Acid Controlling Drugs

Question 1

what does the stomach secrete?

Answer 1

Hydrochloric acid (HCl)
Bicarbonate
Pepsinogen
Intrinsic factor
Mucus
Prostaglandins

Question 2

what are the different glands of the stomach?

Answer 2

Cardiac
Pyloric
Gastric
The cells of the gastric gland are the largest in number and of primary importance when discussing acid control.

Question 3

wha are the cells of the gastric glands?

Answer 3

Parietal
Chief
Mucous
Endocrine
Enterochromaffin

Question 4

what does the parietal cells do?

Answer 4

Produce and secrete hydrochloric acid
Primary site of action for many of the drugs used to treat acid-related disorders

Question 5

what does cheif cells do?

Answer 5

Secrete pepsinogen, a proenzyme
Pepsinogen becomes pepsin when activated by exposure to acid.
Pepsin breaks down proteins (proteolytic

Question 6

what do mucous cells do?

Answer 6

Mucus-secreting cells (surface epithelial cells)
Provide a protective mucus coat
Protect against self-digestion by hydrochloric acid and digestive enzymes

Question 7

what does hydrochloric acids do?

Answer 7

Secreted by parietal cells when stimulated by food, caffeine, chocolate, and alcohol
Maintains stomach at pH of 1 to 4
Acidity aids in the proper digestion of food and defenses against microbial infection via the gastrointestinal tract.
Secretion also stimulated by:
Large fatty meals
Emotional stress

Question 8

what does triple therapy do?

Answer 8

Triple therapy includes a 7- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole or quadruple therapy of a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole.

Question 9

what are the three types of acid controlling drugs.

Answer 9

Antacids
H2 antagonists
PPIs

Question 10

what do antiacids do?

Answer 10

• Basic compounds used to neutralize stomach acid
• many antacid preparations also contain the antiflatulent (antigay) drug simethicone..
• many aluminum and calcium-based formulations also include magnesium. constipating effects of aluminum and calcium.

Question 11

calcium antacids may lead to?

Answer 11

the development of kidney stones and increased gastric and acid secretions.

Question 12

sodium bicarbonate is a highly?

Answer 12

is a highly soluble antacid form with a quick onset but a short duration of action.

Question 13

antacids do not?

Answer 13

Do not prevent the overproduction of acid but instead help to neutralize acid secretions
Promote gastric mucosal defensive mechanisms

Question 14

antacids stimulate the secretions of?

Answer 14

Mucus: protective barrier against hydrochloric acid
Bicarbonate: helps buffer acidic properties of hydrochloric acid
Prostaglandins: prevent activation of proton pump

Question 15

antacids drug effects?

Answer 15

Reduction of pain and reflux associated with acid-related disorders
- Raising the gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid.
- Reducing acidity reduces pain as a result of:
Base-mediated inhibition of the protein-digesting ability of pepsin
Increase in the resistance of the stomach lining to irritation
Increase in the tone of the cardiac sphincter

Question 16

Antacids: Indications

Answer 16

Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn

Question 17

Antacids: Contraindications

Answer 17

• Known allergy to a specific drug product
• Severe renal failure or electrolyte disturbances: potential toxic accumulation of electrolytes in the antacids themselves
• Gastrointestinal obstruction: Antacids may stimulate gastrointestinal motility when they are undesirable because of the presence of an obstructive process requiring surgical intervention.

Question 18

antacids OTC

Answer 18

Over-the-counter (OTC) formulations available as:
Capsules and tablets
Powders
Chewable tablets
Suspensions
Effervescent granules and tablets

Question 19

Types of antacids

Answer 19

Used alone or in combination:
Aluminum hydroxide
Magnesium hydroxide
Simethicone
Combination aluminum hydroxide and magnesium hydroxide contain a local anaesthetic (Mucaine®).

Question 20

antacids - magnesium salts

Answer 20

Commonly cause diarrhea; usually used with other drugs to counteract this effect
Dangerous when used with renal failure; the failing kidney cannot excrete extra magnesium, resulting in accumulation
Magnesium hydroxide and mineral oil (Magnolox®)

Question 21

examples of aluminum salts

Answer 21

Combination products (aluminum and magnesium): Antacid Plus®, Diovol®, Gelusil®, Maalox®, Multiaction®

Question 22

antacids - aluminum salts

Answer 22

Have constipating effects
Often used with magnesium to counteract constipation
Often recommended for patients with renal disease (more easily excreted)
Examples

Question 22

examples of magnesium salts

Answer 22

Magnesium hydroxide and mineral oil (Magnolox®)

Question 23

antacids - calcium salts

Answer 23

Many forms but carbonate is most common
May cause constipation, kidney stones
Also not recommended for patients with renal disease—may accumulate to toxic levels
Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound)
Often advertised as an extra source of dietary calcium

Question 23

examples of calcium salts

Answer 23

Example: calcium carbonate and simethicone (Maalox, Rolaids®)

Question 24

antacids - sodium bicarbonate

Answer 24

Highly soluble Buffers the acidic properties of hydrochloric acid Quick onset but short duration May cause metabolic alkalosis Sodium content may cause problems in patients with heart failure, hypertension, or renal insufficiency.

Question 25

Antacids and Antiflatulents

Answer 25

used to relieve the painful symptoms associated with gas

Question 26

Antacids: Adverse Effects

Answer 26

Minimal and depend on the compound used - Overuse: metabolic alkalosis - Aluminum and calcium: constipation - Magnesium: diarrhea - Calcium: kidney stones, rebound hyperacidity - Calcium carbonate: produces gas and belching; often combined with simethicone

Question 26

Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products an examples would be?

Answer 26

simethicone

Question 27

atancids drug interactions -Adsorption of other drugs to antacids

Answer 27

Reduces the ability of the other drug to be absorbed into the body

Question 28

antacids drug interactions - Chelation

Answer 28

Chemical binding, or inactivation, of another drug Produces insoluble complexes Result: reduced drug absorption

Question 29

antacids dug interactions - increased stomach ph

Answer 29

Increased absorption of basic drugs Decreased absorption of acidic drugs

Question 30

antacids drug interactiins - increased urinary ph

Answer 30

Increased excretion of acidic drugs Decreased excretion of basic drugs

Question 31

H2 Receptor Antagonists

Answer 31

Reduce acid secretion All available OTC in lower-dosage forms

Question 32

H2 receptor agonists - Most popular drugs for treatment of acid-related disorders

Answer 32

- ranitidine hydrochloride (Zantac®) - famotidine (Pepcid®)

Question 33

H2 Antagonists: Mechanism of Action

Answer 33

Competitively block the H2 receptor of acid-producing parietal cells Reduce hydrogen ion secretion from the parietal cells Increase in the pH of the stomach Relieve of many of the symptoms associated with hyperacidity-related conditions

Question 34

H2 Antagonists: Drug Effect and Indications

Answer 34

Drug effect: Suppressed acid secretion in the stomach Indications: Gastroesophageal reflux disease (GERD) Peptic ulcer disease Erosive esophagitis Adjunct therapy to control upper gastrointestinal bleeding Zollinger-Ellison syndrome

Question 35

H2 Antagonists: Adverse Effects

Answer 35

Overall, very few adverse effects Central nervous system adverse effects in elderly patients include confusion and disorientation. Cimetidine may cause erectile dysfunction and gynecomastia. Thrombocytopenia has been reported with ranitidine hydrochloride and famotidine.

Question 36

H2 Antagonists: Drug Interactions(1 of 2)

Answer 36

- All H2 antagonists may inhibit the absorption of drugs that require an acidic gastrointestinal environment for absorption. Because of its potential to cause drug interactions, -cimetidine has been largely replaced by ranitidine and famotidine.

Question 37

H2 Antagonists: Drug Interactions (2 of 2)

Answer 37

- Smoking has been shown to decrease the effectiveness of H2 blockers. - For optimal results, H2 receptor antagonists are taken 1 hour before antacids.

Question 38

Proton Pump Inhibitors do what

Answer 38

The parietal cells release positive hydrogen ions (protons) during hydrochloric acid production. This process is called the proton pump. H2 blockers and antihistamines do not stop the action of this pump.

Question 39

types of proton pump inhibitors, ends with zoles.

Answer 39

lansoprazole (Prevacid®) omeprazole (Losec®) pantoprazole sodium (Pantoloc®)

Question 40

Proton Pump Inhibitors: Mechanism of Action

Answer 40

Irreversibly bind to H+/K+ adenosine triphosphatase (ATPase) enzyme This bond prevents the movement of hydrogen ions from the parietal cell into the stomach. Results in achlorhydria—all gastric acid secretion is temporarily blocked. To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.

Question 41

Proton Pump Inhibitors: Indications

Answer 41

Gastroesophageal reflux disease Erosive esophagitis Short-term treatment of active duodenal and benign gastric ulcers Zollinger-Ellison syndrome Nonsteroidal anti-inflammatory drug (NSAID)–induced ulcers Stress ulcer prophylaxis Treatment of H. pylori–induced infections Given with an antibiotic

Question 42

Proton Pump Inhibitors: Adverse Effects

Answer 42

Protein pump inhibitors (PPIs) are generally well tolerated. Possible predisposition to gastrointestinal tract infections: Clostridium difficile Osteoporosis and risk of wrist, hip, and spine fractures in long-term users Pneumonia Depletion of magnesium

Question 43

Proton Pump Inhibitors: Drug Interactions

Answer 43

Increase serum levels of diazepam and phenytoin Warfarin: increased chance of bleeding Absorption of ketoconazole, ampicillin, iron salts, and digoxin Copidogrel (Plavix): risk of MI, death Sucralfate: may delay the absorption of PPIs Food may decrease absorption of the PPIs.

Question 44

Miscellaneous Acid-Controlling Drugs

Answer 44

sucralfate misoprostol Simethicone (Ovol®)

Question 45

Sucralfate ( know this)

Answer 45

Cytoprotective drug Used for stress ulcers, peptic ulcer disease. Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas. Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse). Little absorption from the gut. May cause constipation, nausea, and dry mouth. May impair absorption of other drugs. Give other drugs at least 2 hours before sucralfate. Do not administer with other medications. Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels

Question 46

Misoprostol

Answer 46

Prostaglandin E analogue Prostaglandins have cytoprotective activity. Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate Promote local cell regeneration Help to maintain mucosal blood flow. Used for prevention of NSAID-induced gastric ulcers Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps and diarrhea.

Question 47

Simethicone

Answer 47

Antiflatulent drug Used to reduce the discomforts of gastric or intestinal gas (flatulence) Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones Result is decreased gas pain and increased expulsion via mouth or rectum.

Question 48

Nursing Implications: Antacids

Answer 48

Assess for allergies and pre-existing conditions that may restrict the use of antacids, such as: Fluid imbalances Renal disease Gastrointestinal obstruction Heart failure Pregnancy Patients with heart failure or hypertension should not use antacids with high sodium content.

Question 49

Nursing Implications: Antacids

Answer 49

Use with caution with other medications because of the many drug interactions. Administer antacids within 1 to 2 hours of other medications. Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset.

Question 49

Nursing Implications: Antacids

Answer 49

Be sure that chewable tablets are chewed thoroughly and that liquid forms are shaken well before giving. Administer with at least 240 mL of water to enhance absorption (except for “rapid-dissolve” forms).

Question 50

Nursing Implications: Antacids

Answer 50

Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers. If symptoms remain ongoing, the patient should seek medical evaluation.

Question 51

Nursing Implications: Antacids - adverse effects and therapeutic response.

Answer 51

Monitor for adverse effects. Nausea, vomiting, abdominal pain, diarrhea With calcium-containing products: constipation, acid rebound Monitor for therapeutic response. Notify the health care provider if symptoms are not relieved.

Question 52

Nursing Implications: H2 Antagonists

Answer 52

Assess for allergies and impaired renal or liver function. Use with caution in patients who are confused, disoriented, or in older adult patients. Take 1 to 2 hours before antacids. For intravenous doses, follow administration guidelines.

Question 53

Nursing Implications: Proton Pump Inhibitors

Answer 53

Assess for allergies and history of liver disease. Not all are available for parenteral administration. May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin. The granules of pantoprazole capsules may be given via nasogastric tubes Capsules may be open and their contents mixed with apple juice, but delayed-release granules are not to be crushed or chewed.