of proton pump inhibitors?

Increased risk of bleeding Signup and view all the answers

Which of the following is NOT a recommended nursing implication for patients taking proton pump inhibitors?

Educate patients to stop taking the medication immediately if they experience any adverse effects. Signup and view all the answers

How should a nurse educate a patient regarding the frequency of proton pump inhibitor administration?

Once daily Signup and view all the answers

What is a crucial nursing consideration when administering antacids?

Administer most medications 1 to 2 hours after an antacid. Signup and view all the answers

Which of the following is a potential adverse effect associated with calcium-containing antacids?

Constipation Signup and view all the answers

Which of the following patient populations should use antacids with caution due to potential complications?

Patients with a history of renal disease Signup and view all the answers

Why is it important to assess for allergies before administering antacids?

All of the above. Signup and view all the answers

What should be done if a patient experiencing heart failure needs relief from heartburn?

Administer antacids only after consulting with the healthcare provider. Signup and view all the answers

How should chewable antacid tablets be administered?

Chewed thoroughly before swallowing. Signup and view all the answers

What should the nurse monitor for when assessing the therapeutic response to antacid therapy?

Relief of symptoms like nausea, vomiting, and abdominal pain. Signup and view all the answers

Which of the following statements regarding long-term self-medication with antacids is TRUE?

Long-term use of antacids can mask serious underlying diseases. Signup and view all the answers

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

Increased risk of osteoporosis Signup and view all the answers

Which of the following medications may have its absorption affected by Proton Pump Inhibitors?

Ampicillin Signup and view all the answers

What is a possible effect of Proton Pump Inhibitors on the gut flora?

Increased risk of Clostridium difficile infections Signup and view all the answers

Why should patients taking Proton Pump Inhibitors be monitored?

To monitor for signs of magnesium depletion Signup and view all the answers

What should be taken into consideration when administering Proton Pump Inhibitors with food?

Food decreases the absorption of PPIs Signup and view all the answers

Which of the following is a potential indication for Proton Pump Inhibitors?

Gastroesophageal reflux disease Signup and view all the answers

What is a potential consequence of Proton Pump Inhibitors on the bones?

Decreased bone density Signup and view all the answers

Which of the following is a possible adverse effect of Proton Pump Inhibitors?

Pneumonia Signup and view all the answers

What bacterium is commonly associated with duodenal ulcers in patients?

Helicobacter pylori Signup and view all the answers

Which of the following is NOT a common treatment for peptic ulcer disease?

Narcotic analgesics Signup and view all the answers

What are antacids primarily used for?

To neutralize stomach acid Signup and view all the answers

In which condition is stress-related mucosal damage most commonly found?

Intensive care unit patients Signup and view all the answers

Which medication class is used for the prevention of stress ulcers in the ICU?

Histamine receptor-blocking drugs or PPIs Signup and view all the answers

What combined effect does magnesium have when included in antacids?

Counteracts constipation caused by aluminum and calcium Signup and view all the answers

What is the recommended duration for the first-line therapy of peptic ulcer disease?

10 to 14 days Signup and view all the answers

What misconception might students have about stress ulcer prophylaxis?

It should be continued indefinitely Signup and view all the answers

What should the nurse assess for before administering proton pump inhibitors?

Allergies and history of liver disease Signup and view all the answers

When administering pantoprazole capsules via a nasogastric (NG) tube, what is important to consider?

The NG tube must be at least 16 gauge Signup and view all the answers

What is a potential drug interaction with proton pump inhibitors?

Increased serum levels of diazepam and phenytoin Signup and view all the answers

Why is it important to take proton pump inhibitors on an empty stomach?

To increase absorption of the medication Signup and view all the answers

What should the nurse monitor for when assessing the therapeutic response to proton pump inhibitor therapy?

Resolution of heartburn symptoms Signup and view all the answers

What is a potential consequence of long-term use of proton pump inhibitors?

Increased risk of osteoporosis Signup and view all the answers

Why should the nurse assess for history of liver disease before administering proton pump inhibitors?

To prevent liver damage Signup and view all the answers

What should the nurse educate the patient about when taking proton pump inhibitors?

Taking the medication on an empty stomach Signup and view all the answers

When should antacids be administered in relation to other medications?

1 to 2 hours after other medications Signup and view all the answers

What should the nurse assess for before administering antacids?

Allergies and preexisting conditions Signup and view all the answers

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

To prevent the antacid from neutralizing the H2 antagonist Signup and view all the answers

What is a potential adverse effect of calcium-containing antacids?

Constipation and acid rebound Signup and view all the answers

What is a potential advantage of famotidine over cimetidine in terms of drug interactions?

Famotidine has fewer interactions with other medications Signup and view all the answers

Why should patients with heart failure or hypertension avoid antacids with high sodium content?

To avoid exacerbating heart failure or hypertension Signup and view all the answers

What is a common adverse effect of cimetidine?

Gynecomastia Signup and view all the answers

What should the nurse monitor for when assessing the therapeutic response to antacid therapy?

Notify the healthcare provider if symptoms are not relieved Signup and view all the answers

What should the nurse assess for in an older adult patient taking H2 antagonists?

Confusion and disorientation Signup and view all the answers

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

Malignancy or bleeding ulcers may be masked Signup and view all the answers

Why should smoking patients be monitored when taking H2 blockers?

Smoking decreases the effectiveness of H2 blockers Signup and view all the answers

What is a crucial nursing implication when administering H2 antagonists?

Assessing for allergies and impaired renal or liver function Signup and view all the answers

How should chewable antacid tablets be administered?

Chewed thoroughly and followed by 8 oz of water Signup and view all the answers

What is the mechanism of action of proton pump inhibitors?

Inhibiting the proton pump in the parietal cells Signup and view all the answers

What is a nursing consideration when administering antacids?

Taking the antacid 1 to 2 hours before H2 antagonists Signup and view all the answers

What is a potential consequence of long-term use of proton pump inhibitors?

Impaired calcium absorption Signup and view all the answers

A patient is prescribed pantoprazole for the treatment of gastroesophageal reflux disease (GERD). What administration guideline should the nurse provide to the patient?

Take the medication on an empty stomach, at least 30 minutes before meals. Signup and view all the answers

A patient taking warfarin is prescribed omeprazole for GERD. What is a priority nursing consideration related to this drug interaction?

Monitor for signs and symptoms of bleeding. Signup and view all the answers

A patient is taking lansoprazole for long-term treatment of GERD. Which potential adverse effect should the nurse monitor for in this patient?

Increased risk of developing osteoporosis. Signup and view all the answers

A patient is taking esomeprazole for GERD. Which of the following laboratory values would be most important for the nurse to monitor?

Serum magnesium levels. Signup and view all the answers

A patient reports experiencing persistent heartburn despite taking a proton pump inhibitor for several weeks. What is the most appropriate nursing action?

Assess for any potential causes for ineffective medication therapy. Signup and view all the answers

A patient is receiving rabeprazole for the treatment of a duodenal ulcer. Which assessment finding would indicate a therapeutic response to the medication?

Decreased gastric acid production. Signup and view all the answers

A patient is prescribed omeprazole for GERD. What important patient education should the nurse provide regarding the use of this medication?

The medication may increase the risk of developing osteoporosis with long-term use. Signup and view all the answers

A patient is taking dexlansoprazole for GERD. Which of the following medications, if taken concurrently, could potentially interact with dexlansoprazole?

Warfarin. Signup and view all the answers

What is the primary action of antacids in the gastrointestinal system?

Neutralize stomach acid Signup and view all the answers

Which combination of medications is part of the first-line therapy for peptic ulcer disease associated with H. pylori?

Proton pump inhibitor and clarithromycin with either amoxicillin or metronidazole Signup and view all the answers

Which adverse effect is commonly associated with the long-term use of calcium-containing antacids?

Constipation Signup and view all the answers

When should the administration of a histamine receptor-blocking drug or a proton pump inhibitor be considered in ICU patients?

Within the first 24 hours of admission Signup and view all the answers

What is a key nursing assessment prior to administering proton pump inhibitors?

Patient allergy history Signup and view all the answers

Which of the following is a common misconception regarding stress ulcer prophylaxis in ICU patients?

Prophylaxis should be continued indefinitely Signup and view all the answers

What monitoring is important when assessing the therapeutic response to antacid therapy?

Relief of symptoms such as heartburn Signup and view all the answers

What is a potential outcome if a patient takes magnesium-based antacids excessively?

Diarrhea Signup and view all the answers

What should the nurse consider when administering antacids to a patient with heart failure?

Avoid antacids with high sodium content Signup and view all the answers

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

Masking of serious underlying diseases Signup and view all the answers

When should patients take H2 receptor antagonists in relation to antacids?

1 to 2 hours before antacids Signup and view all the answers

What should the nurse monitor for when assessing the therapeutic response to antacid therapy?

Relief of symptoms Signup and view all the answers

What is a potential adverse effect of antacids containing calcium?

Constipation Signup and view all the answers

What should the nurse educate the patient about when taking antacids?

Shaking liquid forms well before giving Signup and view all the answers

Why should the nurse assess for allergies before administering antacids?

To prevent adverse effects Signup and view all the answers

What should the nurse consider when administering antacids to a patient with renal disease?

Avoid antacids with high sodium content Signup and view all the answers

What can occur when antacids are taken with other drugs?

Adsorption of other drugs to antacids Signup and view all the answers

Why should calcium carbonate antacids be taken with simethicone?

To alleviate gas and belching Signup and view all the answers

What is a potential adverse effect of H2 antagonists in elderly patients?

Confusion and disorientation Signup and view all the answers

What should be monitored when assessing the therapeutic response to H2 antagonists?

All of the above Signup and view all the answers

Why should patients taking H2 antagonists be monitored for?

Upper GI bleeding Signup and view all the answers

What is a potential consequence of taking antacids with other drugs?

Reduced efficacy of other drugs Signup and view all the answers

Why should patients taking calcium antacids be monitored for?

All of the above Signup and view all the answers

What is a potential consequence of long-term use of H2 antagonists?

Rebound hyperacidity Signup and view all the answers

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

Increased risk of bleeding Signup and view all the answers

When administering pantoprazole capsules via a nasogastric tube, what is important to consider?

The NG tube must be at least 16 gauge Signup and view all the answers

What is a potential adverse effect associated with the use of proton pump inhibitors?

Increased risk of bleeding Signup and view all the answers

Why is it important to assess for allergies before administering proton pump inhibitors?

To prevent allergic reactions Signup and view all the answers

What should the nurse monitor for when assessing the therapeutic response to proton pump inhibitor therapy?

Relief from heartburn symptoms Signup and view all the answers

What is a crucial nursing implication for patients taking proton pump inhibitors?

Take the medication on an empty stomach Signup and view all the answers

What is a potential consequence of long-term use of proton pump inhibitors?

Increased risk of osteoporosis Signup and view all the answers

Why is it important to assess for history of liver disease before administering proton pump inhibitors?

To prevent liver damage Signup and view all the answers

What is a potential consequence of administering sucralfate with other medications?

Impairment in the absorption of other drugs Signup and view all the answers

When counseling a patient about the timing of sucralfate administration, which statement should be emphasized?

Take sucralfate 1 hour before your other medications. Signup and view all the answers

Which adverse effect is most commonly associated with sucralfate administration?

Nausea Signup and view all the answers

Which statement best describes the primary action of sucralfate in ulcer healing?

It forms a protective barrier over ulcers, limiting damage from pepsin. Signup and view all the answers

What is the recommended patient assessment prior to initiating therapy with sucralfate?

Review of the patient's medication regimen for potential interactions Signup and view all the answers

What should be monitored to assess the therapeutic response to sucralfate treatment?

The frequency and severity of ulcer-related symptoms Signup and view all the answers

In which situation may sucralfate be specifically beneficial?

In chronic renal failure to reduce phosphate levels Signup and view all the answers

What adverse effect should the nurse specifically monitor for in patients taking sucralfate?

Changes in bowel habits indicating possible gastrointestinal obstruction Signup and view all the answers

Which drug is associated with binding to the P-450 microsomal oxidase system and increasing drug levels?

Cimetidine Signup and view all the answers

What is the recommended time frame for taking H2 receptor antagonists in relation to antacids for optimal results?

1 to 2 hours before antacids Signup and view all the answers

Which adverse effect is specifically noted with the use of famotidine?

Thrombocytopenia Signup and view all the answers

Which factor can potentially decrease the therapeutic effectiveness of H2 blockers?

Smoking Signup and view all the answers

In older patients, the use of which drug class may lead to confusion and disorientation?

H2 antagonists Signup and view all the answers

What is a critical consideration for monitoring patients taking cimetidine due to its drug interactions?

Liver function tests Signup and view all the answers

Which of the following conditions indicates a potential risk of impaired absorption when using H2 blockers?

Alkaline GI environment Signup and view all the answers

For patients taking H2 antagonists, what specific aspect of nursing assessment is important?

Evaluating gastrointestinal bleeding Signup and view all the answers

Study Notes

Nursing Implications: Proton Pump Inhibitors

Assess for allergies and history of liver disease.
Not all proton pump inhibitors (PPIs) are available for parenteral administration.
May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin.
The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 gauge or the tube may become clogged.
Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules.

Audience Response System: Question #5

When providing education regarding the use of PPIs, the nurse should instruct the patient to take the medication on an empty stomach, 30 to 60 minutes before eating.

Simethicone

Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum.

Nursing Implications: Antacids

Assess for allergies and preexisting conditions that may restrict the use of antacids, such as fluid imbalances, renal disease, GI obstruction, HF, and pregnancy.
Patients with HF or hypertension should not use antacids with high sodium content.
Use with caution with other medications because of the many drug interactions.
Most medications should be administered 1 to 2 hours after an antacid.
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset.
Be sure that chewable tablets are chewed thoroughly and liquid forms are shaken well before giving.
Administer with at least 8 oz of water to enhance absorption (except for “rapid-dissolve” forms).
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.
Monitor for adverse effects: nausea, vomiting, abdominal pain, diarrhea, constipation, acid rebound.
Monitor for therapeutic response: notify the healthcare provider if symptoms are not relieved.

Nursing Implications: H2 Antagonists

Assess for allergies and impaired renal or liver function.
Use with caution in patients who are confused, disoriented, or older.
Take 1 to 2 hours before antacids.
Cimetidine may induce impotence and gynecomastia.
Thrombocytopenia has been reported with famotidine.

H2 Antagonists: Drug Interactions

Cimetidine binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels.
All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption.
Because of its potential to cause drug interactions, cimetidine has been largely replaced by famotidine.
Cimetidine is still used to treat certain allergic reactions.
Smoking has been shown to decrease the effectiveness of H2 blockers.
For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids.

Proton Pump Inhibitors

The parietal cells release positive hydrogen ions (protons) during HCl production, which is called the proton pump.
H2 blockers and antihistamines do not stop the action of this pump.
Secretion also stimulated by large fatty meals and emotional stress.

Peptic ulcer disease (PUD) involves digestion of the GI mucosa by the enzyme pepsin.
Helicobacter pylori (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 includes a 10- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole or a combination of a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole.

Types of Acid-Controlling Drugs

Antacids
H2 antagonists
PPIs

Antacids

Basic compounds used to neutralize stomach acid
Salts of aluminum, magnesium, calcium, and/or sodium
Many antacid preparations also contain the antiflatulent (antigas) drug simethicone.
Many aluminum- and calcium-based formulations also include magnesium, which not only contributes to the acid-neutralizing capacity but also counteracts the constipating effects of aluminum and calcium.

Proton Pump Inhibitors: Mechanism of Action

Irreversibly bind to H+/K+ ATPase enzyme
This bond prevents the movement of hydrogen ions from the parietal cell into the stomach.
Results in achlorhydria—all gastric acid secretion is temporarily blocked.
To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.

Proton Pump Inhibitors: 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 with an antibiotic

Proton Pump Inhibitors: Adverse Effects

PPIs are generally well tolerated.
Possible predisposition to GI tract infections: Clostridium difficile
Osteoporosis and risk of wrist, hip, and spine fractures in long-term users
Pneumonia
Depletion of magnesium
Link between PPIs and dementia as well as development of systemic lupus erythematous

Proton Pump Inhibitors: Drug Interactions

Increase serum levels of diazepam and phenytoin
Warfarin: increased chance of bleeding
Absorption of ketoconazole, ampicillin, iron salts, and digoxin
Clopidogrel
Sucralfate: may delay the absorption of PPIs
Food may decrease absorption of the PPIs.

Nursing Implications: Proton Pump Inhibitors

Assess for allergies and history of liver disease.
Not all proton pump inhibitors (PPIs) are available for parenteral administration.
May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin.
The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 gauge or the tube may become clogged.
Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules.

Audience Response System: Question #5

When providing education regarding the use of PPIs, the nurse should instruct the patient to take the medication on an empty stomach, 30 to 60 minutes before eating.

Simethicone

Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum.

Nursing Implications: Antacids

Assess for allergies and preexisting conditions that may restrict the use of antacids, such as fluid imbalances, renal disease, GI obstruction, HF, and pregnancy.
Patients with HF or hypertension should not use antacids with high sodium content.
Use with caution with other medications because of the many drug interactions.
Most medications should be administered 1 to 2 hours after an antacid.
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset.
Be sure that chewable tablets are chewed thoroughly and liquid forms are shaken well before giving.
Administer with at least 8 oz of water to enhance absorption (except for “rapid-dissolve” forms).
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.
Monitor for adverse effects: nausea, vomiting, abdominal pain, diarrhea, constipation, acid rebound.
Monitor for therapeutic response: notify the healthcare provider if symptoms are not relieved.

Nursing Implications: H2 Antagonists

Assess for allergies and impaired renal or liver function.
Use with caution in patients who are confused, disoriented, or older.
Take 1 to 2 hours before antacids.
Cimetidine may induce impotence and gynecomastia.
Thrombocytopenia has been reported with famotidine.

H2 Antagonists: Drug Interactions

Cimetidine binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels.
All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption.
Because of its potential to cause drug interactions, cimetidine has been largely replaced by famotidine.
Cimetidine is still used to treat certain allergic reactions.
Smoking has been shown to decrease the effectiveness of H2 blockers.
For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids.

Proton Pump Inhibitors

The parietal cells release positive hydrogen ions (protons) during HCl production, which is called the proton pump.
H2 blockers and antihistamines do not stop the action of this pump.
Secretion also stimulated by large fatty meals and emotional stress.

Peptic ulcer disease (PUD) involves digestion of the GI mucosa by the enzyme pepsin.
Helicobacter pylori (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 includes a 10- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole or a combination of a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole.

Types of Acid-Controlling Drugs

Antacids
H2 antagonists
PPIs

Antacids

Basic compounds used to neutralize stomach acid
Salts of aluminum, magnesium, calcium, and/or sodium
Many antacid preparations also contain the antiflatulent (antigas) drug simethicone.
Many aluminum- and calcium-based formulations also include magnesium, which not only contributes to the acid-neutralizing capacity but also counteracts the constipating effects of aluminum and calcium.

Proton Pump Inhibitors: Mechanism of Action

Irreversibly bind to H+/K+ ATPase enzyme
This bond prevents the movement of hydrogen ions from the parietal cell into the stomach.
Results in achlorhydria—all gastric acid secretion is temporarily blocked.
To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.

Proton Pump Inhibitors: 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 with an antibiotic

Proton Pump Inhibitors: Adverse Effects

PPIs are generally well tolerated.
Possible predisposition to GI tract infections: Clostridium difficile
Osteoporosis and risk of wrist, hip, and spine fractures in long-term users
Pneumonia
Depletion of magnesium
Link between PPIs and dementia as well as development of systemic lupus erythematous

Proton Pump Inhibitors: Drug Interactions

Increase serum levels of diazepam and phenytoin
Warfarin: increased chance of bleeding
Absorption of ketoconazole, ampicillin, iron salts, and digoxin
Clopidogrel
Sucralfate: may delay the absorption of PPIs
Food may decrease absorption of the PPIs.

Miscellaneous Acid-Controlling Drugs

Sucralfate (Carafate), Misoprostol (Cytotec), and Simethicone (Mylicon) are miscellaneous acid-controlling drugs.

Sucralfate (Carafate)

Sucralfate is a cytoprotective drug (mucosal protectant) used for stress ulcers and peptic ulcer disease.
It attracts and binds to the base of ulcers and erosions, forming a protective barrier over these areas.
Sucralfate protects these areas from pepsin, which normally breaks down proteins (making ulcers worse).
It has little absorption from the gut and may cause constipation, nausea, and dry mouth as side effects.
Sucralfate may impair absorption of other drugs, so other drugs should be given at least 2 hours before sucralfate.

Nursing Implications: Antacids

Assess for allergies and preexisting conditions that may restrict the use of antacids, such as fluid imbalances, renal disease, GI obstruction, HF, and pregnancy.
Patients with HF or hypertension should not use antacids with high sodium content.
Use antacids with caution with other medications due to many drug interactions.
Most medications should be administered 1 to 2 hours after an antacid.
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset.
Chewable tablets should be chewed thoroughly, and liquid forms should be shaken well before giving.
Administer antacids with at least 8 oz of water to enhance absorption (except for “rapid-dissolve” forms).
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers.
Monitor for adverse effects, such as nausea, vomiting, abdominal pain, diarrhea, constipation, and acid rebound.
Monitor for therapeutic response, and notify the healthcare provider if symptoms are not relieved.

Nursing Implications: H2 Antagonists

Assess for allergies and impaired renal or liver function.
Use with caution in patients who are confused, disoriented, or older.
Take H2 antagonists 1 to 2 hours before antacids.
For intravenous doses, follow administration guidelines.

Nursing Implications: Proton Pump Inhibitors

Assess for allergies and history of liver disease.
Not all proton pump inhibitors are available for parenteral administration.
May increase serum levels of diazepam and phenytoin, and may increase the chance of bleeding with warfarin.
The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 gauge or the tube may become clogged.
Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules.

Simethicone

Simethicone alters the elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum.

Antacids: Adverse Effects

Antacids have minimal adverse effects, which depend on the compound used.
Overuse can lead to metabolic alkalosis.
Aluminum and calcium can cause constipation.
Magnesium can cause diarrhea.
Calcium can cause kidney stones and rebound hyperacidity.
Calcium carbonate can produce gas and belching, often combined with simethicone.

Antacids: Drug Interactions

Adsorption of other drugs to antacids reduces the ability of the other drug to be absorbed into the body.
Chelation, or chemical binding, of another drug produces insoluble complexes, resulting in reduced drug absorption.
Increased stomach pH increases absorption of basic drugs and decreases absorption of acidic drugs.
Increased urinary pH increases excretion of acidic drugs and decreases excretion of basic drugs.

Histamine 2 (H2) Receptor Antagonists

H2 antagonists reduce acid secretion.
All H2 antagonists are available OTC in lower dosage forms.
They are the most popular drugs for treatment of acid-related disorders, including cimetidine (Tagamet), nizatidine (Axid), famotidine (Pepcid), and ranitidine (Zantac).

H2 Antagonists: Mechanism of Action

H2 antagonists competitively block the H2 receptor of acid-producing parietal cells.
They reduce hydrogen ion secretion from the parietal cells, increasing the pH of the stomach.
They relieve many symptoms associated with hyperacidity-related conditions.

H2 Antagonists: Drug Effect and Indications

H2 antagonists suppress acid secretion in the stomach.
They are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), erosive esophagitis, and as adjunct therapy to control upper GI bleeding, as well as Zollinger-Ellison syndrome.

H2 Antagonists: Adverse Effects

H2 antagonists have few adverse effects.
Central nervous system adverse effects, such as confusion and disorientation, may occur in elderly patients.
Cimetidine may induce impotence and gynecomastia.
Thrombocytopenia has been reported with famotidine.

H2 Antagonists: Drug Interactions

Cimetidine binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels.
All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption.
Smoking decreases the effectiveness of H2 blockers.
For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids.

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This quiz covers the administration guidelines and nursing implications of proton pump inhibitors, including assessing for allergies and liver disease, and potential drug interactions.