_____ antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones, they also cause increased gastric acid production
Calcium
Antacids containing _____must be avoided in patients with renal failure
magnesium
_____ _____ is a highly soluble antacid form with a quick onset but short duration of action.
Sodium bicarbonate
_____ based antacids have a constipating effect as well as an acid neutralizing capacity, so make sure to educate your patients on this effect.
Aluminum
These antacids are often used with magnesium to counteract constipation?
Aluminum Salts
These type of antacids are often recommended for patients with renal disease (more easily excreted)
Aluminum Salts
Antacids: Aluminum Salts Examples=
there are 3 with brand name of each.3rd has 4 brand names
Aluminum carbonate: Basaljel
Hydroxide salt: AlternaGEL
Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel
Both _____& ______ antacids are more likely to accumulate to toxic levels in PTs w/ renal disease and are commonly avoided in this PT group.
calcium
magnesium
Calcium salts have many forms but _____is most common
carbonate
Calcium salts may cause _____ & _____ _____.
constipation
kidney stones
Calcium salts have ____ duration of acid action—may cause _____ gastric acid secretion (hyperacidity rebound)
long
increased
_____ ____ are often advertised as an extra source of dietary calcium.
Calcium salts
Example of Calcium Salts?
brand & chemical name
Tums (calcium carbonate)
Excessive use of _____ _____ may lead to systemic alkalosis.
sodium bicarbonate
Sodium bicarbonate is _____ soluble, buffers the acidic properties of ___, and has a _____ onset but ____duration.
highly
HCl
quick
short
Sodium bicarbonate sodium content may cause problems in patients with?
there are 3
heart failure (HF)
hypertension
renal insufficiency
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?
B.
Aluminum- and sodium-based antacids are recommended for patients with renal compromise because they are more easily excreted. Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are often avoided in this patient group.
Long term self medication w/antacids may mask symptoms of serious underlying diseases such as _____ ____ or _____. PT w/on going symptoms need to undergo regular medical evaluations because additional medications or other interventions may be needed.
bleeding ulcer
malignancy
1 adverse effect of overuse of antacids would be?
Metabolic Alkalosis
An adverse effect to aluminum & calcium is?
constipation
An adverse effect to magnesium antacids would be?
diarrhea
An adverse effect to calcium antacids would be?
there are 2
kidney stones
rebound hyperacidity
An adverse effect to to calcium bicarbonate antacids would be?
production of gas & belching
_____/_____ is used to reduce the discomforts of gastric or intestinal gas (flatulence) and aid in its release via the mouth or rectum. It is therefore classified as an antiflatulent drug
Simethicone (Mylicon)
Calcium carbonate is often combined with _____.
simethicone
Medications are not to be taken unless prescribed within _____ of taking an _____ because of the impact on the absorption of many medications in the stomach. E.g. if you have medications to administer @ 7am you would have to wait until 8am to give the _____.
1-2 hours
antacid
antacid
4 main Drug interactions of Antacids
Adsorption of other drugs to Antacids
Chelation
Increased Stomach pH
Increased Urinary pH
_____ involves the chemical binding of other drugs w/antacids, and reduces the ability of the other drug to be absorbed into the body
Adsorption
_____, which is the chemical inactivation of other drugs that produces insoluble complex--> result is _____ drug absorption
Chelation
reduced
Antacids cause interactions that _____ stomach pH, which increases the absorption of _____ drugs and decreases the absorption of _____ drugs
increase
basic
acidic
Antacids cause interactions that _____ urinary pH, which increases the excretion of _____ drugs and decreases the excretion of _____ drugs
increase
acidic
basic
Antacids _____ acid in the stomach, _____ base antacids cause diarrhea, _____ base antacid cause constipation, _____ based antacids often cause rebound hyperacidity.
neutralize
magnesium
aluminum
calcium
______ may impair the absorption of antagonists.
Smoking
For optimum results, __ ____ ____ are taken 1 to 2 hours before antacids
receptor antagonists
When working with an older patient who has been admitted for a possible GI bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation?
C.
H2 antagonists may cause confusion and disorientation in older adults.
______ needs to be taken before meals an entire capsule must be taken whole, not crushed, chewed, open, or dissolved in liquid when treating ____. This medication is used in a long term basis to maintain healing.
Omeprazole
GERD
Proton Pump Inhibitors:
there are 5 generics w/5 brand names
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
Rabeprazole (AcipHex)
Stress related mucosal damage is an important issue for critically ill PTs. _____ _____ _____ or therapy to prevent severe GI damage is undertaken in almost every critically ill PT in ICU & for many PTs on general med surg units. Procedures performed commonly in critically ill PTs i.e. passing _____ tube, placing PTs on _____, & others predispose PTs to bleeding of the GI tract, guidelines suggest that all PTs receive either histamine receptor blocking drug or ___.
Stress ulcer prophylaxis
nasogastric
ventilators
PPIs
Proton Pump Inhibitors Indications
there are 7
GERD
Erosive esophagitis
Zollinger-Ellison syndrome
To treat active duodenal and benign gastric ulcers
to treat NSAID–induced ulcers
to treat Stress ulcer
to Treat H. pylori–induced ulcers-Given with an antibiotic
New concerns have arisen over the potential for long-term users of Proton Pump inhibitors (PPIs) to develop _____, this is thought to be due to the inhibition of _____ ____ and is speculated that PPIs speed up ____ _____ loss.
osteoporosis
stomach acid
bone mineral
Proton Pump Inhibitors Adverse Effects:
there are 5
Pneumonia
Osteoporosis
Depletion of magnesium
Possible predisposition to GI tract infections: Clostridium difficile
Link between PPIs and dementia & lupus erythematous
___ are generally well tolerated.
PPIs
When teaching a patient about sucralfate (Carafate) therapy, which of the following statements will the nurse include?
B.
Sucralfate forms a protective barrier that can be thought of as a liquid bandage, binds to the exposed proteins of ulcers and erosions, and limits the access of pepsin. Pepsin is an enzyme that normally breaks down proteins in food but can have the same effect on GI epithelial tissue, either causing ulcers or making them worse. Sucralfate also binds and concentrates epidermal growth factor, present in the gastric tissues, which promotes ulcer healing. Other drugs should be taken at least 2 hours ahead of sucralfate. Despite its many beneficial actions, sucralfate has fallen out of common use because its effects are transient and multiple daily dosing (up to four times daily) is therefore needed. Sucralfate acts locally, not systemically, binding directly to the surface of an ulcer.
Simethicone (Mylicon) is often combined with calcium carbonate antacids because of what effect?
D.
Calcium carbonate neutralization will produce gas and possibly belching, so the addition of simethicone is intended to reduce this effect. Simethicone alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum.
When providing education regarding the use of PPIs, which statement will the nurse include?
A.
Food may decrease absorption of the PPIs, and it is recommended that they be taken on an empty stomach. They are taken on a daily basis, not as needed for heartburn.
1. A patient is taking simethicone for excessive flatus associated with diverticulitis. The nurse is teaching about the mechanism of action of simethicone. Which statement is correct?
C.
The nurse is evaluating the medication list of a patient who will be starting therapy with an H2 Antagonist.
Which of these drugs may cause an interaction?
B.
Which is the correct action when the nurse is administering sucralfate? (Select all that apply.)
a. Giving the drug with meals
b. Giving the drug on an empty stomach
c. Instructing the patient to restrict fluids
d. Waiting 30 minutes before administering other drugs
e. Giving other drugs 2 hours before giving the sulcrafate
B, E
A patient with a history of renal problems is asking for advice about which antacid he should use. The nurse will make which recommendation?
C.
A patient who is taking oral tetracycline complains of heartburn and requests an antacid. Which action by the nurse is correct?
C.
When the nurse is administering a proton pump inhibitor (PPI), which actions by the nurse are correct? (Select all that apply.)
a. Giving the PPI on an empty stomach
b. Giving the PPI with meals
c. Making sure the patient does not crush or chew the capsules
d. Instructing the patient to open the capsule and chew the contents for best absorption
e. Administering the PPI only when the patient complains of heartburn
a, c
The nurse is preparing to administer the first dose of miso-prostol (Cytotec) for a patient who has been diagnosed with a gastric ulcer. What condition would be a contraindication to this medication?
antagonists.