-
what digestive enzyme is activated by HCl to form pepsin?
pepsinogen
-
what is dyspepsia?
heartburn/indigestion
-
what is the LES? its significance to GERD?
- lower esophogeal sphincter.
- when it does not properly close, GERD & reflux occurs
-
what are the aggressive (causative) factors of ulcers?
- H. pylori infection
- NSAIDs
- gastric acid
- pepsin
- smoking
-
3 types of cells found in the stomach lining?
- chief (form pepsinogen - which HCl converts to pepsin)
- mucous (from Goblet cells; form protective secretions)
- parietal (makes HCl for acidic pH)
-
what are the defensive (protective) factors of ulcers?
- mucous
- bicarbonate
- blood flow
- prostaglandins
-
5 classes of drugs used to treat PUD (peptic ulcer disease)?
- antibiotics
- antisecretory agents
- mucosal protectants
- combo antisecretory agents & mucosal protectants
- antacids
-
what combo of drug classes are given to treat H. pylori?
2 to 3 antibiotics PLUS an antisecretory agent
-
what abx has side effects of an unpleasant, "metallic" taste?
clarithromycin
-
what abx works best in a neutral pH? what is it given with to achieve this?
amoxicillin. antacids are given to make stomach more alkaline
-
what abx has side effects of a black tongue & stools?
bismuth (Pepto Bismol)
-
what abx has a high resistance and is usually only given in conjunction with other abx?
metronidazole
-
what abx is not recommended for use in children < 8! yrs of age? why?
tetracycline. can stain adult set of teeth
-
what are the two types of antisecretory agents usually given to treat H. pylori?
histamine-2 receptor antagonist OR proton pump inhibitor
-
describe the treatment of H. pylori, and why compliance is difficult to obtain
- 2-3 abx PLUS either H2 receptor antagonist/proton pump inhibitor (an antisecretory agent).
- course must be followed for 14-21 days.
- compliance is difficult due to side effects, or feeling better and stopping too soon. strict, multi-dose days.
- education is important for patients to know the infx WILL NOT GO AWAY until full course is taken.
-
what is cimetidine (Tagamet)? therapeutic uses? mechanism of action? side effects?
- prototype for histamine-2 receptor antagonists
- uses: GERD, PUD, dyspepsia, Z-E syndrome, prevention of aspiration pneumonia
- side effects: antiadronergic & CNS effects (confusion in elderly)
- can cross the blood-brain barrier (also into BM & placenta)
-
what is ranitidine (Zantac)? therapeutic uses? mechanism of action? side effects? interactions?
- class: h2 receptor antagonist (more potent than cimetidine)
- uses: GERD, PUD, Z-E syndrome, dyspepsia
- action: inhibits h2 receptor; decreases secretions
- side effects: does not cross blood-brain barrier as easily as cimetidine, no antiadronergic effects
- interaction: antacids can decrease absorption
-
famotidine (Pepcid)
- class: antisecretory (h2 receptor antagonist)
- does not inhibit liver enzymes
-
what is omeprazole (Prilosec)? uses? action? side effects? nursing considerations?
- prototype agent of proton pump inhibitors
- uses: GERD, PUD, Z-E syndrome, dyspepsia
- action: inhibits proton formation; less gastric acid; less stomach acid secretions
- side effects: N/V/D, headache
- needs to be taken before meals. can NOT crush.
-
can h2 receptor antagonists and proton pump inhibitors both be given together?
yes due to different mechanisms of action. if secretions are severely acidic and only one med is ineffective, both can be used together
-
other proton pump inhibitors?
- lansoprazole (Prevacid) - IV
- pantoprazole (Protonix) - IV
- esmoprazole (Nexium) - IV
- Rabeprazole (Aciphex)
-
what is sucralfate (Carafate)? action? uses? nursing indications? interactions?
- mucosal protectant. non-absorbant chemical "band aid" that lines the stomach and covers the ulcer.
- used for PUD
- does NOT decrease acid secretions
- if cannot be swallowed as a pill orally, can be dissolved and made into a "slurpee"
- interactions: should not be given at same time as other meds due to coating of stomach lining
-
what is misoprostol (Cytotec)? action? uses? side effects? nursing indications?
- antisecretory agent that ALSO enhances mucosal defenses
- synthetic form of prostaglandin E
- used to prevent NSAID-related gastric ulcers. does not prevent NSAID-related duodenal ulcers
- side effects: diarrhea, abd pain, spotting/dysmenorrhea
- category X. known teratogenic. women should be educated about increased contraception during use
- should be taken with food.
-
general antacids - uses? action? dosage? nursing considerations?
- types: MoM, aluminum hydroxide, calcium carbonate, sodium bicarbonate
- uses: symptom mgmt of GERD, PUD, dyspepsia
- action: raises the stomach pH to make it less acidic; composed of inorganic salts
- dosage: given around 7x a day. 1 & 3 hours after each meal and at bedtime.
- education is important for pts to maintain daily schedule. should be given 2 hrs after other oral meds to avoid any interactions.
-
at what pH level are antacids given? why?
- when the stomach pH is <5, antacids are given to inactivate pepsin.
- (pepsin is activated normally to stimulate HCl and break down foods, making stomach acidic)
-
how is the potency of antacids measured?
ANC - acid neutralizing capacity. measures the potency and strength of antacids
-
milk of magnesia? nursing indications? side effects?
- class: antacid
- should not be given to renal patients
-
aluminum hydroxide (Amphogel, Alternagel)? side effects?
- class: antacid
- okay to give to renal patients
-
calcium carbonate (Tums)? side effects?
- class: antacid
- associated with acid rebound- taking too many can make symptoms worse
- side effects: constipation, eructation from CO2 production
- Remember: C for Calcium and Constipation
-
sodium bicarbonate? nursing implications?
- class: antacid
- not the choice antacid used for PUD.
- caution in pt's at risk for sodium overload - hx of HTN, heart failure
-
aluminum + magnesium (Maalox)?
- class: antacid
- combination of two salts with reverse SE (constipation and diarrhea) balances them out.
-
what type of antacid has the highest ANC?
suspensions
|
|
