Podcast
Questions and Answers
What is a potential side effect of cimetidine?
What is a potential side effect of cimetidine?
Why has cimetidine been largely replaced by famotidine?
Why has cimetidine been largely replaced by famotidine?
What can decrease the effectiveness of H2 blockers?
What can decrease the effectiveness of H2 blockers?
When should H2 receptor antagonists be taken in relation to antacids?
When should H2 receptor antagonists be taken in relation to antacids?
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What type of drug can cause confusion and disorientation in older adults?
What type of drug can cause confusion and disorientation in older adults?
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What process is inhibited by H2 blockers?
What process is inhibited by H2 blockers?
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What is the mechanism of action of proton pump inhibitors?
What is the mechanism of action of proton pump inhibitors?
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What is a potential advantage of famotidine over cimetidine?
What is a potential advantage of famotidine over cimetidine?
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Which of the following medications may have increased serum levels when administered concurrently with proton pump inhibitors?
Which of the following medications may have increased serum levels when administered concurrently with proton pump inhibitors?
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What is a crucial nursing assessment prior to administering proton pump inhibitors?
What is a crucial nursing assessment prior to administering proton pump inhibitors?
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Which of the following administration routes is NOT typically available for all proton pump inhibitors?
Which of the following administration routes is NOT typically available for all proton pump inhibitors?
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What is the recommended timing for taking proton pump inhibitors in relation to meals?
What is the recommended timing for taking proton pump inhibitors in relation to meals?
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Which of the following statements is TRUE about administering pantoprazole capsules via a nasogastric (NG) tube?
Which of the following statements is TRUE about administering pantoprazole capsules via a nasogastric (NG) tube?
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What is a potential adverse effect associated with the use of proton pump inhibitors?
What is a potential adverse effect associated with the use of proton pump inhibitors?
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Which of the following is NOT a recommended nursing implication for patients taking proton pump inhibitors?
Which of the following is NOT a recommended nursing implication for patients taking proton pump inhibitors?
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How should a nurse educate a patient regarding the frequency of proton pump inhibitor administration?
How should a nurse educate a patient regarding the frequency of proton pump inhibitor administration?
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What is a crucial nursing consideration when administering antacids?
What is a crucial nursing consideration when administering antacids?
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Which of the following is a potential adverse effect associated with calcium-containing antacids?
Which of the following is a potential adverse effect associated with calcium-containing antacids?
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Which of the following patient populations should use antacids with caution due to potential complications?
Which of the following patient populations should use antacids with caution due to potential complications?
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Why is it important to assess for allergies before administering antacids?
Why is it important to assess for allergies before administering antacids?
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What should be done if a patient experiencing heart failure needs relief from heartburn?
What should be done if a patient experiencing heart failure needs relief from heartburn?
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How should chewable antacid tablets be administered?
How should chewable antacid tablets be administered?
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What should the nurse monitor for when assessing the therapeutic response to antacid therapy?
What should the nurse monitor for when assessing the therapeutic response to antacid therapy?
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Which of the following statements regarding long-term self-medication with antacids is TRUE?
Which of the following statements regarding long-term self-medication with antacids is TRUE?
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What is a potential consequence of long-term use of Proton Pump Inhibitors?
What is a potential consequence of long-term use of Proton Pump Inhibitors?
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Which of the following medications may have its absorption affected by Proton Pump Inhibitors?
Which of the following medications may have its absorption affected by Proton Pump Inhibitors?
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What is a possible effect of Proton Pump Inhibitors on the gut flora?
What is a possible effect of Proton Pump Inhibitors on the gut flora?
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Why should patients taking Proton Pump Inhibitors be monitored?
Why should patients taking Proton Pump Inhibitors be monitored?
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What should be taken into consideration when administering Proton Pump Inhibitors with food?
What should be taken into consideration when administering Proton Pump Inhibitors with food?
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Which of the following is a potential indication for Proton Pump Inhibitors?
Which of the following is a potential indication for Proton Pump Inhibitors?
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What is a potential consequence of Proton Pump Inhibitors on the bones?
What is a potential consequence of Proton Pump Inhibitors on the bones?
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Which of the following is a possible adverse effect of Proton Pump Inhibitors?
Which of the following is a possible adverse effect of Proton Pump Inhibitors?
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What bacterium is commonly associated with duodenal ulcers in patients?
What bacterium is commonly associated with duodenal ulcers in patients?
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Which of the following is NOT a common treatment for peptic ulcer disease?
Which of the following is NOT a common treatment for peptic ulcer disease?
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What are antacids primarily used for?
What are antacids primarily used for?
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In which condition is stress-related mucosal damage most commonly found?
In which condition is stress-related mucosal damage most commonly found?
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Which medication class is used for the prevention of stress ulcers in the ICU?
Which medication class is used for the prevention of stress ulcers in the ICU?
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What combined effect does magnesium have when included in antacids?
What combined effect does magnesium have when included in antacids?
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What is the recommended duration for the first-line therapy of peptic ulcer disease?
What is the recommended duration for the first-line therapy of peptic ulcer disease?
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What misconception might students have about stress ulcer prophylaxis?
What misconception might students have about stress ulcer prophylaxis?
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What should the nurse assess for before administering proton pump inhibitors?
What should the nurse assess for before administering proton pump inhibitors?
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When administering pantoprazole capsules via a nasogastric (NG) tube, what is important to consider?
When administering pantoprazole capsules via a nasogastric (NG) tube, what is important to consider?
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What is a potential drug interaction with proton pump inhibitors?
What is a potential drug interaction with proton pump inhibitors?
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Why is it important to take proton pump inhibitors on an empty stomach?
Why is it important to take proton pump inhibitors on an empty stomach?
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What should the nurse monitor for when assessing the therapeutic response to proton pump inhibitor therapy?
What should the nurse monitor for when assessing the therapeutic response to proton pump inhibitor therapy?
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What is a potential consequence of long-term use of proton pump inhibitors?
What is a potential consequence of long-term use of proton pump inhibitors?
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Why should the nurse assess for history of liver disease before administering proton pump inhibitors?
Why should the nurse assess for history of liver disease before administering proton pump inhibitors?
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What should the nurse educate the patient about when taking proton pump inhibitors?
What should the nurse educate the patient about when taking proton pump inhibitors?
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When should antacids be administered in relation to other medications?
When should antacids be administered in relation to other medications?
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What should the nurse assess for before administering antacids?
What should the nurse assess for before administering antacids?
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Why do H2 antagonists need to be taken 1 to 2 hours before antacids?
Why do H2 antagonists need to be taken 1 to 2 hours before antacids?
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What is a potential adverse effect of calcium-containing antacids?
What is a potential adverse effect of calcium-containing antacids?
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What is a potential advantage of famotidine over cimetidine in terms of drug interactions?
What is a potential advantage of famotidine over cimetidine in terms of drug interactions?
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Why should patients with heart failure or hypertension avoid antacids with high sodium content?
Why should patients with heart failure or hypertension avoid antacids with high sodium content?
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What is a common adverse effect of cimetidine?
What is a common adverse effect of cimetidine?
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What should the nurse monitor for when assessing the therapeutic response to antacid therapy?
What should the nurse monitor for when assessing the therapeutic response to antacid therapy?
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What should the nurse assess for in an older adult patient taking H2 antagonists?
What should the nurse assess for in an older adult patient taking H2 antagonists?
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What is a potential consequence of long-term self-medication with antacids?
What is a potential consequence of long-term self-medication with antacids?
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Why should smoking patients be monitored when taking H2 blockers?
Why should smoking patients be monitored when taking H2 blockers?
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What is a crucial nursing implication when administering H2 antagonists?
What is a crucial nursing implication when administering H2 antagonists?
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How should chewable antacid tablets be administered?
How should chewable antacid tablets be administered?
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What is the mechanism of action of proton pump inhibitors?
What is the mechanism of action of proton pump inhibitors?
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What is a nursing consideration when administering antacids?
What is a nursing consideration when administering antacids?
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What is a potential consequence of long-term use of proton pump inhibitors?
What is a potential consequence of long-term use of proton pump inhibitors?
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A patient is prescribed pantoprazole for the treatment of gastroesophageal reflux disease (GERD). What administration guideline should the nurse provide to the patient?
A patient is prescribed pantoprazole for the treatment of gastroesophageal reflux disease (GERD). What administration guideline should the nurse provide to the patient?
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A patient taking warfarin is prescribed omeprazole for GERD. What is a priority nursing consideration related to this drug interaction?
A patient taking warfarin is prescribed omeprazole for GERD. What is a priority nursing consideration related to this drug interaction?
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A patient is taking lansoprazole for long-term treatment of GERD. Which potential adverse effect should the nurse monitor for in this patient?
A patient is taking lansoprazole for long-term treatment of GERD. Which potential adverse effect should the nurse monitor for in this patient?
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A patient is taking esomeprazole for GERD. Which of the following laboratory values would be most important for the nurse to monitor?
A patient is taking esomeprazole for GERD. Which of the following laboratory values would be most important for the nurse to monitor?
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A patient reports experiencing persistent heartburn despite taking a proton pump inhibitor for several weeks. What is the most appropriate nursing action?
A patient reports experiencing persistent heartburn despite taking a proton pump inhibitor for several weeks. What is the most appropriate nursing action?
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A patient is receiving rabeprazole for the treatment of a duodenal ulcer. Which assessment finding would indicate a therapeutic response to the medication?
A patient is receiving rabeprazole for the treatment of a duodenal ulcer. Which assessment finding would indicate a therapeutic response to the medication?
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A patient is prescribed omeprazole for GERD. What important patient education should the nurse provide regarding the use of this medication?
A patient is prescribed omeprazole for GERD. What important patient education should the nurse provide regarding the use of this medication?
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A patient is taking dexlansoprazole for GERD. Which of the following medications, if taken concurrently, could potentially interact with dexlansoprazole?
A patient is taking dexlansoprazole for GERD. Which of the following medications, if taken concurrently, could potentially interact with dexlansoprazole?
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What is the primary action of antacids in the gastrointestinal system?
What is the primary action of antacids in the gastrointestinal system?
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Which combination of medications is part of the first-line therapy for peptic ulcer disease associated with H. pylori?
Which combination of medications is part of the first-line therapy for peptic ulcer disease associated with H. pylori?
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Which adverse effect is commonly associated with the long-term use of calcium-containing antacids?
Which adverse effect is commonly associated with the long-term use of calcium-containing antacids?
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When should the administration of a histamine receptor-blocking drug or a proton pump inhibitor be considered in ICU patients?
When should the administration of a histamine receptor-blocking drug or a proton pump inhibitor be considered in ICU patients?
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What is a key nursing assessment prior to administering proton pump inhibitors?
What is a key nursing assessment prior to administering proton pump inhibitors?
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Which of the following is a common misconception regarding stress ulcer prophylaxis in ICU patients?
Which of the following is a common misconception regarding stress ulcer prophylaxis in ICU patients?
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What monitoring is important when assessing the therapeutic response to antacid therapy?
What monitoring is important when assessing the therapeutic response to antacid therapy?
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What is a potential outcome if a patient takes magnesium-based antacids excessively?
What is a potential outcome if a patient takes magnesium-based antacids excessively?
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What should the nurse consider when administering antacids to a patient with heart failure?
What should the nurse consider when administering antacids to a patient with heart failure?
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What is a potential consequence of long-term self-medication with antacids?
What is a potential consequence of long-term self-medication with antacids?
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When should patients take H2 receptor antagonists in relation to antacids?
When should patients take H2 receptor antagonists in relation to antacids?
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What should the nurse monitor for when assessing the therapeutic response to antacid therapy?
What should the nurse monitor for when assessing the therapeutic response to antacid therapy?
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What is a potential adverse effect of antacids containing calcium?
What is a potential adverse effect of antacids containing calcium?
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What should the nurse educate the patient about when taking antacids?
What should the nurse educate the patient about when taking antacids?
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Why should the nurse assess for allergies before administering antacids?
Why should the nurse assess for allergies before administering antacids?
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What should the nurse consider when administering antacids to a patient with renal disease?
What should the nurse consider when administering antacids to a patient with renal disease?
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What can occur when antacids are taken with other drugs?
What can occur when antacids are taken with other drugs?
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Why should calcium carbonate antacids be taken with simethicone?
Why should calcium carbonate antacids be taken with simethicone?
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What is a potential adverse effect of H2 antagonists in elderly patients?
What is a potential adverse effect of H2 antagonists in elderly patients?
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What should be monitored when assessing the therapeutic response to H2 antagonists?
What should be monitored when assessing the therapeutic response to H2 antagonists?
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Why should patients taking H2 antagonists be monitored for?
Why should patients taking H2 antagonists be monitored for?
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What is a potential consequence of taking antacids with other drugs?
What is a potential consequence of taking antacids with other drugs?
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Why should patients taking calcium antacids be monitored for?
Why should patients taking calcium antacids be monitored for?
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What is a potential consequence of long-term use of H2 antagonists?
What is a potential consequence of long-term use of H2 antagonists?
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What is a potential interaction between proton pump inhibitors and warfarin?
What is a potential interaction between proton pump inhibitors and warfarin?
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When administering pantoprazole capsules via a nasogastric tube, what is important to consider?
When administering pantoprazole capsules via a nasogastric tube, what is important to consider?
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What is a potential adverse effect associated with the use of proton pump inhibitors?
What is a potential adverse effect associated with the use of proton pump inhibitors?
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Why is it important to assess for allergies before administering proton pump inhibitors?
Why is it important to assess for allergies before administering proton pump inhibitors?
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What should the nurse monitor for when assessing the therapeutic response to proton pump inhibitor therapy?
What should the nurse monitor for when assessing the therapeutic response to proton pump inhibitor therapy?
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What is a crucial nursing implication for patients taking proton pump inhibitors?
What is a crucial nursing implication for patients taking proton pump inhibitors?
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What is a potential consequence of long-term use of proton pump inhibitors?
What is a potential consequence of long-term use of proton pump inhibitors?
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Why is it important to assess for history of liver disease before administering proton pump inhibitors?
Why is it important to assess for history of liver disease before administering proton pump inhibitors?
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What is a potential consequence of administering sucralfate with other medications?
What is a potential consequence of administering sucralfate with other medications?
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When counseling a patient about the timing of sucralfate administration, which statement should be emphasized?
When counseling a patient about the timing of sucralfate administration, which statement should be emphasized?
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Which adverse effect is most commonly associated with sucralfate administration?
Which adverse effect is most commonly associated with sucralfate administration?
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Which statement best describes the primary action of sucralfate in ulcer healing?
Which statement best describes the primary action of sucralfate in ulcer healing?
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What is the recommended patient assessment prior to initiating therapy with sucralfate?
What is the recommended patient assessment prior to initiating therapy with sucralfate?
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What should be monitored to assess the therapeutic response to sucralfate treatment?
What should be monitored to assess the therapeutic response to sucralfate treatment?
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In which situation may sucralfate be specifically beneficial?
In which situation may sucralfate be specifically beneficial?
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What adverse effect should the nurse specifically monitor for in patients taking sucralfate?
What adverse effect should the nurse specifically monitor for in patients taking sucralfate?
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Which drug is associated with binding to the P-450 microsomal oxidase system and increasing drug levels?
Which drug is associated with binding to the P-450 microsomal oxidase system and increasing drug levels?
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What is the recommended time frame for taking H2 receptor antagonists in relation to antacids for optimal results?
What is the recommended time frame for taking H2 receptor antagonists in relation to antacids for optimal results?
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Which adverse effect is specifically noted with the use of famotidine?
Which adverse effect is specifically noted with the use of famotidine?
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Which factor can potentially decrease the therapeutic effectiveness of H2 blockers?
Which factor can potentially decrease the therapeutic effectiveness of H2 blockers?
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In older patients, the use of which drug class may lead to confusion and disorientation?
In older patients, the use of which drug class may lead to confusion and disorientation?
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What is a critical consideration for monitoring patients taking cimetidine due to its drug interactions?
What is a critical consideration for monitoring patients taking cimetidine due to its drug interactions?
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Which of the following conditions indicates a potential risk of impaired absorption when using H2 blockers?
Which of the following conditions indicates a potential risk of impaired absorption when using H2 blockers?
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For patients taking H2 antagonists, what specific aspect of nursing assessment is important?
For patients taking H2 antagonists, what specific aspect of nursing assessment is important?
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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.
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 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.
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 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.
