Chapter 37, Drug Therapy for Peptic Ulcer Disease and Hyperacidity

A female client is currently taking sucralfate and has been given a prescription for ciprofloxacin for treatment of a urinary tract infection. The nurse will inform the client that she should take her medication in what way?

"Take the ciprofloxacin 2 hours before the sucralfate.", to ensure full absorption of the ciprofloxacin. * Administer the drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug.

The following data identified during a nursing assessment and interview. When considering risks for the development of a peptic ulcer, which situation should the nurse discuss with the client?

* Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.

A 30-year-old female client is prescribed misoprostol. Which instruction should the nurse prioritize in the teaching session for this client?

* Use a reliable contraceptive. *

1. benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection? 2. A client is diagnosed with an infection with H. pylori. The nurse anticipates the client will be prescribed which drug(s) in combination with an antibiotic? 3. A client is diagnosed with an infection with H. pylori. The nurse anticipates the client will be prescribed which drug(s) in combination with an antibiotic?

* decreases production of gastric secretions * PPIs decrease gastric acid secretion. Antimicrobials and bismuth can eliminate H. pylori infection. Sucralfate provides a protective barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production. 2. Omeprazole, Lansoprazole

prescribed cimetidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has:

* renal disease. *H2RAs must be used with caution in clients with renal disease. Since these drugs are eliminated through the kidneys, dosages are reduced to avoid adverse effects. * Inspect the client's chest for the development of gynecomastia. * Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Rashes, insomnia, and orthostatic hypotension are not typical adverse effects.

prescribed sucralfate. When does the nurse instruct the client to take the medication?

*one hour before or 2 hours after meals and at bedtime * "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."

1. bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms 2. A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. What is one of the preferred antibiotics?

1. A bismuth preparation is added to some regimens. Bismuth exerts antibacterial effects against H. pylori. It also increases secretion of mucus and bicarbonate, inhibits pepsin activity, and accumulates in ulcer craters. 2. clarithromycin and amoxicillin

prescribed ranitidine for a hospitalized client on a unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the client?

Headache * Adverse effects with H2RAs such as ranitidine are typically uncommon and mild with the usual doses and duration of treatment. However, effects can include diarrhea or constipation, headache, dizziness, muscle aches, and fatigue.

A male client is receiving morphine sulfate for pain after an accident. The health care provider has also ordered cimetidine IV to assist in preventing a stress ulcer. The nurse will monitor for what effect that is caused by the interaction of these two drugs?

Increased incidence of respiratory depression

Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?

Omeprazole * Omeprazole increases blood levels of the anticoagulant warfarin, thus creating a risk for bleeding. Such an elevation in warfarin would not increase the risk for the development of any of the other options.

proton pump inhibitor, upper gastrointestinal system drugs

Omeprazole Esomeprazole

A female client's diagnoses include diabetes mellitus, gastric ulcer disease, and chronic renal disease. When the nurse reviews her medications with her, the nurse discover that she self-administers antacids

They are contraindicated for clients with renal disease

A health care provider has prescribed omeprazole for a client. The nurse will carefully monitor the client for increased

Warfarin Digoxin Daizepam

emetic A client is brought to the emergency department for a drug overdose. The nurse concludes the emetic is safe to give to the client if which client assessment finding is noted?

a medicine or other substance which causes vomiting * Mental status is intact. *The client can be administered an emetic only if the client does not have an altered mental status or is not comatose. A client who is comatose has an increased risk of aspiration of stomach contents. Clients with an existing condition of severe hypertension, a medical history of convulsions, or an existing condition of hemorrhagic diathesis should not be given an emetic as these conditions may be exacerbated by vomiting.

Which drugs treat heartburn by neutralizing the acidity of the stomach by combining with hydrochloric acid (HCl) and increasing the pH of the stomach acid?

aluminum hydroxide * Aluminum hydroxide neutralizes or reduces the acidity of the stomach and duodenal contents by combining with hydrochloric acid and increasing the pH of the stomach. Omeprazole is a proton pump inhibitor that suppresses gastric acid secretion by inhibition of the hydrogen-potassium adenosine triphosphatase (ATPase) enzyme system of the gastric parietal cells. Famotidine is a histamine-2 receptor antagonist that inhibits the action of histamine at H2 receptor cells of the stomach, which then reduces the secretion of gastric acid. Metoclopramide is used to treat delayed gastric emptying and emesis—that is, it increases the motility of the upper GI tract without increasing the production of secretions.

Of the commonly used antacids, which is rarely used in the treatment of peptic ulcer disease (PUD) because of its effect on gastrin release?

calcium compounds

While reviewing the medication history of a client newly prescribed omeprazole, the nurse sees that the client is also taking warfarin. What potential interaction should the nurse account for when developing the plan of care for this client?

hemorrhage * The nurse should instruct the client to use a reliable contraceptive method to avoid pregnancy during the course of treatment as it can cause spontaneous abortion. The nurse should instruct the client taking proton pump inhibitors not to chew, open, or crush the tablet and to swallow the tablet whole at least 1 hour before eating. The nurse needs to inform the client taking a drug for motion sickness to administer it about 1 hour before travel.

Antacids containing magnesium are contraindicated

in clients with impaired renal function.