Pharm prepu 37: Peptic Ulcer Disease and Hyperacidity

Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms.

A bismuth preparation is added to some regimens. Bismuth exerts antibacterial effects against H. pylori. It also increases secretion of mucus and bicarbonate, inhibits pepsin activity, and accumulates in ulcer craters.

An older client has been prescribed omeprazole for the treatment of gastresophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine?

"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." Explanation: Proton pump inhibitors like omeprazole may be the best choice for treating GERD in older patients because of fewer adverse effects and better therapeutic response with these drugs. Famotidine is a histamine-2 antagonists. The cost of the medication is not a primary factor in prescribing therapy for GERD. It is not standardly recommended to take omeprazole at bedtime.

A female client is currently taking sucralfate and has been given a prescription for ciprofloxacin for treatment of a urinary tract infection. The nurse will inform the client that she should take her medication in what way?

"Take the ciprofloxacin 2 hours before the sucralfate." Explanation: It is important for the client to take the ciprofloxacin 2 hours prior to taking sucralfate to ensure full absorption of the ciprofloxacin.

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?

Closely monitor the patient for confusion and dizziness. Explanation: The nurse should closely monitor the elderly patient who has been administered cimetidine for confusion and dizziness. When the patient is receiving an antiemetic, the nurse monitors the patient frequently for continued reports of pain, sour taste, spitting blood, or coffee-ground-colored emesis. When antacids are given to the patient, the nurse should observe the patient for concentrated urine and restlessness. When the patient is administered prolonged doses of metoclopramide, the nurse reports any sign of tardive dyskinesia or extrapyramidal symptoms to the PHCP.

Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?

Digoxin Explanation: Administering an antacid to a client taking digoxin will decrease the absorption of digoxin and result in a decreased digoxin effect. Quinidine, dextroamphetamine, and simvastatin are not affected by the use of antacids.

The nurse is caring for a client who is receiving antacids to relieve gastrointestinal discomfort. Which nursing action is most appropriate?

Give 1 hour before or 2 hours after other oral medications. Explanation: A client taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so clients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs or with food.

Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?

Gynecomastia Explanation: Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.

A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?

Infection with H. pylori Explanation: Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).

The nurse is providing care for a 51-year-old client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment?

Inspect the client's chest for the development of gynecomastia. Explanation: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Rashes, insomnia, and orthostatic hypotension are not typical adverse effects.

A client with a nasogastric tube is prescribed misoprostol. The nurse anticipates administering this drug in which manner?

Liquid formulation Explanation: The nurse should request the liquid form when administration is in a tube to decrease the chance of a clogged NG tube. Although it is appropriate to crush the tablet and mix it with apple juice, there is still a risk for clogging. Intravenous or intramuscular administration would be inappropriate. The IV route is typically preferred if the client has an existing IV line, because these drugs are irritating, and IM injections need to be given deep into the muscular tissue to minimize harm.

Antacids have not been effective in managing a client's gastroesophageal reflux disease, so the health care provider is prescribing a proton pump inhibitor. Why might the health care provider prescribe a proton pump inhibitor (PPI) rather than a histamine2 receptor antagonist (H2RA)?

PPIs suppress acid more strongly and for a longer time. Explanation: Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases.

A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?

Proton pump inhibitors Explanation: The treatment of choice for Helicobacter pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

A nurse is caring for a patient who is prescribed omeprazole for a duodenal ulcer. The patient is also taking benzodiazepines for the management of a seizure disorder. Which of the following should be the effect of the interaction between these two drugs?

Risk for toxic level of benzodiazepines Explanation: When the proton pump inhibitor is administered with benzodiazepines, there will be a risk for a toxic level of benzodiazepines. When the patient is administered sucralfate with the proton pump inhibitor, there will be a decrease in absorption of the proton pump inhibitor. When the patient is administered an antacid with opioid analgesics, there will be an increased risk of respiratory depression. There will be increased risk of bleeding when the patient is taking oral anticoagulants with the proton pump inhibitor.

The following data identified during a nursing assessment and interview. When considering risks for the development of a peptic ulcer, which situation should the nurse discuss with the client?

Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. Explanation: The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach. While the other situations may contribute to GI distress, NSAID used in primary risk factor for this client.

A client is receiving a liquid antacid. Which would the nurse instruct the client to do?

Shake the antacid thoroughly before using. Explanation: Liquid antacid preparations must be shaken thoroughly immediately before administration. Taking 1 hour before meals is a directive of administering a proton pump inhibitor. A full glass of water is taken after a client chews an antacid tablet thoroughly. Removing strong smells or odors is important for the client experiencing nausea

The nurse is caring for a female client who has been recently been prescribed misoprostol. What change in the client's health status should the nurse communicate most promptly to the primary health care provider?

The client believes that they may be pregnant. Explanation: Misoprostol is absolutely contraindicated during pregnancy because it is an abortifacient. None of the other listed aspects of the client's recent health history contraindicate the safe use of the drug

The nurse is caring for a female client who has been recently been prescribed misoprostol. What change in the client's health status should the nurse communicate most promptly to the primary health care provider?

The client believes that they may be pregnant. Explanation: Misoprostol is absolutely contraindicated during pregnancy because it is an abortifacient. None of the other listed aspects of the client's recent health history contraindicate the safe use of the drug.

A woman is prescribed a Histamine-2 (H2) antagonists. What information should the nurse provide the client concerning the use of this class of medication if a pregnancy should occur?

The safety of these drugs during pregnancy had not been established. Explanation: The safety of these drugs during pregnancy and lactation has not been established, so they should be used with caution during pregnancy or lactation. Misoprostol is an abortifacient and should never be used during pregnancy.

A female client's diagnoses include diabetes mellitus, gastric ulcer disease, and chronic renal disease. When the nurse reviews her medications with her, the nurse discover that she self-administers antacids containing magnesium. What statement is true about antacids containing magnesium?

They are contraindicated for clients with renal disease. Antacids containing magnesium are contraindicated in clients with impaired renal function.

A client diagnosed with an H. pylori-associated ulcer has been prescribed treatment that includes two antimicrobials. What does the nurse identify as the reason for using multiple antimicrobials?

Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms. Explanation: Effective treatment of an H. pylori-associated ulcer involves two antimicrobials—including amoxicillin, clarithromycin, metronidazole, or tetracycline—to reduce the risk of resistance. None of the other options present accurate information regarding the basis for treatment.

What should the nurse identify as indications for a client taking antacids? Select all that apply. gastric hyperacidity gastritis peptic esophagitis hiatal hernia diverticulosis

gastric hyperacidity gastritis peptic esophagitis hiatal hernia Antacids neutralize stomach acid by direct chemical reaction. Antacids are recommended for the symptomatic relief of upset stomach associated with hyperacidity, as well as the hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, and hiatal hernia. Diverticulosis is not an indication for the use of an antacid.

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is:

headache. Explanation: Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the client to adjust lights or temperature and avoid noise if headaches occur and to contact the health care provider if the headache becomes intolerable. Irritability, dry mouth, and heart palpitations are not associated with this drug.

What type of medication might be included in the medication therapy to treat a peptic ulcer by serving as a barrier to gastric secretions?

sucralfate Explanation: Sucralfate provides a barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production. Histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) decrease gastric acid secretion

The health care provider has prescribed sucralfate for a client with a gastric ulcer. The client asks how long he must take this medication. What is the nurse's best response to this client?

"You will need to take this medication for 4 to 8 weeks to ensure healing has occurred." Explanation: Sucralfate must be taken for 4 to 8 weeks to ensure healing of the ulcer has occurred.

When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?

Alopecia Explanation: Alopecia can occur with proton pump therapy, but it is not a common adverse effect. Common adverse effects include dizziness, headache, and cough.

A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. What is one of the preferred antibiotics?

Amoxicillin Explanation: The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

A client with a gastrointestinal (GI) disorder is prescribed the proton pump inhibitor omeprazole. Which information would the nurse include when instructing the client about this medication?

Instruct the client to swallow the capsule whole. Explanation: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. The client should be instructed to swallow the capsule whole and not open, chew, or crush the capsule. Frequent small meals should be encouraged. The medication should be taken as prescribed and doses should not be skipped. Proton pump inhibitors can cause side effects that affect the central nervous system, gastrointestinal (GI) tract, upper respiratory tract, and skin rashes in addition to electrolyte imbalances.

A 75-year-old client is treating an ulcer with antacids. Based on the client's age, the nurse expects the health care provider to prescribe a dose of antacid that compares with the average prescribed dose in what way?

Smaller than the average prescribed dose Explanation: Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.

A 30-year-old nonpregnant patient is prescribed misoprostol. Which of the following should the nurse instruct the patient as part of the teaching plan?

Use a reliable contraceptive. Explanation: The nurse should instruct the patient to use a reliable contraceptive to avoid pregnancy during the course of treatment as it can cause birth defects. The nurse should instruct the patient taking proton pump inhibitors not to chew, open, or crush the tablet but to swallow the tablet whole at least one hour before eating. The nurse needs to inform the patient to take the drug for motion sickness about one hour before travel.

When caring for a client diagnosed with a peptic ulcer, the nurse administers omeprazole and amoxicillin. What diagnostic finding indicates therapeutic effects of this drug regimen?

absence of Helicobacter pylori Explanation: Gastric acid pump or proton pump inhibitors are recommended in combination with amoxicillin and clarithromycin for the treatment of H. pylori infection. Eradication of this bacterium would be the priority outcome, due to the fact that the client is taking an antibioyic

An older adult client has been on long-term proton pump inhibitor (PPI) therapy. The nurse practitioner should focus on what assessment related to adverse effects?

bone density Explanation: Long-term use of PPIs is associated with increased risk of hip fractures in people older than 50 years of age; the risk of fractures increases the longer the medications are taken and is greater in people who take higher dosages of PPIs. Bone density assessment may thus be warranted. None of the other options are associated with this class of medications

The nurse administers ranitidine cautiously to clients with evidence of what condition?

pregnancy Explanation: Caution should be used during pregnancy or lactation because of the potential for adverse effects on the fetus or nursing baby and with hepatic or renal dysfunction, which could interfere with drug metabolism and excretion. No caution is necessary with ranitidine therapy in clients with diabetes, pulmonary disease, or migraine headaches.

The 59-year-old client who has been diagnosed with peptic ulcer disease is started on sucralfate. What is an appropriate nursing concern related to this medication?

risk for constipation Explanation: The adverse effects associated with sucralfate are primarily related to its gastrointestinal effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug.

A client who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess:

serum phosphate level. Explanation: The nurse should monitor the client's serum phosphate level because aluminum binds with phosphate. This can lower phosphate levels and cause an electrolyte imbalance. Blood glucose, urine specific gravity, and aspartate transaminase levels are not affected by this drug combination.

For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be?

20 mg bid Explanation: Famotidine should be administered 40 mg every day at bedtime or 20 mg bid. for treatment of a gastric ulcer.

A 75-year-old client is diagnosed with type 2 diabetes mellitus, hypertension, osteoporosis, and gastric ulcer disease. She is prescribed PPIs. The nurse is aware that long-term (greater than 1 year) administration of PPIs may increase the risk for which problem for this client?

Hip fractures Explanation: Proton pump inhibitors (PPIs) are known to decrease calcium absorption which can lead to hypocalcemia. This in turn affects the bones leading to osteoporosis. For clients over the age of 50, the long term use of PPIs (more than one year) will increase the risk for hip fractures due to the affect on the bones. PPTs can be used to treat gastric ulcers. It is not known to cause liver cancer.

Which of the following would a nurse expect to administer if the goal of therapy is to block the release of hydrochloric acid in the stomach?

Histamine-2 receptor antagonist Explanation: Histamine-2 (H2) antagonists block the release of hydrochloric acid in response to gastrin. Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antacids interact with acids at the chemical level to neutralize them. Prostaglandins inhibit the secretion of gastrin and increase the secretion of the mucous lining of the stomach, providing a buffer.

Why are histamine2 receptor antagonists preferred in the treatment of upper gastrointestinal (GI) disorders over traditional histamine1 receptor antagonists?

Histamine1 receptor antagonists do not block histamine effects on gastric acid production. Explanation: Traditional antihistamines or histamine1 receptor antagonists prevent or reduce other effects of histamine but do not block histamine effects on gastric acid production. Histamine2 receptor antagonists inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin.

The nurse is preparing to administer ranitidine to a client who is currently receiving warfarin. Which assessment finding should the nurse prioritize for this client?

Increased bleeding Explanation: Histamine H2 receptor antagonists when given with warfarin place the client at an increased risk for bleeding. A decreased white blood cell count occurs when histamine H2 receptor antagonists are given with carmustine. An increased risk of respiratory depression occurs when histamine H2 receptor antagonists are given with opioid analgesics. This class of drugs does not interact with any antiseizure medications. There is a risk for toxic levels of antiseizure drugs when used concomitantly with proton pump inhibitors.

A male client is receiving morphine sulfate for pain after an accident. The health care provider has also ordered cimetidine IV to assist in preventing a stress ulcer. The nurse will monitor for what effect that is caused by the interaction of these two drugs?

Increased incidence of respiratory depression Explanation: The combination of an opioid analgesic and cimetidine will cause an increase in respiratory depression

Mr. Palmer is scheduled to receive ranitidine at 9:00 am this morning. What is a correct explanation of the pharmacodynamics of ranitidine?

It inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion. Explanation: Ranitidine inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion stimulated by food, betazole, and pentagastrin. Ranitidine does not affect pepsin secretion. It has little or no effect on fasting or postprandial serum gastrin secretion. It has no effect on prolactin levels, gonadotropins, thyroid-stimulating hormone, growth hormone, cortisol, aldosterone, androgen or estrogen levels, or sperm count.

A client has sought care because of symptoms of gastroesophageal reflux disease (GERD). When teaching the client ways to minimize acid reflux, the nurse will include which recommended practice(s)? Select all that apply. -Keep the head of the bed elevated when sleeping. -Eat smaller meals rather than a smaller number of large meals. -Avoid lying down for an hour or two after meals. -Include acidic foods in the diet to reduce the quantity of gastric acid released. -Avoid the use of over-the-counter antacids.

Keep the head of the bed elevated when sleeping. Eat smaller meals rather than a smaller number of large meals. Avoid lying down for an hour or two after meals. Explanation: Small meals, sitting up after eating, and sleeping with the head of bed elevated can reduce acid reflux. For most clients, over-the-counter antacids can be used safely as part of a management strategy. Highly acidic foods do not reduce gastric acid secretion and intake should be minimized.

After teaching a group of students about proton pump inhibitors, the instructor determines that the students have understood the information when they identify which agent as the prototype proton pump inhibitor?

Omeprazole Explanation: Omeprazole is considered the prototype proton pump inhibitor.

Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?

Omeprazole Explanation: Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.

A group of nursing students are analyzing the various categories of upper gastrointestinal system drugs. The instructor determines the session is successful when the students correctly choose which drug(s) as an example of a proton pump inhibitor? Omeprazole Esomeprazole

Omeprazole Esomeprazole Omeprazole and esomeprazole are examples of proton pump inhibitors. Nizatidine is a histamine H2 receptor antagonist. Sucralfate and misoprostol are examples of miscellaneous acid reducers.

A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?

Quitting smoking will significantly increase the chance that this drug will heal your ulcer." Explanation: Smoking reverses the drug-induced inhibition of nocturnal gastric acid production and hinders ulcer healing. Cigarette smoking also is related closely to ulcer recurrence. Ranitidine should not be taken simultaneously with antacids and it does not eradicate H. pylori. It is not necessary to eat multiple small meals during the day.

A female client presents to the health care provider's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client?

Rebound acidity Explanation: Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.

Client teaching should include what instruction about antacids?

Take antacid 1 hour before other medications. Explanation: Administer the drug apart from any other oral medications approximately 1 hour before or 2 hours after to ensure adequate absorption of the other medications.

Antacids are alkaline substances primarily used to directly neutralize gastric acid in the stomach to prevent/treat PUD, GERD, heartburn, and GI bleed. In the treatment of what medical diagnosis might aluminum-based antacids be used? Select all that apply. chronic renal failure hyperphosphatemia gastresophageal reflux disease (GERD) peptic ulcer disease hypophosphatemia

chronic renal failure hyperphosphatemia Aluminum-based antacids are given to clients with chronic renal failure to decrease absorption of phosphates in food. Hypophosphatemia and osteomalacia may develop in people who ingest large amounts of aluminum-based antacids over a long period because aluminum combines with phosphates in the GI tract and prevents phosphate absorption. Aluminum compounds are rarely used alone for acid-peptic disorders.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

decreases production of gastric secretions Explanation: PPIs decrease gastric acid secretion. Antimicrobials and bismuth can eliminate H. pylori infection. Sucralfate provides a protective barrier between mucosal erosions or ulcers and gastric secretions.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

decreases production of gastric secretions Explanation: PPIs decrease gastric acid secretion. Antimicrobials and bismuth can eliminate H. pylori infection. Sucralfate provides a protective barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production.

While reviewing the medication history of a client newly prescribed omeprazole, the nurse sees that the client is also taking warfarin. What potential interaction should the nurse account for when developing the plan of care for this client?

hemorrhage Explanation: Omeprazole increases blood levels of the anticoagulant warfarin, thus creating a risk for bleeding. Such an elevation in warfarin would not increase the risk for the development of any of the other options.

A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for:

metabolic alkalosis. Explanation: Overuse of antacids containing calcium carbonate can cause alkalosis and raise urine pH.

The nurse is preparing to discharge a client who has been prescribed sucralfate. When does the nurse instruct the client to take the medication?

one hour before or 2 hours after meals and at bedtime Explanation: Administer the drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug.