Drugs for PUD
A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? 1 Amoxicillin 2 Cimetidine 3 Omeprazole 4 Metronidazole
2 Rationale: Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.
A patient is prescribed ranitidine for the treatment of peptic ulcers. To ensure drug safety, what should the nurse assess before administering the drug? 1 Blood glucose levels 2Blood pressure levels 3 Serum antibody levels 4 Serum creatinine levels
4 Rationale: Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H 2 receptor antagonist drugs such as ranitidine. Monitoring blood glucose and blood pressure gives a general idea about the patient's well-being. Serum antibody levels detect possible infections in the patient.
The nurse is providing medication teaching for a patient with a duodenal ulcer. Which statement is accurate regarding symptoms that would require a patient on cimetidine to call the health care provider? 1 Onset of headaches 2 Ongoing mild acid indigestion 3 Development of mild allergic rhinitis 4 Development of a productive cough
4 Rationale: Elevation of gastric pH with an antisecretory agent increases the risk of pneumonia. Reduction in gastric acidity increases bacterial colonization of the stomach, resulting in a secondary increase in colonization of the respiratory tract. Among people using H 2 receptor antagonists such as cimetidine, the relative risk of acquiring pneumonia is doubled. Development of a productive cough may indicate pneumonia, so a patient would notify the health care provider in this case. A headache is a minor, expected side effect that may occur with the use of cimetidine. Acid indigestion is treated by cimetidine, so this would be expected to improve gradually with treatment. Allergic rhinitis is not a typical side effect of cimetidine.
A patient reports vomiting blood. Upon further analysis, the patient is diagnosed with increased production of gastric acid. Which drug should the nurse anticipate being included in the treatment plan? 1 Famotidine 2 Misoprostol 3 Simethicone 4 Lansoprazole
4 Rationale: Lansoprazole is a proton pump inhibitor that inhibits the proton pump and thereby decreases the acid levels in the stomach. The proton pump is stimulated by the release of calcium ions that occurs when gastrin receptors bind to gastrin and inhibits the production of gastric acid. Misoprostol is a prostaglandin analogue that protects the lining of the gastrointestinal tract from stomach acids but does not reduce or inhibit the production of acids. Famotidine is an H 2 receptor antagonist that inhibits the binding of H 2 receptors to histamine, but it has no effect on gastrin receptors. Simethicone is an antiflatulent drug and has no effect on the secretion of acid in the stomach.
A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? 1 Encourage the patient to increase dietary fiber. 2 Ask the healthcare provider for a reduction in dose. 3 Instruct the patient to keep an accurate stool count. 4 Administer the drug with an aluminum hydroxide antacid.
4 Rationale: Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.
A patient who was using antacids for a week reports having an upset stomach and liquid bowel movements. After reviewing the patient's record, the nurse asks the patient to immediately stop taking the antacid. Which over-the-counter antacid is the patient likely consuming? 1 Calcium carbonate 2 Aluminum hydroxide 3 Sodium bicarbonate 4 Magnesium hydroxide
4 Rationale: Magnesium hydroxide is an antacid that contains magnesium and is known to cause diarrhea if used over the long term, so the nurse should ask the patient to immediately stop taking the antacid. Aluminum hydroxide is an aluminum-based antacid that can cause constipation and other severe conditions such as hypercalcemia. The combination of magnesium- and aluminum-based antacids can nullify the adverse effects caused by each. Calcium carbonate is a calcium-based antacid known to cause nausea and vomiting, as well as severe conditions such as kidney stones. Sodium bicarbonate is a sodium-based antacid known to cause metabolic alkalosis if used over the long term. It also causes adverse effects in patients with cardiac problems.
A patient is prescribed enteric-coated omeprazole for hyperacidity. What instructions should the nurse provide to the patient regarding medication administration? 1 "Take the medication by chewing or crushing it." 2 "Take this medication 30 to 60 minutes after meals." 3 "Take the medication by dissolving it in water or milk." 4 "Take this medication 30 to 60 minutes before meals."
4 Rationale: Omeprazole and other proton pump inhibitors act directly on the proton pump on parietal cells and decrease acid levels. For the drug to be absorbed and show its action, it should be administered at least 30 to 60 minutes before meals. Crushing and chewing the drug will damage its enteric coating and thus should be avoided. The medication can be given by dissolving in water only when the patient has difficulty swallowing and for patients with a nasogastric tube. The medication will have no effect when taken after meals because of the presence of food.
An assessment reveals that a patient has renal calculi. During the assessment, the nurse learns that the patient has taken over-the-counter antacids for a long time. The patient also consumes two glasses of milk every day. What should the nurse infer from this information? 1 The patient has high gastric pH. 2 The patient is unable to process milk. 3 The patient is taking a lower dose of antacid. 4 The patient is using a calcium-based antacid.
4 Rationale: Renal stones may occur from the deposition of calcium from milk and calcium-based antacids. The fact that the patient takes an over-the-counter antacid explains the patient's digestive issues and low gastric pH (hyperacidity). A lower dose of antacid would not be effective for treating hyperacidity or cause renal stones. The fact that the patient drinks two glasses of milk every day is an indication that the patient can process milk.
A patient is admitted to the intensive care unit after a myocardial infarction. The provider has ordered drugs to prevent gastrointestinal disorders. Which is a likely reason for administering acid-controlling drugs? 1 The patient is prone to stress ulcers. 2 The patient's stress levels are treated by these drugs. 3 The general procedures for the treatment include these drugs. 4 The adverse effects of the treatment are treated by these drugs.
1 Rationale: A critically ill patient is prone to stress-related mucosal damage. Therefore, these patients should be prescribed a histamine receptor blocker or a proton pump inhibitor. The patient's stress levels can cause gastrointestinal disorders, but these drugs do not lower stress levels. The general procedures performed on the patients, such as the use of nasal tubes or feeding tubes, only increase the chances of gastrointestinal disorders. Adverse effects are specific to the type of treatment received and can be addressed by specific drugs.
Which clinical findings are associated with a diagnosis of erosive gastroesophageal reflux disease (GERD)? Select all that apply. 1 Ulcers 2 Anemia 3 Vomiting 4 Difficulty chewing 5 Painful swallowing
1, 2, 3, 5 Rationale: GERD is a common disorder characterized by heartburn and acid regurgitation. Complications of erosive GERD include ulcers, anemia, vomiting, and painful swallowing. Difficulty chewing is not a clinical finding associated with erosive GERD.
A nurse monitors a patient who has peptic ulcer disease and is taking antibacterial medications. If the treatment has been effective, the patient's breath test result should reveal the absence of what? 1 H. pylori 2 Histamine 2 3 Bicarbonate 4 Prostaglandins
1 Rationale: Antibacterial medications should be given to patients who have confirmed infection with H. pylori, a cause of ulcers. A breath test is a noninvasive means of measuring H. pylori levels. The patient is given radiolabeled urea, which converts to carbon dioxide and ammonia if H. pylori is present. Radiolabeled carbon dioxide then can be detected in the breath. Bicarbonate, histamine 2, and prostaglandins are not affected by the actions of antibacterial medications for peptic ulcers.
How do H 2 receptor antagonists reduce the secretion of acids? 1 By blocking the H 2 receptors 2 By stimulating gastrin receptors 3 By blocking acetylcholine receptors 4 By stimulating acetylcholine receptors
1 Rationale: H 2 receptor antagonists block H 2 receptors and stop the secretion of acids by parietal cells. H 2 receptor antagonists do not block acetylcholine receptors. They make parietal cells unresponsive to the stimulation of acetylcholine and gastrin receptors. H 2 receptor antagonists do not directly affect gastrin and acetylcholine receptors.
Which increases the concentration of gastric acids? 1 Hypersecretion of parietal cells 2 Inhibition of proton pump activity 3 Inhibition of acetylcholine receptors 4 Hypersecretion of proteolytic enzymes
1 Rationale: Hydrochloric acid, which is necessary for digestion, is secreted by the parietal cells lining the stomach. Hypersecretion of these cells causes acidity or more severe disorders. Inhibition of the proton pump reduces the hypersecretion of acid. Proteolytic enzymes such as pepsinogen, which is activated by hydrochloric acid, are secreted by the chief cells of the stomach and are responsible for the cleaving of proteins. Acetylcholine receptors also mediate the proton pump, and inhibition of these receptors helps to prevent the effects caused by a highly acidic environment.
A patient who is hospitalized for a fractured hip develops abdominal pain and is diagnosed with a gastric ulcer. Which drug will the primary healthcare provider likely order? 1 Sucralfate 2 Misoprostol 3 Omeprazole 4 Lansoprazole
1 Rationale: Sucralfate is known to act locally by forming a protective barrier (mucus) against pepsin on the surface of the ulcer, healing the ulcer. Therefore, the nurse should administer sucralfate. Since the patient has a fractured hip, misoprostol would not be prescribed because of probable adverse effects such as diarrhea. Proton pump inhibitors such as omeprazole and lansoprazole are known to stimulate bone mineral loss and thus may interfere with the healing of the bone.
The nurse provides a patient with educational materials about antacids. Which statements about antacids are appropriate? Select all that apply. 1 Calcium-containing antacids cause constipation. 2 Antacids form a protective barrier in the stomach. 3 Aluminum-containing antacids cause constipation. 4 Antacids neutralize the acid present in the stomach. 5 Magnesium-containing antacids cause constipation. 6 Antacids decrease the secretion of acid in the stomach.
1, 3, 4 Rationale: Both calcium- and aluminum-containing antacids cause constipation as an adverse effect. Antacids neutralize the excess acid secreted in the stomach by forming salts. Agents protective against ulcers, such as sucralfate, form a mucous barrier in the stomach; the antacids do not. Antacids can only neutralize the acid secreted in the stomach; they cannot influence the secretion of acids. Magnesium-containing antacids reduce the effect of constipation resulting from aluminum- and calcium-containing antacids.
The nurse should associate which factor(s) with the pathophysiology of peptic ulcer disease? Select all that apply. 1 Poor submucosal gastric blood flow 2 Increased synthesis of prostaglandins 3 Presence of Zollinger-Ellison syndrome 4 Reduced stomach production of bicarbonate 5 Gastrointestinal tract colonized with Haemophilus influenzae
1, 3, 4 Rationale: Peptic ulcers develop when an imbalance exists between mucosal defensive factors and aggressive factors. Sufficient blood flow to cells of the gastrointestinal mucosa is needed to maintain integrity. In Zollinger-Ellison syndrome, hypersecretion of acid alone causes ulcers by overcoming mucosal defenses. Bicarbonate is needed to neutralize hydrogen ions. Prostaglandins are needed to stimulate mucus and bicarbonate to maintain mucosal blood flow. Helicobacter pylori, not Haemophilus influenzae, is a bacillus that can disrupt the protective mucosal layer when colonized in the GI tract.
Which administration technique(s) would be appropriate when giving a sucralfate tablet to a patient with a duodenal ulcer? Select all that apply. 1 Break the tablet in half so it is easier to swallow. 2 Administer the tablet with an antacid for maximum benefit. 3 Allow the tablet to dissolve in water before administering it. 4 Administer the tablet with sips of water 1 hour before meals. 5 Crush the tablet into a fine powder before mixing it with water.
1, 3, 4 Rationale: Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form should not be crushed because crushing it could reduce the effectiveness of the drug. Sucralfate tablets are large and difficult to swallow but can be broken or dissolved in water prior to ingestion. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.
Instruction by the nurse regarding alcohol abstinence is essential when a patient will be discharged taking which medication? 1 Tetracycline 2 Metronidazole 3 Clarithromycin 4 Bismuth subsalicylate
2 Rationale: A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore, alcohol must be avoided during treatment with this drug. Although the use of alcohol is not promoted in patients who take tetracycline, clarithromycin, or bismuth subsalicylate, it does not create an adverse reaction.
A patient with a peptic ulcer is prescribed sucralfate. To promote drug efficiency, the nurse advises the patient to take the drug on an empty stomach. The nurse also asks the patient to avoid consuming any other form of antacid along with sucralfate. What is the most appropriate reason for giving these instructions? 1 Sucralfate promotes the healing of ulcers. 2 Sucralfate is active in acidic environments. 3 Sucralfate reduces the absorption of other drugs. 4 Sucralfate forms a protective barrier between the ulcer and gastric acids.
2 Rationale: An empty stomach has a high content of gastric acids. Sucralfate is an acid-controlling drug that is activated and dissociates into aluminum hydroxide and sulfate anions when it comes into contact with the acid present in the stomach. If accompanied with any other antacid, the activity of the drug decreases. It is consumed independently and rarely reduces the absorption of other drugs. It binds and accumulates the epidermal growth factor in the gastric tissue and forms a protective barrier between the ulcer and the gastric acids. Sucralfate promotes ulcer healing by this mechanism.
.A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? 1 Reduced duodenal pH 2 Neutralized gastric acid 3 Reduced stomach motility 4 Increased barrier to pepsin
2 Rationale: Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. An increased barrier to pepsin is an effect of sucralfate. Reduced stomach motility is not an effect of milk of magnesia. A reduced duodenal pH would result in a more acidic environment.
A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine and bismuth subsalicylate. Which statement by the patient indicates that the teaching has been effective? 1 "I'll include more calcium and vitamin D in my diet to prevent osteoporosis." 2 "While I'm taking these medications, my bowel movements could look black." 3 "I'm so glad that my allergies will be helped while I'm taking these medications." 4 "I have a medicine at home to take when I start having some loose diarrhea stools."
2 Rationale: Regimens for eradicating H. pylori include using two or three antibacterials with an antisecretory agent or histamine 2 receptor antagonist. Bismuth acts topically to disrupt the cell wall of H. pylori. It can cause a harmless black stool discoloration. Loose stools are an adverse effect of systemic antibacterials such as amoxicillin. Ranitidine produces selective blockade of H 2 receptors, which inhibits gastric acid secretion only, not allergy symptoms. Osteoporosis is an adverse effect of omeprazole, a proton pump inhibitor.
The nurse reviews the patient's medication record and notes the following: sucralfate 1 gram orally 4 times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin 200 mg orally daily at 8:00 AM. Which modifications, if any, should be made to the medication regimen? 1 The medications can be administered as ordered. 2 The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. 3 The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. 4 The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate, because this is more time efficient.
2 Rationale; Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, it is not appropriate to administer the drugs as ordered, switch the phenytoin to the IV form, or administer the phenytoin with the sucralfate.
Which instruction should the nurse give a patient who is to take bismuth subsalicylate for eradication of H. pylori? 1 "Nausea and diarrhea are common side effects." 2 "Do not drink alcohol while taking this medication." 3 "The drug can cause your bowel movements to be black." 4 "Take the medication through a straw to prevent staining of your teeth."
3 Rationale: Bismuth may impart a harmless black coloration to the tongue and the stool, and patients should be forewarned of this effect. Nausea and diarrhea are the most common side effects of clarithromycin, which also is used to treat H. pylori. Alcohol must be avoided when the patient is treated with metronidazole for H. pylori infection because it may cause a disulfiram-like reaction. Tetracycline, which is also highly active against H. pylori, can cause staining of developing teeth.
An elderly, critically ill patient who was hospitalized underwent gastric surgery 1 week ago. The caregiver reports that the patient has seemed confused for the past 2 to 3 days. Which drug would most likely have caused this symptom in the patient? 1 Sucralfate 2 Misoprostol 3 Cimetidine 4. Pantoprazle
3 Rationale: Cimetidine is an H 2 receptor antagonist that is associated with confusion and disorientation as adverse effects in elderly patients. Sucralfate is an agent that protects against ulcers. It is not prescribed for critically ill patients. Misoprostol is a prostaglandin analogue associated with adverse effects such as gastrointestinal distress, bleeding in the vagina, and headache. Pantoprazole is a proton pump inhibitor associated with gastric tumors.
An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? 1 +3 pitting edema 2 Pain with urination 3 New onset of disorientation to time and place 4 Heart rate changes from a baseline of 70 to 80 beats/min to 110 to 120 beats/min
3 Rationale: Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. Pitting edema, dysuria, and tachycardia are not adverse effects of cimetidine.
Why are proton pump inhibitors (PPIs) used in the treatment of patients with bleeding due to erosive esophagitis? 1 They affect the absorption of food. 2 They do not alter the levels of acid. 3 They act directly on the proton pump. 4 They inhibit the proton pumps in all cells of the digestive system.
3 Rationale: Erosive esophagitis is a condition in which irritation is caused by acid in the esophagus. PPIs directly inhibit the hydrogen-potassium-ATPase pump, thus reducing the release of hydrogen ions that form acid. Food digestion and absorption are unaltered by these drugs. About 90% of acid secretion is stopped within 24 hours of administration, bringing relief to the patient. PPIs inhibit only the proton pump of parietal cells and reduce only gastric acids.
A patient is prescribed an aluminum-containing antacid for hyperacidity. The nurse should inform the patient about which possible adverse effect? 1 Diarrhea 2 Flatulence 3 Constipation 4 Muscle twitching
3 Rationale: Formulations containing aluminum or calcium cause constipation. Aluminum, used to reduce gastric acid, binds to phosphate and may lead to hypercalcemia. Early hypercalcemia is characterized by constipation. Diarrhea is an adverse effect of magnesium-containing antacids. Flatulence is due to the accumulation of gas in the intestine and is not related to the intake of aluminum-containing antacids. Muscle twitching is due to metabolic alkalosis resulting from the excessive use of sodium bicarbonate antacids.
What advice should a nurse give to a patient who was prescribed omeprazole for peptic ulcers? 1 "Take omeprazole only at bedtime." 2 "Take aspirin along with omeprazole." 3 "Eat foods that are rich in magnesium." 4 "Take dietary supplements containing vitamin D."
3 Rationale: Omeprazole is a proton pump inhibitor (PPI). PPIs come with the warning that they deplete magnesium. Therefore, the nurse should advise the patient to eat magnesium-rich foods to combat the adverse effect associated with omeprazole. Taking vitamin D supplements along with omeprazole does not have any therapeutic benefit unless taken along with calcium supplements. A patient with peptic ulcers should not take aspirin along with omeprazole; this combination will aggravate the situation because aspirin is a nonsteroidal antiinflammatory drug that can cause peptic ulcers. Omeprazole works better when taken before meals, not before bedtime.
Which is the mechanism of action of a proton pump inhibitor? 1 Reacts with gastric acid to form neutral salts 2 Forms a barrier over the ulcer crater to protect it from acid and pepsin 3 Suppresses acid secretion by inhibiting the enzyme that makes gastric acid 4 Eradicates the H. pylori that is associated with the ulceration of the mucosa
3 Rationale: Proton pump inhibitors are antisecretory agents which suppress acid secretion by inhibiting the enzyme that makes gastric acid. Antacids react with gastric acid to form neutral salts. A mucosal protectant is prescribed to form a barrier over the ulcer crater to protect it from acid and pepsin. An antibacterial drug is prescribed to eradicate H. pylori.
The use of a sodium-based antacid is contraindicated in which group of patients? 1 Patients with infections 2 Patients with renal failure 3 Patients with heart failure 4 Patients with low bone density
3 Rationale: Sodium-based antacids have adverse effects on patients with heart failure because the sodium content in these formulations is very high. Sodium-based antacids can be taken by patients suffering from renal disorders because they are easily excreted. Patients with infection can also consume sodium-based antacids in low doses since the acids protect the system from infection. Patients with a low bone density are advised not to consume aluminum-based antacids.
A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin. The nurse is aware that amoxicillin has which mechanism of action? 1 Coating of the ulcer crater as a barrier to acid 2 Inhibition of an enzyme to block acid secretion 3 Selective blockade of parietal cell histamine 2 receptors 4 Disruption of the bacterial cell wall, causing lysis and death
4 Rationale: Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors. Coating of the ulcer crater as a barrier to acid is an action of sucralfate. Selective blockade of parietal cell histamine 2 receptors is an action of the histamine 2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? 1 Ranitidine 2 Famotidine 3 Misoprostol 4 Omeprazole
4 Rationale: Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine 2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.
A patient has been taking aluminum hydroxide to treat gastric hyperacidity for a few days. The patient reports being constipated. Which drug will the provider likely order in addition to aluminum hydroxide? 1 Sodium citrate 2 Calcium carbonate 3 Aluminum carbonate 4 Magnesium hydroxide
4 Rationale: The constipation caused by the aluminum-based antacid is neutralized when taken in combination with a magnesium-based antacid such as magnesium hydroxide, which acts as a laxative. Administration of aluminum carbonate and aluminum hydroxide would aggravate constipation. Sodium-based antacids such as sodium citrate along with aluminum hydroxide have no effect in relieving the effects of the latter. Calcium-based antacids such as calcium carbonate also cause constipation, and hence their use will not alleviate the patient's discomfort.
A patient with peptic ulcers reports pain in the stomach. A gastric tissue biopsy reveals the presence of Helicobacter pylori infection. What should be the first-line treatment for the patient? 1 Cimetidine combined with sucralfate and clarithromycin 2 Omeprazole combined with clarithromycin and sucralfate 3 Cimetidine combined with metronidazole and ketoconazole 4 Omeprazole combined with metronidazole and clarithromycin
4 Rationale: The first-line treatment for peptic ulcers associated with Helicobacter pylori infections includes a 10- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole. Omeprazole is a PPI that decreases the levels of hydrochloric acid in the stomach, and the antibiotics metronidazole and clarithromycin inhibit the growth of H. pylori. Cimetidine is an H 2 receptor blocker, which is less safe than PPIs and is not preferred. Sucralfate decreases the absorption of PPIs and so should not be taken with them.
A nurse should give which nonpharmacologic instruction to a patient who has peptic ulcers? 1 "Reduce your intake of caffeinated beverages such as coffee and colas." 2 "Take a nonsteroidal antiinflammatory drug once a day to help with pain." 3 "An ulcer diet of bland foods with milk and cream products will speed healing." 4 "It would be better to eat five or six small meals a day instead of three larger ones."
4 Rationale: \One optimal, nondrug measure, in addition to drug management, to aid patients with peptic ulcers is changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that caffeinated beverages promote ulcer formation or that an "ulcer diet" improves healing. Nonsteroidal antiinflammatory drugs inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.
