Pharmacology – Chapter 48 ATI Chapter 28

Promote ulcer healing by neutralizing hydrochloric acid and reducing pepsin activity, they do not coat the ulcer. Two types: Those that have systemic and those that have nonsytemic effect.

duodenal ulcer
Caused by hypersecretion of acid from the from the stomach passing into the duodenum because of (1) insufficient buffers to neutralize gastric acid in the stomach, (2) a defective or incompetent pyloric sphincter, or (3) hypermotility of the stomach

esophageal ulcer
Results from reflux of acidic gastric secretion into esophagus from a defective or incompetent cardiac sphincter

gastric mucosal barrier (GMB)
A thick, viscous, mucous material that provides a barrier between the mucosal lining and acidic gastric secretions

gastric ulcer
A stomach ulcer that frequently results from a breakdown of the GMB

gastroesophageal reflux disease (GERD)
inflammation or erosion of the esophageal mucosa caused by a reflux of gastric acid content from the stomach into the esophagus

histamine2, receptor agonists
Popular drugs used in the treatment of gastric acid duodenal ulcers. Prevent acid reflux in the esophagus by blocking the receptors in the parietal cells of the stomach, this reducing gastric acid secretion and concentration.

hydrochloric acid (HCL)
a component of gastric juice that helps create the environment that pepsin needs to break down protein in the stomach

A digestive enzyme, is activated at a pH of 2, and the acid-pepsin complex of gastric secretions can cause mucosal damage

peptic ulcer
Broad term for an ulcer occuring in the esophagus, stomach, or duodenum within the upper gastrointestinal (GI) tract

stress ulcer
Usually follows a critical situation such as extensive trauma or major surgery (e.g. burns, cardiac surgery).

Peptic ulcer
Peptic Ulceration
– Mucosal lining erosion
— Esophageal
— Gastric
— Duodenal
– Hypersecretion
— HCl – (acid)
— Pepsin
— pH of 2-5 (acidic)

Peptic ulcer
Predisposing factors
– Helicobacter pylori (H. pylori) –
– Mechanical – increased acid and pepsin
– Genetic – increased parietal cells in stomach
– Environmental – caffiene, spicy foods
– Drugs – NSAIDs

-Aching pain – Heartburn

Nonpharmacologic Measures
– Avoid tobacco – especially chewing tobacco
– Avoid alcohol
– Weight loss – reduces pressure on gut
– Avoid hot, spicy, and greasy foods
– Take any NSAIDs, including aspirin and oral glucocorticoids, with food or in decreased dosage
– Sit upright
– Do not eat before bedtime – NO heavy treats
– Wear loose-fitting clothing

Antiulcer drugs
– Tranquilizers – minimal effect
– Anticholinergic drugs – reduces GI motility and secretions
– Antacids – promotes ulcer healing by neutralizing HCl and reduced pepcid activity
– Histamine2 blockers – blocks parietal cell receptors
– reduces gastric acid secretion
– reduces acid concentration
– Proton pump inhibitors – supresses gastric acid
– Pepsin inhibitor – protects mucosa
– Prostaglandin E1 analog – supresses gastric acid
– protects mucosa in GI tract

Antiulcer drugs – Tranquilizers
Chlordiazepoxide and clidinium (Librax) is combination of anxiolytic/anticholinergic – kind of like Librium
Glycopyrrolate (Robinul) – 1.4mg dose used as pre-op treatment for surgery – reduces anxiety and vagal stimulation
Reduces vagal stimulation, decreases anxiety

Antiulcer drugs – Anticholinergics
Propantheline (Pro-Banthine)
Inhibits release of HCl by blocking acetylcholine and histamine
Take with meals to decrease acid secretion

Antiulcer drugs – Antacids
Aluminum (Al) hydroxide (Amphojel)
Magnesium (Mg) hydroxide/aluminum hydroxide (Maalox)
Calcium carbonate (Tums) – works as a calcium increaser
Sodium bicarbonate (Alka-Seltzer) (systemic)
– Neutralize gastric acid, reduce pepsin activity

Systemic side effects
-Sodium excess, water retention, metabolic alkalosis, acid rebound

Nonsystemic side effects
Mg: diarrhea; Al: constipation – combination drug for cancers
Combination: none

Antiulcer drugs – Histamine2 blockers
Cimetidine (Tagamet), Ranitidine (Zantac) OTC
Famotidine (Pepcid) OTC, Nizatidine (Axid)
-Reduce gastric acid by blocking H2 receptors of parietal cells in stomach
– Promote healing of ulcer by eliminating cause

Side effects
-Headaches, dizziness, diarrhea, constipation, reversible impotence, gynecomastia

Proton pump inhibitors
Esomeprazole (Nexium), Pantoprazole (Protonix)
Omeprazole (Prilosec), Lansoprazole (Prevacid)
– Reduce gastric acid by inhibiting hydrogen/potassium ATPase

Side effects
-Headache, insomnia, dizziness, dry mouth, flatulence, d, abdominal pain

Antiulcer drugs – Pepsin inhibitors
Sucralfate (Carafate)
– Combines with protein to form thick paste covering ulcer, protects from acid and pepsin

Side effects
– Constipation

Nursing Interventions
– Given 30 min before meals and bedtime

Antiulcer drugs – Prostaglandin E1 analog
Misoprostol (Cytotec)
– Inhibits gastric acid secretion and protects mucosa

Side effects
– GI distress, constipation

Q: A client is diagnosed with peptic ulcer disease. The nurse knows that which condition is a predisposing factor?
A: Heliobacter pylori

Q: When a client is given sulcrafate (Carafate), the nurse knows that its mode of action is what?
A: To combine with protein to form a viscous substance that forms protective covering of ulcer

Q: A client is taking ranitidine (Zantac). Nurse teaching about this drug includes which three items?
A: (1) drug must be administered seperate from antacid by a t least one hour
(2) Smoking should be avoided while taking this drug
(3) Food high in vitamin B12 should be increased in the diet

Q: When a client complains of pain accompanying a peptic ulcer, why should an antacid be given?
A: Antacids neutralize HCl and reduce pepsin activity

A client is taking famotidine (Pepcid) to inhibit gastric secretions. What are three side effects of famotidine?
A: (1) Dizziness
(2) Headaches
(3) Decreased libido

Q: A nurse is teaching a client with PUD how to properly administer ranitidine (Zantac). Which statement indicates effective teaching by the nurse?
A: I should call my doctor if stools look black and sticky

Q: A client is starting omeprazole (Prisolec) PO for mangement of GERD. A nurse should know that this medication works by?
A: decreasing the production of gastric acid

Q: A client taking sulcrafate (Carafate) PO for peptic ulcer disease has been started on phenyotin (Dilantin) to control seizures. Which item needs to be included in the client teaching?
A: Allow a 2 hour interval between the medications

Q: For which client with peptic ulcer disease is misoprostol (Cyotec) contraindicated?
A: A 27-year old who is pregnant

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Antacids neutralizing gastric hydrochloric acid and are widely available in many over-the-counter (OTC) preparations for the relief of indigestion, heartburn, and sour stomach Antiulcer drugs are use to relive symptoms association with ulcers and to promote healing WE WILL WRITE …

Antiemetic A drug that inhibits impulses that cause vomiting from going to the stomach. Crohn disease An inflammatory bowel disease affecting the entire GI tract from mouth to anus. WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY …

List the H2 Blockers Cimetidine, ranitidine, famotidine, nizatidine H2 Blockers: Mechanism; (Reversible or Irreversible?) block of histamine H2 receptors —> ? Reversible block of histamine H2 receptors —> Decreased H+ secretion by parietal cells. WE WILL WRITE A CUSTOM ESSAY …

Acute Gastritis 1. Pathology 2. Histology 3. Organisms 1. Inflammation of the gastric mucosa due to H. Pylori, alcohol or NSAIDs 2. Neutrophils 3. CMV, Albicans and H. Pylori Chronic Gastritis 1. Pathology 2. Histology 1. Due to either H. …

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client’s stools to be: black and tarry. A nurse is teaching a group of middle-aged men about peptic ulcers. …

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