PPI's
Why do we use PPI's? Suffix?
"zole"
- PUD
- GERD
- ZES
Why do we use H2 blockers?
Suffix?
"tidine" - famotidine
- Heart Burn
- PUD (PPI's are preferred)
- GERD (PPI's are preferred)
- Stress Ulcers
What do we use ANTACIDS for? What do ANTACIDS DO?
Antacids treat HEARTBURN by NEUTRALIZING STOMACH ACID!
Antacids also are used as an OSMOTIC LAXATIVE (water)!
Why do we use MUCOSAL PROTECTANTS?
What do they treat and how?
PUD (PEPTIC ULCER DISEASE):
- FORMS A VISCOUS ADHESIVE THAT PROMOTES ULCER HEALING (provides a gel-like layer over the ulcer to prevent pain and promote healing (DOES NOT HEAL THE ULCER) of the ulcer)
Why do we use PROSTAGLANDINS?
What do PROSTAGLANDINS DO?
WE USE PROSTAGLANDINS TO:
- PREVENT NSAID-INDUCED GASTRIC ULCERS:
- by DECREASING ACID SECRETION and INCREASING GASTRIC CYTO-PROTECTIVE MUCUS.
What do PPI's do?
INHIBIT GASTRIC ACID SECRETION
What do H2 BLOCKERS DO?
What adverse effects do they cause in patients?
Inhibits Gastric Acid Secretion (same as PPI's)
- headache
- dizziness
- fatigue
- confusion
- GYNECOMASTIA
- THROMBOCYTOPENIA
What are the adverse effects that ANTACIDS can cause in patients? What are the MAIN ONES?
- ELECTROLYTE DISTURBANCES
- Diarrhea
- Abdominal Cramping
What adverse effects can a patient experience if they take MUCOSAL PROTECTANTS?
- CONSTIPATION
- NAUSEA
- dry mouth (metallic taste)
- ALUMINUM TOXICITY (esp. in renal insufficency)
- MUCOSAL PROTECTANTS ALSO INHIBIT THE ABSORPTION OF ANTACIDS!
What adverse effects can PROSTAGLANDINS cause?
- Nausea/Diarrhea
- Abdominal Pain
- Flatulence (GAS)
- Headache
What adverse effects do PPI's cause? What is the main one we need to look out for?
- headache
- N/D
- Constipation
- Abdominal Pain
- Nausea
- Diarrhea
THROMBOCYTOPENIA!
What are the main differences in adverse effects between PPI's and H2 BLOCKERs?
PPI's: "PAIN"
- Nausea/Diarrhea
- Constipation
- Abdominal Pain
H2 Blockers: "TIRED"
- Dizziness
- Fatigue
- Confusion
- Gynecomastia
How fast do ANTACIDS work? What are the max doses that a patient can take at a time?
- VERY RAPID ACTING: ANTACIDS provide IMMEDIATE RELIEF (take PRN)
- NO MORE THAN 4 DOSES per 24 hours!
What is the most important patient education/nursing consideration for MUCOSAL PROTECTANTS?
- TAKE 30-60 MINUTES BEFORE EATING: to protect the ulcer and to prevent pain in the patient.
What should patients avoid if they are taking PROSTAGLANDINS?
MAGNESIUM or ANTACIDS!!!
(can cause SEVERE DIARRHEA)
What are patients at risk for when taking this medication?
- C. DIFF
- OSTEOPOROSIS (decreased calcium absorption)
- Chronic Kidney Disease
What nursing considerations should you implement/educate to the patient?
- less effective than PPI's
- may effect the absorption of other meds the pt might be taking
- Available OTC
What should patients avoid when taking this ANTACIDS?
AVOID: ALUMINUM and MAGNESIUM
- they contain products in severe renal impairment which can cause HYPOTENSION
WATCH FOR GERO POPULATION
What should we do if the patient has a renal impairment?
ADJUST THE DOSE!
mucosal protectants accumulate in renal insufficiency
What are the two most important NURSING CONSIDERATIONS REGARDING PROSTAGLANDINS?
- PROSTAGLANDINS = CLASS D DRUG (pregnancy - meaning there is a potential human fetal risk) (can cause INCREASED uterine contractions)
- PROSTAGLANDINS CAN CAUSE HYPOTENSION in PATIENTS WHO HAVE CAD
What is the duration/onset for PPI's? What dietary considerations do we need to implement/educate our patients of?
PPI's have a SLOW ONSET and a LONG DURATION of up to 72 hours!
- administer 30-60 min prior to meals!
What do PPI's and H2 BLOCKERS both have in common?
MOA: inhibits gastric acid secretion
ADVERSE EFFECTS: BOTH PPI's and H2 BLOCKERS CAUSE THROMBOCYTOPENIA
What do patients need to keep in mind when taking ANTACIDS?
- avoid aluminum and magnesium (can cause hypotension)
- NOT FOR HEALING GASTRIC EROSIONS
- do not take more than 4 doses a day
Do MUCOSAL PROTECTANTS HEAL ULCERS?
NOOOOO!
They only relieve symptoms and PROMOTE ULCER HEALING
What nursing considerations should patients keep in mind if they are taking NSAIDS?
TAKE PROSTAGLANDINS AT THE SAME TIME AS NSAID therapy STARTS