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