Ch 43: Antiulcer Drugs (Elsevier)

Which statement by the patient demonstrates understanding of patient teaching regarding the use of histamine 2 receptor antagonists?

--"Smoking decreases the effects of this medication, so I should look into cessation programs." Patients taking histamine 2-receptor-blocking drugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking. They should also increase bulk and fluids in the diet to prevent constipation. Cimetidine should be taken with meals, whereas famotidine can be taken without regard to meals.

The nurse would teach a patient prescribed simethicone (Gas-X) to avoid which substances?

--Carbonated beverages Simethicone is used to decrease gas and belching, both of which can be aggravated or caused by ingesting carbonated beverages. It may be given in combination with other medications used to decrease acidity.

What is the action of histamine 2 receptor antagonists?

--They compete with histamine for binding sites on the parietal cells. Histamine receptor-blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.

PPI

Proton Pump Inhibitors: reduce gastric acid production

Dyspepsia

difficult digestion; indigestion

A patient is undergoing treatment for erosive esophagitis. Which advice given by the nurse will be helpful in reducing stomach acidity? Select all that apply.

--"Avoid greasy and spicy food." --"Avoid intake of alcohol." Alcohol intake increases the acid levels in the stomach and must be avoided. Avoiding greasy and spicy food may relieve the irritation caused in the esophageal lining. Increasing physical activity helps the patient achieve health and relief from any sort of stress. However, it does not decrease the patient's symptoms. Water or fluid intake helps the patient to be hydrated. However, the acid in the stomach is not affected. Dietary bulk helps relieve constipation and is good for digestive health. It should not necessarily be avoided.

What information will the nurse include in a teaching plan for the patient who is prescribed sucralfate (Carafate)?

--"This medication will form a protective barrier over the gastric mucosa." Sucralfate (Carafate) affects the gastric mucosa. It forms a paste-like substance in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.

A primary health care provider prescribes an antacid to a patient with peptic ulcer disease. What information should the nurse provide to the patient?

--"You may experience white or speckled stools." Antacids are used to treat peptic ulcers. They contain salts and elements such as calcium and aluminum, which may cause white or speckled stools. Edema and mental confusion may be observed if tranquilizers are prescribed. Reversible impotence and gynecomastia may be observed if a histamine 2 blocker is prescribed. Palpitations and decreased body secretions may be observed if anticholinergic medication is prescribed.

The nurse will question an order for misoprostol (Cytotec) in which patient?

--A 32-year-old pregnant woman with a urinary tract infection Misoprostol (Cytotec) is a prostaglandin E analogue and is believed to inhibit gastric acid secretion and protect the gastric mucosa from injury by enhancing the local production of mucus. However, it is also an abortifacient and therefore would be contraindicated in pregnancy. The drug may be useful in treating patients with Zollinger-Ellison syndrome (a hypersecretory syndrome) and GERD. Hypertension is not a contraindication for its use.

The nurse is caring for a patient who is taking sucralfate (Carafate) for treatment of a duodenal ulcer. Which assessment requires action by the nurse?

--Absent bowel sounds, hard abdomen Because sucralfate (Carafate) is not systemically absorbed, there are few adverse effects. Constipation is an adverse effect of sucralfate, so the absence of bowel sounds and a hard abdomen would require immediate action from the nurse. The sodium level listed is considered to be within the normal range; 30 mL/hr is a normal urinary output.

Which is a priority nursing intervention when administering ranitidine (Zantac)?

--Administer with meals. Ranitidine (Zantac) should be given just before or with a meal to decrease food-induced acid secretion. A second daily dose should be given at bedtime to minimize acid reflux when in the recumbent position. Administration on an empty stomach minimizes the efficacy of the medication.

The health care provider has prescribed lansoprazole (Prevacid) for the patient. Within 30 minutes of receiving the first dose of the medication, the patient experiences shortness of breath and develops a rash on the skin. What does the nurse expect that the patient is experiencing?

--Allergic reaction to the medication The patient's symptoms are indicative of an allergic reaction to the medication. It is not a typical side effect, nor does it indicate toxic levels of the medication.

Which drug affects the absorption of isoniazid (Nydrazid) in the gastrointestinal tract?

--Aluminum hydroxide (Amphojel) Aluminum hydroxide (Amphojel) is an antacid that interacts with isoniazid (Nydrazid) and decreases its absorption in the gastrointestinal tract because of complexation of the drug. Ranitidine (Zantac), cimetidine (Tagamet), and omeprazole (Prilosec) are antacids that do not interact with the absorption of isoniazid (Nydrazid) but may interact with other drugs such as allopurinol (Zyloprim) and tetracycline (Sumycin) and reduce their absorption in the gastrointestinal tract.

Which class of antiulcer drugs causes dry mouth as a side effect?

--Anticholinergics Anticholinergics treat peptic ulcers by blocking the action of acetylcholine. Inhibiting acetylcholine can cause dry mouth. Tranquilizers are antiulcer drugs that cause ataxia and edema. Pepsin inhibitors are antiulcer drugs that may cause constipation. Histamine-2 blockers are antiulcer drugs that can cause gynecomastia.

How do H 2 receptor antagonists reduce the secretion of acids?

--By blocking the H2 receptors H2 receptor antagonists block H2 receptors and stop the secretion of acids by parietal cells. H2 receptor antagonists do not block acetylcholine receptors. They make parietal cells unresponsive to the stimulation of acetylcholine and gastrin receptors. H2 receptor antagonists do not directly affect gastrin and acetylcholine receptors.

How does a tranquilizer treat a peptic ulcer?

--By decreasing vagal activity Peptic ulcer is a broad term for an ulcer occurring in the esophagus, stomach, or duodenum within the upper gastrointestinal tract. Tranquilizers act by decreasing vagal activity and are used to decrease anxiety in patients with peptic ulcers. Antacids treat peptic ulcers by neutralizing gastric acid. Proton pump inhibitors treat peptic ulcers by inhibiting gastric acid secretion. Anticholinergics treat peptic ulcers by blocking cholinergic receptors.

A nurse plans to recommend an over-the-counter (OTC) antacid to a patient. Which fact about OTC antacids will the nurse consider?

--Calcium carbonate is the most effective but can cause acid rebound. Calcium carbonate is the most effective in neutralizing acid, but because of high systemic absorption, it can cause acid rebound and hypercalcemia. Various antacids differ in effect and adverse reactions. Sodium bicarbonate has many side effects, including hypernatremia. Aluminum hydroxide has decreased effects when given with tetracycline and fluoroquinolones.

The nurse provides a patient with educational materials about antacids. Which statements about antacids are appropriate? Select all that apply.

--Calcium-containing antacids may cause constipation. --Aluminum-containing antacids may cause constipation. --Antacids neutralize the acid present in the stomach. Both calcium- and aluminum-containing antacids may cause constipation as an adverse effect; therefore, it is recommended that patients increase fluid consumption during use. Antacids neutralize the excess acid secreted in the stomach by forming salts. Agents protective against ulcers, such as sucralfate (Carafate), 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.

A patient is prescribed an aluminum-containing antacid for hyperacidity. The nurse should inform the patient about which possible adverse effect?

--Constipation 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.

A nurse is teaching a patient with peptic ulcer disease about measures to be followed while taking antacids. Which action taken by the patient will ensure a positive outcome of the therapy?

--Drinking 2 oz of water after taking an antacid Antacids treat peptic ulcers by neutralizing gastric acid. A client with a peptic ulcer who is on antacid therapy should drink 2 oz of water after taking the antacid to ensure the movement of the drug to the stomach. Antacids should not be taken with milk, because calcium in the milk reacts with the antacid and reduces the drug's activity. Antacids should not be taken with meals, because food increases gastric secretions. Spicy foods should not be eaten before taking any antacid, because this may cause gastric irritation.

Which nursing intervention is appropriate when administering ranitidine (Zantac) via rapid intravenous infusion?

--Frequent monitoring of blood pressure during the infusion. Ranitidine (Zantac) is an H2 receptor antagonist that is known to decrease blood pressure during rapid infusion. This may cause hypotension, and thus the nurse should constantly monitor the patient's blood pressure. Ranitidine (Zantac) inhibits the absorption of other drugs; hence the nurse should not administer any other drug with ranitidine (Zantac). Creatinine levels and liver function are assessed before the start of the treatment.

Upon assessment, a patient describes symptoms, saying he or she believes they are related to heartburn. The patient is awakened in the night, gasping for air with a burning sensation in the middle of the chest. Which is an alternative diagnosis?

--Gastroesophageal reflux disease (GERD) Heartburn, although uncomfortable, does not have the dramatic nighttime symptoms the patient describes; these typically occur with GERD. With GERD, the lower esophageal sphincter is incompetent, allowing stomach acid to reflux back into the esophagus. This causes an intense burning and temporary shortness of breath. H. pylori infection is not related to sphincter incompetence but is the result of infection. Duodenal ulcers would not cause these symptoms in the lower stomach. Dyspepsia is a symptom of GERD but not a diagnosis of its own.

Which statement is true regarding sucralfate (Carafate)?

--It has very few side effects. Sucralfate (Carafate) is a mucosal protective drug used in the treatment of peptic ulcers. It has very few side effects as it is not systemically absorbed. Sucralfate (Carafate) causes constipation because it slows the action of the stomach. Sucralfate (Carafate) covers the ulcer, protects it, and does not neutralize gastric acid. Sucralfate (Carafate) does not decrease gastric acid secretions.

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?

--Lansoprazole (Prevacid) Lansoprazole (Prevacid) 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 (Cytotec) 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 (Pepcid) is an H2 receptor antagonist that inhibits the binding of H2 receptors to histamine, but it has no effect on gastrin receptors. Simethicone (Mylicon) is an antiflatulent drug and has no effect on the secretion of acid in the stomach.

Which drug is a proton pump inhibitor?

--Lansoprazole (Prevacid) Lansoprazole (Prevacid) is a proton pump inhibitor. Proton pump inhibitors also are considered acid-controlling drugs.

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 consuming?

--Magnesium hydroxide Magnesium hydroxide (milk of magnesia) 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 (Amphojel) 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 (Tums) is a calcium-based antacid known to cause nausea and vomiting, as well as severe conditions such as kidney stones. Sodium bicarbonate (Alka-Seltzer) is 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 has been taking aluminum hydroxide (Amphojel) to treat gastric hyperacidity for a few days. The patient reports being constipated. Which drug will the provider order in addition to aluminum hydroxide (Amphojel)?

--Magnesium hydroxide (milk of magnesia) The constipation caused by the aluminum-based antacid is neutralized when taken in combination with a magnesium-based antacid such as magnesium hydroxide (milk of magnesia), which acts as a laxative. Administration of aluminum carbonate (Basaljel) and aluminum hydroxide (Amphojel) would aggravate constipation. Sodium-based antacids such as sodium citrate (Citra pH) along with aluminum hydroxide (Amphojel) have no effect in relieving the effects of the latter. Calcium-based antacids such as calcium carbonate (Tums) also cause constipation, and hence their use will not alleviate the patient's discomfort.

Which type of antacids will the nurse most likely question in an order for a patient with chronic renal failure?

--Magnesium-containing antacids Magnesium-containing antacids can cause hypermagnesemia in patients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic renal failure. Sodium- and aluminum-containing antacids are chemically more easily excreted in patients with renal compromise. Although calcium-containing antacids may accumulate in the bloodstream of patients with renal failure, they may also be appropriate because these patients may be hypocalcemic.

What condition will the nurse monitor for in a patient using sodium bicarbonate to treat gastric hyperacidity?

--Metabolic alkalosis Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serum calcium would decrease with alkalosis, not increase.

A patient with a peptic ulcer is prescribed sodium bicarbonate (Alka-Seltzer). What side effects should the nurse expect? Select all that apply.

--Metabolic alkalosis --Water retention A peptic ulcer is a lesion in the lining of the digestive tract, which can be treated by sodium bicarbonate (Alka-Seltzer). Excess sodium can result in water retention in the client. Excess bicarbonate and excess acid production result in metabolic alkalosis. Excess sodium from sodium bicarbonate causes hypernatremia. Antacids containing aluminum salts cause encephalopathy in a client with renal insufficiency. Calcium carbonate causes Burnett's syndrome because of hypercalcemia.

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?

--Omeprazole (Prilosec) combined with metronidazole (Flagyl) and clarithromycin (Biaxin) 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 (Biaxin) and either amoxicillin (Amoxil) or metronidazole (Flagyl). Omeprazole (Prilosec) is a PPI that decreases the levels of hydrochloric acid in the stomach, and the antibiotics metronidazole (Flagyl) and clarithromycin (Biaxin) inhibit the growth of H. pylori. Cimetidine (Tagamet) is an H2 receptor blocker, which is less safe than PPIs and is not preferred. Sucralfate (Carafate) decreases the absorption of PPIs and so should not be taken with them.

Which cells in the stomach secrete hydrochloric acid?

--Parietal cells Parietal cells in the stomach secrete hydrochloric acid. They are the primary site of action for many acid-controlling drugs. Chief cells are involved in the secretion of pepsinogen. Mucous cells secrete mucus, which protects the gastrointestinal layers. Endocrine cells secrete hormones used in the digestion of food.

A nurse is reviewing the laboratory reports of four patients who are being treated for peptic ulcers. Which client does the nurse suspect to be on esomeprazole (Nexium) therapy? -Patient A: Pt has elevated alanine transaminase. -Patient B: Pt has blood dyscrasias. -Patient C: Pt has hypophosphatemia. -Patient D: Pt has hypomagnesemia.

--Patient A Esomeprazole (Nexium) is an antiulcer medication, which elevates alanine transaminase levels with long-term use. Therefore, the nurse suspects that patient A is on long-term esomeprazole (Nexium) therapy. Ranitidine (Zantac) is an antiulcer medication that causes blood dyscrasias. Aluminum hydroxide (Amphojel) is an antiulcer medication that causes hypophosphatemia. Sucralfate (Carafate) is an antiulcer medication that causes hypomagnesemia.

A patient with rheumatoid arthritis is successfully treated with high doses of nonsteroidal antiinflammatory drugs (NSAIDs), but he or she is experiencing gastric irritation as a side effect. The nurse practitioner is considering prescribing misoprostol. Which factor is a contraindication to this course?

--Pregnancy Misoprostol (Cytotec) is contraindicated in pregnancy as it can also be used to induce labor. The drug is, however, indicated for peptic ulcer disease, so this condition is not a contraindication. The drug should be used cautiously in patients with decreased renal function, not decreased hepatic function. Constipation is a potential side effect but not a contraindication.

A patient with hypertension reports pain in the abdomen, for which the primary health care provider plans to prescribe antacids. Which assessment in the patient is most important in planning the medication regimen?

--Previous and current prescriptions The list of previous and current prescriptions may help the primary health care provider treat the gastrointestinal problem with drugs that have few or no interactions with the antihypertensive or other drugs being taken. The duration of abdominal pain would help assess the severity of the condition. The activity level of the patient would help determine the severity of the symptoms. The patient's adherence to treatment regimen will be an added advantage in treatment.

The patient's health care provider prescribes rabeprazole (Aciphex) to a patient. The nurse recognizes that this drug is effective for the patient because it belongs to which drug class?

--Proton pump inhibitor The drug rabeprazole (Aciphex) is classified as a proton pump inhibitor.

Which drug is administered only after assessing normal renal and hepatic functioning?

--Ranitidine (Zantac) Ranitidine (Zantac) is administered after tests of kidney and hepatic functioning show satisfactory results because it may cause adverse effects in patients with abnormal renal and hepatic functioning. Misoprostol (Cytotec) is administered to patients with known drug allergies and those who are not pregnant. The nurse should assess the patient's ability to swallow and the presence of gastrointestinal infections before administering lansoprazole (Prevacid). Simethicone (Mylicon) administration requires an assessment of the patient's bowel movements.

A patient is prescribed ranitidine (Zantac) for the treatment of peptic ulcers. To ensure drug safety, what will the nurse assess before administering the drug?

--Serum creatinine levels Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H2 receptor antagonist drugs such as ranitidine (Zantac). 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.

A patient is taking cimetidine (Tagamet) for hyperacidity and reports that the drug is not effective. Which finding in the patient's history, will the nurse interpret as being responsible for the ineffectiveness of the drug?

--The patient drinks two cups of coffee daily. Caffeine is a gastric stimulant, which increases the release of hydrochloric acid from the stomach. Even if an antacid like cimetidine (Tagamet) is administered, the excessive caffeine will maintain the secretion of hydrochloric acid in the stomach. Cimetidine (Tagamet) taken with meals is effective in the treatment of hyperacidity. Antacids taken before or after cimetidine (Tagamet) are effective in relieving the symptoms of hyperacidity.

A patient with hyperacidity who was prescribed aluminum-containing antacid reports constipation, headache, and dry mouth. On assessment, the nurse finds that the patient has high blood pressure. What can the nurse interpret from these symptoms?

--The patient has hypercalcemia. The nurse interprets that the patient has hypercalcemia. Aluminum-containing antacids used to reduce gastric acid can bind to phosphate and may lead to hypercalcemia. The condition manifests as constipation, headache, dry mouth, and increased blood pressure. Renal failure may be associated with high blood pressure, among other symptoms. Renal failure is not associated with symptoms such as constipation, headache, and dry mouth. Presence of gastric tumors cannot be assessed by increased blood pressure. Thrombocytopenia is assessed through a blood test, not a blood pressure test.

Why are proton pump inhibitors used in the treatment of patients with bleeding due to erosive esophagitis?

--They act directly on the proton pump. Erosive esophagitis is a condition in which irritation is caused by acid in the esophagus. Proton pump inhibitors 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. Proton pump inhibitors inhibit only the proton pump of parietal cells and reduce only gastric acids.

The nurse will teach patients that antacids are effective in treatment of hyperacidity because they:

--neutralize gastric acid. Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.

Which medication is contraindicated during pregnancy?

Misoprostol (Cytotec) The use of misoprostol (Cytotec) is contraindicated in pregnant women because it is classified under pregnancy category X and is known for its abortifacient property. Cimetidine (Tagamet) is an H2 receptor antagonist, and lansoprazole (Prevacid) a proton pump inhibitor. Both are classified under pregnancy category B and can be safely administered to pregnant women. Calcium carbonate (Tums) is a calcium-containing antacid classified under pregnancy category A. Drugs that are classified under pregnancy categories A and B are safe for pregnant woman and cause no adverse effects.