1. Agents Used to Treat Hyperacidity and Gastroesophageal Reflux Disease
Chapter 23

2. Secretory Functions of the Stomach Lining
Parietal cells secrete hydrochloric (HCl) acid
Chief cells secrete pepsinogen
Mucoid cells secrete mucus

3. Rate varies throughout day Highest just before or during meals
Gastric Acid
Hydrochloric acid is secreted by parietal cells that are in the lining of the stomach
Rate varies throughout day
Highest just before or during meals

4. Gastric Acid
Gastric juice contains pepsin
Excess hydrochloric acid results in indigestion, sour stomach, heartburn
Causes can include a fatty meal, large meal, excessive alcohol, or emotional turmoil

5. GERD
Common disorder
Backflow of stomach contents
Leads to inflammation and pain
Esophageal erosion may result

6. Peptic Ulcer Disease (PUD)
Local lesion of the GI lining
Usually in the duodenum or stomach
Common cause is H. pylori
Proton pump inhibitors (Prilosec, Prevacid, Nexium, or Protonix) with clarithromycin, amoxicillin, tetracycline or metronidazole (Flagyl)

7. Peptic Ulcer Disease (PUD)
(cont’d)
Acid blockers (H2) may be prescribed: Zantac, Tagamet, Pepcid
Antacids
Cytoprotective agents to coat GI lining: Carafate, Cytotec, Pepto-Bismol

8. Goal of Antacid Therapy
Neutralize the acid
Inhibit pepsin activity
Increase resistance of the stomach lining
Increase tone of the lower esophageal sphincter

9. Useful in short-term therapy Rapid onset
Systemic Antacids
Useful in short-term therapy
Rapid onset
Prolonged use causes an overload on the kidneys
Example: sodium bicarbonate

10. Nonsystemic Antacids
Remain in gastrointestinal tract; useful in long-term therapy
Most of the dose remains in the gastrointestinal tract
Will not alter acid-base system
Examples: calcium carbonate (Tums, Rolaids), aluminum carbonate (Basaljel), magaldrate (Riopan), etc.

11. Antacid Interactions
Binding of other drugs to the antacid causes reduced availability of the other drugs to the client.
Chemical inactivation
Increases stomach and urine pH (alkaline), which decreases the absorption and excretion of certain drugs

12. Antacids: Nursing Interventions
Monitor for side effects
Nausea, vomiting, abdominal pain, diarrhea
With calcium-containing products: constipation, acid rebound
Monitor for therapeutic response
Notify heath care provider if symptoms are not relieved.

13. Antacids: Nursing Considerations
Chewable tablets must be chewed completely
Administration with food or drugs may reduce absorption
Do not take other drugs within 1-2 hours of antacids
Monitor stools during antacid therapy
Shake liquid antacids well
Assess response to antacid use

14. Histamine H2 Receptor Antagonists
Used to treat duodenal ulcers, gastric ulcers, and other disorders
Inhibits the action of histamine at the receptor sites of the parietal cells in the stomach
Drastic reduction of acid secretion in the stomach

15. Histamine H2 Receptor Antagonists
(cont’d)
Can occasionally cause diarrhea, muscle pain, drowsiness, rash, dizziness, and/or confusion
Not recommended for nursing mothers or children younger than 16
Most cautions are for cimetidine

16. Histamine (H2) Receptor Antagonists
Examples
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)

17. Proton Pump Inhibitors
Newest agents
Suppress gastric acid secretion
Used to treat esophagitis
Esomeprazole (Nexium) has highest healing effects
Should be taken on an empty stomach
Agents used to treat H. pylori infection (along with antibiotics)

18. Proton Pump Inhibitors
Omeprazole (Prilosec)
Blocks the final step of acid production in the stomach
Indicated for clients with:
Gastroesophageal reflux disease (GERD)
Gastric hypersecretory condition
Interactions
Causes warfarin (an anticoagulant) action to be increased