1. Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Diseases
Chapter 33
Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Diseases
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2. Chapter 33
Lesson 33.1
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3. Objectives Describe the physiology of the stomach
Cite common stomach disorders that require drug therapy
Identify factors that prevent breakdown of the body’s normal defense barriers resulting in ulcer formation
Develop health teaching that incorporates pharmacologic and nonpharmacologic treatment for an individual with stomach disorders
State the drug classifications and actions used to treat stomach disorders
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4. Physiology of the Stomach
Functions
Store food
Mix food
Emptying
Types of secretory cells
Chief – secrete pepsinogen
Parietal – secrete hydrochloric acid
Mucus – secrete mucus
Hydrochloric acid is needed for optimal pH of stomach.
Parietal cells also secrete intrinsic factor needed for absorption of vitamin B12.
Mucus protects the stomach wall from injury to stomach acids and enzymes.
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5. Common Stomach Disorders
Gastroesophageal reflux disease (GERD)
Known as heartburn
Symptoms: burning, bloating, belching, regurgitation
Reflux of gastric secretions such as pepsin and hydrochloric acid into the esophagus
Peptic ulcer disease (PUD)
Several stomach disorders – commonly gastric and duodenal ulcers
Symptoms: burning, gnawing, aching
GERD is referred to as acid indigestion; PUD is commonly referred to as heartburn or sour stomach.
Always treat signs and symptoms of heartburn as cardiac disease until it is ruled out! Symptoms may resemble conditions such as ischemic heart disease, scleroderma, and gastric cancer.
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6. Patient Education and Health Promotion
Treatment of GERD and PUD
Education – weight reduction, smoking cessation, consume smaller meals, avoid eating at bedtime, avoid tight clothing over abdomen
Drug therapy – used to relieve symptoms, promote healing, prevent recurrence
Limit use of NSAIDs – switch to acetaminophen if feasible
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7. Drug Class: Antacids Actions Uses Common adverse effect: chalky taste
Buffer hydrochloric acid to a lower concentration
Uses
Treat heartburn from excessive eating and drinking
Acute ulcer treatment requires large volumes
Common adverse effect: chalky taste
Serious adverse effects: constipation, diarrhea
For specific drugs, see Table 33-1.
Therapeutic outcomes: relief of discomfort, reduced frequency of heartburn, healing of irritated tissues.
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8. Drug Class: Histamine-2 Receptor Antagonists
Actions
Block H2 receptors resulting in decreased volume of acid secreted
Uses
Treat GERD, duodenal ulcers, stress ulcers, Zollinger-Ellison syndrome
Common adverse effects
Dizziness, headache, somnolence, diarrhea, constipation
Serious adverse effects
Confusion, disorientation, hallucinations, gynecomastia, hepatotoxicity
For specific drugs, see Table 33-2.
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9. Drug Class: Gastrointestinal Prostaglandins
Drug: misoprostol (Cytotec)
Actions
Inhibit gastric acid and pepsin secretion
Uses
Prevent and treat gastric ulcers caused by NSAIDs (including aspirin)
Common adverse effect
Diarrhea
Contraindicated for use in pregnancy because of the effect of inducing uterine contractions.
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10. Drug Class: Proton Pump Inhibitors
Actions
Inhibit gastric secretion by inhibiting gastric acid pump of the parietal cells
Uses
Treat severe esophagitis, GERD, gastric and duodenal ulcers
Common adverse effects
Diarrhea, headache, fatigue, muscle pain
Serious adverse effects
Rash
For specific drugs, see Table 33-3.
Be alert to drug interactions.
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11. Drug Class: Coating Agents
Drug: sucralfate (Carafate)
Actions
Adhere to craters of an ulcer, protecting it from acids, pepsin, and bile salts
Uses
Treat duodenal ulcers; for patients who cannot tolerate other therapies
Common adverse effects
Constipation, dry mouth, dizziness
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12. Drug Class: Prokinetic Agents
Drug: metoclopramide (Reglan)
Actions
Reduce reflux, increase stomach contractions, relax pyloric valve, increase peristalsis
Uses
Treat gastric reflux esophagitis, diabetic gastroparesis; antiemetic
Common adverse effects
Drowsiness, fatigue, lethargy, dizziness, nausea
Serious adverse effects
Extrapyramidal symptoms
Be alert for drug interactions.
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13. Drug Class: Antispasmodic Agents
Actions: anticholinergic
Uses
Treat irritable bowel syndrome, biliary spasm, mild ulcerative colitis, pancreatitis, infant colic, PUD
Common adverse effects
Blurred vision; constipation; urinary retention, dry mouth, nose, throat
Serious adverse effects
Confusion, depression, nightmares, hallucinations, orthostatic hypotension, palpitations, dysrhythmias
For specific drugs, see Table 33-4.
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.