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

2. Secretory Functions of the Stomach Lining p564
Parietal cells secrete hydrochloric (HCl) acid
Chief cells secrete pepsin
Mucoid cells secrete mucus
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

3. Stomach Hyperchlorhydria p564
Condition of excess hydrochloric acid
Produced from:
Eating high-fat meals
Increased alcohol intake
Emotional turmoil

4. GERD p564 Gastroesophageal reflux disease Results from regurgitation
Leads to inflammation in LES sphincter and esophagus
results in
If unresolved, esophageal erosion may result

5. Peptic ulcer disease (PUD) p565
A peptic ulcer is a local lesion of the gastrointestinal lining
Duodenal ulcer
Gastric ulcer
Role of H. pylori

6. Goal of Antacid Therapy p565
Neutralize the acid
General goal of antacid therapy is pain relief

7. Systemic Antacids p 566 Useful in short-term therapy Rapid onset
Prolonged use : overload on the kidneys, acid/base and electrolyte disturbances
Example: sodium bicarbonate
Cause rebound hyperacidity

8. Nonsystemic Antacids Table 24-1 pg 567-568
Three Forms of OTC non-systemic antacids
Calcium based
Aluminum based
Magnesium based
Mechanism of action
Neutralize acid
Acid rebound may result from large doses of antacids, particularly Ca+ based antacid

9. Side Effects Nonsystemic antacids p567-568
Magnesium: diarrhea
Aluminum: constipation
Calcium: constipation
Administration time

10. Antacid Interactions p566
Binds with drugs
Promotes alkalinity of GI tract
Avoid simultaneous administration of antacids and antibiotics.
Don’t take oral drugs or enteric coated med within 1-2 hours of taking an antacid

11. Simethicone p566
Simethicone eliminates gas bubbles

12. Nursing Interventions antacids p572-573
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. Histamine H2 receptor antagonists Table 24-2 p569
Action: Inhibit action of histamine at H2 receptor sites of the parietal cells in the stomach
Used to treat PUD
Side effects:
Diarrhea, muscle pain, rash, drowsiness, dizziness, confusion in some patients

14. Histamine (H2) Receptor Antagonists “H2 blockers” p569
Examples
Cimetidine (Tagamet) (prototype)
Famotidine (Pepcid)
Ranitidine (Zantac)

15. Cimetidine p569
Contraindicated in nursing mothers or children younger than 16 years
Cimetidine:
anti-androgenic effects
CNS effects
Cigarette smoking diminishes the effects of cimetidine.
Antacids will reduce the absorption of cimetidine

16. Proton Pump Inhibitors p570
Action: blocks the final step of acid production in the stomach Result: decreased hydrochloric acid
Examples:
Omeprazole (Prilosec)
Esomeprazole magnesium (Nexium)
Indicated for clients with:
GERD and esophagitis
PUD
Interactions
Increases effects of warfarin

17. Proton pump inhibitors cont p570
Side effects:
Diarrhea, abdominal pain, nausea
Used in combination with clarithromycin and amoxicillin for 14 days for treatment of H. pylori infections

18. Sucralfate (Carafate) p571
Sucralfate: derivative of sucrose.
Sucralfate combines with protein at the ulcer site to form an adherent complex
Adverse effects: Nausea, constipation, diarrhea

19. Nursing considerations for pt with PUD p573
Observe for s/s of complications for PUD
Hemorrhage
Obstruction
Perforation
Teach lifestyle behaviors that contribute to PUD
Smoking, alcohol, coffee, cola, stress
ASA, ibuprofen, naproxen are contraindicated in patients with PUD
Protein and calcium in milk are stimulators of hydrochloric acid secretion
Teach that ulcer pain often subsides prior to ulcer being healed. Pt to remain on meds until DC by doctor. .

20. Metoclopramide (Reglan) p571
Prokinetic agent
Increases gastric motility
Actions:
Promotes gastric emptying
Increases peristalsis
Decreases gastroesophageal reflux
Useful in treating diabetic gastroparesis

21. Metoclopramide (Reglan) p571
Adverse effects
Extrapyramidal symptoms
Central nervous system depression
Gastrointestinal upset
Contraindicated in pt with epilepsy or antipsychotic drugs that can cause extrapyramidal symptoms

22. Gastrointestinal enzymes p572
Pancreatic enzymes
Pancrelipase and pancreatin
Lactase enzyme
For pt who have developed lactose intolerance
Symptoms of lactose intolerance
Diarrhea, flatulence, bloating with ingestion of dairy products