1. Chapter 24 Agents Used to Treat Hyperacidity and Gastroesophageal Reflux Disease

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 2 Secretory Functions of the Stomach Lining Parietal cells secrete hydrochloric (HCl) acid Chief cells secrete pepsinogen Mucoid cells secrete mucus

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 3 Stomach Hyperchlorhydria Produced from:  Eating high-fat meals  Increased alcohol intake  Emotional turmoil

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 4 Goal of Antacid Therapy Neutralize the acid Inhibit pepsin activity Increase resistance of the stomach lining Increase tone of the lower esophageal sphincter

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 5 Antacids Three Forms 1. Aluminum 2. Magnesium 3. Calcium Mechanism of action  Neutralization of gastric acidity  Low doses promote gastric mucosal defensive mechanisms

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 6 Systemic Antacids Useful in short-term therapy Rapid onset Prolonged use causes an overload on the kidneys  Example: sodium bicarbonate

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 7 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 carbohydrate (Tums, Rolaids), aluminum carbonate (Basaljel), magaldrate (Riopan), etc.

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 8 Side Effects and Adverse Effects Magnesium: diarrhea Aluminum: constipation Calcium: constipation

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 9 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

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 10 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.

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 11 Histamine (H 2 ) Receptor Antagonists Examples  Cimetadine (Tagamet)  Famotidine (Pepcid)  Nizatidine (Axid)  Ranitidine (Zantac)

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 12 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

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 13 Helicobacter Pylori An organism associated with the development of peptic ulcer disease Treatment  Metronidazole (Flagyl), an antimicrobial agent, along with bismuth subsalicylate (Pepto-Bismol) and tetracycline (antimicrobial) for 4 weeks to eradicate Helicobacter pylori

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 14 Metoclopramide (Reglan) A drug that stimulates the motility of the upper GI tract without stimulating the production of gastric, biliary, or pancreatic solutions Action  Increases peristalsis in the duodenum and jejunum  Decreases gastroesophageal reflux (continues)

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 24 - 15 Metoclopramide (Reglan) Adverse effects  Produces extrapyramidal (Parkinson-like symptoms) effects  Central nervous system depression  Gastrointestinal upset (continued)