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Unit 7: The Gastrointestinal System

Gastric Secretory Cells . Chief cellsSecrete pepsinogenParietal cells Secrete 1-3 L of Hydrochloric Acid dailyIntrinsic factor Gastric juice = combined secretions of chief and parietal cells. Most acid fluid in the body. Question. If gastric juice is the most acid fluid in the body, what prevents the mucosal lining from being damaged? .

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Unit 7: The Gastrointestinal System

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    1. Unit 7: The Gastrointestinal System Chapter 40: Drugs for Peptic Ulcer Disease

    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 Gnawing or burning upper abd pain 1-3 hrs after meals Worse pain when stomach empty Bleeding occurs with deep erosion Hematemesis Melena Gastric 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 Barrett’s 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 client’s 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? Teaching Keep all scheduled lab visits (phosphorus and calcium levels) Do not take antacids with magnesium if kidney disease Do not take antacids with sodium if heart failure or HTN Take antacids at least 2 hrs before other oral medications Note number and consistency of stools Stools may appear white Shake liquid preparations well before administering Thoroughly chew tablets until wet before swallowing Teaching Keep all scheduled lab visits (phosphorus and calcium levels) Do not take antacids with magnesium if kidney disease Do not take antacids with sodium if heart failure or HTN Take antacids at least 2 hrs before other oral medications Note number and consistency of stools Stools may appear white Shake liquid preparations well before administering Thoroughly chew tablets until wet before swallowing

    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

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