Week 2: GI Tract - Drugs for PUD

Question 1

What is the goal of using drugs for PUD? (4)

Answer 1

• Alleviate symptoms
• promote healing
• Prevent complications (hemorrhage, perforation, obstruction)
• Prevent recurrence

Question 2

What are the 4 types of drugs that are used for PUD?

Answer 2

• H2 receptor antagonist
• Proton pump inhibitors
• Other antacids
• antibiotics

Question 3

Many of the medications for PUD can also be used to manage GERD. Which 3 types of drugs are those?

Answer 3

• H2 receptor antagonist
• Proton pump inhibitors
• Other antacids

Question 4

What is the goal of drug therapy for GERD? (3)

Answer 4

1. Alleviate symptoms
2. promote healing of esophageal mucosal injury (ulceration or bleeding)
3. Prevent complications like esophageal strictures, Barrett’s esophagus, etc.

Question 5

What is the goal of drug therapy for PUD? (4)

Answer 5

• Alleviate symptoms
• promote healing of gastric/duodenal mucosa
• Prevent complications (hemorrhage, perforation, obstruction)
• Prevent recurrence

Question 6

Which medication is a histamine-2 receptor antagonist?

Answer 6

• ranitidine

Question 7

What is the difference between H1 receptor antagonists (antihistamines) and H2 receptor antagonists?

Answer 7

• H1 are targeted towards allergy symptoms
• H2 receptors are located in the parietal cells of the stomach

Question 8

What occurs when you block the H2 receptors?

Answer 8

• reduces the volume of gastric juice and decreases the concentration of acid

Question 9

How long does it take to heal gastric and duodenal ulcers with ranitidine?

Answer 9

• requires long term therapy, 6-12 weeks

Question 10

What are the indications for using ranitidine? (2)

Answer 10

• PUD
• GERD

Question 11

What are the adverse effects of ranitidine? (4)

Answer 11

CNS:
- confusion
- hallucinations
- CNS depression (cross BBB poorly so rare)

• increased risk for pneumonia (loss of acidic buffer means increased pH)

Question 12

What are nursing considerations for ranitidine? (3)

Answer 12

• Assess for epigastric pain, abd pain or signs of GI bleeding (hematemesis, frank blood or occult blood in stool)
• Assess for signs of confusion (esp. in older adults)
• Administer antacids an hour apart from other medications
• Monitor for signs of pneumonia

Question 13

Which medication is an example of a proton pump inhibitor?

Answer 13

omeprazole (Losec)

most effective in suppressing gastric acid secretion

Question 14

What is the MOA of omeprazole?

Answer 14

• causes irreversible inhibition of H=, K+ ATPase, the enzyme that generates gastric acid

Question 15

A single dose of omeprazole inhibits acid production by ___% in 2 hours

Answer 15

97

Question 16

Is the effect of omeprazole reversible? (2)

Answer 16

• Irreversible
• no new acid until new enzyme is made, which may take days to weeks

Question 17

Why is omeprazole enteric coated? (2)

Answer 17

• Drug is acid-labile
• enteric coated will dissolve in duodenum

Question 18

What are the indications for omeprazole? (2)

Answer 18

• PUD
• GERD

Question 19

What are the minor adverse effects of omeprazole? (3)

Answer 19

• Headache
• Diarrhea
• N+V

Question 20

What are the more severe adverse effects of omeprazole? (4)

Answer 20

• Pneumonia
• Fractures (calcium is absorbed in highly acidic environments, but there is decreased absorption)
• Rebound acid hypersecretion DYSPEPSIA
• Hypomagnesemia (likes acidic environments)

Question 21

What are nursing considerations for omeprazole? (4)

Answer 21

• Administer before meals
• Monitor serum Mg with prolonged use
• Monitor for signs of pneumonia
• Monitor for fractures