-
What is peptic ulcer disease
- when the patient has a gastric or duodenal ulcer or
- GERD
-
risk factors for PUD
- family history
- tobacco use and caffeine
- glucocorticoids and NSAIDS
- psychological stress
- type O blood
-
other causes of PUD
- Helicobactor pylori- primary cause, its a gram negative bacteria
- -secretion of gastric acid
- -hyposcretion of adequate mucus
- -NSAIDS- 2nd most common
-
GERD caused by
- loosening of sphincter between esophagus and stomach
- symptoms- heartburn
- could lead to strictures, esophageal ulcers, esophagitis
-
duodenal ulcer
- more common than gastric
- common in 30-50
- s/s gnawing or burning
- occurs 1-3 hours after meal
- pain is worse on empty stomach
- nocturnal pain
- nausea
- vomiting
- bleeding in vomit or stool
-
gastric ulcer
- less common
- more common over 60
- s/s pain may be relieved after food or may continue
- anorexia, weight loss, vomiting
- remissions infrequent or absent
- more commonly associated with cancer
-
Treatment of GERD, PUD
- H2 receptor blockers
- antacids
- proton pump inhibitors
-
antiacid
prototype
mech of action
use
adverse effects
- aluminum hydroxide
- mech of action - neutralizes stomach acid by raising pH of stomach
- use- in combo other antiulcer agents, for heartburn related to PUD, GERD
- adverse effects - minor constipation
- other antiacids
- amphojel
- tums
- mylanta
- milk of mag
- maalox
- mylanta plus
- riopan
- alka sletzer
- baking soda
-
proton pump inhibitors
prototype
mech of action
primary use
adverse effects
- Prilosec
- mech- reduces acid secretion
- use- short term 4-8 weeks for peptic ulcers and GERD
- adverse effects- headache, nausea, diarrhea, rash, abd pain, long term increases the risk of cancer
-
other common proton pump inhibitors
- nexium
- prevacid
- prilosec
- protonix
- aciphex
- ----headache, diarrhea, nausea, rash, dizziness
-
H2 receptor blockers
prototype
mech of action
use
adverse effects
- zantac
- mech - decrease acid production
- use PUD
- adverse effects- reduction in RBC, WBC, platelets, impotence or loss of libido
- common H2 meds
- tagament- confusion in elderly
- pepcid
- mylanta
- axid
- zantac
-
when to take proton pump inhibitors- prilosec, prevacid, nexium, protonix, aciphex
- 30 min before breakfast
- -you can take with antiacids
- -often given with biaxin for H-Pylori
-
assessment for Antacid for PUD
amphojel
tums
milk of mag
mylanta
maalox alkaseltzer etc
- med history
- all meds including OTC
- renal insufficiency- can cause hypermagnesmia when unable to excrete magnesium
-
fyi antiacids
calcium causes constipation
magnesium and aluminum cause diarrhea
-
fyi interactions
no antiacids with H2 so no amphojel and zantac
-
what to monitor for in PUD GERD
- old carts
- s/s gi bleeding
- rigid belly
- increased temp
- loc
- cbc
- liver and renal function
- emesis
-
constipation and pt teaching
- how to prevent
- drink fluids
- eat fiber
- exercise
-
how do bulk forming laxatives work (psyllium)
adverse effects
- absorbs water adding to size of fecal mass
- adverse effects abd fullness, cramping, fainting, esophageal or GI obstruction if not taken with enough fluids
-
how do stool softener work
adverse reactions
- cause more water and fat to be absorbed into stool
- abd cramping, diarrhea
-
stimulants work by....
adverse reactions
- causing irritation to the bowel to increase peristalsis
- adverse reactions abd cramping, nausea, fainting, diarrhea, fluid and electrolyte loss
-
saline or osmotic laxatives work by....
adverse reactions...
- pulls water into fecal mass to create a watery stool
- adverse reactions are diarrhea, abd cramping, diarrhea, heypermagnesmia with magnesium hydoxide, dysrhythmias, resp failure
-
mineral oil works by....
adverse reaction.....
- lubrication of stool and colon mucosa
- adverse reaction diarrhea, nausea, nutritional deficiencies
-
laxatives
prototype
mech of action
use
advese effects
other common names
- psyllim mucilloid (metamucil
- mech of action- swells and increases size of fecal mass
- use-promote passsage of stool
- adverse effects- rare, less cramping that with other lax types.
- nuring alert- instrut patient to drink enough water due to obstrutions in esophagus or intestine
- other common names fibercon, fiberall, citrucel, metamucil (then the saline and osmotics, and stimulants, softners, herbal agents senna, mineral oil.
-
saline and osmotic laxative.....
adverse reactions....
- milk of mag
- miralax
- fleets phospho soda
- adverse reactions... diarrhea, cramping, diarrhea, hypermagnesemia with magnesium hydroxide, dysrhythmias, resp failure.
-
stimulant laxatives....
adverse reactions......
- dulcolax
- castor oil
- ex lax feen a mint
- correctol
- adverse reaction.... abd cramping, nausea, fainting , diarrhea, fluid and electrolyte loss
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-
-
reglan
- is an anti emetic and gastric stimulant
- for prevention of emesis related to chemo
- reduction of GERD
- prevention of aspiration in enteral feedings
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