Ati Gastrointestinal System And Nutrition Meds (Peptic Ulcer Disease)

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antibiotics

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amoxicillin (Amoxil)
bismuth (Pepto-Bismol)
clarithromycin (Biaxin)
metronidazole (Flagyl)
tetracycline (Achromycin V, Sumycin)

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antibiotics MOA and use

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eradication of H.Pylori

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antibiotics admin

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therapy should include combination of two or three antibiotics for 14 days to increase effectiveness and to minimize the development of drug resistance
advise clients that adverse effects of nausea and diarrhea are common
remind clients to take full prescription of meds

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histamine 2 receptor antagonist

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ranitidine hydrochloride (Zantac)
other meds:
cimetidine (Tagament)
famotidine (Pepcid)
nizatindine (Axid) - PO use only

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histamine 2 receptor agonist MOA

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supress the secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining the stomach

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histamine 2 receptor agonist use

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prescribed for gastric and peptic ulcers, GERD, and hypersecretory conditions such as Zollinger Ellison syndrome
used in conjunction with antibiotics used to treat ulcers caused by H. pylori

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histamine 2 receptor agonist contraindications

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use in older adults can cause antiadrenergic effects (impotence) and CNS effects (confusion)
promotes bacterial colonization of the stomach and secondarily of the respiratory tract.
high risk of pneumonia
COPD

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histamine 2 receptor interactions

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can inhibit medication metabolizing enzymes and thus increase the levels of warfarin, phenytoin, theophylline, and lidocaine

can decrease absorption of histamine 2 receptor antagonists

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histamine 2 receptor interventions

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warfarin- monitor for bleeding
adjust doses of phenytoin, theophylline, lidocaine and monitor serum levels
monitor warfarin serum levels

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histamine 2 receptor admin

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avoid foods that promote gastric secretion
adequate rest and reduction of stress may promote healing
avoid smoking
avoid aspirin and NSAID
avoid alcohol

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proton pump inhibitor

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proto: omazeprole (Prilosec)

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proton pump inhibitor MOA

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reduce gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid
reduce basal and stimulated acid production

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proton pump inhibitor use

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gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions such as Zollinger-Ellison syndrome

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proton pump inhibitor adverse

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insignificant adverse and side effects with short-term treatment
low incidence of headache, diarrhea, nausea, vomiting

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proton pump inhibitor contraindications

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lactation
dysphagia or liver disease
increase risk of pneumonia
long-term use increases risk of osteoporosis

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proton pump inhibitor interactions

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digoxin, phenytoin, and warfarin levels may be increased when used concurrently with omeprazole
absorption of ketoconazole, itraconazole (Sporanox, and atazanavir (Reyataz) is extremely decreased when taken concurrently with proton pump inhibitors

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proton pump inhibitor admin

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take omeprazole once a day prior to eating in the morning
avoid alcohol and irritating meds such as NSAIDS
active ulcers should be treated for 4-6 weeks
notify provider for any sign of GI bleeding

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mucosal protectant

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sucralfate (Carafate)

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mucosal protectant MOA

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acidic environment of the stomach and duodenum changes sucralfate into a thick substance that adheres to an ulcer.
can stick to the ulcer for up to 6 hours

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mucosal protectant USE

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used for clients with acute duodenal ulcers and those requiring maintenance therapy
investigational use of sucralfate includes gastric ulcers and GERD

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mucosal protectant adverse

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increase dietary fiber and consume at least 1500 mL of fluid a day in order to prevent constipation
sucralfate has no systemic effects

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mucosal protectant contraindicaitons

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chronic renal failure
hypersensitive to this med

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mucosal protectant interactions

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interfere with absorption of phenytoin, digoxin, warfarin, and ciprofloxacin
interfere with the absorption of sucralfate

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mucosal protectant nursing interventions

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maintain a 2 hour interval between these meds and sucralfate to minimize this interaction
antacids should not be administered within 30 min of sucralfate

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mucosal protectant admin

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sucralfate should be taken 4 times a day, 1 hour before meals and again at bedtime

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antacid

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proto: aluminum hydroxide (Amphojel)
other: aluminum carbonate (Basaljel)
magnesium hydroxide (Milk of magnesia)
sodium bicarbonate
calcium carbonate (Tums)

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antacid MOA

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neutralize gastric acid and inactivate pepsin
protection occurs by the antacid's ability to stimulate the production of prostaglandins

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antacid use

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PUD- promotes healing and relief of pain
provide symptomatic relief for patients with GERD

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antacid adverse

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aluminum and calcium compounds cause constipation
magnesium compounds cause diarrhea
antacids containing sodium may cause fluid retention
aluminum hydroxide can lead to hypophosphatemia and hypomagnesemia
can lead to toxicity in clients with renal impairment

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antacid interventions

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teach clients with hypertension or heart failure to avoid antacids that contain sodium
monitor electrolyte levels
renal impairment to avoid antacids that contain magnesium

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antacid contraindications

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GI perforation or obstruction
abdominal pain

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antacid interactions

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aluminum compounds bind to warfarin and tetracycline and interfere with absorption- teach clients to take these meds one hour apart

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antacid admin

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may be administered 7 times a day, 1 and 3 hours after meals, and again at bedtime.
take all meds at least 1 hour before antacids

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prostaglandin E analogs

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misoprostol (Cytotex)

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prostaglandin E MOA

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decrease acid secretion
increase the secretion of bicarbonate and protective mucus, and promote vasodilation to maintain submucosal flow
prevent gastric ulcers

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prostaglandin E use

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used in clients taking long-term NSAIDs to prevent gastric ulcers
induce labor by causing cervical ripening

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prostaglandin E adverse

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concurrent use of magnesium antacids may increase diarrhea
dysmenorrhea and spotting

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prostaglandin E analog Contraindications

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pregnancy risk category X

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prostaglandin E analog admin

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take with meals and at bedtime

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prostaglandin E effectiveness

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frequency or absence of GERD symptoms
absence of GI bleeding
gastric and duodenal ulcers
no reoccurence of ulcer