{"id":355,"date":"2019-11-04T23:42:17","date_gmt":"2019-11-05T04:42:17","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-5-anti-ulcer\/"},"modified":"2023-08-15T14:19:02","modified_gmt":"2023-08-15T18:19:02","slug":"7-5-anti-ulcer","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-5-anti-ulcer\/","title":{"raw":"7.5 Anti-Ulcer Medications","rendered":"7.5 Anti-Ulcer Medications"},"content":{"raw":"
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Hyperacidity Medication Classes<\/h1>\r\nThere 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.\r\n\r\nAs 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.\r\n\r\nOther 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). [footnote]Lilley, L., Collins, S., & Snyder, J. (2014). Pharmacology and the Nursing Process. pp. 782-862. Elsevier<\/em>.[\/footnote][footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach<\/em>. pp. 443-454. Elsevier.[\/footnote][footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote][footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Antacids<\/h2>\r\n<\/div>\r\n

Indications<\/h3>\r\n[pb_glossary id=\"826\"]Antacids<\/strong>[\/pb_glossary] (see Figure 7.5a)[footnote]\"Antacid-L478.jpg<\/a>\" by Midnightcomm is licensed under CC BY-SA 3.0<\/a>[\/footnote]) reduce the symptoms of heart burn.\r\n

Mechanism of Action<\/h3>\r\nNeutralize stomach acid\r\n

Specific Administration Considerations<\/h3>\r\nThere are many OTC medications available for this purpose, such as calcium carbonate, aluminum hydroxide, and magnesium hydroxide. Calcium carbonate is the prototype discussed as an example. Many antacids also contain simethicone, an antiflatulent used for gas relief. Simethicone is further described in the medication grid below. In general, clients should be reminded to take OTC meds appropriately as prescribed and should not exceed the maximum dose.\r\n

Client Teaching & Education<\/h3>\r\nBe sure to read drug label information regarding antacids as you administer them because each type has its own specific side effects.\u00a0<\/span>\r\n
\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"506\"]\"An Figure 7.5a Example of Antacid tablets bottle[\/caption]\r\n

H2-Receptor Antagonist<\/h2>\r\nA common H2-receptor antagonist is famotidine <\/em>(see Figure 7.5b).[footnote]\"My Still LIfe<\/a>\" by Bast Productions<\/a> is licensed under CC BY-NC-ND 2.0<\/a>[\/footnote]\u00a0It is available OTC and is also often prescribed orally or as an IV injection in the hospital setting. Other H2-receptor antagonists include cimetidine<\/em> and ranitidine<\/em>. Cimetidine<\/em> has a high risk of drug interactions, especially in elderly clients because of its binding to [pb_glossary id=\"651\"]cytochrome P-450 enzymes[\/pb_glossary]<\/strong> in the liver, which affects the metabolism of other drugs.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"377\"]\"Photo Figure 7.5b OTC Famotidine[\/caption]\r\n

Indications<\/h3>\r\nFamotidine 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.\r\n

Mechanism of Action<\/h3>\r\nH2-receptor antagonists block histamine\u2019s action at the H2 receptor of the parietal cell, thus reducing the production of hydrochloric acid.\r\n

Specific Administration Considerations<\/h3>\r\nTo 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.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n

Client Teaching & Education<\/h3>\r\nClients taking the oral suspension should be instructed to shake it vigorously for 5 to 10 seconds prior to each use.[footnote]Lilley, L., Collins, S., Snyder, J. (2014). Pharmacology and the Nursing Process<\/em>. pp. 782-862. Elsevier.[\/footnote][footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach<\/em>. pp. 443-454. Elsevier.[\/footnote] The medication may cause constipation, so fluids and a high-fiber diet should be encouraged.\u00a0 Additionally, smoking interferes with histamine antagonists and should be discouraged.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote][footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Proton Pump Inhibitors<\/h2>\r\nA common [pb_glossary id=\"827\"]proton pump inhibitor<\/strong>[\/pb_glossary] (PPI) is pantoprazole (see Figure 7.5c[footnote]\"Prilosec Box 001<\/a>\" by cygnus921<\/a> is licensed under CC BY 2.0<\/a>[\/footnote]). 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.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"470\"]\"Photo Figure 7.5c OTC Omeprazole[\/caption]\r\n

Indications<\/h3>\r\nPantoprazole 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<\/em> infections, a common cause of duodenal ulcers.\r\n

Mechanism of Action<\/h3>\r\nPPIs bind to the hydrogen-potassium ATPase enzyme system of the parietal cell, also referred to as the \u201cproton pump\u201d because it pumps hydrogen ions into the stomach. PPIs inhibit the secretion of hydrochloric acid, and the antisecretory effect lasts longer than 24 hours.\r\n

Specific Administration Considerations<\/h3>\r\nPackets 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.\u00a0 IV pantoprazole can potentially exacerbate zinc deficiency, and long-term therapy can cause hypomagnesemia, so the nurse should monitor for these deficiencies. [footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n

Client Teaching & Education<\/h3>\r\nIn addition to the considerations above, instruct clients to call their provider if their condition does not improve or gets worse, especially if bleeding occurs.[footnote]Lilley, L., Collins, S., Snyder, J. (2014). Pharmacology and the Nursing Process.<\/em> pp. 782-862. Elsevier.[\/footnote][footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em> pp. 443-454. Elsevier.[\/footnote]\u00a0 Use of alcohol, NSAIDS, or foods that cause GI irritation should be discouraged.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote][footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27; https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Mucosal Protectants<\/h2>\r\nSucralfate is a mucosal protectant used to cover and protect gastrointestinal ulcers.\r\n

Indications<\/h3>\r\nUsed in the treatment of ulcers.\r\n

Mechanism of Action<\/h3>\r\nSucralfate 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.\r\n

Specific Administration Considerations<\/h3>\r\nAdminister 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.\r\n

Client Teaching & Education<\/h3>\r\nIn addition to the considerations above, instruct clients to call their provider if their condition does not improve or gets worse.[footnote]Lilley, L., Collins, S., Snyder, J. (2014). Pharmacology and the Nursing Process.<\/em> pp. 782-862. Elsevier.[\/footnote][footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A Patient-Centered Nursing Process Approach.<\/em> p.188-194 and 604-633. Elsevier.[\/footnote][footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote][footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Antiflatulent<\/h2>\r\nSimethicone is an antiflatulent that is commonly found in other OTC antacids (see Figure 7.5d[footnote]\"Gelusil Antacid and Anti-Gas<\/a>\" by Wellspring Pharmaceutical<\/a> is licensed under CC BY 2.0<\/a>[\/footnote]).\u00a0 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.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"382\"]\"Photo Figure 7.5d OTC Simethicone[\/caption]\r\n

Indications<\/h3>\r\nSimethicone is used to treat the symptoms of gas such as uncomfortable or painful pressure, fullness, and bloating.\r\n

Mechanism of Action<\/h3>\r\nSimethicone 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.\r\n

Specific Administration Considerations<\/h3>\r\nSimethicone is usually taken four times a day, after meals and at bedtime. For liquid form, shake drops before administering.\r\n

Client Teaching & Education<\/h3>\r\nClients 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. [footnote]Lilley, L., Collins, S., Snyder, J. (2014). Pharmacology and the Nursing Process.<\/em> pp. 782-862. Elsevier.[\/footnote],[footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em> pp. 443-454. Elsevier.[\/footnote][footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote][footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n
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\u00a0Interactive Activity<\/h3>\r\n[h5p id=\"20\"]\r\n\r\n<\/div>\r\n<\/div>\r\nNow let\u2019s take a closer look at the medication grids comparing medications used to treat hyperacidity in Table 7.3a.[footnote]Lilley, L., Collins, S., & Snyder, J. (2014).\u00a0Pharmacology and the Nursing Process.<\/em> pp. 782-862. Elsevier.[\/footnote][footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018).\u00a0Pharmacology: A patient-centered nursing process approach.<\/em>\u00a0pp. 443-454. Elsevier.[\/footnote]<\/span>,[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote] [footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n\r\nMedication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below.\u00a0 Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.\r\n
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Medication Card 7.5: Comparing Hyperacidity Medications[footnote] This work is a derivative of\u00a0 <\/span>Daily Med <\/a>by\u00a0<\/span>U.S. National Library of Medicine<\/a>\u00a0in the\u00a0<\/span>public domain<\/a>.<\/span>[\/footnote][footnote]RNPedia. (2021). https:\/\/www.rnpedia.com[\/footnote][footnote]DailyMed from US National Library of Medicine. www.dailymed.com[\/footnote][footnote]OpenMD.Com at openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral[\/footnote]<\/span><\/h2>\r\n<\/header>\r\n
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Generic Prototype (Brand)<\/h3>\r\n