Monday, April 30, 2012

ANTIULCER DRUGS



ANTACIDS

·         Neutralize gastric acid or reduce the acidity of stomach and duodenal contents by combining HCl and increasing pH in the GI tract.
·         Indications:
o    Indigestion, heartburn, acid  ingestion, reflux esophagitis, peptic ulcer, bind dietary phosphate in renal failure,hyperphosphatemia, relief of GI discomforts
·         Contraindications:   
o     Pregnancy, lactation, hypersensitivity, electrolyte disorders, GI obstruction, kidney disease

Example:
aluminum hydroxide ( AlternaGEL®, Amphojel®)
aluminum hydroxide, magnesium hydroxide ( Gaviscon®, Gelusil®, Maalox®, Mylanta®)
calcium carbonate (Tums®)
magnesium hydroxide (Mag-Ox®, Milk of Magnesia)

Adverse Reactions:

·         Aluminum-containing antacids – constipation, intestinal impaction, anorexia, weakness, tremors, and bone pain
·         Magnesium-containing antacids – severe diarrhea, dehydration, hypomagnesaemia, nausea, vomiting, hypotension, decreased respirations
·         Calcium-containing antacids – rebound hyperacidity, metabolic alkalosis, hypocalcaemia, vomiting, confusion, headache, renal calculi, and neurological impairment
·         Sodium bicarbonate -  systemic alkalosis and rebound hyperacidity

Nursing Considerations:

ü  Should be taken on a regular schedule, 1-3 hours after each meal and at bedtime.
ü  Instruct to chew thoroughly & followed with a glass of water or milk.
ü   Interactions with other medications can be minimized by allowing 1 hour between antacid administration and the administration of other medications.
ü  Aluminum based are used with patients in renal failure.

HISTAMINE-2 ANTAGONIST

·         Decrease secretion of gastric acid and formation of pepsin by blocking histamine-2 receptor sites and from stimulating the parietal cells that secrete acid, thus creating less acid in the stomach,
·         Indications:
o    Gastroesophageal reflux disease (GERD), heartburn, Zollinger-Ellison Syndrome, stress ulcers, GI bleeding, gastric & duodenal ulcers
·         Contraindications:   
o     Lactation, hypersensitivity, electrolyte disorders, GI obstruction, kidney disease


Example:
cimetidine ( Tagamet®)
famotidine (Pepcid®)
nizatidine (Axid®)
ranitidine ( Zantac®)

Side Effects:

·         Dizziness, headache
·         Constipation, diarrhea
·         Gynecomastia
·        

Tagamet®
 
Decreased libido
·         Impotence
·         Malaise
·         Pruritus, rash

Nursing Considerations:

ü  Monitor blood pressure and assess pulse in initial days of therapy.
ü  If the drug is given by rapid IV injection, monitor for profound bradycardia and other cardiotoxic effects. Report physician if there is slow heart rate.
ü  Separate administration with antacids by giving 1 hour before or 2 hours after administration.
ü  Monitor CBC, liver, kidney function.
ü  May cause mental confusion, agitation, psychosis, depression, anxiety and disorientation. Drugs must be stopped if this occurs.
ü  Inform the patient that cimetidine may cause sexual dysfunction.

PROTON PUMP INHIBITORS

·         It suppress gastric acid secretion by inhibiting  the hydrogen-potassium adenosine triphosphatase (ATPase) enzyme system of the gastric parietal cells.
·         Indications:
o    Gastroesophageal reflux disease (GERD),erosive esophagitis, heartburn, Zollinger-Ellison Syndrome, stress ulcers, GI bleeding, gastric & duodenal ulcers, pathologic hypersecretory conditions
·         Contraindications:   
o     Hypersensitivity, pregnant & breast feeding patients

Example:
esomeprazole (Nexium®
lansoprazole (Prevacid®)
omeprazole ( Prilosec®, Prilosec® OTC)
pantoprazole ( Protonix®)
rabeprazole (Aciphex®)

Side Effects:

·         Headache
·         Nausea, vomiting
·         Abdominal pain
·         Diarrhea

Nursing Considerations:

ü  Administer 1 hour before meals
ü  Monitor for diarrhea & abdominal pain.
ü  Do not chew or crush the drug.
ü  Avoid smoking, alcohol, products containing aspirin, caffeine, NSAIDs, and foods that cause GI irritation which may counteract drug effects.

CHOLINERGIC BLOCKERS

·         Inhibits GI motility & gastric secretions.
·         Indications:
o    Adjunctive therapy for peptic ulcer disease

·         Contraindications:   
o     Children, breast-feeding patients, angle-closure  glaucoma, uncontrolled tachycardia, urinary or GI tract obstruction, hypersensitivity, severe ulcerative colitis, myasthenia gravis, acute or severe hemorrhage, unstable cardiovascular status]
Example:
glycopyrrolate ( Robinul®)
mepenzolate (Cantil®)
methscopolamine ( Pamine®)
propantheline (Pro-Banthine®)

Side Effects:

·         Tachycardia
·         Headache, drowsiness
·         Blurred vision
·         Dry mouth
·         Decreased secretions
·         Constipation
·         Urine retention, hesitancy

Nursing Considerations:

ü  Avoid gastric irritants, alcohol, products containing aspirin, caffeine, NSAIDs, and foods that cause GI irritation which may counteract drug effects.
ü   Notify physician for abdominal pain & bleeding.

MISCELLANEOUS AGENTS

·         Bismuth subsalicylate: Reduces GI motility and gastric secretions
·         Misoprostol: Replaces gastric prostaglandins and enhances natural local protective mechanisms
·         Sucralfate: Protect gastric mucosa by coating the ulcer crater
·         Indications:
o    Adjunct to antibiotic therapy to eradicate Helicobacter pylori
o    Prevent gastric ulcers resulting from use of NSAIDs or treat duodenal ulcers not responding to other medication regimens
o    Short term treatment, prevention of gastric, duodenal, and stress ulcers.
·         Contraindications:   
o     Hypersensitivity, pregnant & breast feeding patients, chronic renal failure, liver impairment, allergic to prostaglandins
Example:
bismuth (Pepto-Bismol)
misoprostol ( Cytotec)
sucralfate ( Carafate)



Side effects:

·         Darkened tongue or stools
·         Nausea, vomiting
·         Diarrhea
·         Abdominal pain
·         Flatulence
·         Dyspepsia
·         Uterine cramping

Nursing Considerations:

ü  Assess for epigastric or abdominal pain, frank bleeding, occult bleeding & constipation.
ü  Do not administer with an antacid, separate administration time by at least 30 minutes.
ü  Administer drug at least 1 hour before meals and at bedtime for maximum effectiveness

No comments:

Post a Comment