PUD and Upper GI - Ch 41

ranitidine (Zantac): drug class, MOA

-H2 blocker -blocks H2 receptors to ↓ stomach acid production/secretion

omeprazole (Prilosec): drug class, MOA

-PPI -reduces stomach acid secretion by irreversibly binding to enzyme H+, K+-ATPase → enzyme that pumps out H+ ions and ↑ acidity

aluminum hydroxide (AlternaGEL): drug class, MOA

-antacid -neutralizes stomach acid by raising pH of stomach contents

role of nurse in antacid therapy for PUD

-assess pt for signs of renal insufficiency → hypermagnesemia, watch for hypercalcemia

role of nurse in H2 blocker therapy

-assess pt't use of OTC formulations -persistent epigastric pain/heartburn may be a sx of more serious disease -assess kidney and liver func -watch pt's CBC for possible anemia during long term use -can be given IV

PPIs all end in what

-azole

gastroesophageal reflux disease (GERD)

-caused by loosening of esophageal sphincter -intense burning (heartburn) -associated w/ obesity -other causes: pregnancy, diet, infancy -can lead to barrett's esophagus which can lead to cancer

what are 6 risk factors of PUD

-family hx of PUD -smoking tobacco -caffeine -drugs (NSAIDs, corticosteroids) -excessive psychological stress -H. pylori infection

aluminum hydroxide (AlternaGEL): primary use, SE

-in combo w/ other antiulcer drugs for heartburn relief r/t PUD or GERD -minor SE, constipation -can interfere w/ inner absorption of other meds → take at least 2hrs from other meds, ideally 4hrs

gastric ulcers

-less common -age 60+ -pain may be relieved by food or may continue after meal -anorexia, weight loss, vomiting -infrequent or absent remission -more commonly associated with cancer

duodenal ulcer

-more common than gastric -ages 30-50 -gnawing or burning upper abd pain -1-3hrs after meal -pain is worse when stomach is empty -nocturnal pain, nausea, vomiting is uncommon -bleeding may occur (bright red in vomit, black tarry stools)

what are the most common drug types to treat PUD

-proton pump inhibitors (PPIs) -H2-receptor antagonists (H2 blockers) -Antacids -Antibiotics -Misc drugs

omeprazole (Prilosec): primary use, SE

-short term (4-8 weeks) PUD and GERD tx -HA, nausea, diarrhea, rash, abd pain → long term use associated w/ gastric cancer can cause low magnesium and B12 over time

all H2 blockers end in

-tidine

ranitidine (Zantac): primary use, SE

-treat PUD -well tolerated, impotence or loss of libido in men (didn't even talk about SE in lecture) -SMOKING decreases effectiveness

role of nurse for PPI therapy for PUD

-watch liver func and serum gastrin w/ long-term use -assess for drug-drug interactions -obtain pt's hx of smoking -ideally take 30mins before breakfast -can be taken w/ antacids

when should antacids be taken

2hrs before or after meals w/ a full glass of water don't take with other things unless its a combo product or HCP tells you to

what is the primary cause of peptic ulcers

H. pylori gram-neg bacterium

what is the most common cause of peptic ulcers besides H. pylori infection

NSAIDs

combination antibiotic regimen for H. pylori often includes

PPI and bismuth compound

what drug classes are used to treat GERD in addition to surgery

PPIs H2 blockers Antacids

when should you take H2 blockers

anytime, mealtime doesn't matter not with antacids though

due to the risk of getting stomach contents into the lungs it is important to assess for

bacterial infections in the lungs

PPIs work best when given when

before eating

what protects the stomach mucosa from the acidity of the stomach

bicarbonate (HCO3)

Metoclopramide (Reglan)

causes muscles in upper intestines to contract → faster gastric emptying BB: tardive dyskinesia

sucralfate (Carafate)

coats ulcer and protects it from further erosion

calcium based antacids cause

constipation

magnesium and aluminum based antacids cause

diarrhea

H2 receptor blockers can cause what

dizziness, confusion, and even psychosis

lesion in the small intestine

duodenal ulcer

what are the two muscular rings of the stomach

esophageal (cardiac) sphincter - keeps food from going back up the esophagus pyloric sphincter - regulates flow out of stomach

NSAIDs are more likely to cause what kind of ulcer

gastric ulcer

lesion in stomach

gastric ulcer

Misoprostol (Cytotec)

inhibits acid and stimulates production of mucus diarrhea and cramping prostaglandin analogue - make sure pt is not pregnant

long term PPI use is linked to what

osteopenia and osteoporosis as well as low B12

what type of cell secretes hydrochloric acid (HCl)

parietal cells

what cell secretes intrinsic factor (IF) and why is it important

parietal cells it is needed for absorption of vitamin B12

what is the primary goal when treating GERD and PUD

reducing gastric acid secretion

what is the most acidic fluid in the body (pH of 1.5-3.5)

stomach acid