Chapter 57: Drugs Affecting Gastrointestinal Secretions

A female client is prescribed ranitidine in addition to the antacid that she already takes for gastric reflux. Which statement made by the client indicates that she understood the teaching provided about taking these medications?

"I should take ranitidine 2 hours before or after my antacid dosage." If both ranitidine and antacids are prescribed, they should be taken at least 2 hours apart to prevent decreased absorption of ranitidine.

A female client has GERD and is taking ranitidine (Zantac). 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 ranitidine." If both ranitidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of ranitidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the ranitidine. The other three statements are not true.

A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?

2 tablets The required dosage is 200 mcg. Available tablets contain 100 mcg of the drug. Therefore, the nurse should administer two tablets each time to the client.

Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which medication will likely be used in an attempt to eradicate the patient's H. pylori infection? (Select all that apply.)

Antibiotics A PPI Classic quadruple therapy for H. pylori eradication (bismuth, a PPI, 1,500 mg of metronidazole, and 1,500 mg of tetracycline) is highly effective and is frequently the regimen of choice. A newer sequential therapy (PPI plus amoxicillin followed by a PPI plus clarithromycin plus metronidazole) has been proposed and is expected to replace legacy therapy. Both regimens include PPIs and antibiotics and exclude aluminum hydroxide, ondansetron, and cisapride.

Which medication reduces the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells? Select all that apply.

Esomeprazole Lansoprazole The proton pump inhibitors, like esomeprazole and lansoprazole, reduce the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate enzyme system of the gastric parietal cells. Famotidine (Pepcid) and ranitidine are both histamine H2 antagonists decreasing stomach acid by inhibiting the action of H2 receptors in the stomach. Calcium carbonate is an acid neutralizer that reduces the pH of the acid in the stomach and duodenum.

Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?

Gynecomastia Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.

A male patient is taking misoprostol (Tagamet). Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

Gynecomastia Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine.

A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the midepigastric 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).

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; lansoprazole, rabeprazole, and esomeprazole are prescription medications.

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 nurse in a health care facility is caring for a patient who is administered milk of magnesia to control constipation. Which nursing diagnosis should the care plan for this patient include?

Risk for imbalanced fluid volume The patient care plan should include risk for imbalanced fluid volume for the patient administered acid neutralizers. The nursing diagnoses checklist should include disturbed sensory perception for a patient receiving anticonvulsants. The nursing diagnoses checklist should include impaired physical mobility for a patient receiving antiparkinsonism drugs. The nursing diagnoses checklist should include ineffective tissue perfusion for a patient receiving cholinergic-blocking drugs.

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 Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.

Pancrelipase would most likely be used to treat a patient with cystic fibrosis.

True

The use of calcium carbonate is associated with the development of acid rebound.

True

The client receiving omeprazole should swallow the tablet whole with a large glass of water.

True Omeprazole should be swallowed whole to ensure the therapeutic effectiveness of the drug.

A 23-year-old female client is prescribed misoprostol (Cytotec). Which client teaching intervention is most important?

Use effective contraceptive measures Misoprostol (Cytotec) is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. It is not necessary for a client aged 23 years to report postmenopausal bleeding. The medication should be administered two to four times per day.

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 proton pump inhibitor, 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.

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.

An older adult's has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect?

constipation With the antacid which contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.

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 Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.

A client is prescribed ranitidine 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.

What is an effect of histamine release that is related to ulcer formation?

stimulates gastric acid secretion Histamine also causes strong stimulation of gastric acid secretion. Vagal stimulation causes release of histamine from cells in the gastric mucosa. The histamine then acts on receptors located on the parietal cells to increase production of hydrochloric acid that is a factor in stomach ulcer formation. Histamine is not associated with either pepsin or gastrin.

Which instruction would be most important to give to a client who is receiving omeprazole?

"Swallow the tablet whole with a large glass of water." The medication should be swallowed whole with a large glass of water. It should not be chewed, crushed, or opened. Antacids, if prescribed, should be taken 1 hour before or 2 hours after the omeprazole.

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 Omeprazole is considered the prototype proton pump inhibitor.

A client is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which disease is a result of cellular destruction of the gastrointestinal tract from this medication?

Peptic ulcer disease Cell destruction will occur from the ingestion of NSAIDs, which can lead to the development of peptic ulcer disease. Nonsteroidal anti-inflammatory agents do not cause esophageal cancer, bowel obstruction, or liver cancer.

Which teaching intervention is most important to share with the client prescribed misoprostol?

Use effective contraceptive measures. Misoprostol is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. While reporting postmenopausal bleeding, this medication is not associated with that adverse reaction. The medication should be administered two to four times per day.

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. Unlike cimetidine, ranitidine does not affect the cytochrome P450 drug-metabolizing system in the liver and therefore does not interfere with the metabolism of other drugs by that system.

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 nurse should closely monitor the elderly patient who has been administered cimetidine for confusion and dizziness. When the patient is receiving an antiemetic, the nurse monitors the patient frequently for continued reports of pain, sour taste, spitting blood, or coffee-ground-colored emesis. When antacids are given to the patient, the nurse should observe the patient for concentrated urine and restlessness. When the patient is administered prolonged doses of metoclopramide, the nurse reports any sign of tardive dyskinesia or extrapyramidal symptoms to the PHCP.

Carter, age 2, is diagnosed with cystic fibrosis; the physician places him on pancrelipase. What would be the most appropriate diagnosis for Carter related to his medication regimen?

Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes Pancrelipase is administered as enzymatic replacement therapy for patients with deficient exocrine pancreatic secretions; cystic fibrosis; chronic pancreatitis; ductal obstructions caused by cancer of the pancreas or common bile duct; pancreatic insufficiency; or steatorrhea from malabsorption syndrome and after pancreatectomy, gastrectomy, or post-GI surgery, such as Billroth II gastroenterostomy. Caution must be used with large doses because they may cause nausea, abdominal cramps, and diarrhea. Hyperuricosuria and hyperuricemia have occurred with extremely high doses. Less often, allergic reactions have occurred.

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?

Increased fracture risk An increase in fractures of the hip, wrist, and spine have been seen in clients taking high doses of PPIs and undergoing treatment of osteoporosis with bisphosphonates.