Peptic Ulcer Disease Ch. 40

Other Proton Pump Inhibitor meds (4) {Please Let Rebekah Eat}

-Pantoprazole -Lansoprazole -Rabeprazole sodium -Esomeprazole

H2 receptor antagonists are used w/

antiobiotics to treat ulcers caused by H. Pylpri

H2 receptor antagonist

are a class of drugs used to block the action of histamine on parietal cells in the stomach ---> decreasing the production of acid by these cells

Other H2 receptor antagonists (3) Call Fabio Now

- Cimetidine (Tagamet) - Famotidine (Pepcid) - Nizatidine (Axid) [PO use ONLY]

Mucosal Protectants adverse efects

- Constipation *Tell pts to increase dietary fiber/ drink at least 1500 ml/day

Proton pump inhibitors med admin

- DO not crush, break, chew, open capsules - omeprazole should be taken once/day BEFORE eating in the morning - Avoid alcohol and NSAIDs - Active ulcers should be treated for 4-6 weeks - Teach pt to notify if any signs of occult GI bleeding

For acute situations, H2 receptor antagonists can be administered IV (3)

- rantidine hydrochloride - cimetidine - famotidine

Proton Pump Inhibitor action...

-reduce gastric acid secretion by irrevirably inhibitng enzyme that produces gastric acid -reduce basal /stimuleted acid production

H2 receptor antagonists medication/food interactions (2)

1. Cimetidine can inhibit med-metabolizing enzymes ---> so it will increase levels of: - warfarin (Coumadin) - phenytoin (Dilantin) - theophyline - lidocane *If pt taking warfarin ---> monitor for signs of bleeding *Monitor INR and PT and adjust warfarin dosages accordingly *If pt taking phenytoin/theophyline/lidocane ---> monitor serum levels and adjust dosages accordingly 2. Use w/ antacids can decrease absortion of the H2 receptor antagonists. *Tell pt not to take antacid 1 hr before/after taking H2 receptor antagonists

Antibiotics used to ...

Get rid of H. pylori

osteoporosis

a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D Osteoporosis is a disease in which bones become fragile and more likely to fracture. Usually the bone loses density, which measures the amount of calcium and minerals in the bone.

PT prothrombin time

a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working. A PT test may also be called an INR Prothrombin time is measured in seconds If you are not taking blood thinning medicines such as warfarin, the normal range for your PT results is: 11 - 13.5 seconds, or INR of 0.8 - 1.1 If you are taking warfarin to prevent blood clots, your doctor will most likely choose to keep your INR between 2.0 and 3.0. If you are not taking blood thinning medicines such as warfarin, an INR result above 1.1 means your blood is clotting more slowly than desired. This may be due to: -Bleeding disorders -Disseminated intravascular coagulation -Liver disease -Low levels of Vitamin K

Peptic Ulcer

a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.

Protein Pump Inhibitor Prototype Drug

omeprazole (Prilosec)

H2 receptor antagonists prototype drug

ranitidine hydrochloride (Zantac) [can be taken w/ or w/out food]

Pepsin

the chief digestive enzyme in the stomach, which breaks down proteins into polypeptides.

Groups of meds used in Pepcid Ulcer Disease management (4)

{AAMA} - Antibiotics - Antisecretory (H2 receptor antagonists and proton pump inhibitors) - Mucosal Prtectants - Antacids

Mucosal Protectants

- Acidic stomach/duodenal environment changes med to a thick substance that adheres to ulcer ---> protects ulcer from further injury caused by acid/pepsin - sucralfate (Carafate) can stick to ulcer for up to 6hr

Antacids contrindications (3)

- Aluminum hydroxide and sodium bicarbonate = Pregnancy risk C - Don't admin if pt has GI perforation or obstruction - caution if pt has abdominal pain

Antibiotic Prototype Drugs (5) {ABCMT}

- Amoxicillan (Amoxil) - Bismuth (Pepto-Bismol) - Clarithromycin (Biaxin) - Metronidazole (Flagyl) - Tetracycline (Achromycin V/ Sumycin)

Theraputic use for Proton pump inhibitors.. (4)

- Gastric/duodenal ulcers -erosive esophagitis - GERD - hypersecratory conditions

Antacids

- Neutralize gastric - Inactivate pepsin - Mucosal protection can occur by antacid ability to stimulate production of prostaglandins

H2 receptor antagonists are prescribed for...

- Peptic Ulcers - GERD - Hypersecretory conditions (Ex Zollinger-Ellison Syndrome)

Mucosal Protectants contraindications

- Pregancy risk B - for pts who are hypersensitive to med - caution w/ renal failure

Proton pump inhibitors contrindications (6)

- Pregnancy risk B (omeprazole = C) - if pt is hypersensitive to med - if pt lactating - caution w. childen/dysphagia/liver disease - increase risk of pnemonia (*carful if client at risk) - long term use ---> increase risk of osteoporosis

Mucosal Protectants med admin

- Should be given qid (1 hour ac and at bedtime) - Can dissolve in water but DO NOT cruah/chew - Complete course of treatment

Antacids med admin

- Tablets should be chewed thoughly and then drink at least a cup of water/milk - Shake liquids - can be administered 7 x a day (1 hr ac and 1 hr bc and hs - other meds should be taken 1 hr before or after antacid

which 2 of the 4 H2 receptor antagonists meds have few adverse effects and interaction

- ranitidine hydrochloride (Zantac) - famotidine (pepcid)

H2 receptor antagonists contraindications/precautions

- These meds = Pregnancy Risk Category B - Cimetidine in older adults - H2 receptor antagonists decrease gastric acidity ---> promotes BACTERIAL COLONIZATION in stomach and secondarily to the RT. Use caution in pts w/ high risk for pneumonia (Ex pt w/ COPD)

Antacid therpaputic use (2)

- Used in PUD - symptomatic relief for GERD

Antacid drugs (4)

- aluminum carbonate (Basaljel) - magnesium hydroxide (Milk of Magnesia) - sodium nicarbonate - calcium carbonate (Tums)

Mucosal Protectants theraputic use..

- for pts w/ acute duodenal ulcers - inverstigational for gastric ulcers and GERD

Poton pump inhibitirs complications = low incidence of... (3)

- headache - diarrhea - nausea/vomitting - med pantoprazole can be administered IV. ---> may have infalmmation at injection site ---> thrombophlebitis * Monitor site for inflammation

Antacid adverse effects

-1. Al and Ca compounds ---> cause cnstipation Mg compounds cause diarhea *Tell pt to alternate compounds to not get adverse effects 2. Na compounds ---) fluid retention * Tell pts w/ hypertension/heart failure to avoid antacids w/ Na 3. Aluminum hysroxide ---> may casue hypophosphatatremia and hypomagnesemia *Monitor electrolyte level 4. Mg compounds --> cdan cause toxicity in pts w/ rena failure * Tell clients w/ renal impairment to avoid antacids w/ Mg

H2 receptor antagonists ADVERSE EFFECTS (2)

-Cimetidine may block androgen receptors ---> resilting in decreased libido and impotence Nursing intervention = Inform client - Cimetidine can cause CNS effects (lethargy , depression, confusion) Nursing Intervention = This is seen more in older adults w/ kidney/liver dysfuntion. Avoid using in older adults

Causes of Peptic Ulcer Disease (4)

-H. pylori infection -NSAIDs - Secretions (Gastric Acid and pepsin)

Antibiotic therapy What are common adverse effects

-Nausea - Diarrhea

med/food interactions w/Proton pump inhibitors (2)

1. Digoxin/phenytoin/warfarin levels may increase if used w/ omeprazole *Monitor med levels if used concurrently 2. absorbtion of ketoconazole/itraconazole/atazanavir are greatly decreased if used w ppinhibitors *avoid using concurrenty. if necessary - separate admin 2-12 hrs

Mucosal Protectants med/food interaction

1. Sucralfate can interfere w/ absorbtion of phenytoin/digoxin/warfarin/ciprofalxin *Keep a 2hr interval btwn meds to 2. Antacids interfere w/ absorbtion of sucralfate *Don't administer w/in 30 min of antacids

Most ulers occur in the first layer of the inner lining

A hole that goes all the way through the stomach or duodenum = PERFORATION. A perforation = medical emergency.

ANtacids med interactions

Al compounds bind to warfarin/tetracycline and interfere w/ abaorbtion *Tell pts to take 1 hr apart

H. Pylori

Helicobacter pylori Type of bacteria that causes infection in the stomach. It is found in about two-thirds of the world's population. It may be spread by unclean food and water, but researchers aren't sure. It causes Peptic ulcers and can also cause stomach cancer

NSAIDs

Nonsteroidal anti-inflammatory Drug Nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal anti-inflammatory medicines, are a class of drugs that provides analgesic and antipyretic effects, and, in higher doses, anti-inflammatory effects. Are a type of pain reliever. At prescription doses, these drugs also reduce inflammation. NSAIDS AND PEPTIC ULCERS Prostaglandins are natural chemicals that serve as messengers to promote inflammation. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammation and the symptoms and signs of inflammation, pain, tenderness, and fever. However, certain prostaglandins also are important in protecting the stomach lining from the corrosive effects of stomach acid as well as playing a role in maintaining the natural, healthy condition of the stomach lining.

H2 receptor antagonists action does...

Suppress secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining the stomach

Nurse admin for H2 receptor antagonists

Tell pt to: - avoid foods that promote gastric secretion - have good nutrition - avoid smoking/alcohol (smoking can delay healing) - avoid aspirin and other NSAIDs (unless low dose for cardiovascular disease) - discourage OTCs - notify provider of any sign of occult GI bleeding (ex. coffee ground emesis)

How should the antibiotics be used

Therapy used include 2-3 antibiotics for 14 to increase effectiveness minimize drug resistance *Nurse should tell pt to to take FULL course of prescribed med

Antacid prototype drug

aluminum hydroxide ( Amphejel)

Peptic ulcer treatment w/ H2 receptor antagonists time...

usually = PO BID until ulcer healed ---> then followed by maintenance dose usually QHS