Acid Controlling Drugs Chapter 50 Acid related pathophysiology o The stomach secretes Hydrochloric acid HCl digest Bicarbonate buffer to keep acid from getting too strong Pepsinogen proteins Intrinsic factor vitamin b12 Mucus protective of the lining of the stomach Prostaglandins anti inflammatory affect Cells of the Gastric Gland o Parietal Produce and secrete HCl Primary site of action for many of the drugs used to treat acid related disorders o Chief Secrete pepsinogen a proenzyme Pepsinogen becomes pepsin when activated by exposure to acid Pepsin breaks down proteins proteolytic o Mucous Mucus secreting cells surface epithelial cells Provide a protective mucus coat Protect against self digestion by HCl and digestive enzymes Acid Related Diseases o Helicobacter pylori H pylori Bacterium found in GI tract of 90 of patients with duodenal ulcers and 70 of those with gastric ulcers First line therapy includes a 10 to 14 day course of a proton pump inhibitor and antibiotics Types of Acid Controlling Drugs o Antacids Basic compounds used to neutralize stomach acid Salts of aluminum magnesium calcium and or sodium Many antacid preparations also contain the antiflatulent antigas drug simethicone anti flatulent o Aluminum salts o Have constipating effects o Often used with magnesium to counteract constipation o Often recommended for patients with renal disease more easily excreted o Aluminum carbonate Basaljel kidney faliure patients o Hydroxide salt AlternaGEL Acid Controlling Drugs o Combination products aluminum and magnesium Gaviscon Maalox Mylanta Di Gel o Magnesium Salts o Commonly cause diarrhea usually used with other drugs to counteract this effect o Dangerous when used with renal failure the failing kidney cannot excrete extra magnesium resulting in accumulation o Commonly cause diarrhea usually used with other drugs to counteract this effect o Dangerous when used with renal failure the failing kidney cannot excrete extra magnesium resulting in accumulation o Calcium Salts o Many forms but carbonate is most common o May cause constipation kidney stones o Also not recommended for patients with renal disease may accumulate to toxic levels o Long duration of acid action may cause increased gastric acid secretion hyperacidity rebound month to regulate o Often advertised as an extra source of dietary calcium o Example Tums calcium carbonate o Sodium Bicarbonate o Highly soluble o Buffers the acidic properties of HCl o Quick onset but short duration o May cause metabolic alkalosis everyday o Sodium content may cause problems in patients with heart failure hypertension or renal insufficiency o H2 antagonists Reduce acid secretion All available over the counter in lower dosage forms Most popular drugs for treatment of acid related disorders cimetidine Tagamet nizatidine Axid famotidine Pepcid most common ranitidine Zantac most common o 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 Drugs lansoprazole Prevacid Acid Controlling Drugs omeprazole Prilosec rabeprazole AcipHex pantoprazole Protonix hospital environment esomeprazole Nexium Antiflatulents used to relieve the painful symptoms associated with gas o Simethicone Miscellaneous Acid Controlling Drugs o 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 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 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 o misoprostol Cytotec Prostaglandin E analog Prostaglandins have cytoprotective activity Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate Promote local cell regeneration Help to maintain mucosal blood flow Used for prevention of NSAID induced gastric ulcers Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps diarrhea o simethicone Mylicon Only use this for gas 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 Nursing Implications Antacids o Assess for allergies and preexisting conditions that may restrict the use of antacids such as Fluid imbalances Acid Controlling Drugs Renal disease GI obstruction Heart failure HF Pregnancy o Patients with heart failure or hypertension should not use antacids with high sodium content o Use with caution with other medications because of the many drug interactions o Most medications should be administered 1 to 2 hours after an antacid o Antacids may cause premature dissolving of enteric coated medications resulting in stomach upset Nursing Implications H2 Antagonists o Assess for allergies and impaired renal or liver function o Use with caution in patients who are confused disoriented or elderly o Take 1 to 2 hours before antacids o For intravenous doses follow administration guidelines Nursing Implications Proton Pump Inhibitors o Assess for allergies and history of liver disease o Not all are available for parenteral administration o May increase serum levels of diazepam and phenytoin may increase chance for bleeding with warfarin Acid Controlling Drugs Questions 1 A patient who has chronic renal failure wants to self treat with an antacid for occasional heartburn Which medication is the best choice for this patient A A magnesium containing antacid B A calcium containing antacid C An aluminum containing antacid D Because of renal problems the patient should not take antacids for this problem Rationale Aluminum and sodium based antacids are recommended for patients with renal compromise because they are more easily excreted Both calcium and magnesium based antacids are more likely to accumulate to toxic levels in patients with renal disease and are often avoided in this patient group 2 When working with an elderly patient who has been admitted for a possible gastrointestinal bleed the nurse identifies which drug as