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Secretory Functions of the Stomach Lining p564 Parietal cells secrete hydrochloric (HCl) acid Chief cells secrete pepsin Mucoid cells secrete mucus Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
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Agents Used to Treat Hyperacidity and Gastroesophageal Reflux
Disease
Chapter 24 Agents Used to Treat Hyperacidity and Gastroesophageal
Reflux Disease Secretory Functions of the Stomach Lining p564
Parietal cells secrete hydrochloric (HCl) acid Chief cells secrete
pepsin Mucoid cells secrete mucus Copyright 2007 Thomson Delmar
Learning, a division of Thomson Learning Inc. All rights reserved.
Stomach Hyperchlorhydria p564
Condition of excess hydrochloric acid Produced from: Eating
high-fat meals Increased alcohol intake Emotional turmoil GERD p564
Gastroesophageal reflux disease Results from regurgitation
Leads to inflammation in LES sphincter and esophagus results in If
unresolved, esophageal erosion may result Peptic ulcer disease
(PUD) p565
A peptic ulcer is a local lesion of the gastrointestinal lining
Duodenal ulcer Gastric ulcer Role of H. pylori Goal of Antacid
Therapy p565
Neutralize the acid General goal of antacid therapy is pain relief
Systemic Antacids p 566 Useful in short-term therapy Rapid
onset
Prolonged use : overload on the kidneys, acid/base and electrolyte
disturbances Example: sodium bicarbonate Cause rebound hyperacidity
Nonsystemic Antacids Table 24-1 pg 567-568
Three Forms of OTC non-systemic antacids Calcium based Aluminum
based Magnesium based Mechanism of action Neutralize acid Acid
rebound may result from large doses of antacids, particularly Ca+
based antacid Side Effects Nonsystemic antacids p567-568
Magnesium: diarrhea Aluminum: constipation Calcium: constipation
Administration time Antacid Interactions p566
Binds with drugs Promotes alkalinity of GI tract Avoid simultaneous
administration of antacids and antibiotics. Dont take oral drugs or
enteric coated med within 1-2 hours of taking an antacid
Simethiconep566 Simethicone eliminates gas bubbles Nursing
Interventions antacids p572-573
Monitor for side effects Nausea, vomiting, abdominal pain, diarrhea
With calcium-containing products:constipation, acid rebound Monitor
for therapeutic response Notify heath care provider if symptoms are
not relieved. Histamine H2 receptor antagonists Table 24-2
p569
Action:Inhibit action of histamine at H2 receptor sites of the
parietal cells in the stomach Used to treat PUD Side effects:
Diarrhea, muscle pain, rash, drowsiness, dizziness, confusion in
some patients Histamine (H2) Receptor Antagonists H2 blockers
p569
Examples Cimetidine (Tagamet) (prototype) Famotidine (Pepcid)
Ranitidine (Zantac) Cimetidinep569 Contraindicated in nursing
mothers or children younger than 16 years Cimetidine:
anti-androgenic effects CNS effects Cigarette smoking diminishes
the effects of cimetidine. Antacids will reduce the absorption of
cimetidine Proton Pump Inhibitors p570
Action:blocks the final step of acid production in the
stomachResult:decreased hydrochloric acid Examples: Omeprazole
(Prilosec) Esomeprazole magnesium (Nexium) Indicated for clients
with: GERD and esophagitis PUD Interactions Increases effects of
warfarin Proton pump inhibitors cont p570
Side effects: Diarrhea, abdominal pain, nausea Used in combination
with clarithromycin and amoxicillin for 14 days for treatment of H.
pylori infections Sucralfate (Carafate) p571
Sucralfate: derivative of sucrose. Sucralfate combines with protein
at the ulcer site to form an adherent complex Adverse
effects:Nausea, constipation, diarrhea Nursing considerations for
pt with PUD p573
Observe for s/s of complications for PUD Hemorrhage Obstruction
Perforation Teach lifestyle behaviors that contribute to PUD
Smoking, alcohol, coffee, cola, stress ASA, ibuprofen, naproxen are
contraindicated in patients with PUD Protein and calcium in milk
are stimulators of hydrochloric acid secretion Teach that ulcer
pain often subsides prior to ulcer being healed.Pt to remain on
meds until DC by doctor. . Metoclopramide (Reglan) p571
Prokinetic agent Increases gastric motility Actions: Promotes
gastric emptying Increases peristalsis Decreases gastroesophageal
reflux Useful in treating diabetic gastroparesis Metoclopramide
(Reglan) p571
Adverse effects Extrapyramidal symptoms Central nervous system
depression Gastrointestinal upset Contraindicated in pt with
epilepsy or antipsychotic drugs that can cause extrapyramidal
symptoms Gastrointestinal enzymes p572
Pancreatic enzymes Pancrelipase and pancreatin Lactase enzyme For
pt who have developed lactose intolerance Symptoms of lactose
intolerance Diarrhea, flatulence, bloating with ingestion of dairy
products
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