Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Diseases Chapter 33 Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Diseases Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 33 Lesson 33.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives Describe the physiology of the stomach Cite common stomach disorders that require drug therapy Identify factors that prevent breakdown of the body’s normal defense barriers resulting in ulcer formation Develop health teaching that incorporates pharmacologic and nonpharmacologic treatment for an individual with stomach disorders State the drug classifications and actions used to treat stomach disorders Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Physiology of the Stomach Functions Store food Mix food Emptying Types of secretory cells Chief – secrete pepsinogen Parietal – secrete hydrochloric acid Mucus – secrete mucus Hydrochloric acid is needed for optimal pH of stomach. Parietal cells also secrete intrinsic factor needed for absorption of vitamin B12. Mucus protects the stomach wall from injury to stomach acids and enzymes. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Common Stomach Disorders Gastroesophageal reflux disease (GERD) Known as heartburn Symptoms: burning, bloating, belching, regurgitation Reflux of gastric secretions such as pepsin and hydrochloric acid into the esophagus Peptic ulcer disease (PUD) Several stomach disorders – commonly gastric and duodenal ulcers Symptoms: burning, gnawing, aching GERD is referred to as acid indigestion; PUD is commonly referred to as heartburn or sour stomach. Always treat signs and symptoms of heartburn as cardiac disease until it is ruled out! Symptoms may resemble conditions such as ischemic heart disease, scleroderma, and gastric cancer. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Patient Education and Health Promotion Treatment of GERD and PUD Education – weight reduction, smoking cessation, consume smaller meals, avoid eating at bedtime, avoid tight clothing over abdomen Drug therapy – used to relieve symptoms, promote healing, prevent recurrence Limit use of NSAIDs – switch to acetaminophen if feasible Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Antacids Actions Uses Common adverse effect: chalky taste Buffer hydrochloric acid to a lower concentration Uses Treat heartburn from excessive eating and drinking Acute ulcer treatment requires large volumes Common adverse effect: chalky taste Serious adverse effects: constipation, diarrhea For specific drugs, see Table 33-1. Therapeutic outcomes: relief of discomfort, reduced frequency of heartburn, healing of irritated tissues. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Histamine-2 Receptor Antagonists Actions Block H2 receptors resulting in decreased volume of acid secreted Uses Treat GERD, duodenal ulcers, stress ulcers, Zollinger-Ellison syndrome Common adverse effects Dizziness, headache, somnolence, diarrhea, constipation Serious adverse effects Confusion, disorientation, hallucinations, gynecomastia, hepatotoxicity For specific drugs, see Table 33-2. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Gastrointestinal Prostaglandins Drug: misoprostol (Cytotec) Actions Inhibit gastric acid and pepsin secretion Uses Prevent and treat gastric ulcers caused by NSAIDs (including aspirin) Common adverse effect Diarrhea Contraindicated for use in pregnancy because of the effect of inducing uterine contractions. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Proton Pump Inhibitors Actions Inhibit gastric secretion by inhibiting gastric acid pump of the parietal cells Uses Treat severe esophagitis, GERD, gastric and duodenal ulcers Common adverse effects Diarrhea, headache, fatigue, muscle pain Serious adverse effects Rash For specific drugs, see Table 33-3. Be alert to drug interactions. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Coating Agents Drug: sucralfate (Carafate) Actions Adhere to craters of an ulcer, protecting it from acids, pepsin, and bile salts Uses Treat duodenal ulcers; for patients who cannot tolerate other therapies Common adverse effects Constipation, dry mouth, dizziness Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Prokinetic Agents Drug: metoclopramide (Reglan) Actions Reduce reflux, increase stomach contractions, relax pyloric valve, increase peristalsis Uses Treat gastric reflux esophagitis, diabetic gastroparesis; antiemetic Common adverse effects Drowsiness, fatigue, lethargy, dizziness, nausea Serious adverse effects Extrapyramidal symptoms Be alert for drug interactions. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Antispasmodic Agents Actions: anticholinergic Uses Treat irritable bowel syndrome, biliary spasm, mild ulcerative colitis, pancreatitis, infant colic, PUD Common adverse effects Blurred vision; constipation; urinary retention, dry mouth, nose, throat Serious adverse effects Confusion, depression, nightmares, hallucinations, orthostatic hypotension, palpitations, dysrhythmias For specific drugs, see Table 33-4. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.