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Acid Controlling Drugs

Hydrochloric Acid Secreted by parietal cells when stimulated by food Maintains stomach at pH of 1 to 4 Secretion also stimulated by: Large fatty meals Excessive amounts of alcohol Emotional stress
Acid-Related Diseases PUD, GERD, H. pylori
Helicobacter pylori Bacterium found in GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers Can be detected by serum antibody tests Antibiotics are used to eradicate H. pylori
Types of Acid Controlling Drugs Antacids, H2 antagonists, proton pump inhibitors
Antacids Antacids DO NOT prevent the overproduction of acid Antacids DO neutralize the acid once it is in the stomach
Antacids: Drug Effects Reduction of pain associated with acid-related disorders Raising gastric pH from 1.3 to 1.6 neutralizes 50% of the gastric acid Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid Reducing acidity reduces pain
Antacids They are given prophylactically in the hospital for stress ulcers; give 30 min before meal and at bedtime. If your are giving with a medication that cannot be taken with an antacid: 1 hour before or 2 hours after.
Antacids Aluminum salts Magnesium salts Calcium salts Sodium bicarbonate
Antacids: Aluminum Salts Have constipating effects Often used with magnesium to counteract constipation Often recommended for patients with renal disease (more easily excreted)
Antacids: Aluminum Salts, Examples Aluminum carbonate: Basaljel Hydroxide salt: AlternaGEL Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel
Antacids: Magnesium Salts Commonly cause diarrhea; usually used with other drugs to counteract this effect Dangerous when used with renal failure—the failing kidney cannot excrete extra magnesium, resulting in accumulation
Antacids: Magnesium Salts, Examples Hydroxide salt: magnesium hydroxide (Milk of Magnesia) – laxative (MOM) Carbonate salt: Gaviscon (also a combination product) Combination products such as Maalox, Mylanta (aluminum and magnesium)
Antacids: Calcium Salts Many forms, but carbonate is most common May cause constipation, kidney stones Also not recommended for patients with renal disease—may accumulate to toxic levels
Antacids: Calcium Salts Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound) Often advertised as an extra source of dietary calcium Example: Tums (calcium carbonate)
Antacids: Sodium Bicarbonate Highly soluble Buffers the acidic properties of HCl Quick onset, but short duration
Antacids: Sodium Bicarbonate May cause metabolic alkalosis Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency
Simethicone • Alters elasticity of mucus-coated bubbles, causing them to break • Used often, but there are limited data to support effectiveness
Antacids: Implications Assess for allergies and preexisting conditions that may restrict the use of antacids, such as: Fluid imbalances Renal disease GI obstruction Heart failure (HF) Pregnancy
Antacids: Implications Patients with HF or hypertension should not use antacids with high sodium content Use with caution with other medications because of the many drug interactions Most medications should be given 1 to 2 hours after giving an antacid
Antacids: Implications Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset Be sure that chewable tablets are chewed thoroughly, and liquid forms are shaken well before giving
Antacids: Implications Administer with at least 8 ounces of water to enhance absorption (except for “rapid-dissolve” forms) Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as cancer or bleeding ulcers, or cardiac disease
Antacids: Implications If symptoms remain ongoing, patient should seek medical evaluation Monitor for adverse effects Nausea, vomiting, abdominal pain, diarrhea With calcium-containing products: constipation, acid rebound Monitor for therapeutic response
Histamine Type 2 (H2) Antagonists Reduce acid secretion cimetidine (Tagamet) famotidine (Pepcid)
Histamine Type 2 (H2) Antagonists: Mechanism of Action Block histamine at the (H2) receptors of acid-producing parietal cells Production of hydrogen ions is reduced, resulting in decreased production of HCl
Histamine Type 2 (H2) Antagonists: Indications GERD PUD Erosive esophagitis Adjunct therapy to control upper GI bleeding Pathologic gastric hypersecretory conditions
H2 Antagonists: Drug Interactions Smoking has been shown to decrease the effectiveness of H2 blockers
Proton Pump Inhibitors The parietal cells release positive hydrogen ions (protons) during HCl production This process is called the proton pump H2 blockers and antihistamines do not stop the action of this pump
Proton Pump Inhibitors: Mechanism of Action Irreversibly bind to H+/K+ ATPase enzyme This bond prevents the movement of hydrogen ions from the parietal cell into the stomach
Proton Pump Inhibitors: Mechanism of Action Results in achlorhydria—ALL gastric acid secretion is temporarily blocked To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase
Proton Pump Inhibitors omeprazole (Prilosec)* *First in this new class of drugs pantoprazole (Protonix) (IV form available) most often seen in hospital
Proton Pump Inhibitors: Indications GERD maintenance therapy Erosive esophagitis Short-term treatment of active duodenal and benign gastric ulcers Zollinger-Ellison syndrome Treatment of H. pylori–induced ulcers: Given with an antibiotic - Biaxin/Prilosec
Proton Pump Inhibitors: Adverse Effects Safe for short-term therapy Some approved for long-term therapy Adverse effects uncommon
Proton Pump Inhibitors: Implications Assess for allergies and history of liver disease Not all are available for parenteral administration May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin
Proton Pump Inhibitors: Implications The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 g or the tube may become clogged
Proton Pump Inhibitors: Implications Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules Proton pump inhibitors often work best when taken 30 to 60 minutes before meals
Sucralfate (Carafate) Cytoprotective drug Used for stress ulcers, peptic ulcer disease Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas
Sucralfate (Carafate) Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse) Little absorption from the gut May cause constipation, nausea, and dry mouth
Sucralfate (Carafate) May impair absorption of other drugs—give other drugs at least 2 hours before sucralfate Do not administer with other medications Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels
Simethicone Antiflatulent drug Used to reduce the discomforts of gastric or intestinal gas (flatulence) Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones Result is decreased gas pain and increased expulsion via mouth or rectum
Assessment Drugs such as cimetidine and famotidine should not be administered simultaneously with antacids. These drugs may be spaced 1 hour apart if both drugs need to be given.
Teaching If the patient is taking enteric-coated medications, the patient should know that the use of antacids may promote premature dissolution of the enteric coating.
Teaching Enteric coatings are used to diminish the stomach upset caused by irritating medications, and if the coating is destroyed early in the stomach, gastric upset may occur.
Created by: codzep