Antiulcer

• 7 GROUPS OF ANTIULCER


  • Proton Pump Inhibitor
  • Pepsin Inhibitor
  • Sucralfate
  • Prostaglandin E1 Analogue
  • Misoprostol
  • Anticholenergics
  • Antacids
  • Tranquilizer
  • H2 Blockers
• TRANQUILIZER


  Drugs that reduce vagal stimulation and decrease anxiety (minimal effects in preventing / treating ulcer)
• ANTICHOLINERGICS


  Drugs that relieves pain by decreasing the GI motility and secretion of histamine and HCl
• ANTACIDS


  Drugs that promote ulcer healing by neutralizing hydrochloric acid and reducing pepsin activity (do not coat the ulcer)
• 2 Types of Antacids

  • Systemic effects - these are antacids that are systemically absorbed; it has side effects of Na excess, causing hypernatremia and water retention and metabolic acidosis
  • Non systemic effects - these are antacids with small degree of absorption. Its composition is alkaline salts and magnesium.
• HISTAMINE2 BLOCKERS


  Drugs that prevent acid reflux in the esophagus (reflux esophagitis). It prevents by blocking the H2 receptors of the parietal cells in the stomach thus reducing gastric acid secretions and concentrations.
• HISTAMINE2 BLOCKERS


  • Ranitidine
  • Famotidine
  • Nizatidine
• PROTON PUMP INHIBITORS


  Drugs that suppress gastric acid secretions by inhibiting hydrogen/ potassium ATPase enzyme system located in the gastric parietal cell. (block the final step of acid production). It inhibit 90% of gastric secretions greater than H2 blockers.
• PEPSIN INHIBITOR


  Drugs that combines with protein to form viscous substance that covers the ulcer and protects it from acid and pepsin. (does not neutralize / decrease acid)
• PROSTAGLANDIN ANALOGUE ANTIULCER DRUG


  New drug that prevent and treat peptic ulcer by suppressing gastric acid secretions and increase cytoprotective mucus in the GIT tract. It also causes moderate decrease in pepsin secretions
• Tranquilizer

  Chlordiazepoxide HCl
• Nursing Implicationsof Tranquilizer 


  • Reconstitute sol'n for IM w/ special diluent provided
  • IM route slowly
  • V/S monitoring
  • Driving caution
  • Analgesics narcotic less intake
  • Monitor kidney, liver function, CBC on long term therapy
  • No small veins
  • Not to stop drug without consulting the doctor
• Mechanism of Action(Tranquilizer)


  • Blocks effects of Acetylcholine at receptors that mediate the effect of parasympathetic postganglionic impulses
  • Depress salivary and bronchial secretions
  • Dilates bronchi
  • Gastric secretions inhibits
  • Relaxes GI
  • Vagal stimulation on the heart inhibits
• Antacids


  Neutralizes or reduces gastric acidity to increase pH of the stomach and duodenal bulb
• Mechanism of Action(Antacids)


  Inhibit proteolytic activity of pepsin, w/c protects lining of the stomach and duodenum
• Therapeutic Uses(Antacids)


  • Relief of upset stomach w/ hyperacidity
  • Hyperacidity associated with peptic ulcer, gastritis peptic esophagitis, gastric hyperacidity, hiatal hernia
  • Tx or mgt. of hyperphosphatemia - aluminum carbonate
• Nursing Implications(Antacids)


  • Hx of drug allergy to establish
  • Bone and muscle strength assessment
  • Oral drugs within 1-2 hrs. after antacid administration should not be administer
  • Monitor PR, BP, peripheral edema, abdominal exam, bowel sounds
  • Monitor serum phosphorus levels periodically on long term therapy
  • Chew oral drugs thoroughly; follow with a glass of water.
  • In between meals and at bedtime to administer
• Mechanism of Action(H2 Blocker)


  Inhibits the action of histamine at histamine receptors of parietal cells of the stomach, inhibiting basal gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin
• Therapeutic Uses(H2 Blocker)


  • Maintenance therapy of duodenal ulcer (in reduce dose)
  • Erosive esophagitis
  • Duodenal ulcer and gastroesophageal reflux disease short term treatment at reduced dosage
• Nursing Implications(H2 Blocker)


  • With meals and at bedtime
  • Hx of renal or hepatic impairment
  • Assess for skin lesion, orientation, liver evaluation, output and CBC
  • Report for sore throat, bruising, bleeding, tarry stool, muscle and joint pain
  • Monitor for side effects such as constipation or diarrhea; nausea and vomiting; enlargement of breasts; impotence; headache
• Proton Pump Inhibitor


  Gastric Acid Secretion Inhibitors, Gastric Acid Pump Inhibitor
• Omeprazole


  Indications: Tx of H. pylori, Tx Peptic Ulcers
• Mechanism of Action(Proton Pump Inhibitor)


  Suppress gastric acid secretion by inhibiting the hydrogen / potassium ATPase enzyme system at the gastric parietal cells
• Nursing Implications(Proton Pump Inhibitor)


  • Monitor for side effects as follows: headache, abdominal pain, rash dizziness, diarrhea
  • Caution on pt. w/ liver impairment
  • Prolong use may lead to CA
  • Use of drug enhance effect of anticoagulant, benzodiazepines, and phenytoin
• Indications(Pepsin Inhibitor)


  Short term treatment of duodenal ulcers
• Mechanism of Action(Pepsin Inhibitor)


  • Formation of ulcer adherent complex at duodenal ulcer sites, protecting ulcers against acids pepsin and bile salts, thereby promoting ulcer healing
  • Also inhibits pepsin activity.
• Nursing Implications(Pepsin Inhibitor)


  • Hx of liver impairment, CRF
  • Empty stomach (1 hr. before or 2hrs. after meals)
  • Pain scale monitoring when used antacids to relieve pain
  • Administer antacids between doses of sucralfate
  • Mucous membrane, normal output monitoring
• Indication(Prostaglandin)


  Prevention of NSAID induced gastric ulcers
• Mechanism of Action(Prostaglandin)

  • Synthetic prostaglandin E1 analog
  • Inhibits gastric acid secretions and increases bicarbonate and mucus production, protecting the lining of the stomach
• Nursing Implications(Prostaglandin)

  • Meals at bedtime
  • Establish Hx of pregnancy and allergy
  • Negative of pregnancy test within 2 wks beginning the therapy
  • S/sx of bleeding, spotting, menstrual pain to report