ANTIULCER DRUGS

Sudario, Carmella Dawn B. BSN 2-1

PEPTIC ULCER DISEASE

Esophageal Ulcer
Reflux of acidic gastric contents into the esophagus

Gastric Ulcer
Occurs of breakdown of GMB

Duodenal Ulcer
hyper secretion of acid from the stomach that passed to the duodenum

SIGNS & SYMPTOMS

Pain The vomiting of blood which may appear red or black Dark blood in stools or stools that are black or tarry Nausea or vomiting Unexplained weight loss Appetite changes

RISK FACTORS
Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori. Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced. Have uncontrolled stress. Although stress alone isn't a cause of peptic ulcers, it's a contributing factor. You may undergo stress for a number of reasons an emotionally disturbing circumstance or event, surgery, or a physical trauma, such as a burn or other severe injury

TRANQUILIZERS
ACTION: To reduce vagal stimulation and decrease anxiety. Examples: Librax combination of the anxiolytics chlordiazepoxide (Librium) and the anticholinergic Clidinium bromide (Quarzan)

ANTICHOLINERGICS
Action: 1. Decreases acetylcholine by blocking the cholinergic receptors. 2.Relieves pain by decreasing gastric motility and secretion 3.Delays gastric emptying Ex: propantheline bromine (Pro-banthine)

ANTACIDS
Action: 1. Neutralize hydrochloric acid 2. Reduce pepsin activity

ANTACIDS
2.no systemic eects: Aluminum: AlOH & AlCO3 Sodium Bicarbonate: Bromo-Seltzer & Alka- S/E: constipation, hypophosphathemia Seltzer 1.w/ systemic eects: Ca Carbonate (Tums) Magnesium: MgOH Mg carbonate, Mg phosphate S/E: diarrhea, hypermagnesemia

Nursing Considerations
Avoid administering antacid with other drugs, it should be 12 hours after other medications Encourage to take 2oz of water to ensure that the drug reaches the stomach Administer on empty stomach or 13 hours after meal and at bedtime Avoid taking antacids w/ milk or foods high in vitamin D Shake suspension well before administering Monitor electrolytes & urinary ph, calcium & phosphate levels Instruct client to report pain, coughing, or hematemesis

HISTAMINE2 BLOCKER
Action: Block the H2 receptors of the parietal cells in the stomach thus reducing gastric secretion and concentration Examples:
cimetidine (Tagamet) ranitidine (Zantac) famotidine (Pepcid) nizatidine (Axid)

Cimetidine (Tagamet)

Ranitidine (Zantac) 1983

-1975, first H2 blocker -Increases the effects of theophylline, beta-blockers, anticoagulants, anticonvulsants -Duration: 4-5 hours -Peak conc: 1-3 hours -Gastric and duodenal ulcer, used prophylactically, relieves symptoms of reflux esophagitis, prevent stress ulcer and aspiration pneumonitis -Duration: up to 12 hours

Famotidine (Pepcid) 1986

-Short term use for Duodenal ulcer and Zollinger-Ellison syndrome - 50-80% more potent than Cimetidine and 5-8x than Ranitidine -Latest H2 blocker -Relieves nocturnal gastric acid secretion for 12 hours -Administer at bedtime to prevent recurrence of duodenal ulcer

Nizatidine (Axid) 1988

HISTAMINE2 BLOCKER
Side Eects and Adverse Reactions
Headache Dizziness Constipation Pruritus Skin rash Gynecomastia Decreased libido Impotence

HISTAMINE2 BLOCKER
Drug and Laboratory Interactions Cimetidine enhances the eects of warfarin, theophylline, caeine, phenytoin, diazepam, propanolol, phenobarbital, & Ca channel blockers Cimetidine can increase BUN, Serum creatinine, serum alkaline phosphatase Antacids

NURSING CONSIDERATIONS
Administer drug just before meals or bedtime Instruct client to report pain, coughing, or hematemesis Direct client to separate ranitidine and antacid dosage by at least 1 hour if possible Educate clients in the use of relaxa7on technique s Teach client to eat foods rich in Vitamin B12 Alert client to avoid foods and liquids that can cause Gastric irritation

PROTON PUMP INHIBITORS

Action: Suppress gastric acid secretion by inhibiting the hydrogen/K ATPase enzyme system located in the gastric parietal cells It inhibits gastric acid secre7on up to 9 0% Agents that block the nal step of acid production

Omeprazole (Prilosec) Lansoprazole (Prevacid)

Rabeprazole (Aciphex)

first; - DOA: 72 hrs -1993 -Ulcer relief usually occurs within 1 week -DOA: 24 ohurs -More effective in treating duodenal ulcers rather than gastric -Most effective in GERD and hypersecretory dse (Zollinger- Ellison Sydrome)

Pantoprazole (Protonix)

-Treat short term erosive GERD -IV is effective in treating Zollinger-Ellison Symdrome -Newest PPI -Highest success ratein healing erosive GERD

Esomeprazole (Nexuim)
S/E:

Headache, Dizziness, Diarrhea, Abdominal Pain, Rash

PROTON PUMP INHIBITORS

Omeprazole can enhance the action of oral anticoagulants, certain benzodiazepines, and phenytoin Lansoprazole may decrease theophylline levels Pantoprazole, no signicant drug interactions

PEPSIN INHIBITOR
ACTION: Covers the ulcer and protects it from acid and pepsin; adhering to the ulcer surface It does not neutralize acid or decrease acid secretions Example: Sucralfate (Carafate) S/E: *given cons7pa7on, dry mouth, dizziness before meal and at bed7me

NURSING CONSIDERATIONS
Administer on empty stomach. Administer antacid 30 minutes before or after sucralfate Allow 12 hours to elapse between sucralfate and other prescribed drugs Instruct that therapy usually takes 48 weeks for optimal ulcer healing Increase OFI, dietary bulk; No smoking Encourage relaxation techniques & exercise Instruct client to report pain, coughing or hematemesis Teach client to avoid gastric irritating foods

PROSTAGLANDIN ANTIULCER DRUGS

Action: suppress gastric acid secre7on and inc rease cytoprotec7ve mucus in the GI tract.

Ex:

MISOPROSTOL (Cytotec)

C/I: pregnant and women of childbearing age S/E: diarrhea, abdominal pain, atulence, nausea, vomiting, constipated and menstrual spotting

THE END