Chapter 32: Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Disease

Which medication is used in the treatment of gastric reflux esophagitis and diabetic gastroparesis? a. Metoclopramide b. Misoprostol c. Pantoprazole d. Ranitidine

ANS: A Metoclopramide is a gastric stimulant used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis, aid in small bowel intubation, and stimulate gastric emptying and intestinal transit of barium after radiologic examination of the upper gastrointestinal (GI) tract. Misoprostol is used to prevent and treat gastric ulcers caused by NSAIDs, including aspirin. Pantoprazole and ranitidine do not treat gastroparesis.

A patient who is taking NSAIDs to treat arthritis asks the nurse why misoprostol has also been prescribed. Which explanation by the nurse is accurate? a. NSAIDs often cause GI irritation that can result in peptic ulcers. b. NSAIDs promote the production of prostaglandins and reduce the incidence of gastric irritation. c. Antiulcer medications eradicate the presence of bacteria in the stomach that cause ulcers. d. Drug interactions are prevented when antiulcer medications are used in combination with NSAIDs.

ANS: A Misoprostol, a GI prostaglandin, is used to prevent and treat gastric ulcers caused by NSAIDs. Prostaglandin inhibition is effective in reducing pain and inflammation, especially in arthritis, but makes the patient more predisposed to peptic ulcers. Prostaglandins are normally present in the GI tract to inhibit gastric acid and pepsin secretion to protect the stomach and duodenal lining against ulceration. NSAIDs inhibit prostaglandin production. Bismuth subsalicylate, metronidazole, and tetracycline combination (Helidac), as well as lansoprazole, clarithromycin, and amoxicillin combination (Prevpac), are used to treat infections caused by Helicobacter pylori. Drug interactions are not prevented by the presence of antiulcer medications.

The nurse is preparing to administer medications and notes that a patient has sucralfate ordered qid. When is the best time to administer this medication? a. 1 hour before meals b. With meals c. 1 hour after meals d. With a bedtime snack

ANS: A This medication should be administered on an empty stomach. Taking the medication with meals, 1 hour after meals, or with a bedtime snack does not allow the medication to form its protective coat of the gastric mucosa.

Which organism or disorder is responsible for many cases of PUD? a. H. pylori b. Candida albicans c. Escherichia coli d. Herpes zoster

ANS: A Various combinations of antibiotics (e.g., amoxicillin, tetracycline, metronidazole, clarithromycin), bismuth, and antisecretory agents (e.g., H2 antagonists, proton pump inhibitors) are used to eradicate H. pylori. Candida albicans is the causative agent of candidiasis. Escherichia coli is a normal bowel flora. Herpes zoster is also known as shingles.

The nurse is instructing a patient recently diagnosed with GERD. Which statement by the patient indicates a need for further teaching? a. "I will avoid foods high in fat." b. "I will eat small frequent meals and have a snack at bedtime." c. "Orange juice may aggravate my symptoms." d. "I will wait 2 hours after eating lunch before lying down for a nap."

ANS: B Late-night snacks need to be avoided to reduce increased gastric secretions. The patient with GERD needs to avoid foods high in fat and should wait 2 hours after eating before lying down. Orange juice may aggravate the symptoms of a patient with GERD.

Cimetidine (Tagamet) is an example of which class of drug? a. Protokinetic agent b. Proton pump inhibitor c. Histamine (H2) receptor antagonist d. Coating agent

ANS: C All H2 receptor antagonists end in "dine." Examples in this category include cimetidine, ranitidine, famotidine, and nizatidine. An example of a protokinetic agent is metoclopramide. An example of a proton pump inhibitor is omeprazole. An example of a coating agent is sucralfate.

The nurse is planning to administer an antacid to a patient diagnosed with PUD who will receive an H2 antagonist at 8:00 AM. When is the most appropriate time for the nurse to provide the antacid to this patient? a. With the H2 antagonist b. 30 minutes prior to the H2 antagonist c. 2 hours after the H2 antagonist d. Within an hour after the H2 antagonist

ANS: C Because antacid therapy is often continued during early therapy of PUD, administer 1 hour before or 2 hours after H2 antagonist dose.

Which explanation by the nurse is accurate to include when teaching a patient who is beginning therapy for gastroesophageal reflux disease (GERD) with metoclopramide? a. "This medication decreases esophageal muscle tone to reduce reflux." b. "Peristalsis is increased, so food is digested more quickly." c. "Gastric emptying is delayed, so you may feel full for longer intervals." d. "This medication is an antikinetic agent, so you may have difficulty with motor skills."

ANS: B Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux. Metoclopramide increases lower esophageal sphincter pressure. Metoclopramide hastens gastric emptying. Metoclopramide is a prokinetic agent and does not affect motor function.

A patient with PUD asks the nurse about the action of prokinetic medications. Which explanation by the nurse is accurate? a. It blocks the formation of hydrochloric acid, reducing irritation of the gastric mucosa. b. It increases the lower esophageal sphincter muscle pressure and peristalsis. c. It reduces the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids. d. It decreases the volume of hydrochloric acid produced, increasing the gastric pH.

ANS: B Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux. Proton pump inhibitors block the formation of hydrochloric acid, reducing irritation of the gastric mucosa. Antispasmodic agents reduce the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids necessary for digestion and decrease GI motility and secretions. H2 antagonists decrease the volume of hydrochloric acid produced, increasing the gastric pH, which results in decreased irritation to the gastric mucosa.

Which is considered an acceptable time frame for a patient with gastric distress to self-medicate with over-the-counter antacids? a. Hours b. Days c. Weeks d. Months

ANS: C For indigestion, antacids should not be administered for more than 2 weeks. If after this time the patient is still experiencing discomfort, a healthcare provider should be contacted. A time frame of hours or days is less than the acceptable time interval. A time frame of months is greater than the acceptable time interval.

A postoperative appendectomy patient has a nasogastric tube and wonders why the previous nurse told him that he was receiving an IV "ulcer-preventing" medication called ranitidine. The patient states that he has never had any stomach problems in his life. Which is the best response by the nurse? a. "This medication will cause the pH in your stomach to drop." b. "This medication helps coat your stomach while the nasogastric tube is in place." c. "Because you are not eating after surgery, this medication will help reduce the hydrochloric acid your stomach is still secreting." d. "The nasogastric tube will cause peptic ulcer disease. This medication will help prevent that."

ANS: C Patients who are not eating still secrete hydrochloric acid from the stomach's parietal cells. H2 receptor antagonists block the H2 receptors, resulting in a decrease in the amount of acid secreted. The pH of the stomach contents then becomes less acidic, which reduces the stress of the mucosal lining of the stomach. Ranitidine causes the stomach contents to become less acidic as the amount of acid secreted decreases; consequently, the pH of the stomach rises. This is not a coating agent, and giving it parenterally will not work to coat the stomach. Increased gastric acid, not nasogastric tubes, causes peptic ulcer disease (PUD).

Which is a common adverse effect of magnesium-based antacid preparations? a. Heartburn b. Rebound indigestion c. Constipation d. Diarrhea

ANS: D Magnesium oxide, magnesium hydroxide, and magnesium trisilicate are used in antacid preparations. All magnesium products can cause diarrhea. Milk of Magnesia is often taken for constipation. Antacids are given to relieve heartburn. Calcium-based antacids are likely to cause rebound indigestion. Magnesium is often given as a laxative, in antacid form or as magnesium sulfate.

A patient taking misoprostol (Cytotec) to treat a gastric ulcer reports recurrent diarrhea. The nurse should encourage this patient to: a. immediately discontinue misoprostol (Cytotec). b. take with a magnesium-containing antacid. c. omit fresh fruits from diet. d. take medication with meal

ANS: D Taking medication with meals may lessen diarrhea. Diarrhea associated with misoprostol therapy is dose related. The patient should not discontinue therapy without first consulting with the healthcare provider. Magnesium-containing antacids should be avoided. Fresh fruits are considered roughage and should be encouraged.