Chapter 37: Drugs Therapy for Peptic Ulcer Disease and Hyperacidity
An older client has been prescribed omeprazole for the treatment of gastresophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidin
"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population."
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."
A female client has GERD and is taking cimetidine. She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse?
"Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine."-If both cimetidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of cimetidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the cimetidine. The other three statements are not true.
The health care provider has prescribed sucralfate for a client with a gastric ulcer. The client asks how long he must take this medication. What is the nurse's best response to this client?
"You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."
A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time?
1 hour before eating
A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time?
1 hour before eating-Proton pump inhibitors such as lansoprazole should be swallowed whole at least 1 hour before eating. The proton pump inhibitors suppress gastric acid secretion by blocking the final step in the production of gastric acid by the gastric mucosa. After meals will inhibit suppression of gastric acid. On rising and at bedtime are not optimal times to take lansoprazole.
Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms.
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.
The nurse is caring for a client who is receiving antacids to relieve GI discomfort. What nursing action is most appropriate?
Administer the antacid 1 hour before or 2 hours after other oral medications
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
Alopecia- can occur with proton pump therapy, but it is not a common adverse effect. Common adverse effects include dizziness, headache, and cough.
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?
Amoxicillin
The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects?
Constipation-The nurse should warn a client taking aluminum- and calcium-containing antacids about constipation, which can be associated with taking products containing either medication. Client taking magnesium- and sodium-containing antacids can have diarrhea. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.
Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?
Digoxin- Administering an antacid to a client taking digoxin will decrease the absorption of digoxin and result in a decreased digoxin effect. Quinidine, dextroamphetamine, and simvastatin are not affected by the use of antacids.
Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?
Drug-drug interactions
A male client is overweight and lives a sedentary lifestyle. He presents to the office with reports of acid regurgitation, especially at night. The nurse is aware that this client is displaying symptoms of what disorder?
Gastresophageal reflux disease-Gastresophageal reflux disease (GERD) is characterized by regurgitation of acidic gastric contents into the esophagus resulting in esophagitis or esophageal ulceration.
Why are histamine2 receptor antagonists preferred in the treatment of upper gastrointestinal (GI) disorders over traditional histamine1 receptor antagonists?
Histamine1 receptor antagonists do not block histamine effects on gastric acid production.
The nurse is preparing to administer ranitidine to a client who is currently receiving warfarin. Which assessment finding should the nurse prioritize for this client?
Increased bleeding
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?
Increased fracture risk
The nurse is providing care for a 51-year-old client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment?
Inspect the client for gynecomastia.-Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea.
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?
Mental status is intact.
A female client presents to the health care provider's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client?
Rebound acidity- Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.
A female client presents to the health care provider's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client?
Rebound acidity-Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.
The nurse administers ranitidine cautiously to clients with evidence of what condition?
Renal disease
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 75-year-old client is treating an ulcer with antacids. Based on the client's age, the nurse expects the health care provider to prescribe a dose of antacid that compares with the average prescribed dose in what way?
Smaller than the average prescribed dose
A 75-year-old client is treating an ulcer with antacids. Based on the client's age, the nurse expects the health care provider to prescribe a dose of antacid that compares with the average prescribed dose in what way?
Smaller than the average prescribed dose. (r)Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.
Client teaching should include what instruction about antacids?
Take antacid 1 hour before other medications.-Administer the drug apart from any other oral medications approximately 1 hour before or 2 hours after to ensure adequate absorption of the other medications.
A client with a history of chronic constipation presents to the clinic with reports of occasional heartburn. The nurse will caution the client about using which antacid(s) that may exacerbate the constipation?
The aluminum- and calcium-containing antacids may produce constipation.
The nurse is caring for a client who has recently been prescribed misoprostol. What change in the client's health status should the nurse communicate most promptly to the care provider?
The client believes that she may be pregnant.-Misoprostol is absolutely contraindicated during pregnancy because it is an abortifacient. None of the other listed aspects of the client's recent health history contraindicate the safe use of the drug
The nurse is preparing to administer a prescribed medication to a client diagnosed with GERD. If the nurse discovers the client has a history of vitamin B12, which medication(s) will the nurse administer cautiously?
The nurse should administer proton pump inhibitors, like rabeprazole and pantoprazole, cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12.
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:
an hour before meals.-Sucralfate, a gastrointestinal protectant, must be given time to act before significant gastric activity, and it requires an acidic environment to be effective. For these reasons, sucralfate should be given an hour before meals and antacids.
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 is teaching a client about lansoprazole prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease?
inhibiting acid secretion
Ranitidine and cimetidine are both H2RAs used in the treatment of peptic ulcer disease. Of the two, ranitidine is preferred in critically ill clients because it is less likely to:
interfere with the metabolism of other drugs.
A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for:
metabolic alkalosis.
A client is 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.
Administer the antacid 1 hour before or 2 hours after other oral medications
"I need to swallow the drug whole."
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
A health care provider has prescribed omeprazole for a client. The nurse will carefully monitor the client for increased adverse reactions if the client is also prescribed which additional medication(s)?
The initiation of proton pump inhibitors, like omeprazole, can result in increased adverse reactions and toxicities of warfarin, benzodiazepines, digoxin, phenytoin, and clarithromycin. The concomitant use of ketoconazole and proton pump inhibitors may result in the decreased absorption of the anti-infective. The use of lithium with an antiemetic can result in the increased risk of extrapyramidal effects.
The nurse is caring for a male client in the medical unit. He is fed via a nasogastric tube. The dose of antacid is based on what factors?
The pH of the stomach contents
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?
Proton pump inhibitors
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.-The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach. While the other situations may contribute to GI distress, NSAID used in primary risk factor for this client.
A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?
Closely monitor the patient for confusion and dizziness.
The health care provider has 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 75-year-old client is diagnosed with type 2 diabetes mellitus, hypertension, osteoporosis, and gastric ulcer disease. She is prescribed PPIs. The nurse is aware that long-term (greater than 1 year) administration of PPIs may increase the risk for which problem for this client?
Hip fractures
Why are histamine2 receptor antagonists preferred in the treatment of upper gastrointestinal (GI) disorders over traditional histamine1 receptor antagonists?
Histamine1 receptor antagonists do not block histamine effects on gastric acid production.-Traditional antihistamines or histamine1 receptor antagonists prevent or reduce other effects of histamine but do not block histamine effects on gastric acid production. Histamine2 receptor antagonists inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin.
A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?
Infection with H. pylori-Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).
Mr. Palmer is scheduled to receive ranitidine at 9:00 am this morning. What is a correct explanation of the pharmacodynamics of ranitidine?
It inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion.
A group of nursing students are analyzing the various categories of upper gastrointestinal system drugs. The instructor determines the session is successful when the students correctly choose which drug(s) as an example of a proton pump inhibitor?
Omeprazole and esomeprazole are examples of proton pump inhibitors.
After teaching a group of students about proton pump inhibitors, the instructor determines that the students have understood the information when they identify which agent as the prototype proton pump inhibitor?
Omeprazole-
A nurse is reviewing information about proton pump inhibitors. The nurse recognizes that which of the following is available as an over-the-counter agent?
Omeprazole-Omeprazole is available over the counter; pantoprazole, rabeprazole, and dexlansoprazole are prescription medications.
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-Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
A client is prescribed misoprostol. The nurse would expect to administer this drug by which route?
Oral
A female client comes to the clinic with reports of burning pain in the stomach. She states that she thinks she had a virus 48 hours ago and she vomited many times. She hasn't vomited in 24 hours. She asks the health care provider to give her a prescription for omeprazole because she saw an ad on TV that said it would heal stomach pain. The nurse assists the client in understanding that PPIs are considered drugs of choice for treatment of what conditions? (Select all that apply.)
PPIs are considered drugs of choice for treatment of heartburn, gastric and duodenal ulcers, GERD, esophagitis, and hypersecretory syndromes such as Zollinger-Ellison syndrome. It is not used in the treatment of anaphylaxis.
Antacids have not been effective in managing a client's gastroesophageal reflux disease, so the health care provider is prescribing a proton pump inhibitor. Why might the health care provider prescribe a proton pump inhibitor (PPI) rather than a histamine2 receptor antagonist (H2RA)?
PPIs suppress acid more strongly and for a longer time.
The nurse admits a client who reports having taken a proton pump inhibitor for more than a decade. What assessment question will the nurse ask this client?
Research indicates that clients taking proton pump inhibitors or histamine-2 antagonists demonstrate a significant increase in cases of Clostridium difficile infections leading to diarrhea so the nurse should assess this client for diarrhea.
A 30-year-old nonpregnant patient is prescribed misoprostol. Which of the following should the nurse instruct the patient as part of the teaching plan?
Use a reliable contraceptive.
Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in clients who:
are pregnant. (rationale) Misoprostol is contraindicated during pregnancy because it may cause abortion, premature birth, or birth defects. It is also contraindicated in women of childbearing potential who are not using effective contraception.
Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in clients who:
are pregnant.-Misoprostol is contraindicated during pregnancy because it may cause abortion, premature birth, or birth defects. It is also contraindicated in women of childbearing potential who are not using effective contraception.
