Antiulcer Drugs

Question 1

Antacids

Answer 1

Drugs:

• Calcium Carbonate (chewable tablet, suspension, gum)
• Magnesium Hydroxide (suspension/tablet; osmotic laxative)
• Magnesium Hydroxide/Aluminum Hydroxide (suspension/tab)

MOA:

• Neutralizes HCL acid –> decreases pepsin activity
• Promotes healing of ulcers
• Decreases inflammation

Side Effects:
- OD of electrolytes specifically with hx of RF (Mg, Ca, Al)

Contraindication:

• ETOH
• Don’t give magnesium-hydroxide if they already have diarrhea, don’t give magnesium-hydroxide/aluminum-hydroxide if diarrhea or constipated

Nursing:

• Take up to 7 doses/day (1 & 3 hrs after meals & HS; 7 doses/day)
• Take other drugs at least 1 hr before or 4 hours after antacids
• Monitor for diarrhea as a sign of infection (low acidity = opportunistic infection)
• Chewable (must chew), suspension (shake well)
• Take with 8 oz water to ensure that the drug reaches the stomach

Question 2

Histamine 2 Receptor Blockers

Answer 2

Drugs:

• Famotidine (IV/PO)
• Cimetidine (IV/PO)
• Nizatidine (PO)

MOA:

• Reduces gastric acid by blocking H2 receptors on the stomach wall
• Promotes healing of ulcer by reducing HCL production

Contraindication:
- Renal failure

Side Effects:

• B12 deficiency (take supplement)
• Blocking androgen receptors (impotence, decreased libido, gynecomastia)
• CNS effects: lethargy, depression, confusion (so take HS; caution in elderly pts)
• Low gastric acidity –> may cause bacterial colonization
• Renal failure

Nursing:

• Take right before meals to decrease food-induced acid secretion
• Take at HS (can cause lethargy, confusion…)
• Monitor I/Os
• Labs –> renal panel & CMP
• Don’t take with antacids (lower absorption); take separately 1-2 hours
• Older adults need smaller doses d/t less gastric acid
• May cause toxicity with warfarin, phenytoin, theophylline & lidocaine**

Vegans are famished –> B12 deficiency. Also think this is why it makes you lethargic & its why you should take it at bedtime

“Fam: Wendy, Peter, Thomas, Lucy”

Question 3

Proton Pump Inhibitors (prazoles)

Answer 3

Drugs:

• Pantoprazole (IV/PO)
• Omeprazole (PO)

MOA:

• Reduce gastric acid
• Oral peak effect after several days

Side Effects:

• Diarrhea
• Insomnia
• Dizziness
• Dry mouth
• Flatulence
• Liver failure
• C.diff
• Long term use = osteoporosis

Nursing:

• Take at least an hour before meal/drugs to avoid poor digestion & absorption
• Taper off to avoid rebound acid hyper-secretion
• Oral peak effect after several days

“The zole of your foot has osteoporosis”
“ FIDDLCOD –> flatulence, insomnia, dizziness, dry mouth, liver failure, C. diff, osteoporosis, diarrhea.”

Question 4

Sucralfate

Answer 4

• Pepsin inhibitor; mucosal protective drug
• PO (tablet or oral suspension)

MOA:

• Reacts with gastric acid & forms a thick paste
• Selectively adheres to the ulcer protecting it from acid & pepsin for up to 6 hours

Side Effects:

• Constipation
• Hyperglycemia (sugar content of the drug; watch in diabetes)

Nursing:

• Give 30 mins AC & HS (QID)
• Avoid taking with other drugs (at least 2 hrs apart to prevent poor absorption of other drugs)
• Finish the course even if feeling better
• Increase activity, water & fiber to avoid constipation