antiulcer drugs

7/28/2019 Antiulcer Drugs ....

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ANTIULCER DRUGS

Sudario, Carmella Dawn B.

BSN 2-1


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PEPTIC ULCER DISEASE

Esophageal Ulcer

Reflux of acidic gastric contents into the

esophagus

Gastric Ulcer

Occurs of breakdown of GMB

Duodenal Ulcer

hyper secretion of acid from the stomach that

passed to the duodenum


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SIGNS & SYMPTOMS

Pain

The vomiting of blood which may

appear red or black

Dark blood in stools or stools that are

black or tarry

Nausea or vomiting Unexplained weight loss

Appetite changes


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RISK FACTORS

Smoke. Smoking may increase the risk of pepticulcers in people who are infected with H. pylori.

Drink alcohol. Alcohol can irritate and erode the

mucous lining of your stomach, and it increasesthe amount of stomach acid that's produced.

Have uncontrolled stress.Although stress

alone isn't a cause of peptic ulcers, it's a

contributing factor. You may undergo stress for anumber of reasons an emotionally disturbing

circumstance or event, surgery, or a physical

trauma, such as a burn or other severe injury


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TRANQUILIZERS

ACTION: To reduce vagal stimulation and

decrease anxiety.

Examples: Librax combination of the

anxiolytics chlordiazepoxide (Librium)

and the anticholinergic Clidinium bromide

(Quarzan)


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ANTICHOLINERGICS

Action:

1. Decreases acetylcholine by blocking

the cholinergic receptors.

2.Relieves pain by decreasing gastric

motility and secretion

3.Delays gastric emptying

Ex: propantheline bromine (Pro-banthine)


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ANTACIDS

Action:

1. Neutralize hydrochloric acid

2. Reduce pepsin activity


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ANTACIDS

1.w/ systemic eff

ects:

Sodium Bicarbonate:

Bromo-Seltzer & Alka-

Seltzer

Ca Carbonate

(Tums)

2.no systemic effects:

Aluminum:

AlOH & AlCO3

S/E: constipation,

hypophosphathemia

Magnesium: MgOH

Mg carbonate, Mg phosphate

S/E: diarrhea,

hypermagnesemia


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Nursing Considerations

Avoid administering antacid with other drugs, it shouldbe 12 hours after other medications

Encourage to take 2oz of water to ensure that the drug

reaches the stomach

Administer on empty stomach or 13hours after meal and at bedtime

Avoid taking antacids w/ milk or foods high in

vitamin D

Shake suspension well before administering

Monitor electrolytes & urinary ph, calcium & phosphate

levels

Instruct client to report pain, coughing, or hematemesis


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HISTAMINE2 BLOCKER

Action: Block the H2 receptors of the

parietal cells in the stomach thus reducing

gastric secretion and concentration

Examples:

cimetidine (Tagamet)

ranitidine (Zantac)

famotidine (Pepcid)

nizatidine (Axid)


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Cimetidine

(Tagamet)-1975, first H2 blocker

-Increases the effects of

theophylline, beta-blockers,anticoagulants,

anticonvulsants

-Duration: 4-5 hoursRanitidine(Zantac)

1983-Peak conc: 1-3 hours-Gastric and duodenal ulcer,

used prophylactically,

relieves symptoms of reflux

esophagitis,prevent stress ulcer and

aspiration pneumonitis

-Duration: up to 12 hours


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Famotidine

(Pepcid)1986

-Short term use for Duodenal

ulcer and Zollinger-Ellison

syndrome

- 50-80% more potent than

Cimetidine and 5-8x than

RanitidineNizatidine

(Axid)

1988-Latest H2 blocker

-Relieves nocturnal gastric

acid secretion for 12 hours

-Administer at bedtime toprevent recurrence of

duodenal ulcer


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HISTAMINE2 BLOCKER

Side Effects and Adverse Reactions Headache

Dizziness

Constipation

Pruritus

Skin rash

Gynecomastia

Decreased libido

Impotence


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HISTAMINE2 BLOCKER

Drug and Laboratory Interactions

Cimetidine enhances the effects of

warfarin, theophylline, caffeine,

phenytoin,

diazepam, propanolol, phenobarbital,

& Ca channel blockers

Cimetidine can increase BUN, Serum

creatinine, serum alkaline phosphatase

Antacids


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NURSING CONSIDERATIONS

Administer drug just before meals or bedtime

Instruct client to report pain, coughing, or

hematemesis

Direct client to separate ranitidine and antacid

dosage by at least 1 hour if possible

Educate clients in the use of relaxa7on technique

sTeach client to eat foods rich in Vitamin B12

Alert client to avoid foods and liquids that can cause

Gastric irritation


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PROTON PUMP INHIBITORS

Action: Suppress gastric acid

secretion by inhibiting the hydrogen/K

ATPase enzyme system located in the

gastric parietal cells

It inhibits gastric acid secre7on up to 9

0%

Agents that block the final step of

acid production


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S/E: Headache, Dizziness, Diarrhea, Abdominal Pain, Rash

Pantoprazole

(Protonix)-Treat short term erosive

GERD

-IV is effective

in

treating Zollinger-Ellison

SymdromeEsomeprazole

(Nexuim)-Newest PPI

-Highest success rateinhealing erosive GERD


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PROTON PUMP INHIBITORS

Omeprazole can enhance the action of

oral anticoagulants, certain

benzodiazepines, and phenytoin

Lansoprazole may decrease theophylline

levels

Pantoprazole, no significant drug interactions


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PEPSIN INHIBITOR

ACTION: Covers the ulcer and protects itfrom acid and pepsin; adhering

to the ulcer surface

It does not neutralize acid or decrease acid

secretions

Example: Sucralfate (Carafate)

S/E: cons7pa7on, dry mouth, dizziness

*given before meal and at bed7me


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NURSING CONSIDERATIONS Administer on empty stomach.

Administer antacid 30 minutes before or aftersucralfate

Allow 12 hours to elapse between sucralfate and

other prescribed drugsInstruct that therapy usually takes 48 weeks for

optimal ulcer healing

Increase OFI, dietary bulk; No smoking

Encourage relaxation techniques & exercise

Instruct client to report pain, coughing or

hematemesis

Teach client to avoid gastric irritating foods


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PROSTAGLANDIN ANTIULCER

DRUGSAction: suppress gastric acid secre7on and inc

rease

cytoprotec7ve mucus in the GI tract.

Ex: MISOPROSTOL (Cytotec)

C/I: pregnant and women of childbearing age

S/E: diarrhea, abdominal pain, flatulence, nausea,

vomiting, constipated and menstrual spotting


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THEEND

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