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