Chapter 35 Peptic Ulcer Disease & Gastroesophageal Disease – Flashcards
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Peptic Ulcer Disease
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Can be caused by: Helicobacter pylori (H. Pylori) [bacterial infection] Overuse of NSAIDS Smoking Psychological stress Physiologic stress Major trauma Critical illness
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GERD
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Chronic digestive disease occurring when stomach acid or bile refluxes into esophagus, irritating lining of esophagus Incompetent lower esophageal sphincter
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Circumstances contributing to GERD
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Foods (fats, chocolate) Beverages (alcohol, caffeine) Some medications Recumbent posture (lying down)
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Antacids
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Neutralizes Acids. Ex. Mylanta (Magnesium-based aluminum-containing). Titralac (Tums) (Calcium based)
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Mylanta (Antacids): Uses
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-Preventing/treating peptic ulcers -GERD -Heartburn -Gastritis *TYPICALLY USED ON AN "AS NEEDED BASIS
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Mylanta: Adverse Effects
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Diarrhea/Constipation Hypermagnesium
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Titralac (Tums): Adverse Effects
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Constipation
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Mylanta: Contraindications
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-Impaired renal function or renal failure (r/t risk for hypermagnesemia) -Appendicitis -Inflamed bowels
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Mylanta:Precautions/Interactions
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Prevents absorption of most drugs; should not take with other drugs
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Mylanta: Nursing Implications
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Do not administer with other meds - decreases absorption of those drugs taken at the same time
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Mylanta: Patient Education
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-For active ulcers, patient should take: 1 hr before and 3 hrs after meals and at bedtime for greatest acid neutralization
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Mylanta: Special Populations
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Renal Impairment - contraindicated Critically Ill - Given to prevent stress ulcers NG route (continues intragastric drip)
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Histamine 2 Receptor Anatagonists (H2 Blockers)
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Inhibits gastric acid secretion. Ex. Cimetidine (Tagamet), Famotidine (Pepcid), Ranitidine (Zantac)
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Cimetidine (Tagamet) H2 Blocker: Uses
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-Prevention/treatment of peptic ulcer disease, GERD -GI bleeding due to acute stress ulcers
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Cimetidine (Tagamet): Adverse Effects
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-In older adults: Confusion, agitation -Gynecomastia (with cimetidine mainly)
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Cimetidine (Tagamet): Precautions/Interactions
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-MANY drug interactions -Usually ↑ effects of other drugs -Renal impairment -Hepatic impairment -Pregnancy/lactation
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Cimetidine (Tagamet): Nursing Implications
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Monitor for therapeutic effects
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Cimetidine (Tagamet): Special Populations
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-Older adults - increased incidence of confusion, agitation -Hepatic & Renal Impairment - great caution advised -Critical Illness - commonly used (IV route) to prevent stress-induced peptic ulcers
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Advantage to patient of using other H2 Blockers such as Ranitidine (Zantac) INSTEAD of cimetidine (Tagamet)
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LESS drug-drug interactions!! (cimetidine has MANY drug-drug interactions!!
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Proton Pump Inhibitors
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STRONG inhibitors of gastric acid secretion; inhibits both stimulated (meal-time) and unstimulated (nocturnal) acid secretion. Ex. Omeprazole (prilosec), Pantoprazole (Protonix)
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Omeprazole (Prilosec): Uses
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-Drug class of choice for peptic ulcer disease Duodenal and gastric ulcers GERD with erosive esophagitis -Healing of duodenal and gastric ulcers may occur after **1-2 WEEKS (compared to 4 weeks with H2 Blockers)
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Omeprazole (Prilosec): Adverse Reactions, Contraindications, Precautions/Interactions
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AR: Minimal Contraindications: None Precautions/Interactions: Few **PPI's are generally well tolerated
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Omeprazole (Prilosec): Nursing Implications
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Monitor for therapeutic effects
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Omeprazole (Prilosec): Patient Education
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Administer before food intake
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Omeprazole (Prilosec): Special Population Use
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-Children - Tx GERD, peptic ulcer disease, and eradication of H. pylori -Older Adults - drug of choice for tx GERD Long-term use associated with hip fractures r/t decreased calcium absorption -Critically Ill - drugs of choice, pts tolerate well (IV) -Renal & Hepatic Impairment - no adjustments
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Adjuvant Medications for GI Issues
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Misoprostol (Cytotec), Sucralfate (Carafate)
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Misoprostol (Cytotec): Action
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-Prostaglandin -Inhibits gastric acid secretion, increases mucus & bicarb secretion, possibly aids in mucosal repair
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Misoprostol (Cyotec): Use
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-Approved for concurrent use with NSAIDS to protect gastric mucosa from NSAID-induced erosion
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Misoprostol (Cyotec): Contraindications
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-Pregnant women :This drug is also used to induce labor (off label use) - may cause uterine contractions and premature delivery or miscarriage (if less than 20 wks pregnant)
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Misoprostol (Cyotec): Patient Teaching
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Women must use contraceptives while taking this drug
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Sucralfate (Carafate): Use
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-Binds to normal and ulcerated gastric mucosa -Creates "protective coating" in stomach lining -Prevention and treatment of peptic ulcer disease
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Sucralfate (Carafate): Patient Teaching
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-Tablet is large -Must be taken twice daily Should NOT be given with antacid (requires an acidic pH for activation)
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H. Pylori: Spread By
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-fecal-oral route (most common) -Contaminated endoscopes -Biopsy forceps -NG tubes
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H. Pylori: Medication Management (Triple Therapy)
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-Combination drug therapy including: -Acid reducer (proton pump inhibitor widely used) -Two antibiotics (choice of ATB varies) -Occasionally a bismuth subsalicylate is added
