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Alleviate symptoms, promote healing, prevent complications, prevent recurrence.

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Classification: antiulcer agents//histamine H2 antagonist

Mechanism of action:  Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. Therapeutic Effects: Healing and prevention of ulcers. Decreased symptoms of gastroesophageal reflux. Decreased secretion of gastric acid.

Major Adverse Effects:  confusion, dizziness, drowsiness, hallucinations, headache.CV: ARRHYTHMIAS, constipation, diarrhea, nausea, anemia

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Q3: He states "I have a headache and my knee hurts. I need an aspirin or a Motrin." What is your best response?

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Q3: He states "I have a headache and my knee hurts. I need an aspirin or a Motrin." What is your best response?

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Both aspirin and Motrin are considered to be NSAID pain relievers. NSAIDs are known to be a causative factor in PUD. It is strongly discouraged for continued use of NSAIDS with his diagnosis. Potentially contact the prescriber for another form of pain relief.

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Aluminum - relatively low ANC and is slow acting but produces long lasting duration.
Aluminum PO:
Onset: slightly delayed
Peak: 30 min
Duration: 30 min-1 hr (empty stomach); 3 hr (after meals)
Most common adverse effect is constipation.

Magnesium -
Long-lasting effects, rapid acting, high ANC.
Diarrhea is the most common side effect. Avoid in those with undiagnosed abdominal pain.
Magnesium PO:
Onset: slightly delayed
Peak: 30 min
Duration: 30 min-1 hr (empty stomach); 3 hr (after meals)

Calcium Carbonate - Rapid acting, has high ANC, produces effects of long duration.
PO: Peak, Onset and Duration is unknown
IV:
Peak: immediate
Onset: immediate
Duration: 0.5–2 hr
Most common adverse effect is constipation which can be overcome by the combination of Ca and Mg containing antacid

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Q1: Compare and contrast aluminum, magnesium and calcium antacid compounds.

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Q1: Compare and contrast aluminum, magnesium and calcium antacid compounds.

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They differ with acid-neutralizing capacity (ANC), onset and duration of action, effects on the bowel, systemic effects, and special applications.

Magnesium hydroxide:  Rapid-acting, has high ANC, and produces long-lasting effects. Magnesium is a common choice for antacid. Often called milk of magnesia.
Most common adverse effect is diarrhea.

Aluminum hydroxide: Slow-acting and low ANC, but produces long-lasting effects. Rarely used alone, typically combined with magnesium to counter-act diarrhea. Most common adverse effect is constipation.
Commonly interacts with other drugs and compounds to reduce effects or absorption, including warfarin, tetracyclines, digoxin, and phosphate). Aluminum hydroxide also binds with pepsin, raising gastric pH to facilitate ulcer healing.

Calcium carbonate: Rapid-acting, has high ANC, and produces effects of long duration.
Most common adverse effects are constipation, acid rebound and production of carbon dioxide causing flatulence and belching.

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#1 What is H. pylori and what is its relationship to PUD?

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#1 What is H. pylori and what is its relationship to PUD?

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H. pylori is a gram negative bacillus that can colonize the stomach and the duodenum. H. pylori causes enzymatic degradation of the protective mucus layer, elaboration of a cytotoxin that injures mucosal cells, infiltration of neutrophils and other inflammatory cells, and produces urease (enzyme that forms carbon dioxide and ammonia) which are both potentially toxic to gastric mucosa. H. pylori appears to promote gastric cancer. (type 1 carcinogen)

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Question 4: George reveals to the nurse that he does not like taking medications. What explanations would you give the patient regarding why it is important to take the therapy as prescribed ( referred to as Helidac pack)

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Question 4: George reveals to the nurse that he does not like taking medications. What explanations would you give the patient regarding why it is important to take the therapy as prescribed ( referred to as Helidac pack)

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A:
- Each dose is very important to eradicate all the ulcer-causing bacteria. If stopped abruptly, some of these bacteria may not be eradicated and recurrence of ulcer may occur.
-  Indicated for the treatment of patients with an active duodenal ulcer associated with H. pylori infection. The eradication of H. pylori has been demonstrated to reduce the risk of duodenal ulcer recurrence. Appropriate doses of an H2 antagonist indicated for the treatment of active duodenal ulcer should be prescribed for ulcer healing.
-  To reduce the development of drug-resistant bacteria

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Constipation refers to bowel movements that are infrequent or hard to pass

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#2 Additional questions the nurse should ask + rationale

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#2 Additional questions the nurse should ask + rationale

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1. Ask about dietary changes  - changes in diet may have an impact on bowel habits
2. When was the onset of her constipation - to help determine severity
3. Which laxative has she been taking & how long has she been taking it  - to determine the effects
4. Conduct a PQRSTU regarding her 'tummy cramping' - background information on diagnosis
5. Last BM & characteristics of recent BMs - to compare to baseline

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#3 Difference between laxative effect & catharsis

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#3 Difference between laxative effect & catharsis

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Cathartic substances accelerates defecation.
Laxatives are a substance that eases defecation, usually by softening feces.
It is possible for a substance to be both a laxative and a cathartic.

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5. The patient is to continue with lansoprazole 15 mg daily. What adverse effects and teaching should you provide to george?

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5. The patient is to continue with lansoprazole 15 mg daily. What adverse effects and teaching should you provide to george?

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adverse effects: diarrhea, abdominal pain, nausea, pneumonia, hypomagnesemia, osteoporosis, fracture.
teaching : usually taken before meal, morning before breakfast, significant diarrhea

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#4 Identify some factors for increased laxative use in older adults 

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#4 Identify some factors for increased laxative use in older adults 

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Poor diet, lack of adequate fluid intake, lack of exercise , side effects of other drugs, poor bowel habits delayed gastric emptying

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#5 What types of problems are generally related to chronic use of laxatives? Explain your answer.  

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#5 What types of problems are generally related to chronic use of laxatives? Explain your answer.  

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1) reliance due to diminished defecation reflex
2) electrolyte disturbance - potassium, sodium, chloride are drawn out of the body following the water.
3) dehydration - laxatives cause massive losses of water and without replenishing supplies of fluids inside the body water will continue to be drawn out.

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5. what does acid-neutralizing capacity (ANC) mean? 

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5. what does acid-neutralizing capacity (ANC) mean? 

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Acid-neutralizing capacity or ANC in short is a measure for the overall buffering capacity against acidification for a solution

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Q2: What does acid-neutralizing capacity mean?

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Q2: What does acid-neutralizing capacity mean?

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ANC of an antacid is the amount of acid that it can neutralize.

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Q3: what is the mechanism of action of aluminum hydroxide? Compare and contrast its action with that of ranitidine and sucralfate. 

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Q3: what is the mechanism of action of aluminum hydroxide? Compare and contrast its action with that of ranitidine and sucralfate. 

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Aluminum Hydroxide: non systemic antacid with moderate neutralizing action. Reduces acid concentration and pepsin activity by raising pH of gastric and intraesophageal secretions. Reduces gastric acidity by neutralizing the stomach acid content. Aluminium carbonate lowers serum phosphate by binding dietary phosphate to form insoluble aluminum phosphate, which is excreted in fees.
Ranitidine: inhibit the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.
Sucralfate: sucralfate and gastric acid react to form a viscous, adhesive, paste-like substance that resists further reaction with gastric acid. This "paste" adheres to the GI mucosa with a major portion binding electrostatic ally to the positively charged protein molecules in the damaged mucosa of an ulcer crater or an acute gastric erosion. Absorbs bile, inhibits the enzyme pepsin, and blocks back diffusion of H+ ions. these actions plus adherence of the paste-like complex protest damaged mucosa against further destruction from ulcerogenic secretions and drugs

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Q4: Describe the common drug-drug interactions with antacids.

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Q4: Describe the common drug-drug interactions with antacids.

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By raising gastric pH, antacids can influence the absorption and/or dissolution of other drugs, cimetidine and ranitidine are two of these drugs.  These interactions can be avoided by allowing 1h between taking antacids and these other drugs.
Antacids can also interfere with the actions of sucralfate, taking these drugs at least an hour apart will minimize this interaction.
Lastly if antacids are absorbed in substantial amounts they can alkalinize the urine. Elevation of urinary pH can accelerate excretion of acidic drugs and delay the excretion of basic drugs.

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6. Dr.T says, "when i take an antacid, like Rolaids, i feel better. why cant i take antacids anymore? thats what the doctor told me". what is your best response? 

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6. Dr.T says, "when i take an antacid, like Rolaids, i feel better. why cant i take antacids anymore? thats what the doctor told me". what is your best response? 

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you have been prescribed aluminum hydroxide which is an antacid. You have also been prescribed Zantac which will help decrease your stomach pH.

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Q7: Describe important health teaching to include with Ms. J

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Q7: Describe important health teaching to include with Ms. J

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-Report epigastric or abdominal pain; it is a clinical guide for adjusting dosage. Keep prescriber informed. Pain that persists beyond 72 h may signify serious complications.
-Seek medical help if indigestion is accompanied by SOB, sweating, or chest pain, if stools are dark or tarry, or if symptoms are recurrent when taking this medication
-Increase phosphorus in diet when taking large doses of these antacids for prolonged periods; hypophosphatemia can develop within 2 week of continuous use of these antacids. the older adult in a poor nutritional state is at high risk

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Q6:What is the major contraindication for use of aluminum hydroxide? What are indications for cautious use? 

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Q6:What is the major contraindication for use of aluminum hydroxide? What are indications for cautious use? 

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Contraindications: Prolonged use of high doses in presence of low serum phosphate.
Cautious use: Renal impairment; gastric outlet obstruction; older adults decreased bowel activity (e.g., patients receiving anticholinergic, antidiarrheal, or antispasmodic agents); patients who are dehydrated or in a fluid restriction; pregnancy.

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Q5: What are the common side effects of aluminum hydroxide? Magnesium hydroxide?

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Q5: What are the common side effects of aluminum hydroxide? Magnesium hydroxide?

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Aluminum hydroxide: severe stomach pain or constipation, loss of appetite, painful urination, muscle weakness, extreme drowsiness, bloody or tartar stools, coughing blood or vomit that looks like coffee grounds
Magnesium hydroxide: rectal bleeding, no bowel movement after taking medication, sever nausea and vomiting, slow heartbeat, light headed feeling

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Nausea: stomach distress and an urge to vomit brought on by systemic illnesses (influenza), medications or pain.

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Nausea: stomach distress and an urge to vomit brought on by systemic illnesses (influenza), medications or pain.

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Vomiting (emesis) forceful expulsion of stomach contents via the mouth can be caused by food poisoning, medications etc.

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Why would 3 antiemetics be ordered? How do you choose which one to use first?

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Why would 3 antiemetics be ordered? How do you choose which one to use first?

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3 antiemetics are ordered because they they are each used in slightly different ways. Gravol is used more for general nausea and vomiting, where as Zofran and Stemetil are used post-operatively. Stemetil in particular is mainly used for severe nausea and vomiting. I would use Zofran first because the patient is post-op and it can be given IV. Zofran is also given less frequently.

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● Take 2hrs before or after amphogel
● Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses.
● Advise patients taking OTC preparations not to take the maximum dose continuously for more than 2 wk without consulting health care professional. Notify health care professional if difficulty swallowing occurs or abdominal pain persists.
● Inform patient that smoking interferes with the action of histamine antagonists. Encourage patient to quit smoking or at least not to smoke after last dose of the day.
● May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.
● Advise patient to avoid alcohol, products containing aspirin or NSAIDs, excessive amounts of caffeine, and foods that may cause an increase in GI irritation.
● Inform patient that increased fluid and fiber intake and exercise may minimize constipation.
● Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly.

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#6 Compare and contrast the mechanism of action, indications for use, and adverse effects of the following group of laxatives.

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#6 Compare and contrast the mechanism of action, indications for use, and adverse effects of the following group of laxatives.

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Extrapyramidal Reactions: muscle spasms, restlessness, tremors
Anticholinergic Effects: dry mouth, blurred vision, dementia-like symptoms

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#2 Explain the pharmacologic strategies for eradicating H. pylori.

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#2 Explain the pharmacologic strategies for eradicating H. pylori.

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Amoxicillin: is a bactericidal, kills the bacteria by disrupting the cell wall
Bismuth: act topically to disrupt the cell wall causing lysis, may prevent H. pylori from adhering to the gastric surface
Tetracycline: an inhibitor of protein synthesis, highly active against H. pylori
Metronidazole: stops H. pylori from mutating and becoming resistant to antibiotics
PPI: inhibits H. pylori growth by unknown mechanisms

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IV may be considered over PO if the patient is experiencing nausea and vomiting because there is a risk that the PO medication won't get absorbed because of the vomiting therefore IV would be better because there is no risk for that. PCA was not relieving his nausea so it is possible that there is an intestinal buildup causing nausea so Maxeran was ordered to relieve nausea and stimulate GI motility. (See drug data base).

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Q3: At discharge, George is prescribed drug therapy, including bismuth subsalicylate x 7 days, metronidazole x 7 days, tetracycline x 7 days and lansoprazole. What are the classifications and mechanism of actions of these drugs? How do these drugs help with PUD?

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Q3: At discharge, George is prescribed drug therapy, including bismuth subsalicylate x 7 days, metronidazole x 7 days, tetracycline x 7 days and lansoprazole. What are the classifications and mechanism of actions of these drugs? How do these drugs help with PUD?

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-Bismuth subsalicylate (also called Pepto-Bismol)
class: antidiarrheal
Action: It acts as a mucosal protective agent. Efficacy as an antidiarrheal appears to be due to its direct anti microbial action and to an anti secretory effect on intestinal secretions exposed to toxins.
Helps with PUD by: coats ulcers and protects ulcers from stomach acid, can sometimes kill H. Pylori but antibiotics are given with it.
-Metronidazole:
Class: antitrichomonal; amebicide
Action: interacts with DNA to cause loss of DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death in susceptible organisms.
Helps with PUD: to kill the presence of H.pylori
-Tetracycline:
Class: antibiotic
Action: suppressed growth of bacteria
Helps with PUD by: to suppress growth of H. pylori
-Lansoprazole:
Class: antisecretory; protein pump inhibitors
Action: selectively inhibits the membrane enzyme H+/K+ATPase in gastric parietal cells by blocking the final step of acid production
Helps with PUD by: decreasing amount of acid your stomach makes, helps to heal and prevent other ulcers from forming.

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#7 What can you tell this patient about the use of laxatives?

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#7 What can you tell this patient about the use of laxatives?

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only use laxatives when necessary, take with a glass of water, should not be taken if patient has intestinal obstruction or impaction,

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#8 Besides the bulk-forming laxative, what else can this patient do to prevent constipation?

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#8 Besides the bulk-forming laxative, what else can this patient do to prevent constipation?

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increase fluid intake
dietary changes - increase fibre
increase exercise

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#9. A health care provider orders a stimulant laxative for a client with constipation, secondary to postoperative opioid use. Before administering the drug, the nurse would assess:

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#9. A health care provider orders a stimulant laxative for a client with constipation, secondary to postoperative opioid use. Before administering the drug, the nurse would assess:

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a) Blood pressure
b) Dosage of the opioid drug prescribed
c) The client's ability to ambulate to the bathroom.
d) Bowel sounds

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high ANC,  produces effects of long duration.

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high ANC,  produces effects of long duration.

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Magnesium PO slightly delayed 30 min 30 min-1 hr (empty stomach); 3 hr (after meals)

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when taken with acidic drugs they cause the absorption of the acidic drugs to decrease, which lowers effectiveness of acidic drugs.
- take aluminum 2 hours prior or after taking an other drugs.

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constipation
lowers phosphate levels in people with kidney conditions.
take with full glass of water (8oz) do not take double dose if you miss one