Term
| Types of Acid=Controlling Drugs |
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Definition
1. antacids
2. H2 antagonists
3. Proton pump inhibitors |
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Term
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Definition
1. basic compounds used to neutralize stomach acid
2. salts of aluminum, magnesium, calcium, and/or sodium
3. many antacid preparations also contain the antiflatulent (antigas) drug simethicone |
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Term
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Definition
1. DO NOT prevent the overproduction of acid, but instead help neutralize acid secretions
2. promote gastric mucosal defensive mechanism
3. Stimulate secretion of:
a. mucus: protective barrier against HCl
b. bicarbonate: helps buffer acidic properties of HCl
c. prostaglandins: prevent activation of proton pump |
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Term
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Definition
1. Reduction of pain associated with acid related disorders
a. raising gastric pH 1 point (1.3 to 2.3) neurtralizes 90% of gastric acid
b. reducint acidity reduces pain as a result of:
1) base-mediated inhibition of protein digesting ability of pepsin
2) increase in the resistance of the stomach lining to irritation
3) increase the tone of the cardiac sphincter |
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Term
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Definition
1. have constipating effects
2. often used with magnesium to counteract constipation
3. often recommended for patients with renal disease (more easily excreted)
Example:
aluminum carbonate: Basaljel
Hydroxide salt: AlternaGEL
Combination products (aluminum and magnesium)
gaviscon, maalox, mylanta, di-gel |
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Term
| Antacids: Magnesium salts |
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Definition
1. commonly cause diarrhea; usually used with other drugs to counteract this effect
2. dangerous when used with renal failure-the failing kidney cannot excrete extra magnewsium resulting in accumulation
3. Example: hydroxide salt: magnesium hydroxide (Milk of Magnesia); carbonate salt: Gaviscon (also a combination product); combination products such as Maalox and Mylanta |
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Term
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Definition
1. many forms, but carbonate is most common
2. may cause constipation, kidney stones
3. also not recommended for patients with renal disease---may accumulate to toxic levels
4. long duration of acid action---may cause increased gastric acid secretion (hyperacidity rebound)
5. often advertised as an extra source of dietary calcium - Tums |
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Term
| Antacids: Sodium Bicarbonate |
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Definition
1. highly soluble
2. buffers the acidic properties of HCL
3. quick onset, but short duration
4. may cause metabolic alkalosis
5. sodium content may cause problems in pts with heart failure, hypertension, or renal insufficiency |
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Term
| A pt who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient? |
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Definition
An aluminum containing antacid
Aluminum and sodium based antacids are recommended for pts with renal compromise because they are more easily excreted |
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Term
| Antacids and antiflatulents |
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Definition
| Antiflatulents: used to relieve the painful symptoms associated with gas |
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Term
| Antacids : adverse effects |
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Definition
minimal and depend on the compound used;
Aluminum and calcium - constipation
magnesium - diarrhea
calcium carbonate - produces gas and belching, often combined with simethicone |
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Term
| Antacids : drug interactions |
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Definition
1. reduces the ability of other drugs to be absorbed into the body
2. chelation - chemical binding or inactivation of another drug: produces insoluble complexes; reduced drug absorption
3. increased stomach pH - increased absorption of basic drugs, decreased absorption of acidic drugs
4. increased urinary pH - increased excretion of acidic drugs; decreased excretion of basic drugs |
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Term
| Histamine 2 (H2) Receptor Antagonists |
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Definition
1. reduce acid secretion
2. available OTC in lower dosage forms
3. most popular: Tagamet; Axid; Pepcid; Zantac |
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Term
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Definition
1. competitively block H2 receptor of acid producing parietal cells
2. reduced hydrogen ion secretion from from the parietal cells
3. increase in the pH of the stomach
4. relief of many of the symptoms associated with hyperacidity - related conditions |
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Term
| H2 Antagonist - Drug effect and indicatins |
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Definition
1. suppressed acid secretin in the stomach
2. indications: GERD: PUD; erosive esophagitis; adjunct therapy to control upper GI bleeding; Zollinger-Ellison syndrome |
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Term
| H2 Antagonist - Adverse Effect |
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Definition
1. overall, very few adverse effects
2. central nervous system adverese effects in elderly patients include confusion and disorientation
3. Cimetidine may induce impotence and gynecomastia
4. Thrombocytopenia has been reported with ranitidine and famotidine |
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Term
| H2 Antagonists - Drug Interactions |
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Definition
1. cimetidiene (Tagamet) - binds with P-450 microsomal oxidase system in the liver, resulting in inhibitied 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
2. Smoking has been shown to decrease the effectiveness of H2 blockers
3. For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids |
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Term
| When working with an elderly patient who has been admitted for a possible gastrointestinal bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation |
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Definition
An H2 antagonist
H2 antagonists may cause confusion and disorientation in the elderly |
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Term
| Proton Pump Inhibitors (PPIs) |
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Definition
1. the parietal cells release positive hydrogen ions (protons) during HCl production
2. This process is called proton pump
3. H2 blockers and antihistamines do not stop the action of this pump
Examples: Iansoprazole (Prevacid); omeprazole (Prilosec); rabeprazole (AcipHex); pantoprazole (Protonix); esomeprazole (Nexium) |
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Term
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Definition
1. irreversibly bind H+/K+ ATPase enzyme
2. this bond prevents the movement of hydrogen ions from the parietal cell into the stomach
3. 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 |
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Term
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Definition
| 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 when given with antibiotic |
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Term
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Definition
1. generally well tolerated
2. possible predisposition to GI tract infections
3. osteoporosis and risk of wrist, hip, spine fractures in long term users
4. pneumonia
5. depletion of magnesium |
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Term
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Definition
1. misc. acid controller
2. cytoprotective drug
3. used for stress ulcers, peptic ulcer disease
4. attracted to and binds to the base of ulcers and erosions forming a protective barrier over these areas
5. protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)
6. little absorption from the gut
7. may cause constipation, nausea, and dry mouth
8. may impair absorption of other drugs--give other drugs 2 hours before sucralfate
9. do not administer with other meds
10. binds with phosphate; may be used in chronic renal failure to reduce phosphate levels |
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Term
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Definition
1. Prostaglandin E analog
2. Prostaglandins have cytoprotective activity - protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate; promote local cell regeneration; help to maintain mucosal blood flow
3. used for prevention of NSAID induced gastric ulcers
4. doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea |
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Term
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Definition
1. antiflatulent drug
2. used to reduce the discomforts of gastric or intestinal gas (flatulence)
3. alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones
4. result is decreased gas pain and increased expulsion via mouth or rectum |
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Term
| Nursing Implications - Antacids |
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Definition
1. assess for allergies and preexisting conditions that may restrict the use of antacids such as: fluid imbalances, renal disease, GI obstruction, heart failure, pregnancy
2. pts with HF or hypertension should not use antacids with high sodium content
3. use with caustion with other meds b/c of drug interactions
4. most meds should be administered 1 to 2 hours after antacid
5. antacids may cause premature dissolving of enteric-coated medications resulting in stomach upset
6. Be sure that chewable tablets are chewed thoroughly and liquid forms are shaken well before giving
7. administer w/at least 8 ounces of water to enhance absorption (except for rapid dissolve forms)
8. long term self medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers
9. if symptoms remain ongoing, pt should seek medical evaluation
10. monitor for adverse effect - nausea, vomiting, abdominal pain, diarrhea, with calcium-containing products: constipation, acid rebound
11. monitor for therapeutic response - notify health care provider if symptoms are not relieved |
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Term
| Simethicone (Mylicon) is often combined with calcium carbonate antacids because |
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Definition
| semethicone helps reduce the gas that is caused by the calcium antacids |
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Term
| Nursing Implications - H2 Antagonists |
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Definition
1. assess for allergies and impaired renal or liver function
2. use with caution in pts who are confused, disoriented, or elderly
3. take 1-2 hours before antacids
4. for IV doses follow guidelines |
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Term
| Nursing Implications Proton Pump Inhibitors |
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Definition
1. assess for allergies and history of liver disease
2. not all are available for parenteral administrations
3. may increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin
4. The granules of pantoprazole capsules may be given via nasogastric (NG) tubes, but the NG tube must be at least 16 gauge or the tube may become clogged
5. capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed release granules |
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Term
| When providing education regarding the use of proton pump inhibitors, which statement will the nurse include? |
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Definition
Take the medication on an empty stomach 30 to 60 minutes before eating
Food may decrease absorption of the proton pump inhibitors, and it is recommended that they be taken on an empty stomach. Taken on a daily basis, not as needed for heartburn |
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Term
| Calcium based anatacids often cause |
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Definition
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Term
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Definition
1. H2 Receptor Antagonist
2. 1st drug in this class released in 1977
3. 1st major prescription drug to go OTC
4. high potential to cause drug interactions, been replaced by rantidine and famotidine
5. still used to treat certain allergic reactions |
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Term
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Definition
1. H2 receptor antagonist
2. like rantidine, has no drug interaction concerns
3. available in oral and injectable forms - dosing same for both forms |
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Term
| What nursing diagnosis is appropriate for pt receiving famotidine (Pepsid) |
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Definition
| risk for injury related to thrombocytopenia |
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Term
| Which type of antacids will the nurse most likely question in an order for a pt with chronic renal failure |
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Definition
| Magnesium containing antacids |
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Term
| The nurse would teach a pt prescribed simethicone (Gas-X) to avoid |
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Definition
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Term
| The nurse will question an order for misoprostol (Cytotec) in which pt? |
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Definition
| A 32 year old pregnant woman |
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Term
| The nurse will monitor for which adverse reaction to aluminum containing antacids such as aluminum hydroxide (Amphojel)? |
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Definition
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Term
| Teach pts antacids are effective in treating hyperacidity because |
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Definition
| they neurtralize gastric acid |
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Term
| PPIs have ability to almost completely inhibit gas secretion and may cause |
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Definition
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