Agents Used to Treat Hyperacidity and Gastroesophageal Reflux Disease Chapter 23

Secretory Functions of the Stomach Lining Parietal cells secrete hydrochloric (HCl) acid Chief cells secrete pepsinogen Mucoid cells secrete mucus

Rate varies throughout day Highest just before or during meals Gastric Acid Hydrochloric acid is secreted by parietal cells that are in the lining of the stomach Rate varies throughout day Highest just before or during meals

Gastric Acid Gastric juice contains pepsin Excess hydrochloric acid results in indigestion, sour stomach, heartburn Causes can include a fatty meal, large meal, excessive alcohol, or emotional turmoil

GERD Common disorder Backflow of stomach contents Leads to inflammation and pain Esophageal erosion may result

Peptic Ulcer Disease (PUD) Local lesion of the GI lining Usually in the duodenum or stomach Common cause is H. pylori Proton pump inhibitors (Prilosec, Prevacid, Nexium, or Protonix) with clarithromycin, amoxicillin, tetracycline or metronidazole (Flagyl)

Peptic Ulcer Disease (PUD) (cont’d) Acid blockers (H2) may be prescribed: Zantac, Tagamet, Pepcid Antacids Cytoprotective agents to coat GI lining: Carafate, Cytotec, Pepto-Bismol

Goal of Antacid Therapy Neutralize the acid Inhibit pepsin activity Increase resistance of the stomach lining Increase tone of the lower esophageal sphincter

Useful in short-term therapy Rapid onset Systemic Antacids Useful in short-term therapy Rapid onset Prolonged use causes an overload on the kidneys Example: sodium bicarbonate

Nonsystemic Antacids Remain in gastrointestinal tract; useful in long-term therapy Most of the dose remains in the gastrointestinal tract Will not alter acid-base system Examples: calcium carbonate (Tums, Rolaids), aluminum carbonate (Basaljel), magaldrate (Riopan), etc.

Antacid Interactions Binding of other drugs to the antacid causes reduced availability of the other drugs to the client. Chemical inactivation Increases stomach and urine pH (alkaline), which decreases the absorption and excretion of certain drugs

Antacids: Nursing Interventions 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.

Antacids: Nursing Considerations Chewable tablets must be chewed completely Administration with food or drugs may reduce absorption Do not take other drugs within 1-2 hours of antacids Monitor stools during antacid therapy Shake liquid antacids well Assess response to antacid use

Histamine H2 Receptor Antagonists Used to treat duodenal ulcers, gastric ulcers, and other disorders Inhibits the action of histamine at the receptor sites of the parietal cells in the stomach Drastic reduction of acid secretion in the stomach

Histamine H2 Receptor Antagonists (cont’d) Can occasionally cause diarrhea, muscle pain, drowsiness, rash, dizziness, and/or confusion Not recommended for nursing mothers or children younger than 16 Most cautions are for cimetidine

Histamine (H2) Receptor Antagonists Examples Cimetidine (Tagamet) Famotidine (Pepcid) Nizatidine (Axid) Ranitidine (Zantac)

Proton Pump Inhibitors Newest agents Suppress gastric acid secretion Used to treat esophagitis Esomeprazole (Nexium) has highest healing effects Should be taken on an empty stomach Agents used to treat H. pylori infection (along with antibiotics)

Proton Pump Inhibitors Omeprazole (Prilosec) Blocks the final step of acid production in the stomach Indicated for clients with: Gastroesophageal reflux disease (GERD) Gastric hypersecretory condition Interactions Causes warfarin (an anticoagulant) action to be increased