Hyperacidity Medication Classes

There are four major classes of medications used to treat hyperacidity conditions: antacids, H2-receptor antagonists, proton pump inhibitors, and mucosal protectants. Each class of medication is further described below.

As part of the administration of anti-ulcer medications, nurses should record abdominal assessments and bowel patterns. During therapy, the nurse should continue to assess for potential medication interactions and side effects and be aware that vitamin B12 malabsorption may occur whenever stomach acidity levels are altered.

Other interventions to prevent hyperacidity can also be recommended, such as smoking cessation and avoiding food and beverages that can cause increased acidity (alcohol, high-fat or spicy foods, and caffeine). ^[1][2][3][4]

Antacids

H2-Receptor Antagonist

A common H2-receptor antagonist is famotidine (see Figure 7.5b).^[6] It is available OTC and is also often prescribed orally or as an IV injection in the hospital setting. Other H2-receptor antagonists include cimetidine and ranitidine. Cimetidine has a high risk of drug interactions, especially in elderly clients because of its binding to cytochrome P-450 enzymes in the liver, which affects the metabolism of other drugs.

Indications

Famotidine is used to treat GERD, peptic ulcer disease, erosive esophagitis, and hypersecretory conditions, or as an adjunct treatment for the control of upper GI bleeding. OTC famotidine is also used to treat heartburn or sour stomach.

Mechanism of Action

H2-receptor antagonists block histamine’s action at the H2 receptor of the parietal cell, thus reducing the production of hydrochloric acid.

Specific Administration Considerations

To prevent symptoms, oral famotidine is taken 15 to 60 minutes before eating foods or drinking drinks that may cause heartburn. Preexisting liver and kidney disease may require dosage adjustment. Famotidine is supported by evidence as safe for use in pediatric clients younger than 1 year old, as well as in geriatric clients.^[7]

Client Teaching & Education

Clients taking the oral suspension should be instructed to shake it vigorously for 5 to 10 seconds prior to each use.^[8][9] The medication may cause constipation, so fluids and a high-fiber diet should be encouraged.  Additionally, smoking interferes with histamine antagonists and should be discouraged.^[10][11]

Proton Pump Inhibitors

A common proton pump inhibitor (PPI) is pantoprazole (see Figure 7.5c^[12]). It may be prescribed in various routes including orally, with an NG tube, or as an IV injection in the hospital setting. Other PPIs include esomeprazole, lansoprazole, and omeprazole. PPIs are more powerful than antacids and H2-receptor antagonists.

Indications

Pantoprazole is used to treat damage from gastroesophageal reflux disease (GERD) in adults and children five years of age and older by allowing the esophagus to heal and prevent further damage. It is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome in adults. PPIs may also be given in combination with antibiotics to treat H.Pylori infections, a common cause of duodenal ulcers.

Mechanism of Action

PPIs bind to the hydrogen-potassium ATPase enzyme system of the parietal cell, also referred to as the “proton pump” because it pumps hydrogen ions into the stomach. PPIs inhibit the secretion of hydrochloric acid, and the antisecretory effect lasts longer than 24 hours.

Specific Administration Considerations

Packets of delayed-release granules must be mixed with applesauce or apple juice and taken by mouth or given through a feeding tube. Consult the labeling of concomitantly used drugs to obtain further information about interactions because PPIs can interfere with the liver metabolism of other drugs.  IV pantoprazole can potentially exacerbate zinc deficiency, and long-term therapy can cause hypomagnesemia, so the nurse should monitor for these deficiencies. ^[13]

Client Teaching & Education

In addition to the considerations above, instruct clients to call their provider if their condition does not improve or gets worse, especially if bleeding occurs.^[14][15]  Use of alcohol, NSAIDS, or foods that cause GI irritation should be discouraged.^[16][17]

Mucosal Protectants

Sucralfate is a mucosal protectant used to cover and protect gastrointestinal ulcers.

Indications

Used in the treatment of ulcers.

Mechanism of Action

Sucralfate locally covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts. It is minimally absorbed by the gastrointestinal tract.

Specific Administration Considerations

Administer sucralfate on an empty stomach, 2 hours after or 1 hour before meals. Constipation may occur. Sucralfate should be cautiously used with clients with chronic renal failure or those receiving dialysis due to impaired excretion of small amounts of absorbed aluminum that can occur with sucralfate.

Client Teaching & Education

In addition to the considerations above, instruct clients to call their provider if their condition does not improve or gets worse.^{[18][19][20][21]}

Antiflatulent

Simethicone is an antiflatulent that is commonly found in other OTC antacids (see Figure 7.5d^[22]).  It is also safe for use in infants. Gas commonly occurs in the GI tract due to digestive processes and the swallowing of air. Gaseous distension can also occur postoperatively.

Indications

Simethicone is used to treat the symptoms of gas such as uncomfortable or painful pressure, fullness, and bloating.

Mechanism of Action

Simethicone works by altering the elasticity of the mucous-coated gas bubbles, which cause them to break into smaller bubbles, thus reducing pain and facilitating expulsion.

Specific Administration Considerations

Simethicone is usually taken four times a day, after meals and at bedtime. For liquid form, shake drops before administering.

Client Teaching & Education

Clients can be instructed about other measures to assist with gas expulsion such as changing position, ambulation, avoiding the use of straws, and tapering intake of beans and cruciferous vegetables. ^[23],^[24][25][26]