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    Anti Ulcer Drugs

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    Pam Lala
    Chapter 47 ANTIULCER DRUGS Elsevier items and derived items © 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 1 Physiology of the Stomach  Primary Functions  Storing food  Mixing food with gastric secretions  Slowly emptying the stomach  Types of Secretory cells  Chief cells – pepsinogen, inactive enzyme  Parietal cells – hydrochloric acid by stimulation of acetylcholine from cholinergic fibers, gastrin and histamine  Mucus cells – mucus that coats stomach wall Elsevier

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    Anti Ulcer Drugs

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    Chapter 47 ANTIULCER DRUGS Elsevier items and derived items © 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 1 Physiology of the Stomach  Primary Functions  Storing food  Mixing food with gastric secretions  Slowly emptying the stomach  Types of Secretory cells  Chief cells – pepsinogen, inactive enzyme  Parietal cells – hydrochloric acid by stimulation of acetylcholine from cholinergic fibers, gastrin and histamine  Mucus cells – mucus that coats stomach wall Elsevier

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    Chapter 47 ANTIULCER DRUGS Elsevier items and derived items © 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 1 Physiology of the Stomach  Primary Functions  Storing food  Mixing food with gastric secretions  Slowly emptying the stomach  Types of Secretory cells  Chief cells – pepsinogen, inactive enzyme  Parietal cells – hydrochloric acid by stimulation of acetylcholine from cholinergic fibers, gastrin and histamine  Mucus cells – mucus that coats stomach wall Elsevier

    Copyright:

    Attribution Non-Commercial (BY-NC)
    295 views25 pages

    Anti Ulcer Drugs

    Uploaded by

    Pam Lala
    Chapter 47 ANTIULCER DRUGS Elsevier items and derived items © 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 1 Physiology of the Stomach  Primary Functions  Storing food  Mixing food with gastric secretions  Slowly emptying the stomach  Types of Secretory cells  Chief cells – pepsinogen, inactive enzyme  Parietal cells – hydrochloric acid by stimulation of acetylcholine from cholinergic fibers, gastrin and histamine  Mucus cells – mucus that coats stomach wall Elsevier

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    Attribution Non-Commercial (BY-NC)
    of 25

    Chapter 47

    ANTIULCER DRUGS

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Physiology of the Stomach

    Primary Functions
    Storing food Mixing food with gastric secretions Slowly emptying the stomach

    Types of Secretory cells


    Chief cells pepsinogen, inactive enzyme Parietal cells hydrochloric acid by stimulation

    of acetylcholine from cholinergic fibers, gastrin and histamine Mucus cells mucus that coats stomach wall
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 2

    Peptic Ulcers

    Peptic Ulceration
    Mucosal

    lining erosion
    Esophageal Gastric Duodenal

    Hypersecretion HCl Pepsin pH of 2-5

    GERD
    Common sites of peptic ulcers.

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Peptic Ulcers

    Predisposing factors
    Helicobacter pylori Mechanical Genetic Environmental Drugs

    (H. pylori)

    Symptoms
    Aching

    pain

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Nonpharmacologic Measures

    Avoid tobacco Avoid alcohol Weight loss Avoid hot, spicy, and greasy foods Take any NSAIDs, including aspirin and oral glucocorticoids, with food or in decreased dosage Sit upright Do not eat before bedtime Wear loose-fitting clothing
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 5

    Antiulcer Drugs

    Tranquilizers Anticholinergic drugs Antacids Histamine2 blockers Proton pump inhibitors Pepsin inhibitor Prostaglandin E1 analog Prokinetic drugs Antispasmodic drugs

    Actions of the seven antiulcer drug groups.

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Antiulcer Drugs

    Tranquilizers decrease stimulation of vagus nerve Anticholinergic drugs decrease acetylcholine Antacids neutralize gastric acid, thereby causing gastric contents to be less acidic Histamine2 blockers decrease the volume of HCl produced, increasing gastric pH and thereby resulting in decreased irritation of gastric mucosa Proton pump inhibitors block the formation of HCL, reducing irritation of gastric mucosa

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Antiulcer Drugs

    Pepsin inhibitor (Coating agents) provide a protective covering over the ulcer crater Prostaglandin E1 analog inhibit gastric acid and pepsin secretion to protect ulceration in the stomach & duodenum

    Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis
    Antispasmodic agents reduce the secretion of saliva, HCl, pepsin, bile and other enzymes; decrease GI motility

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Antiulcer Drugs (contd)

    Tranquilizers

    Chlordiazepoxide and clidinium (Librax) is combination of anxiolytic/anticholinergic Glycopyrrolate (Robinul) Reduces vagal stimulation, decreases anxiety Propantheline (Pro-Banthine) Inhibits release of HCl by blocking acetylcholine and
    histamine Take with meals to decrease acid secretion

    Anticholinergics

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    Antiulcer Drugs (contd)

    Antacids

    Aluminum (Al) hydroxide (Amphojel) Magnesium (Mg) hydroxide/aluminum hydroxide (Maalox) Calcium carbonate (Tums) Sodium bicarbonate (Alka-Seltzer) (systemic)

    Action

    Neutralize gastric acid, reduce pepsin activity

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    10

    Antiulcer Drugs (contd)

    Systemic side effects

    Sodium excess, water retention, metabolic alkalosis, acid rebound

    Nonsystemic side effects

    Mg: diarrhea; Al: constipation Chalky taste

    Drug Interactions

    Inhibits tetracycline, ciprofloxacin, ketoconazole, digoxin, iron compounds Increases Levodopa absorption Increases urinary pH that inhibits excretion of quinidine and amphetamines
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 11

    Antiulcer Drugs (contd)

    Histamine2 blockers

    Cimetidine (Tagamet), Ranitidine (Zantac) Famotidine (Pepcid), Nizatidine (Axid) Action Reduce gastric acid by blocking H2 receptors of
    parietal cells in stomach Promote healing of ulcer by eliminating cause

    Side effects Headaches, dizziness, diarrhea, constipation,

    reversible impotence, gynecomastia, hepatotoxicity Drug Interactions Inhibits metabolism or excretion of benzodiazepines, theophylline, B-blockers, phenytoin, lidocaine, quinidine Enhances warfarin anticoagulating effects
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 12

    Antiulcer Drugs (contd)

    Proton pump inhibitors


    Esomeprazole (Nexium), Pantoprazole (Protonix) Omeprazole (Prilosec), Lansoprazole (Prevacid) Action Reduce gastric acid by inhibiting gastric acid

    (hydrogen/potassium ATPase) pump of stomachs parietal cells

    Side effects Headache, insomnia, dizziness, dry mouth, flatulence,

    abdominal pain, rashes Drug Interactions Inhibits metabolism or excretion of diazepams, phenytoin, warfarin, Enhances theophylline metabolism
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 13

    Antiulcer Drugs (contd)

    Pepsin inhibitors

    Sucralfate (Carafate) Action Combines with protein to form thick paste covering
    ulcer, protects from acid and pepsin

    Side effects Constipation, dry mouth, dizziness Nursing Interventions Given 30 min before meals and bedtime

    Drug Interactions Interferes with absorption of tetracyclines, omeprazole and lansoprazole

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    14

    Antiulcer Drugs (contd)

    Prostaglandin E1 analog

    Misoprostol (Cytotec) Action Inhibits gastric acid and pepsin secretion and
    protects mucosa Induce uterine contractions

    Side effects GI distress, diarrhea Contraindications Pregnancy and lactation

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    15

    Antiulcer Drugs (contd)

    Prokinetic Agents

    Cisapride (Propulsid) Action Stimulates GI motility by stimulating cholinergic nerve


    fibers Increases lower esophageal sphincter pressure and esophageal motility, accelerates gastric emptying an intestinal transit

    Side effects Headache, diarrhea, nausea Dizziness, rapid or irregular heartbeat

    Drug Interactions Anticholinergics and narcotics decrease therapeutic effects of cisapride Antifungals, phenothiazines, H2 antagonists, diuretics and antiviral agents and grapefruit inhibits metabolism of cisapride
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 16

    Antiulcer Drugs (contd)

    Antispasmodic Agents

    Atropine, Scopolamine Action Acts by preventing acetylcholine from attaching tot the
    cholinergic receptors in the GI tract

    Side effects Blurred vision, constipation, urinary retention, dry mouth Orthostatic hypotension, palpitations, arrhythmias,

    hallucinations Drug Interactions Amantadine, tricyclic antidepressants and phenothiazines potentiates therapeutic effects of antispasmodics

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    17

    Case Study
    A client has peptic ulcer disease due to H. pylori. An antibiotic and proton pump inhibitor have been ordered.

    Critical Thinking Explain the importance and use of a dual, triple, or quadruple drug therapy program in the eradication of this bacterial infection.

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    18

    Quiz for Finals


    1. Which of the following drug classification of antiulcer drugs provide a protective covering over the ulcer crater? a. Proton pump inhibitors b. Histamine2 blockers c. Pepsin inhibitor d. Prostaglandin E1 analog 2. Which of the following nursing actions is appropriate when administering Diazepam with Omeprazole knowing the latter drug inhibits the metabolism or excretion of Diazepam? a. Suggest to the MD to decrease the dosage of diazepam b. Administer the dosage of diazepam as ordered c. Increase the dosage of diazepam d. Suggest to the MD to decrease dosage of omeprazole
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 19

    Quiz for Finals


    3. Which of the following drug classification of antiulcer drugs neutralize gastric acid, thereby causing gastric contents to be less acidic? a. Proton pump inhibitors b. Histamine2 blockers c. Pepsin inhibitor d. Antacids 4. Which of the following assessment findings should the nurse watch out for when administering Warfarin with Cimitedine knowing the latter drug enhances the effects of Warfarin ? a. respiratory distress b. hypertension and tachycardia c. black tarry stools and hematuria d. allergic reactions
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 20

    Quiz for Finals


    5. Which of the following diet should the nurse restrict the client when taking aluminum hydroxide (Amphojel)? a. pineapple b. green leafy vegetables c. banana d. all of the above 6. The client is diagnosed with peptic ulcer disease. Which of the following drug acts on the parietal cells in the stomach that reduces the production of HCL acids to prevent further ulcerations? a. Maalox b. Omeprazole c. Sucralfate d. Cisapride
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 21

    Quiz for Finals


    7. Which of the following clients will the nurse advise to restrict from taking misoprostol, a prostaglandin analog? a. non-nursing mother b. hypertensive mother c. pregnant woman d. woman taking oral contraceptives 8. The client diagnosed with peptic ulcer disease is taking Sucralfate. Which of the following health teachings in taking the medication should the nurse give? a. take the drug 30mins or 1 hour before meals b. take the drug 1 hour after meals c. take the drug with meals d. take the drug with other medications
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 22

    Quiz for Finals


    9. When taking digoxin with antacids, which of the following should the nurse monitor closely knowing that antacids can interfere with digoxin? a. respiratory distress b. hypersensitivity reactions c. dysrhythmias d. urinary retention 10. The client diagnosed with peptic ulcer disease is taking anticholinergics. Which of the following assessment findings will the nurse NOT likely to observe in this client? a. pupil constriction b. bronchial dilation c. tachycardia d. constipation
    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. 23

    Practice Question #1
    Which of the following are most likely to be included in a dual drug therapy program for peptic ulcer disease due to H. pylori?
    A. B. C. D.

    Omeprazole and clarithromycin Tetracycline and metronidazole Ranitidine and amoxicillin Ciprofloxacin and sucralfate

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    24

    Practice Question #1 (contd)


    Answer: A. Rationale: Omeprazole and clarithromycin are commonly included in a dual drug therapy program for peptic ulcer disease due to H. pylori.

    Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

    25

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