Unit 7: The Gastrointestinal System

1
Unit 7 The Gastrointestinal System

• Chapter 40
• Drugs for Peptic Ulcer Disease

2
Gastric Secretory Cells

• Chief cells
• Secrete pepsinogen
• Parietal cells
• Secrete 1-3 L of Hydrochloric Acid daily
• Intrinsic factor
• Gastric juice combined secretions of chief and
  parietal cells. Most acid fluid in the body

3
Question

• If gastric juice is the most acid fluid in the
  body, what prevents the mucosal lining from being
  damaged?

4
Ulcer

• What is an ulcer?
• What factors put the client at risk for
  developing peptic ulcer disease?
• What is the primary cause of peptic ulcer
  disease?

5
Compare and Contrast the symptoms of Duodenal and
Gastric Ulcers

• Duodenal

• Gastric

• Gnawing or burning upper abd pain 1-3 hrs after
  meals
• Worse pain when stomach empty
• Bleeding occurs with deep erosion
• Hematemesis
• Melena

• Relieved by food but pain may persist even after
  eating
• Anorexia, wt loss, vomiting
• Infrequent or absent remissions
• Small become cancerous
• Severe ulcers may erode through stomach wall

6
Gastroesophageal Reflux Disease (GERD)

• Common
• Acid contents reflux back into esophagus
• Intense burning, sometimes belching
• Can lead to esophagitis, esophageal ulcers, and
  strictures
• Barretts esophagus
• Associated with obesity
• Improved with lifestyle management

7
GERD

• What is the primary treatment goal?
• H2-receptor antagonists
• Proton pump inhibitors
• What does the client need to know about drug
  therapy?
• What are the benefits of pharmacotherapy for
  GERD?

8
Pharmacotherapy for Peptic Ulcer Disease

• Four primary classes
• H2-receptor antagonists
• Proton pump inhibitors
• Antacids
• antibiotics
• Miscellaneous drugs

9
Question

• If PUD is secondary to NSAID use, what will be
  done initially?
• Why is a COX-2 inhibitor a safer NSAID choice?
• What will be done if clients pain must be
  controlled with NSAIDs?

10
H2-Receptor Antagonists

• Block activity and suppress parietal cell
  activity resulting in suppressed volume and
  acidity of secretions
• Prototype ranitidine (Zantac) p. 615
• Examples
• Cimetidine (Tagamet)
• Famotidine (Pepcid)
• Nizatidine (Axid)

• Adverse effects
• Minor diarrhea, constipation, headache,
  fatigue,
• At high dose or in elderly confusion,
  restlessness, hallucinations, depression
• Keep in mind
• Do not take with antacids

11
Nursing Considerations

• What are the nursing considerations associated
  with H2-receptor antagonists?
• What teaching should be included?

12
Proton Pump Inhibitors

• Block enzymes responsible for secreting HCL
  binds irreversibly to H,K-ATPase
• Prototype omeprazole (Prilosec) p. 618
• Examples
• Esomeprazole (Nexium)
• Lanoprazole (Prevacid)
• Pantoprazole (Protonix)

• Adverse effects
• Uncommon
• Headache, abdominal pain, diarrhea, n/v
• Reduces more acid than H2-receptor antagonists
• Takes several days therapy to exert effect
• Short term therapy for PUD and GERD

13
Nursing Considerations

• What are the nursing considerations associated
  with proton pump inhibitors?
• What teaching should be included?

14
Antacids

• Inorganic compounds (alkaline)
• MOA neutralizes stomach acid
• Prototype aluminum hydroxide (Amphojel) p. 620
• Available OTC
• Often combined with simethecone
• Rapid onset 10-15 min
• Short duration 2 hrs

15
Nursing Considerations

• What are the nursing considerations associated
  with antacid therapy?
• What teaching should be included?

16
Helicobacter Pylori Treatment

• Infections must be treated properly to eradicate
  bacterium
• Multiple antibiotic therapy
• Antibiotic therapy combined with antiulcer
  medication
• Bismuth compounds may be added to regimen

17
Miscellaneous Drugs

• Sucralfate (Carafate)
• Produces thick, gel-like substance that coats the
  ulcer
• Does not affect gastric acid secretion
• Minimal side effects
• Misprostel (Cytotec)
• Inhibits gastric acid secretion and stimulates
  production of protective mucous
• Common diarrhea and abdominal cramping
• Pregnancy category X