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Chapter 40 PUD & GERD

1. How do chief cells and parietal cells work together to aid digestion? Chief cells secrete pepsinogen, an active form of the enzyme pepsin that chemically breaks down proteins. Parietal cells secrete hydrochloric acid. This acid helps break down food, activates pepsinogen, and kills microbes that may have been ingested. Parietal cells also secrete intrinsic factor, which is essential for the absorption of vitamin B12. Parietal cells are targets for the classes of antiulcer drugs that limit acid secretion. The combined secretion of the chief and parietal cells, gastric juice, is the most acidic fluid in the body. 2. What common OTC products can contribute to peptic ulcer disease (PUD)? Glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDS), including aspirin 3. What are the goals of PUD pharmacotherapy? To provide immediate relief from symptoms, promote healing of the ulcer, and prevent future recurrence of the disease. 4. How does ranitidine (Zantac) differ from previously studied antihistamines? It acts by blocking H2-receptors in the stomach to decrease acid production. It has a higher potency that cimtidine, which allows it to be administered once daily, usually at bedtime. It also has fewer drug-drug interactions. 5. Why is cimetidine (Tagamet), the first drug of the class, not considered the prototype? Because it has numerous drug-drug interactions (in inhibits hepatic drugmetabolizing enzymes) and because it must be taken up to four times a day. 6. What time of day should H-2 blockers be administered? Bedtime 7. Many histamine blockers are OTC. What implication does that have for nurses and their clients? They may result in drug-drug interactions and produce aderse effects. Assess the clients use of OTC formulations, clients should be advised to seek medical attention if symptoms persist or recur. Persistent epigatric pain or heartburn may be symptoms of more serous disease that requires different medical treatment. Do not take other prescription drugs, OTC meds, herbal remedies, or vitamins/minerals without notifying the doctor 8. Why are H-2 blockers often used in clients that are NPO? The stomach secretes enzymes and hydrochloric acid that accelerate the process of chemical digestion. H2-receptor blockers slow acid secretion by the stomach. 9. What vitamin absorption may be impaired with PUD treatment? Vitamin B12 10. How might use of anti-ulcer therapies interfere with other drugs? They may interfere with absorption of other drugs 11. How do proton pump inhibitors (PPIs) differ from H-2 blockers? PPIs reduce acid secretion in the stomach by binding irreversibly to the enzyme H+, K+, ATPase ( the enzymes responsible for secreting hydrochloric acid in the

stomach) and is used short term 4-8 weeks. H-2 blockers act by blocking the H-2 receptors in the stomach to decrease acid production. The PPIs reduce acid to a greater extent and have a longer duration of action. 12. When should proton pump inhibitors be administered? 30 minutes prior to eating, usually before breakfast. PPIs are unstable in an acidic environment and are enteric coated to be absorbed in the small intestine. 13. What are the 2 most common conditions requiring PPIs and H-2 Blockers? PUD (peptic ulcer disease) and GERD (Gastroesophageal reflux disease) 14. Why are antacids no longer the primary therapy for PUD? They do not promote healing of the ulcer, nor do they help to eradicate H. Pylori 15. Which antacids cause diarrhea? Magnesium Hydroxide (Milk of Magnesia), Magnesium Hydroxide and Aluminum Hydroxide (Maalox), Magnesium Hydroxide and Aluminum Hydroxide with Simethicone (Mylanta, Maalox Plus, others), and Magaldrate (Riopan) 16. Which antacids cause constipation? Aluminum Hydroxide (ALternaGEL, amphojel, others), Calcium Carbonate (OsCal, Titralac, Tums), Calcium Carbonate with Magnesium Hydroxide (Mylanta Gel-caps, Rolaids) 17. Why is simethicone added to antacids? Because it reduces gas bubbles that cause bloating and discomfort 18. Which clients should not use magnesium-based antacids? Any who have kidney disease 19. Why is it necessary to give more than one antibiotic for treatment of PUD? To increase the effectiveness of therapy and to lower the potential for bacterial resistance. 20. How do bismuth compounds (Pepto-Bismol) treat PUD? They inhibit bacterial growth and prevent H. Pylori from adhereing to the gastric mucosa 21. What protects the gastric layer from being dissolved by HCl? A number of natural defenses protect the stomach ucoas against HCl. Certain cells lining the surface of the stomach secrete a thick mucous layer and bicarbonate ion to neutralize the acid. These form such an effective protective layer that they pH at the mucosal surface is nearly neutral. 22. What is the primary indication for misoprostol (Cytotec)? Prevention of peptic ulcers in clients taking high doses of NSAIDs or glucocorticoids 23. How does sucralfate (Carafate) treat PUD and GERD? The drug produces a thick gel-like substance that coats the ulcer, protecting it against further erosion and promoting healing. 24. What preventive measures can clients with PUD & GERDs initiate? Change lifestyle factors contributing to the severity of PUD or GERD. For example, eliminating tobacco and alcohol use and reducing stress often allow healing of the ulcer and cause it to go into remission. Avoiding certain foods and beverages can lessen the severity of the symptoms.