Chapter 50 Acid-Controlling Drug

Front 1

The stomach secretes: _____________, ______________, ______________, _____________, __________, and _____________.

Back 1

1. Hydrochloric acid (HCL): digestion

2. Bicarbonate: mucus that coats & lubricates the gastric surface of the stomach

3. Pepsinogen: enzyme that degrades protein into peptides

4. Intrinsic factor: mediates absorption of VB12

5. Prostaglandins: lipid compounds

Front 2

There are three stomach glands: ____________, ___________, ______________.

Back 2

1. Cardiac: where content of the esophagus empty into the stomach

2. Pyloric: lower section of the organ and facilitate

3. Gastric: The cells of the gastric gland are the largest in number

Front 3

The cells of the gastric gland: ____________, _____________, _______________, ____________, and ___________.

Back 3

1. Parietal

2. Chief

3. Mucous

4. Endocrine

5. Enterochromaffin

Front 4

The ___________ cells produce and secrete HCL. This is the primary site of action for many of the drugs used to treat acid- related disorders.

Back 4

Parietal

Front 5

The ______ cells secrete pepsinogen, which is a proenzyme. Pepsinogen becomes ________ when activated by exposure to acid. Pepsin breaks down __________ (proteolytic).

Back 5

1. Chief

2. Pepsin

3. Proteins

Front 6

The ________ cells are mucus-secreting cells, that provide a __________ mucus coat, and protect against self-digestion by HCL and digestive enzymes.

Back 6

1. Mucous

2. Protective

Front 7

_____________ acid is secreted by __________ cells when stimulated by ________, _________, ___________, and _______________. Acidity aids in the ________ digestion of food and _________ against microbial infection via GI tract, so maintain the stomach at pH of ____ to ____.

Back 7

1. Hydrochloric

2. Parietal

3. Food

4. Caffeine

5. Chocolate

6. Alcohol 7. Proper 8. Defense 9. 1 - 4

Front 8

The ph of the system is _______ to ______.

Back 8

7.25 - 7.35

Front 9

_________ _______ disease are gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin.

Back 9

Peptic Ulcer

Front 10

_____________ _________ is a bacteria found in the GI tract. First line therapy includes 10 to 14 day course of ______________ and __________.

Back 10

1. Helicobacter pylori (H. pylori)

2. Proton Pump Inhibitor

3. Antibiotics

Front 11

_________________ mucosal damage are common finding in ICU patients, which are influenced by _____________, _____________, _____________, and _______________. _______________ and __________ predispose patients to GI bleeding. A _______ drug or ____________ are given for prevention.

Back 11

1. Stress-related

2. Decreased blood flow

3. Mucosal ischemia

4. Hypoperfusion

5. Reperfusion Injury

6. Nasogastric tubes (NG) 7. Ventilators

8. H2- receptor blocking 9.Proton Pump Inhibitor

Front 12

Types of Acid-Controlling Drugs are: _________, ______________, __________________.

Back 12

1. Antacids

2. H2 blocking

3. Proton Pump Inhibitors

Front 13

________ is a basic compound used to neutralize stomach acid, such as salts of _____________, ______________, __________ and/or ___________. Many antacid preparation also contain the antiflatulent (antigas) drug ________________.

Back 13

1. Antacids

2. Aluminum

3. Magnesium

4. Calcium

5. Sodium bicarbonate

6. Simethicone

Front 14

_________ do not prevent the ______________ of acid, but instead help to _________ acid secretions. Antacids promote gastric mucosal ________ mechanisms, and stimulate secretion of _________, ____________, and ____________.

Back 14

1. Antacids

2. Overproduction

3. Neutralize

4. Defense

5. Mucus: protective barrier against HCL

6. Bicarbonate: helps buffer acidic properties of HCL

7. Prostaglandins: prevent activation of proton pump

Front 15

________ reduce pain associated with acid-related disorders. They raise the gastric pH _____ point (1.3-2.3).

Back 15

1. Antacids

2. 1

Front 16

Reducing acidity reduces pain as a result of: ____________ inhibition of the protein- digesting ability of pepsin, _______ in the resistance of the stomach lining to irritation, _________ in the tone of the cardiac sphincter.

Back 16

1. Base-mediated

2. Increase

3. Increase

Front 17

Antacids are available in the following OTC forms:

Back 17

1. Capsules and tablets

2. Powders

3. Chewable tablets

4. Suspensions

5. Effervescent granules and tablets

Front 18

________________ salts have a constipating effect, which is why they are often use with _____________ to counteract constipation. Also recommended for patients with _________ disease (more easily excreted).

Back 18

1. Aluminum

2. Magnesium

3. Renal

Front 19

Antacids Aluminum Salts examples:

Back 19

1. Aluminum carbonate: Basaljel

2. Hydroxide salt: AlternaGEL

3. (Aluminum+Magnesium): Gavison, Maalox, Mylanta, Di-Gel

Front 20

With renal disease you want to avoid the following antacids:

Back 20

1. Sodium salts

2. Magnesium salts

3. Calcium salts

Front 21

_____________ commonly causes diarrhea, and is dangerous when used with __________ disease, because the failing kidney cannot excrete extra magnesium, resulting in accumulation.

Back 21

1. Magnesium Salts

2. Renal

Front 22

Antacids Magnesium Salts examples:

Back 22

1. Hydroxide salt: magnesium hydroxide (Milk of Magnesia)

2.Carbonate salt: Gavison

3. (Al+Mg): Maalox Mylanta

Front 23

______________ come in many forms, but _____________ is the most common. May cause constipation, and kidney stones, not recommended for pts with _______ disease. Long duration of acid action, may cause ___________ gastric acid secretion. Often advertised as an ________ source of dietary calcium.

Back 23

1. Calcium Salts

2. Carbonate

3. Renal

4. Increase

5. Extra

Front 24

Antacid Calcium Salts example:

Back 24

Tums (calcium carbonate)

Front 25

_______________ are highly ________ and buffer the acidic properties of _____. Sodium Bicarbonate has a quick _____, but ______ duration, and may cause metabolic ___________. Sodium content may cause problems in patients with ____________, ________, or __________ insufficiency.

Back 25

1. Sodium Bicarbonate

2. Soluble

3. HCL

4. Onset

5. Short

6. Alkalosis 7. HF 8. HTN 9. Renal

Front 26

A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient?

Back 26

An aluminum- containing antacid

*Aluminum & sodium based antacids are recommended for patients with renal compromise bc they are more easily excreted.

Front 27

__________ are used to relieve the painful symptoms associated with gas.

Back 27

Antiflatulents

Front 28

__________ is used to relieve to gas.

Back 28

Simethicone

Front 29

Adverse effects of ___________ and __________ is constipation.

Back 29

1. Aluminum

2. Calcium

Front 30

Adverse effects of __________ is diarrhea.

Back 30

Magnesium

Front 31

Adverse effects of _______________ is gas and belching, so the antacids is often combined with _____________.

Back 31

1. Calcium carbonate

2. Simethicone

Front 32

Antacids interact with other drugs by __________ other drugs to antacids, which ______ the ability of the other drugs to be absorbed into the body.

Back 32

1. Absorbing

2. Reduces

Front 33

_________ is chemical binding of another drug and produces insoluble complexes, which results in reduced drug absorption.

Back 33

Chelation (binding)

Front 34

Antacids ________ stomach pH, ________ absorption of basic drugs, ___________ absorption acidic drugs. Also it _________ urinary pH, increase excretion of _____ drugs, and decreased excretion of ______ drugs.

Back 34

1. Increase

2. Increase

3. Decrease

4. Increase

5. Acidic

6. Basic

Front 35

_____________ reduce acid secretion, and are available OTC in lower dosage forms.

Back 35

Histamine 2 Receptor Blockers

Front 36

H2 Receptor Blocker drugs

Back 36

1. Tagamet

2. Axid

3. Pepcid

4. Zantac

Front 37

_____________ competitively block the H2 receptor of acid producing parietal cells, ________ Hydrogen ion secretion from parietal cells, ______ the pH of the stomach, and is relief of many symptoms associated with hyperacidity-related conditions.

Back 37

1. H2 receptor blockers

2. Reduce

3. Increase

Front 38

_________ suppresses acid secretion in the stomach.

Back 38

H2 receptor blockers

Front 39

Use H2 receptor blockers for:

Back 39

1. GERD

2. PUD

3. Erosive esophagitis

4. Adjunct therapy to control upper GI bleeding

5. Zollinger-Ellison sydrom (tumors in stomach)

Front 40

Adverse effects of _______________ are confusion and disorientation in elderly patients, impotence and gynecomastia induced by Tagamet, and thrombocytopenia (platelet level drops) with Zantac and Pepcid.

Back 40

H2 Antagonists

Front 41

_______ binds with P-459 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels.

Back 41

Tagmet

Front 42

All ______ antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption.

Back 42

H2

Front 43

_________ is an anti-fungal that can inhibit absorption, but requires acidic GI environment for gastric absorption.

Back 43

Nizoral

Front 44

__________ has been shown to decrease the effectiveness of H2 blockers. Also, for optimal results H2 antagonists are taken ____ to ____ hours before antacids.

Back 44

1. Smoking

2. 1

3. 2

Front 45

When working with an elderly patient who has been admitted for a possible GI bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation?

Back 45

An H2 antagonist

*Adverse effect of H2 antagonists

Front 46

____________________ decrease build up of acid. _______ blockers and ______ do not stop the action of this pump.

Back 46

1. Proton Pump Inhibitors

2. H2

3. Antihistamines

Front 47

The _________ cells release positive hydrogen ions(protons) during HCL production, which increase acidity.

Back 47

Parietal

Front 48

Proton Pump Inhibitors drugs:

Back 48

1. Prevacid

2. Prilosec

3. Nexium

4. Protonix

5. AcipHex

Front 49

________________ irreversibly bind to H+/K+ ATPase enzyme. This bond prevents the movement of _______ ions from the parietal cell into the _________, which results in _______________.

Back 49

1. Proton Pump Inhibitors

2. Hydrogen

3. Stomach

4. Achlorhydria

Front 50

Indications for Proton Pump Inhibitor use:

Back 50

1. GERD

2. Erosive esophagitis

3. Short-term treatment of active duodenal and benign gastric ulcers

4. Zollinger-Ellison syndrome

5. NSAID induced ulcers

6. Stress ulcer prophylaxis

7. Treatment of H. Pylori (induced ulcers/ given w/ antibiotic)

Front 51

Adverse effects of _________________ are possible predisposition to _______ infections (C.difficile), osteoporosis, pneumonia, and depletion of magnesium.

Back 51

1. PPI

2. GI tract

Front 52

Miscellaneous Acid-controlling drugs:

Back 52

1. Sucralfate

2. Misoprostol

3. Simethicone

Front 53

___________ is a cytoprotective drug, used for stress ulcers, peptic ulcer disease. May cause constipation, nausea, and dry mouth. Do not administer with other medications. Binds with phosphate, may be used in chronic renal failure to reduce phosphate levels.

Back 53

Sucralfate

Front 54

________________ is a prostaglandin E analog that have cytoprotective activity, used for prevention of NSAID-induced gastric ulcers. Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps and diarrhea.

Back 54

Misoprostol

Front 55

_____________ is an antiflatulent drug, which reduces the discomforts of gastric or intestinal gas, results in decreased gas pain and increase expulsion via mouth or rectum.

Back 55

Simethicone

Front 56

Simethicone is often combined with calcium carbonate antacids because:

Back 56

Simethicone helps to reduce the gas that is caused by the calcium antacids.

*Calcium carbonate neutralization will produce gas and possibly belching, so simethicone will reduce that.

Front 57

Before giving Antacids assess for prexisting conditions such as:

Back 57

1. Fluid imbalances

2. Renal disease

3. GI obstruction

4. HF

5. Pregnancy

Front 58

Patients with ______ or _____ should not use antacids with high sodium content.

Back 58

1. HF

2. HTN

Front 59

Pt need to make sure that chewable tab are ______ thoroughly, and liquid forms are _______ well before giving. Administer with at least ____ of water to enhance absorption.

Back 59

1. Chewed

2. Shaken

3. 8 ounces

Front 60

Long term self medication with antacids may ______ symptoms of serious underlying disease.

Back 60

Mask

Front 61

Monitor constipation and acid rebound with ___________________.

Back 61

Calcium containing products

Front 62

When using ____________ assess for impaired renal or liver function, and take ____ to ____ hours before antacids.

Back 62

1. H2 antagonist

2. 1 - 2

Front 63

When using _____ assess for history of liver disease, and they may increase the serum levels of ________ and ______, may increase chance for bleeding with warfarin.

Back 63

1. PPI

2. Diazepam

3. Phenytoin

Front 64

_______ may be given via NG tube, but it must be at least a 16 gauge, capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed released granules.

Back 64

Protonix

Front 65

__________ capsules must be taken whole, and this medication can hide symptoms of other disease.

Back 65

Prilosec

Front 66

When providing education regarding the use of PPI, which statement will the nurse include?

Back 66

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