1. Chapter 48 Antiulcer Drugs
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2. Peptic Ulcers Peptic ulceration Mucosal lining erosion Hypersecretion
Esophageal
Gastric
Duodenal
Hypersecretion
HCl
Pepsin
pH of 2 to 5
Common Sites of Peptic Ulcers
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3. Peptic Ulcers (Cont.) Predisposing factors Symptoms
Helicobacter pylori (H. pylori)
Mechanical
Genetic
Environmental
Drugs
Stress ulcer following a critical situation
Symptoms
Gnawing, aching pain after eating
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4. Gastroesophageal Reflux Disease (GERD)
Also called reflux esophagitis
Inflammation of the esophageal mucosa caused by reflux of gastric acid content into the esophagus
Main cause is an incompetent lower esophageal sphincter.
Smoking tends to accelerate the disease process.
Medical treatment for GERD is similar to the treatment for peptic ulcers.
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5. Nonpharmacologic Measures
Avoid tobacco.
Avoid alcohol.
Avoid hot, spicy, and greasy foods.
Take any NSAIDs, including aspirin and oral glucocorticoids, with food or in decreased dosage.
Sit upright.
Do not eat before bedtime.
Wear loose-fitting clothing.
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6. Actions of the Seven Antiulcer Drug Groups
Antiulcer Drugs
Tranquilizers
Anticholinergic drugs
Antacids
H2 blockers
Proton pump inhibitors
Pepsin inhibitor
Prostaglandin E1 analog
Actions of the Seven Antiulcer Drug Groups
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7. Antiulcer Drugs (Cont.)
Tranquilizers
Chlordiazepoxide (Librium)
Clidinium bromide (Quarzan)
Reduce vagal stimulation, decrease anxiety
Anticholinergics
Propantheline (Pro-Banthine)
Inhibits release of HCl by blocking acetylcholine and histamine
Take before meals
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8. Antiulcer Drugs (Cont.)
Antacids: neutralize hydrochloric acid and reduce pepsin activity
Sodium bicarbonate (Alka-Seltzer)
Calcium carbonate (Tums)
Magnesium (Mg) hydroxide/aluminum hydroxide (Maalox)
Aluminum (Al) hydroxide (Amphojel)
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9. Nursing Process: Antacids
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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10. Antiulcer Drugs (Cont.)
Histamine2 blockers
Cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid)
Action
Reduce gastric acid by blocking H2 receptors of parietal cells in stomach
Promote healing of ulcer by eliminating cause
Side effects
Headaches, dizziness, diarrhea, constipation, reversible impotence, gynecomastia
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11. Histamine2 Blockers Drug and laboratory interactions
Cimetidine interacts with oral anticoagulants, theophylline, caffeine, phenytoin (Dilantin), diazepam (Valium), propranolol (Inderal), phenobarbital, and calcium channel blockers.
Cimetidine can cause an increase in blood urea nitrogen (BUN), serum creatinine, and serum alkaline phosphatase.
Neither cimetidine nor ranitidine should be taken with antacids.
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12. Nursing Process: Histamine2 Blockers
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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13. Antiulcer Drugs (Cont.)
Proton pump inhibitors
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
Dexlansoprazole (Dexilant)
Action
Reduce gastric acid by inhibiting hydrogen/potassium ATPase
Side effects
Headache, insomnia, dizziness, dry mouth, flatulence, abdominal pain
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14. Antiulcer Drugs (Cont.)
Pepsin inhibitors (mucosal protective drugs)
Sucralfate (Carafate)
Action
Combines with protein to form thick paste covering ulcer, protects from acid and pepsin
Side effects
Constipation
Nursing interventions
Given 30 minutes before meals and bedtime
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15. Nursing Process: Pepsin Inhibitors
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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16. Antiulcer Drugs (Cont.)
Prostaglandin analogue
Misoprostol (Cytotec)
Action
Inhibits gastric acid secretion and protects mucosa
Side effects
GI distress, constipation
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17. Case Study
A patient is suspected to have peptic ulcer disease from H. pylori. The patient asks the nurse what kind of testing will be done to determine the cause of the peptic ulcer. The nurse will inform the patient that
blood cultures will need to be drawn.
a biopsy of the stomach will be done.
a breath test will be performed.
computerized scanning will identify if H. pylori is present.
Answer: C
Rationale: In the past, endoscopy and a biopsy of the gastric antrum were needed to check for H. pylori. Currently a noninvasive breath test, the Meretek UBT, can detect H. pylori. This test consists of drinking a liquid containing 13C urea and breathing into a container. If H. pylori is present, the bacterial urease hydrolyzes the urea, releasing 13CO2, which is detected by a spectrometer. This test is 90% to 95% effective for detecting H. pylori. In addition, a serology test may be performed to check for antibodies to H. pylori.
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18. Case Study
The patient tells the nurse that he has been treating his stomach pain with a lot of calcium carbonate. It is most important for the nurse to assess the patient for
Burnett’s syndrome.
hypernatremia.
metabolic alkalosis.
acid rebound.
Answer: A
Rationale: Hypercalcemia and Burnett’s syndrome, formerly called milk-alkali syndrome, can result from excessive use of calcium carbonate. Excess sodium bicarbonate use may cause hypernatremia and water retention, metabolic alkalosis caused by excess bicarbonate, and acid rebound.
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19. Case Study
The patient is ordered cimetidine (Tagamet). It is most important for the nurse to teach the patient about what dietary needs?
Avoid use of salt substitutes.
Eat foods rich in vitamin B12.
Eat a high-protein diet.
Avoid citrus foods.
Answer: B
Rationale: Teach patient to eat foods rich in vitamin B12 to avoid deficiency as a result of drug therapy.
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20. Practice Question #1
Which medications are most likely to be included in a dual drug therapy program for peptic ulcer disease from H. pylori?
Omeprazole and clarithromycin
Tetracycline and metronidazole
Ranitidine and amoxicillin
Ciprofloxacin and sucralfate
Answer: A
Rationale: Omeprazole and clarithromycin are commonly included in a dual drug therapy program for peptic ulcer disease from H. pylori.
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21. Practice Question #2
The nurse has taught a patient about sucralfate (Carafate). Which statement indicates that the patient requires further teaching?
“I need to increase my fluid intake.”
“I need to report pain or vomiting of blood.”
“I need to take Carafate 30 minutes after meals.”
“I need to take Maalox 30 minutes before or after Carafate.”
Answer: C
Rationale: Carafate should be taken 30 minutes before meals, not after. Fluids should be encouraged to prevent constipation and dry mouth. The patient should report any pain or vomiting of blood. Antacids should be taken either 30 minutes before or 30 minutes after sucralfate (Carafate).
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22. Practice Question #3
A patient with peptic ulcer disease is noted to have a positive breath test for H. pylori. The nurse would anticipate treating the patient with
antacids and narcotics.
pepsin inhibitors and antiemetics.
proton pump inhibitors and antibiotics.
emetic agents and tranquilizers.
Answer: C
Rationale: A common treatment protocol for H. pylori is triple antibiotic therapy and a proton pump inhibitor.
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23. Practice Question #4
An older adult patient reports taking aluminum hydroxide (Amphojel) on a daily basis to relieve symptoms of GERD. The nurse needs to evaluate for which condition?
Constipation
Diarrhea
Flatulence
Abdominal pain
Answer: A
Rationale: Use of aluminum hydroxide most often causes constipation. Magnesium products can cause diarrhea.
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24. Practice Question #5
When administering the histamine2 blocker ranitidine (Zantac), the nurse will
monitor laboratory results because ranitidine decreases the effect of oral anticoagulants.
separate ranitidine (Zantac) and antacid dosage by at least 1 hour if possible.
teach the patient to avoid foods rich in vitamin B12.
expect a reduction in the patient’s pain to occur after 5 days of therapy.
Answer: B
Rationale: Antacids can be given 1 hour before or after ranitidine (Zantac) as part of the antiulcer drug regimen. Ranitidine (Zantac) can increase the effect of oral anticoagulants. Patients on ranitidine (Zantac) should eat a diet rich in vitamin B12 to avoid deficiency as a result of drug therapy. The patient’s abdominal pain is expected to decrease after 1 to 2 weeks of drug therapy.
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25. Practice Question #6
A patient with a gastric ulcer is ordered sucralfate (Carafate). This medication works to
calm the patient to reduce acid production.
block the H2 receptors.
neutralize the gastric acids.
coat the gastric lining.
Answer: D
Rationale: Sucralfate (Carafate) is a mucosal protective drug. It forms a viscous substance that covers the ulcer and protects it from acid and pepsin.
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26. Practice Question #7
A patient who complains of gastric distress from NSAIDs such as aspirin or indomethacin will most likely benefit from the administration of which medication?
Misoprostol (Cytotec)
Lansoprazole (Prevacid)
Magaldrate (Riopan)
Magnesium trisilicate (Gaviscon)
Answer: A
Rationale: Patients who complain of gastric distress from NSAIDs such as aspirin or indomethacin prescribed for long-term therapy can benefit from misoprostol.
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