Ch. 23 Drugs For Gastric Ulcers And Reflux

Peptic ulcer disease

-upper GI

-gastric ulcers

-duodenal ulcers

Gastroesophageal reflux disease

-upper GI

-acid stomach contents refluxes into esophagus

-causes esophageal ulcers

Caused by H.pylori infection

•drug therapy- treats infection, excessive acid

•lifestyle changes- avoid irritating foods, caffeine, excessive alcohol, smoking, excessive stress, use of NSAIDs

•untreated ulcers can cause serious damage (bleeding, perforation)

•lower esophageal sphincter (LES) does not work correctly

•chronic condition

•most common symptom is Dyspepsia

•elevate head of bead

•decrease dietary fat

•complications- inflammation, ulcers, bleeding of esophagus

•esophageal stricture

•barrett's esophagus

•baseline vitals

•weight

•bowel habits

•appearance of stool

•assess for bleeding

•assess for vomiting

•assess for reflux

•check abdomen

•vital signs

•daily weights

•monitor for abnormal heart rhythms

•bowel function

•report episodes of reflux, heartburn, and indigestion

•report bowel movements

•do not double dose

•report GI problems

•avoid alcohol, aspirin products, NSAIDs, irritating foods

Decrease secretion of gastric acid

Block secretion of gastric acid

Form a thick coating on open sores

Neutralize acidity of stomach contents

Kill H.Pylori

Speed up the emptying time of stomach

Most available OTC

•nizatidine (axid)

•ranitidine (zantac)

•cimetidine (tagamet)

•famotidine (pepcid)

•decrease secretion of gastric acid

•decrease GERD symptoms

•heal and prevent ulcers

•confusion

•dizziness

•drowsiness

•headache

•altered taste

•nausea

•vomiting

•constipation

•dysrhythmias

•decreased WBC count (agranulocytosis)

•aplastic anemia

•check level of consciousness

•give with meals to prolong effect

•call light within easy reach

•monitor for side effects

•if more than 2 weeks of therapy, contact prescriber

•avoid smoking

•pregnancy and breastfeeding- try lifestyle changes first, avoid while breastfeeding

•older adults- confusion and dizziness are more likely

Most powerful drugs for treating PUD /GERD

-when H2 blockers are ineffective

-decrease gastric acid secretion

-heal ulcers

•diarrhea

•constipation

•belching

•gas

•abdominal pain

•headache

•give before meals in morning

•check IV site for patency and signs of infection

Assess for black, tarry stools

•take exactly as prescribed

•report black, tarry stools

•report diarrhea, abdominal pain, persistent headaches

•pregnancy and breastfeeding- do not take omeprazole, pantoprazole, and rabeprazole not recommended during breastfeeding

•older adults- increased risk of side effects, may decrease absorption of calcium, may decrease absorption of vitamin B12

•neutralize gastric acids

•relieve heartburn, indigestion

•decrease GERD symptoms, ulcer pain, ulcer healing

•constipation (calcium, aluminum salts)

•diarrhea (magnesium salts)

Ensure that antacids are given 1 hour after or 2 hours before any other drug

•contact prescriber if drug therapy has gone more than 2 weeks

•do not take 1 to 2 hours of other drugs

•talk about side effects of diarrhea and constipation

•use of antacids should be avoided id signs of appendicitis or inflamed bowel are present

•pediatric- do not give unless directly prescribed

•pregnancy and breastfeeding- generally safe, do not use long term

•older adults- avoid aluminum containing drugs with bone problems, alzheimers disease

•bismuth subsalicylate (pepto-bismol)

•sucralfate (carafate)

Protect ulcers to prevent further damage

Rare

-constipation (sucralfate)

None when taking as directed

•take as directed, even when feeling better

•prevent constipation

•pediatric- do not give pepto-bismol contains aspirin

•pregnancy and breastfeeding- sucralfate appears safe

Metoclopramide (reglan)

Given 30 mins before meals for 4 to 12 weeks

•increase GI peristalsis

•move digested food through GI tract faster

•decreased GERD symptoms

•fatigue

•drowsiness

•restlessness

•Neuroleptic malignant syndrome

•tardive dyskinesia

•clarithromycin (biaxin)

•metronidazole (flagyl)

•tetracyline (sumycin)

•amoxicillin (trimox)

Give in combination with other drugs to treat ulcers