Pcol😔

• Peptic ulcer disease (PUD)

  Open sores that develop on the stomach lining or small intestine (duodenum) that can lead to perforation and GI bleed
• Perforation


  Risk for GI bleeding
• GI bleeds


  Could be severe and lead to shock and even bigger problems
• Over the counter medications that might help PUD

  • Antacids
  • H2-antagonist
  • Proton pump inhibitors
  • Sucralfate

  
• Mucus


  Secreted by the cells in the mucosa and coats the lining to protect the stomach
• Bicarbonate


  Secreted by the epithelial cells of GI to neutralize the gastric acid
• Adequate blood flow

  Nourishes the mucosa and provides adequate levels of mucus and bicarbonate
• Prostaglandins


  Stimulate mucus and bicarbonate secretion
• Causes of peptic ulcer disease

  • Helicobacter pylori
  • NSAIDs
  • Gastric acid
  • Smoking and alcohol
• Helicobacter pylori


  Gram-negative bacillus that hides in between mucus and epithelial cells, making it harder to treat
• NSAIDs


  Inhibit prostaglandins, reducing healthy levels of mucus and bicarbonate to neutralize gastric acid
• Gastric acid


  Injures the mucosa cells and activates pepsin (enzyme in stomach) which causes damage to stomach lining
• Smoking and alcohol


  Increases gastric acid and reduces bicarbonate production, delaying healing and possibly developing additional sores
• Medications for peptic ulcer disease


  • Antibiotics for H. pylori
  • Limit NSAIDs
  • Histamine receptor antagonists (H2)
  • Proton pump inhibitors (PPI)
  • Mucosal protectants
  • Antacids
  • Encourage patient to stop smoking and limit alcohol
• Options for H. pylori testing

  • Serum antibody test (blood test)
  • Urea breath test
  • Stomach biopsy
• Use a minimum of 2 antibiotics for treatment of H. pylori
• Antibiotics used for H. pylori treatment

  • Clarithromycin
  • Amoxicillin
  • Bismuth
  • Tetracycline
  • Metronidazole
• H2 antagonists


  Block histamine 2 receptors in the stomach lining (parietal cells) to suppress gastric acid secretion
• Examples of H2 antagonists

  • Cimetidine
  • Ranitidine
  • Famotidine
  • Nizatidine
• Adverse effects of H2 antagonists

  • Gynecomastia
  • Decreased libido
  • Impotence
  • Renal or hepatic problems
  • Increased risk for pneumonia
• Proton pump inhibitors (PPIs)

  Most effective at suppressing gastric acid
• Adverse effects of PPIs

  • Increased risk of fractures
  • Pneumonia
  • C. difficile
  • Chronic kidney disease
  • Increased gastric cancer risk
  • Rebound acid secretion when discontinued
• Antacids


  Neutralize stomach acids; do not suppress stomach acids, just neutralize
• Magnesium hydroxide


  Milk of magnesia, can cause diarrhea
• Sucralfate


  Sticky gel that covers ulcer, acts as a protective barrier against pepsin and gastric acid
• Misoprostol


  Acts as a replacement for endogenous prostaglandins, contraindicated in pregnancy
• Antibiotics, H2 receptor antagonists, PPIs, mucosal protectants, and antacids are considered in the medication treatment plan for PUD
• H2 receptor antagonists


  Help suppress gastric acid secretion
• PPIs


  Best at suppressing gastric acid secretion, but have more serious risk factors
• Mucosal protectants


  Help protect and coat the sore in the stomach lining
• Antacids


  Help neutralize gastric acids in the moment
• NSAIDs cause peptic ulcer disease via suppression of prostaglandin production
• Gastric acid activates the enzyme pepsin, which injures the stomach
• Ways smoking and alcohol intake injure the stomach lining


  • Suppresses prostaglandin production
  • Increases pepsin secretion
  • Reduces bicarbonate production
  • Increases gastric acid
  • Delays wound healing
• Proton pump inhibitors block gastric acid production to promote healing of the stomach lining
• Adverse effects of proton pump inhibitors

  • Chronic kidney disease
  • Pneumonia
  • Gastric cancer
  • Fractures
• Common adverse effects of histamine (H2) blockers

  • Altered mental status
  • Gynecomastia
  • Kidney problems
  • Decreased libido
• Magnesium toxicity


  Early signs include nausea and diarrhea
• Misoprostol is contraindicated in pregnancy
• Sucralfate is the appropriate medication to provide a client who might be pregnant to protect her stomach lining