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44 Cards in this Set

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antacids
H2 antagonists
proton pump inhibitors
types of acid controlling agents
DO NOT ALTER GASTRIC PRODUCTION
Promote gastric mucosal defense mechanisms
Secretion of:
Mucus: protective barrier against HCl
Bicarbonate: helps buffer acidic properties of HCl
Prostaglandins: prevent activation of proton pump
Antacids DO NOT prevent the overproduction of acid
Antacids DO neutralize the acid once it’s in the stomach
antacids mechanism of action
Reduction of pain associated with acid-related disorders
Raising gastric pH from 1.3 to 1.6 neutralizes 50% of the gastric acid
Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid
Reducing acidity reduces pain
antacids: drug effects
OTC formulations available as:
Capsules and tablets
Powders
Chewable tablets
Suspensions
Effervescent granules and tablets
Used alone or in combination
Aluminum salts
Magnesium salts
Calcium salts
Sodium bicarbonate
antacids
Forms: carbonate, hydroxide
Have constipating effects
Often used with magnesium to counteract constipation
Examples
Aluminum carbonate: Basaljel
Hydroxide salt: AlternaGEL
Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel
antacids: aluminum salts
Forms: carbonate, hydroxide, oxide, trisilicate
Commonly cause diarrhea; usually used with other agents to counteract this effect
Dangerous when used with renal failure—the failing kidney cannot excrete extra magnesium, resulting in accumulation
Examples
Hydroxide salt: magnesium hydroxide (MOM)
Carbonate salt: Gaviscon (also a combination product)
Combination products such as Maalox, Mylanta (aluminum and magnesium)
antacids: magnesium salts
Forms: many, but carbonate is most common
May cause constipation
Their use may result in kidney stones-IF USED OFTEN GET ALOT OF THEM
Long duration of acid action may cause increased gastric acid secretion (hyperacidity rebound)
Often advertised as an extra source of dietary calcium
Example: Tums (calcium carbonate)
antacids: calcium salts
Highly soluble
Buffers the acidic properties of HCl
Quick onset, but short duration
May cause metabolic alkalosis
Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency
antacids: sodium bicarbonate
Antiflatulents: used to relieve the painful symptoms associated with gas
Several agents are used to bind or alter intestinal gas and are often added to antacid combination products
GAS-X; MYLANTA GAS
antacids and antiflatulents
OTC antiflatulents
Activated charcoal
Simethicone
Alters elasticity of mucus-coated bubbles, causing them to break
Used often, but there are limited data to support effectiveness
antacids and antiflatulents
Minimal, and depend on the compound used
Aluminum and calcium
Constipation
Magnesium
Diarrhea
Calcium carbonate
Produces gas and belching; often combined with simethicone
antacids: side effects
Adsorption of other drugs to antacids
Reduces the ability of the other drug to be absorbed into the body
Chelation
Chemical binding, or inactivation, of another drug
Produces insoluble complexes
Result: reduced drug absorption
Increased stomach pH
Increased absorption of basic drugs
Decreased absorption of acidic drugs
Increased urinary pH
Increased excretion of acidic drugs
Decreased excretion of basic drugs
antacids: drug interactions
Assess for allergies and preexisting conditions that may restrict the use of antacids, such as:
Fluid imbalances – Renal disease – HF
Pregnancy – GI obstruction
Patients with HF or hypertension should use low-sodium antacids such as Riopan, Maalox, or Mylanta II
Use with caution with other medications due to the many drug interactions
Most medications should be given 1 to 2 hours after giving an antacid
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset
antacids: nursing implications
Be sure that chewable tablets are chewed thoroughly, and liquid forms are shaken well before giving
Administer with at least 8 ounces of water to enhance absorption (except for the “rapid dissolve” forms)
Caffeine, alcohol, harsh spices, and black pepper may aggravate the underlying GI condition
Monitor for side effects
Nausea, vomiting, abdominal pain, diarrhea
With calcium-containing products: constipation, acid rebound
Monitor for therapeutic response
Notify heath care provider if symptoms are not relieved
antacids: nursing implications
Reduce acid secretion
All available OTC in lower dosage forms
Most popular drugs for treatment of acid-related disorders
cimetidine (Tagamet) – nizatidine
famotidine (Pepcid)
ranitidine (Zantac)
histamine type 2 (h2) antagonists
Block histamine (H2) at the receptors of acid-producing parietal cells
Production of hydrogen ions is reduced, resulting in decreased production of HCl
H2 antagonists: mechanism of action
Suppressed acid secretion in the stomach
H2 antagonists: drug effect
GERD
PUD
Erosive esophagitis
Adjunct therapy in control of upper GI bleeding
Pathologic gastric hypersecretory conditions
H2 antagonists: indications
Overall, less than 3% incidence of side effects
Cimetidine may induce impotence and gynecomastia
May see:
Headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects
H2 antagonists:side effects
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 has been shown to decrease the effectiveness of H2 blockers
H2 antagonists: drug interactions
Assess for allergies and impaired renal or liver function
Use with caution in patients who are confused, disoriented, or elderly
Take 1 hour before or after antacids
For intravenous doses, follow administration guidelines
H2 antagonists: nursing implications
The parietal cells release positive hydrogen ions (protons) during HCl production
This process is called the “proton pump”
H2 blockers and antihistamines do not stop the action of this pump
proton pump inhibitors
Irreversibly bind to H+/K+ ATPase enzyme
This bond prevents the movement of hydrogen ions from the parietal cell into the stomach
Result: achlorhydria—ALL gastric acid secretion is blocked
In order to return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase
Proton pump inhibitors: mechanism of action
Total inhibition of gastric acid secretion
lansoprazole (Prevacid)
omeprazole (Prilosec)* The first in this new class of drugs
rabeprazole (Aciphex)
pantoprazole (Protonix)
esomeprazole (Nexium)
PPI: drug effect
GERD maintenance therapy
Erosive esophagitis
Short-term treatment of active duodenal and benign gastric ulcers
Zollinger-Ellison syndrome
Treatment of H. pylori–induced ulcers
PPI: indications
Safe for short-term therapy
Incidence low and uncommon
PPI: side effects
Assess for allergies and history of liver disease
pantoprazole is the only proton pump inhibitor available for parenteral administration, and can be used for patients who are unable to take oral medications
May increase serum levels of diazepam, phenytoin, and cause increased chance for bleeding with warfarin
Instruct the patient taking omeprazole:
It should be taken before meals
The capsule should be swallowed whole, not crushed, opened, or chewed
It may be given with antacids
Emphasize that the treatment will be short term
PPI: nursing implications
Cytoprotective agent
Used for stress ulcers, erosions, PUD
Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas
Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)
Little absorption from the gut
May cause constipation, nausea, and dry mouth
May impair absorption of other drugs, especially tetracycline
Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels
Do not administer with other medications
sucralfate (Carafate)
Synthetic prostaglandin analog
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
Used for prevention of NSAID-induced gastric ulcers
Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea
misoprostol (Cytotec)
antacids
H2 antagonists
proton pump inhibitors
types of acid controlling agents
DO NOT ALTER GASTRIC PRODUCTION
Promote gastric mucosal defense mechanisms
Secretion of:
Mucus: protective barrier against HCl
Bicarbonate: helps buffer acidic properties of HCl
Prostaglandins: prevent activation of proton pump
Antacids DO NOT prevent the overproduction of acid
Antacids DO neutralize the acid once it’s in the stomach
antacids mechanism of action
Reduction of pain associated with acid-related disorders
Raising gastric pH from 1.3 to 1.6 neutralizes 50% of the gastric acid
Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid
Reducing acidity reduces pain
antacids: drug effects
OTC formulations available as:
Capsules and tablets
Powders
Chewable tablets
Suspensions
Effervescent granules and tablets
Used alone or in combination
Aluminum salts
Magnesium salts
Calcium salts
Sodium bicarbonate
antacids
Forms: carbonate, hydroxide
Have constipating effects
Often used with magnesium to counteract constipation
Examples
Aluminum carbonate: Basaljel
Hydroxide salt: AlternaGEL
Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel
antacids: aluminum salts
Forms: carbonate, hydroxide, oxide, trisilicate
Commonly cause diarrhea; usually used with other agents to counteract this effect
Dangerous when used with renal failure—the failing kidney cannot excrete extra magnesium, resulting in accumulation
Examples
Hydroxide salt: magnesium hydroxide (MOM)
Carbonate salt: Gaviscon (also a combination product)
Combination products such as Maalox, Mylanta (aluminum and magnesium)
antacids: magnesium salts
Forms: many, but carbonate is most common
May cause constipation
Their use may result in kidney stones-IF USED OFTEN GET ALOT OF THEM
Long duration of acid action may cause increased gastric acid secretion (hyperacidity rebound)
Often advertised as an extra source of dietary calcium
Example: Tums (calcium carbonate)
antacids: calcium salts
Highly soluble
Buffers the acidic properties of HCl
Quick onset, but short duration
May cause metabolic alkalosis
Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency
antacids: sodium bicarbonate
Antiflatulents: used to relieve the painful symptoms associated with gas
Several agents are used to bind or alter intestinal gas and are often added to antacid combination products
GAS-X; MYLANTA GAS
antacids and antiflatulents
OTC antiflatulents
Activated charcoal
Simethicone
Alters elasticity of mucus-coated bubbles, causing them to break
Used often, but there are limited data to support effectiveness
antacids and antiflatulents
Minimal, and depend on the compound used
Aluminum and calcium
Constipation
Magnesium
Diarrhea
Calcium carbonate
Produces gas and belching; often combined with simethicone
antacids: side effects
Adsorption of other drugs to antacids
Reduces the ability of the other drug to be absorbed into the body
Chelation
Chemical binding, or inactivation, of another drug
Produces insoluble complexes
Result: reduced drug absorption
Increased stomach pH
Increased absorption of basic drugs
Decreased absorption of acidic drugs
Increased urinary pH
Increased excretion of acidic drugs
Decreased excretion of basic drugs
antacids: drug interactions
Assess for allergies and preexisting conditions that may restrict the use of antacids, such as:
Fluid imbalances – Renal disease – HF
Pregnancy – GI obstruction
Patients with HF or hypertension should use low-sodium antacids such as Riopan, Maalox, or Mylanta II
Use with caution with other medications due to the many drug interactions
Most medications should be given 1 to 2 hours after giving an antacid
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset
antacids: nursing implications
Be sure that chewable tablets are chewed thoroughly, and liquid forms are shaken well before giving
Administer with at least 8 ounces of water to enhance absorption (except for the “rapid dissolve” forms)
Caffeine, alcohol, harsh spices, and black pepper may aggravate the underlying GI condition
Monitor for side effects
Nausea, vomiting, abdominal pain, diarrhea
With calcium-containing products: constipation, acid rebound
Monitor for therapeutic response
Notify heath care provider if symptoms are not relieved
antacids: nursing implications
Reduce acid secretion
All available OTC in lower dosage forms
Most popular drugs for treatment of acid-related disorders
cimetidine (Tagamet) – nizatidine
famotidine (Pepcid)
ranitidine (Zantac)
histamine type 2 (h2) antagonists