Transcript Antacids
Chapter 24 Agents Used to Treat Hyperacidity and Gastroesophageal Reflux Disease Secretory Functions of the Stomach Lining Parietal cells secrete hydrochloric (HCl) acid Chief cells secrete pepsinogen Mucoid cells secrete mucus 24 - 2 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Stomach Hyperchlorhydria Produced from: Eating high-fat meals Increased alcohol intake Emotional turmoil 24 - 3 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Goal of Antacid Therapy Neutralize the acid Inhibit pepsin activity Increase resistance of the stomach lining Increase tone of the lower esophageal sphincter 24 - 4 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antacids Three Forms 1. Aluminum 2. Magnesium 3. Calcium Mechanism of action Neutralization of gastric acidity Low doses promote gastric mucosal defensive mechanisms 24 - 5 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Systemic Antacids Useful in short-term therapy Rapid onset Prolonged use causes an overload on the kidneys Example: sodium bicarbonate 24 - 6 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 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 carbohydrate (Tums, Rolaids), aluminum carbonate (Basaljel), magaldrate (Riopan), etc. 24 - 7 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Side Effects and Adverse Effects Magnesium: diarrhea Aluminum: constipation Calcium: constipation 24 - 8 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 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 24 - 9 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 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. 24 - 10 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Histamine (H2) Receptor Antagonists Examples Cimetadine (Tagamet) Famotidine (Pepcid) Nizatidine (Axid) Ranitidine (Zantac) 24 - 11 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Proton Pump Inhibitors Omeprazole (Prilosec) Indicated for clients with: Blocks the final step of acid production in the stomach Gastroesophageal reflux disease (GERD) Gastric hypersecretory condition Interactions Causes warfarin (an anticoagulant) action to be increased 24 - 12 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Helicobacter Pylori An organism associated with the development of peptic ulcer disease Treatment Metronidazole (Flagyl), an antimicrobial agent, along with bismuth subsalicylate (Pepto-Bismol) and tetracycline (antimicrobial) for 4 weeks to eradicate Helicobacter pylori 24 - 13 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Metoclopramide (Reglan) A drug that stimulates the motility of the upper GI tract without stimulating the production of gastric, biliary, or pancreatic solutions Action 24 - 14 Increases peristalsis in the duodenum and jejunum Decreases gastroesophageal reflux (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Metoclopramide (Reglan) Adverse effects Produces extrapyramidal (Parkinson-like symptoms) effects Central nervous system depression Gastrointestinal upset 24 - 15 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.