Chapter 47

ANTIULCER DRUGS

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Peptic Ulcers

Peptic Ulceration
Mucosal

lining erosion
Esophageal Gastric Duodenal

Hypersecretion HCl Pepsin pH of 2-5

GERD
Common sites of peptic ulcers.

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Peptic Ulcers

Predisposing factors
Helicobacter pylori Mechanical Genetic Environmental Drugs

(H. pylori)

Symptoms
Aching

pain

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Nonpharmacologic Measures

Avoid tobacco Avoid alcohol Weight loss Avoid hot, spicy, and greasy foods Take any NSAIDs, including aspirin and oral glucocorticoids, with food or in decreased dosage Sit upright Do not eat before bedtime Wear loose-fitting clothing
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Antiulcer Drugs

Tranquilizers Anticholinergic drugs Antacids Histamine2 blockers Proton pump inhibitors Pepsin inhibitor Prostaglandin E1 analog

Actions of the seven antiulcer drug groups.

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Antiulcer Drugs (contd)

Tranquilizers

Chlordiazepoxide and clidinium (Librax) is combination of anxiolytic/anticholinergic Glycopyrrolate (Robinul) Reduces vagal stimulation, decreases anxiety Propantheline (Pro-Banthine) Inhibits release of HCl by blocking acetylcholine and
histamine Take with meals to decrease acid secretion

Anticholinergics

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Antiulcer Drugs (contd)

Antacids

Aluminum (Al) hydroxide (Amphojel) Magnesium (Mg) hydroxide/aluminum hydroxide (Maalox) Calcium carbonate (Tums) Sodium bicarbonate (Alka-Seltzer) (systemic)

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Antiulcer Drugs (contd)

Action

Neutralize gastric acid, reduce pepsin activity Sodium excess, water retention, metabolic alkalosis, acid rebound Mg: diarrhea; Al: constipation Combination: none

Systemic side effects

Nonsystemic side effects

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Antiulcer Drugs (contd)

Histamine2 blockers

Cimetidine (Tagamet), Ranitidine (Zantac) Famotidine (Pepcid), Nizatidine (Axid) Action Reduce gastric acid by blocking H2 receptors of
parietal cells in stomach Promote healing of ulcer by eliminating cause

Side effects Headaches, dizziness, diarrhea, constipation,

reversible impotence, gynecomastia

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Antiulcer Drugs (contd)

Proton pump inhibitors

Esomeprazole (Nexium), Pantoprazole (Protonix) Omeprazole (Prilosec), Lansoprazole (Prevacid) Action Reduce gastric acid by inhibiting
hydrogen/potassium ATPase

Side effects Headache, insomnia, dizziness, dry mouth,

flatulence, d, abdominal pain

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Antiulcer Drugs (contd)

Pepsin inhibitors

Sucralfate (Carafate) Action Combines with protein to form thick paste covering
ulcer, protects from acid and pepsin

Side effects Constipation Nursing Interventions Given 30 min before meals and bedtime

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Antiulcer Drugs (contd)

Prostaglandin E1 analog

Misoprostol (Cytotec) Action Inhibits gastric acid secretion and protects mucosa Side effects GI distress, constipation

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Case Study
A client has peptic ulcer disease due to H. pylori. An antibiotic and proton pump inhibitor have been ordered.

Critical Thinking Explain the importance and use of a dual, triple, or quadruple drug therapy program in the eradication of this bacterial infection.

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Practice Question #1
Which of the following are most likely to be included in a dual drug therapy program for peptic ulcer disease due to H. pylori?
A. B. C. D.

Omeprazole and clarithromycin Tetracycline and metronidazole Ranitidine and amoxicillin Ciprofloxacin and sucralfate

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Practice Question #1 (contd)

Answer: A. Rationale: Omeprazole and clarithromycin are commonly included in a dual drug therapy program for peptic ulcer disease due to H. pylori.

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