Antiulcer Drugs NUR 210 Unit 11 (2023) Galen PPP.pptx

Antiulcer Drugs NUR 210 Unit 11/12  Peptic ulceration  Mucosal lining erosion ◦ Esophageal ◦ Gastric Peptic Ulcers ◦ Duodenal  Hypersecretion ◦ HCl...

Antiulcer Drugs NUR 210 Unit 11/12  Peptic ulceration  Mucosal lining erosion ◦ Esophageal ◦ Gastric Peptic Ulcers ◦ Duodenal  Hypersecretion ◦ HCl ◦ Pepsin ◦ pH of 2 to 5  Predisposing factors  Helicobacter pylori (H. pylori)  Genetic  Environmental Peptic Ulcers  Drugs  Stress ulcer following a critical situation Symptoms  Gnawing, aching pain after eating  Also called reflux esophagitis  Inflammation of the esophageal mucosa Gastroesophageal caused by reflux of gastric acid content Reflux Disease into the esophagus (GERD)  Main cause is an incompetent lower esophageal sphincter.  Smoking tends to accelerate the disease process.  Medical treatment for GERD is similar to the treatment for peptic ulcers.  Avoid tobacco. Avoid alcohol. Avoid hot, spicy, and greasy foods. Nonpharmacologic Take any NSAIDs, including aspirin and oral Measures glucocorticoids, with food or in decreased dosage. Sit upright after meals Do not eat before bedtime. Wear loose-fitting clothing. Antiulcer Drugs 1  Contraindications Few Antiulcer Interactions Other drugs – makes acid alkaline and prevent Drugs: Antacids break-down of other drugs 1 Side effects Aluminum – constipation Magnesium – diarrhea Electrolyte imbalance  Assessment Pain, Renal function, electrolyte imbalances Medication/medical history Interventions Do not take within 1 hour before and wait 2 Nursing Process: hours after any other medication Antacids Take a small amount of fluid to ensure drug 1 reaches stomach Do not take with meals – can slow GI emptying Notify HCP if constipation (aluminum) or diarrhea (magnesium) occurs Talk to HCP is using for more than 2 weeks Help patient with stress control measures Instruct to diet to reduce increase acid  Histamine2 blockers Famotidine (end in dine) Action ◦ Reduce gastric acid by blocking histamine at H2 receptors of parietal cells in stomach Antiulcer Drugs: ◦ Promote healing of ulcer by eliminating histamine 2 blockers cause - Famotidine Use ◦ Prevent and treat peptic ulcers, GERD, and stress ulcers Side effects ◦ Confusion, headaches, dizziness, diarrhea, constipation, nausea, rash, blurred vision, malaise, decreased libido Adverse reactions ◦ Hepatotoxicity, cardiac dysrhythmias, blood dyscrasias  Interactions Antiulcer Drugs: Take 30 minutes before other drugs histamine 2 blockers Can cause confusion in older - Famotidine adults Contraindication Pregnancy, breast feeding Severe renal or liver disease  PPI’s - End in sole Antiulcer Drugs: Action proton pump ◦ Reduce gastric acid by inhibiting inhibitors - hydrogen/potassium ATPase enzyme in gastric parietal cells Pantoprazole ◦ Used in H. Pylori treatment with antibiotics Side effects/Adverse reactions ◦ Headache, insomnia, dizziness, dry mouth, ◦ GI distress Antiulcer Drugs: Contraindications proton pump Allergic Pregnancy/breast feeding inhibitors - Pantoprazole Interactions Take on empty stomach as food can decrease effectiveness Take 30 minutes before other medications Antiulcer Drugs: Contraindications proton pump Allergic Pregnancy/breast feeding inhibitors - Pantoprazole Interactions Take on empty stomach as food can decrease effectiveness Take 30 minutes before other medications  Assessment Pain assessment GI assessment Nursing process: Fluid & electrolyte imbalance antiulcer drugs – H2 Medication/medical history and PPI Interventions Take as directed Avoid smoking Avoid driving until effect is known Eat food rich in Vitamin B12 Avoid foods that cause irritation  Pepsin inhibitors (mucosal protective drugs) Sucralfate Action ◦ Combines with gastric acid to form Antiulcer Drugs: thick paste covering ulcer, protects from acid and pepsin pepsin inhibitor - Side effects sucralfate ◦ Drowsiness, constipation ◦ GI distress ◦ Hyperglycemia Contraindications ◦ Renal failure Interactions ◦ Other drugs may not be absorbed give 1-2 hours around other drugs  Assessment Evaluate patient’s pain GI status Antiulcer Drugs: Renal function pepsin inhibitor - Interventions/teaching sucralfate Administer on empty stomach Give 1 -2 hours after other drugs Take exactly as ordered – up to 4-8 weeks may be required Increase fluids, bulk, exercise to prevent constipation Stop smoking Diet  The nurse has taught a patient about sucralfate. Which statement indicates that the patient requires further teaching? Practice Questions A. “I need to increase my fluid intake.” 1 B. “I need to report pain or vomiting of blood.” C. “I need to take sucralfate 30 minutes after meals.” D. “I need to take Maalox 30 minutes before or after Carafate.”  Answer: C Rationale: Sucralfate should be taken 30 minutes before meals, not after. Practice Questions Fluids should be encouraged to 1 prevent constipation and dry mouth. The patient should report any pain or vomiting of blood. Antacids should be taken either 30 minutes before or 30 minutes after sucralfate (Carafate).  A patient with peptic ulcer disease is noted to have a positive breath test for H. pylori. The nurse would anticipate treating the patient with Practice Questions 1 A. antacids and narcotics. B. pepsin inhibitors and antiemetics. C. proton pump inhibitors and antibiotics. D. emetic agents and tranquilizers.  Answer: C Practice Questions Rationale: A common treatment protocol for H. 1 pylori is triple antibiotic therapy and a proton pump inhibitor.  An older adult patient reports taking aluminum hydroxide on a daily basis to relieve symptoms of GERD. The nurse needs to evaluate for which condition? Practice Questions 1 A. Constipation B. Diarrhea C. Flatulence D. Abdominal pain  Answer: A Rationale: Use of aluminum hydroxide Practice Questions 1 most often causes constipation. Magnesium products can cause diarrhea  When administering the histamine2 blocker famotidine, the nurse will A. monitor laboratory results because famotidine decreases the effect of oral Practice Questions anticoagulants. 1 B. separate famotidine and other medications by at least ½ hour. C. teach the patient to avoid foods rich in vitamin B12. D. expect a reduction in the patient’s pain to occur after 5 days of therapy.  Answer: B Rationale: Antacids can be given 1 hour before or after famotidine as part of the antiulcer drug regimen. Famotidine can Practice Questions increase the effect of oral anticoagulants. 1 Patients on famotidine should eat a diet rich in vitamin B12 to avoid deficiency as a result of drug therapy. The patient’s abdominal pain is expected to decrease after 1 to 2 weeks of drug therapy.  A patient is suspected to have peptic ulcer disease from H. pylori. The patient asks the nurse what kind of testing will be done to determine the cause of the peptic ulcer. The nurse will inform the patient that Practice Questions 1 A. blood cultures will need to be drawn. B. a biopsy of the stomach will be done. C. a breath test will be performed. D. computerized scanning will identify if H. pylori is present.  Answer: C Rationale: In the past, endoscopy and a biopsy of the gastric antrum were needed to check for H. pylori. Currently a noninvasive breath test, the Meretek UBT, can detect H. pylori. This test Practice Questions consists of drinking a liquid containing 13C urea 1 and breathing into a container. If H. pylori is present, the bacterial urease hydrolyzes the urea, releasing 13CO2, which is detected by a spectrometer. This test is 90% to 95% effective for detecting H. pylori. In addition, a serology test may be performed to check for antibodies to H. pylori.  A patient with a gastric ulcer is ordered sucralfate. This medication works to Practice Questions A. calm the patient to reduce acid production. 1 B. block the H2 receptors. C. neutralize the gastric acids. D. coat the gastric lining.  Answer: D Rationale: Sucralfate (Carafate) is a Practice Questions mucosal protective drug. It forms a viscous 1 substance that covers the ulcer and protects it from acid and pepsin.