What are antagonistic factors associated with peptic ulcer disease?
H. pylori infection
NSAIDs
secretions (gastric acid, pepsin)
The peptic ulcer disease process is only altered by ___. All other meds make an environment that's conducive to healing.
antibiotics
What meds are used in the management of peptic ulcer disease?
antibiotics
antisecretory agents
mucosal protectants
antacids
amoxicillin (Amoxil)
bismuth (Pepto-Bismol)
clarithromycin (Biaxin)
metronidazole (Flagyl)
tetracycline (Achromycin V)
What are these?
antibiotics used for peptic ulcer disease
Antibiotics used for peptic ulcer disease are meant to do what?
Eradicate H. pylori bacteria
Antisecretory agents used for peptic ulcer disease are AKA whta 2 classes of meds?
H2 receptor antagonists
proton pump inhibitors
*ranitidine hydrochloride (Zantac)
cimetidine (Tagamet)
nizatidine (Axid)
famotidine (Pepcid)
What are these?
H2 receptor antagonists used for peptic ulcer disease
What is the expected pharm action of H2 receptor antagonists in peptic ulcer disease?
Suppress the secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining stomach
What 2 classes of meds are prescribed for gastric and peptic ulcers, GERD, and hypersecretory conditions (Zollinger-Ellison syndrome)?
H2 receptor antagonists
proton pump inhibitors
___ are used in conjunction with antibiotics to treat ulcers caused by H. pylori.
H2 receptor antagonists
Side effects of this med include antiadrenergic (decreased libido, impotence), and CNS effects (lethargy, depression, confusion).
Cimetidine
In what population does cimetidine more commonly cause CNS effects? What population should avoid this medication?
Older adults w/ kidney or liver dysfunction
Older adults
Why should H2 receptor antagonists and proton pump inhibitors be used cautiously in clients who are at high risk for pneumonia (those w/ COPD)?
They decrease gastric acidity, which promotes bacterial colonization of stomach and respiratory tract
Cimetidine increases levels of what meds?
warfarin
phenytoin (Dilantin)
theophylline
lidocaine
The concurrent use of what meds can decrease the absorption of H2 receptor antagonists?
Antacids
Pts should not take an antacid ___ hr before or after taking a H2 receptor antagonist.
1
*omeprazol (Prilosec)
pantoprazole (Protonix)
lansoprazole (Prevacid)
rabeprazole sodium (AcipHex)
esomeprazole (Nexium)
What are these?
Proton pump inhibitors used for peptic ulcer disease
What is the expected pharm action for proton pump inhibitors in peptic ulcer disease?
Reduce gastric acid secretion by irreversibly inhibiting enzyme that produces gastric acid; reduce basal and stimulated acid production
Which antisecretory agent used in peptic ulcer disease has insignificant ADRs short term, but increases risk of gastric cancer and osteoporosis long term??
Proton pump inhibitors
___ levels may be increased when used concurrently with omeprazole.
Digoxin (Lanoxin)
Absorption of ketoconazole (Nizoral), itraconazole (Sporanox), and atazanavir (Reyataz) is extremely decreased when taken concurrently with which antisecretory agent (thus concurrent use should be avoided)?
Proton pump inhibitors
T/F Pts may sprinkle contents of proton pump inhibitor capsules over food to facilitate swallowing.
T
Pts should take this proton pump inhibitor once a day prior to eating breakfast.
Omeprazole
Pts taking this classification of meds should avoid alcohol and irritating meds (NSAIDs).
Proton pump inhibitors
Active ulcers are generally treated with proton pump inhibitors for how long?
4-6 wks
Which proton pump inhibitor can be administerd IV and may cause thrombophlebitis?
Pantoprazole
For what 2 med classifications used in peptic ulcer disease should pts notify the provider of signs of GI bleeding?
H2 receptor blockers
proton pump inhibitors
*sucralfate (Carafate)
What is this?
mucosal protectant used in peptic ulcer disease
What's the expected pharm action of mucosal protectants?
To be transformed by acid in stomach, duodenum into thick substance that adheres to ulcer, protecting ulcer from further injury by acid, pepsin
Mucosal protectants can stick to ulcers for how long?
Up to 6 hrs
This med is used for pts with acute duodenal ulcers and those requiring maintenance therapy; it is under investigation for use in gastric ulcers and GERD.
sucralfate
This med has no systemic effects, but pts should be encouraged to increase dietary fiber and drink min. 1,500 mL fluids/day to prevent constipation.
sucralfate
This med may interfere with the absorption of phenytoin, digoxin, warfarin, and ciprofloxacin. Antacids interfere with its absorption.
sucralfate
This med used in peptic ulcer disease should be taken on an empty stomach.
sucralfate
*aluminum hydroxide (Amphojel)
aluminum carbonate
magnesium hydroxide (Milk of Magnesia)
sodium bicarbonate
What are these?
Antacid used in peptic ulcer disease
What's the expected pharm action of antacids use in peptic ulcer disease?
Neutralize gastric acid and inactivate pepsin; protection may occur by stimulation of prostaglandin production
What class of meds is used to treat PUD by promoting healing and relieving pain; provide symptomatic relief for GERD.
Antacids
With antacids, which compounds cause constipation? Diarrhea?
aluminum, calcium
magnesium
What is an option for a pt that is having difficulty managing bowel fxn on antacids?
Combo product with aluminum hydroxide, magnesium hydroxide, simethicone
Why should pts w/ HTN or HR avoid antacids w/ sodium?
Fluid retention
Which antacid can lead to hypophosphatemia?
aluminum hydroxide
Pts. w/ renal impairment should avoid antacids that contain ___.
magnesium
Antacids should not be administered to pts. who have what?
GI perf or obstruction
This PUD med class should be used cautiously in pts w/ abdominal pain.
antacids
Antacids that contain ___ bind to warfarin and tetracycline and interfere w/ absorption.
aluminum
Pts should take all meds 1 hour before or after taking this PUD med class?
antacids
*misoprostol (Cytotec)
What is this?
prostaglandin E analog used in PUD
What's the expected pharm action of prostaglandin E analogs in PUD?
Act as endogenous prostaglandin in GI tract to decrease acid secretion, increase secretion of bicarbonate and protective mucus, and promote vasodilation to maintain submucosal blood flow...prevent gastric ulcers
This PUD med class is used in pts taking long term NSAIDs to prevent gastric ulcers, and to induce labor by causing cervical ripening.
prostaglandin E analog
What are the side effects of prostaglandin E analogs?
