Pharmacology: Chapter 32

Drug Class: Histamine-2 Receptor Antagonists

*Actions:* Block H2 receptors resulting in decreased volume of acid secreted *Uses:* Treat GERD, duodenal ulcers, stress ulcers, Zollinger-Ellison syndrome (tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid) *Common Adverse Effects:* Dizziness, headache, somnolence, diarrhea, constipation *Serious Adverse Effects:* Confusion, disorientation, hallucinations, gynecomastia (men w/ breasts), hepatotoxicity

Drug Class: Antispasmodic Agents

*Actions:* anticholinergic *Uses:* Treat irritable bowel syndrome, biliary spasm, mild ulcerative colitis, pancreatitis, infant colic, PUD *Common adverse effects:* Blurred vision; constipation; urinary retention, dry mouth, nose, throat *Serious adverse effects:* Confusion, depression, nightmares, hallucinations, orthostatic hypotension, palpitations, dysrhythmias

Treat Patient as a _______ ______ case when they present with GERD/PUD symptoms, UNTIL, you can rule out ______ _______

*CARDIAC DISEASE*

Patient Education & Health Promotion

*Education*—weight reduction, smoking cessation, consume smaller meals, avoid eating at bedtime, avoid tight clothing over abdomen *Limit use of NSAIDs*—switch to acetaminophen if feasible

Types of Secretory Cells

Chief—secrete pepsinogen Parietal—secrete hydrochloric acid Mucus—secrete mucus

Peptic ulcer disease (PUD)

Several stomach disorders—commonly gastric and duodenal ulcers *Symptoms* burning, gnawing, aching

Drug Class: Antacids

*Actions:* Buffer hydrochloric acid to a lower concentration *Uses:* Treat heartburn from excessive eating and drinking; Acute ulcer treatment requires large volumes *Common Adverse Effect:* chalky taste *Serious Adverse Effects:* constipation (w/ calcium or aluminum), diarrhea (w/ magnesium)

Drug Class: Proton Pump Inhibitors

*Actions:* Inhibit gastric secretion by inhibiting gastric acid pump of the *parietal cells* *Uses:* Treat severe esophagitis, GERD, gastric and duodenal ulcers *Common Adverse Effects:* Diarrhea, headache, fatigue, muscle pain *Serious adverse effects:* Rash, risk of fractures, hypomagnesemia

Drug Class: Prokinetic Agents

*Drug:* metoclopramide (Reglan) *Actions:* Reduce reflux, increase stomach contractions, relax pyloric valve, increase peristalsis *Uses:* Treat gastric reflux esophagitis, diabetic gastroparesis; antiemetic *Common adverse effects:* Drowsiness, fatigue, lethargy, dizziness, nausea *Serious adverse effects:* Extrapyramidal symptoms (involuntary movements, restlessness, shuffling), risk of seizures *diphenhydramine* for treatment of EPS

Drug Class: Gastrointestinal Prostaglandins

*Drug:* misoprostol (Cytotec) *Actions:* Inhibit gastric acid and pepsin secretion *Uses:* Prevent and treat gastric ulcers caused by NSAIDs (including aspirin) *Common adverse effect:* diarrhea *Contraindicated in pregnancy: risk of miscarriage, uterine contractions (induction of labor)*

Drug Class: Coating Agents

*Drug:* sucralfate (Carafate) *Actions:* Adhere to craters of an ulcer, protecting it from acids, pepsin, and bile salts *Uses:* Treat duodenal ulcers; for patients who cannot tolerate other therapies *Common adverse effects:* Constipation, dry mouth, dizziness *Take pc*

Gastroesophageal reflux disease (GERD)

*Heartburn* *Symptoms:* burning, bloating, belching, regurgitation *Reflux of gastric secretions* such as pepsin and hydrochloric acid into the esophagus

The nurse is instructing a patient on how to reduce acid production in the stomach to prevent GERD indicated that measures to take include: (Select all that apply.) 1. decrease or stop smoking. 2. decrease the amount of coffee consumed. 3. increase the amount of spicy foods consumed. 4. decrease the amount of alcohol intake. 5. increase the amount of carbonated beverages.

1. decrease or stop smoking. 2. decrease the amount of coffee consumed. 4. decrease the amount of alcohol intake. *Measures for patients to take to reduce acid production in the stomach to prevent GERD include: decreasing or stopping smoking; decreasing coffee consumption; and decreasing alcohol intake. The nurse would not instruct the patient to increase either the amount of spicy food consumed or the amount of carbonated beverages the patient drinks. One of the causes of GERD is increased acid secretion. Acid secretions are increased by smoking, alcohol, carbonated beverages, coffee, and spicy foods.*

The stomach functions to digest food by secreting pepsinogen from the secretory cells known as the 1. parietal cells. 2. chief cells. 3. mucus cells. 4. salivary cells.

2. Chief Cells *The stomach digests food by secreting pepsinogen from the chief cells. Three types of secretory cells line portions of the stomach—chief, parietal, and mucus cells. The chief cells secrete pepsinogen, an inactive enzyme. Parietal cells secrete hydrochloric acid by way of a hydrogen ion pump, which activates pepsinogen to pepsin, providing the optimal pH for pepsin to start protein digestion. The mucous cells secrete mucus, which coats the stomach wall. Other digestive enzymes are also carried into the stomach from swallowed saliva.*