Transcript Ch. 25-Drugs Used to Treat GERD and PUDx

Chapter 25
Drugs Used to Treat
Gastro-Esophageal
Reflux and Peptic
Ulcer Diseases
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gastro-esophageal reflux disease (GERD) is common stomach
disorder
peptic ulcer disease (PUD), there are ulcerations in the GI
tract (box 25-1 pg. 318)
(box 25-2 p. 318… full description of GERD/PUD)
goals of drug therapy for GERD and PUD:
◦ relieve symptoms
◦ promote healing
◦ prevent recurrence
Box 25-1 Upper Digestive System:
Structure and Function:
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digestive system breaks down food physically and
chemically so it can be absorbed and used by cells
aka: GI (gastro-intestinal) system
removes solid wastes from body
involves alimentary canal (GI tract) and the accessory
organs of digestion (fig 25-1)
alimentary canal is a long tube, extends from
mouth to anus
it’s major parts: mouth pharynx, esophagus, stomach,
small intestine, large intestine
accessory organs: teeth, tongue, salivary glands, liver,
gallbladder, pancreas
Upper Digestive System: Structure and Function cont…
digestion begins in mouth with food being broken down by
teeth chewing the food, tongue aids in chewing and
swallowing
 saliva moistens food particles to ease swallowing and begin
digestion, during swallowing the tongue pushes food into
pharynx
 pharynx (throat) is muscular tube, swallowing continues as
pharynx contracts, this contraction pushes food into
esophagus.
 esophagus is a 10” long muscular tube, extends from pharynx
to stomach
 peristalsis (involuntary muscle contractions) move food
down the esophagus and alimentary canal
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Upper Digestive System: Structure and Function cont…
stomach: muscular, pouch-like sac, in UL abdominal cavity.
strong stomach muscles stir/churn food to break it up
into smaller particles
 mucous membrane lines stomach, it contains glands that
secrete gastric juices
 food mixed and churned with these juices for a semi-liquid
call chyme
 through peristalsis, chyme is pushed from stomach into small
intestine.
 duodenum is first part of small intestine
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Delegation Guidelines
Drugs Used to Treat Gastro-Esophageal
Reflux and Peptic Ulcer Diseases:
Some drugs used to GERD and PUD are given
parenterally- by subcutaneous, intramuscular or
intravenous injection. Because you do NOT give
parenteral dose forms, they are NOT included in
this chapter. Should a nurse delegate the
administration of such to you, you must:
- remember that parenteral dosages are often
very different from dosages other routes
-Refuse the delegation. Make sure to explain why.
Do NOT just ignore the request. Make sure the
nurse knows that you cannot give drug and why
Antacids:
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drugs that buffer, neutralize, or absorb hydrochloric acid in the stomach
pH of hydrochloric acid is 1 or 2, antacids raise it to 3 or 4,
gastric juice loses its corrosive effect
Assisting With the Nursing Process
antacids:
ASSESSMENT: ask about constipation or diarrhea. Measure BP if person
has hypertension, some antacids are high in sodium. Observe for edema
and signs/symptoms of heart failure (ch.21). Observe for “coffee grounds”
vomitus and bloody or tarry stools, ask person to describe onset,
duration and location of pain or discomfort.
PLANNING: see table 25-1 for “Dose Forms”
IMPLEMENTATION: follow directions on MAR and product container,
give other drugs 1 hour before or 2 hours after giving antacids
EVALUATION: report and record:
- chalky taste: common problem, brand or flavor may need to be changed.
- diarrhea, constipation: some products cause one or the other, drug order
may alternate products
Histamine (H2)-Receptor Antagonists:
histamine: substance released in response to allergic
reactions and tissue damage from trauma or infection
 antagonist: drug that has opposite action of another drug or
competes for same receptor site
 histamine causes an increase in the secretion of gastric juices.
 Histamine (H2)- receptor antagonists (aka histamine
blockers) block the action of histamine
 they bind to H2 receptor, this results in decreased amounts
of gastric juices
 pH of stomach contents rises
 drugs are used to treat GERD, duodenal ulcers, stress ulcers
in critically ill persons
 stress ulcer: gastric or duodenal ulcer that develops in
persons under severe stress
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Assisting With the Nursing Process
histamine blocker:
ASSESSMENT: observe for confusion and orientation to person,
time and place
PLANNING: see table 25-2 (pg. 320) for “Dose Forms”
IMPLEMENTATION: see table 25-2 (pg. 320) for “Adult Dosage
Range”, give with food or milk as directed by the nurse and MAR.
give antacids (if ordered) 1 hour before or 2 hours after a
histamine blocker
EVALUATION: report and record:
- dizziness, headache, sleepiness: usually mild and resolve, provide for
safety
- diarrhea, constipation: give drugs as ordered for
diarrhea/constipation, follow care plan for fluid intake and diet
- confusion, slurred speech, disorientation, hallucinations: may occur
in persons with liver or kidney diseases and in persons over
age 50. Resolves 3-4 days after therapy stops. Provide for
safety
- anorexia, nausea, vomiting, jaundice: may signal liver toxicity
Gastro-Intestinal Prostaglandins:
prostaglandins are fatty acids, normally present in GI tract and inhibit gastric
juice secretion
 this protects the stomach and duodenal lining from ulcers
 GI prostaglandins inhibit gastric acid secretion
 misoprostol (Cytotec) used to prevent/treat gastric ulcers caused by
NSAIDS or aspirin
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Assisting With the Nursing Process
misoprostol (Cytotec):
ASSESSMENT: ask about diarrhea
PLANNING: Oral Dose Forms 100 and 200mcg tablets
IMPLEMENTATION: adult dose 100-200mcg tablets, 4x/day, give
drug with food during NSAID therapy
EVALUATION: report and record:
- diarrhea: dose related, usually develops after about 2 weeks of
therapy, often resolves after about 8 days. Follow care plan for fluid
intake and diet
Proton Pump Inhibitors (PPIs):
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parietal cells in stomach secrete gastric acid
PPIs inhibit the gastric acid pump of the parietal cells, thus they block the
gastric acid production
used to treat severe esophagitis, GERD, and gastric and duodenal ulcers
may be used with antibiotics if infection is cause of PUD
Assisting With the Nursing Process
Proton Pump Inhibitors(PPIs):
ASSESSMENT: ask about diarrhea
PLANNING: see table 25-3 (pg 321) for “Oral Dose Forms”
IMPLEMENTATION: : see table 25-3 (pg 321) for “Adult Dosage Range”.
Capsules/tablets should be swallowed whole, should not be opened,
crushed or chewed
EVALUATION: report and record:
- diarrhea, headache, muscle pain, fatigue: usually mild, follow care plan for
fluid intake and diet
- rash: may signal allergic reaction, do NOT give next dose until approved
by nurse
Coating Agents:
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coating agents form a substance that adheres to the crater of an ulcer
agent protects ulcer from gastric juices
does NOT inhibit gastric secretions or change gastric pH
sucralfate (Carafate) is used to treat duodenal ulcers
Assisting With the Nursing Process
sucralfate (Carafate):
ASSESSMENT: ask about constipation
PLANNING: Oral Dose Forms: 1g tablets or 1g/10mL suspension
IMPLEMENTATION: : adult dose is 1 tablet one hour before each meal
and at bedtime. Drug given on empty stomach. Antacids (if ordered) are
given at least 30mins before sucralfate (Carafate)
EVALUATION: report and record:
- constipation: usually mild, tends to resolve. Follow care plan for fluid
intake and diet
- dry mouth: provide oral hygiene: usually mild and tends to resolve. Nurse
may allow person to have hard candy or ice chips
- dizziness: usually mild and tends to resolve, provide for safety
Prokinetic Agents:
drugs that stimulate movement/motility
 metoclopramide (Reglan):
 is a gastric stimulant
 used to:
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◦ lower esophageal sphincter pressure (reduces acid reflux)
◦ increase stomach contractions (empties stomach faster)
◦ relax pyloric valve (allows stomach contents to empty into duodenum
faster
◦ increase GI peristalsis (moves chyme/feces faster through intestinal
tract)
◦ prevent vomiting during cancer therapy
Assisting With the Nursing Process
metoclopramide (Reglan):
ASSESSMENT: observe for GI bleeding, ask about abdominal pain,
discomfort, observe for restlessness, involuntary movements, facial
grimacing, abnormal tongue movements. Measure blood glucose if
diabetic
PLANNING: Oral Dose Forms: 5 and 10 mg tablets, 5mg/5mL
syrup
IMPLEMENTATION: : adult dose is 10mg thirty minutes before
meals and at bedtime
EVALUATION: report and record:
- drowsiness, fatigue, lethargy, dizziness, nausea: usually mild and tend
to resolve, provide for safety
- restlessness, involuntary movements, facial grimacing, abnormal
tongue movements: provide for safety
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Anti-Spasmodic Agents:
GI tract is controlled by cholinergic branch of ANS (ch 14)
 nerve endings that release acetylcholine (neurotransmitter) are
called cholinergic fibers
 cholinergic fibers stimulate GI tract to :
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◦ secrete saliva and gastric juices
◦ move stomach and intestinal contents through the GI tract (peristalsis)
anti-spasmodic agents have an anti-cholinergic action, they prevent
acetylcholine from attaching to cholinergic receptors in the
GI tract
 results in decreased gastric juices and decreased GI motility
 because cholinergic fibers are throughout body effects of these
drugs are also seen throughout:
-reduced perspiration
-reduced oral and bronchial secretions
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-dilated pupils
-constipation
-tachycardia and palpitations
-mental confusion
-nightmares
-paranoia
-blurred vision
-urinary hesitancy or retention
-orthostatic hypotension
-delusions
-euphoria
-hallucinations
Assisting With the Nursing Process
anti-spasmodics:
ASSESSMENT: observe for confusion, depression, nightmares and
hallucinations. Measure BP apical heart rate for 1 minute. Note if rhythm
is regular or irregular. Measure intake/output
PLANNING: see table 25-4 (p. 323) for “Oral Dose Forms”
IMPLEMENTATION: : see table 25-4 (p. 323) for “Adult Dose Range”
EVALUATION: report and record:
- blurred vision: provide for safety
- constipation, urinary retention: follow care plan for fluid intake/diet, give
stool softeners as ordered (ch 26)
- dryness of mouth, throat, nose: provide oral hygiene, nurse may allow
gum, hard candy or ice chips
- confusion, depression, nightmares, hallucinations: provide for safety
- orthostatic hypotension: usually mild, measure BP daily (standing/supine),
provide for safety
- palpitations, dysrhythmias: measure apical heart rate for 1 minute, note if
rhythm is regular or irregular