Gastro medications + Antibiotics

Common Antacids

calcium carbonate (Tums), magnesium hydroxide (MOM), aluminum hydroxide (Mylanta, Maalox – liquid formulations)

MOA + Onset + Uses for antacids (TUMS, magnesium hydroxide, aluminum hydroxide AKA Mylanta +Maalox)

neutralize or reduce acidity of gastric acid and increase gastric pH

Onset: rapid. Duration: short (1-2 hours)

Uses: short-term relief of heartburn, dyspepsia, GERD symptoms, protection of gastric mucosa

Adverse Effects of Antacids ( TUMS, mag hydroxide, aluminum hydroxide AKA Mylanta + Maalox)

• Constipation: common with calcium and aluminum compounds. Diarrhea: magnesium compounds

• Electrolyte imbalances: calcium compounds = hypercalcemia (constipation, N/V, confusion, kidney stones); magnesium compounds – hypermagnesemia (diarrhea, cardiac arrythmias, muscle weakness, lethargy)

• Fluid retention – do not use sodium products with history of heart failure (HF)

Contraindications and Interactions + Nursing actions for Antacids

Contraindications:

• Renal disease – do not use magnesium compounds

• History of kidney stones – do not use calcium compounds

Interactions:

• Decreases the absorption of multiple medications when given together, separate by 1

Nursing Actions:

• Assess for allergies and PMH for conditions that may restrict the use of antacids (see Contraindications)

• Separate other medications from antacids by 1 to 2 hours due to interactions

• Monitor for therapeutic effect – relief of GI

Patient Education for Antacids

• PATIENT EDUCATION:

• SEPARATE ANTACIDS FROM ALL OTHER MEDICATIONS BY 1 TO 2 HOURS.

• ANTACIDS ARE EFFECTIVE FOR RAPID RELIEF OF SYMPTOMS, THERAPEUTIC EFFECT IS OF SHORT DURATION ONLY

• LONG-TERM SELF MEDICATION WITH ANTACIDS CAN MASK SYMPTOMS OF SERIOUS UNDERLYING CONDITIONS (EX. MALIGNANCY OR PUD). THE PATIENT SHOULD CONTACT PROVIDER IF USING ANTACIDS DAILY AND SYMPTOMS ARE ONGOING

• TABLETS: CHEW THOROUGHLY, DRINK 8 OZ WATER OR MILK TO IMPROVE ABSORPTION

• LIQUID: SHAKE BOTTLE WELL BEFORE ADMINISTRATION

• CAN BE USED WITH PREGNANCY AND LACTATION

HISTAMINE2-RECEPTOR ANTAGONISTS OR H2 BLOCKERS (PROTOTYPE: FAMOTIDINE) - Common Examples

famotidine (Pepcid), cimetidine

HISTAMINE2-RECEPTOR ANTAGONISTS OR H2 BLOCKERS (PROTOTYPE: FAMOTIDINE) - MOA, onset, uses

• MECHANISM OF ACTION: BLOCK H2 RECEPTORS IN THE STOMACH LINING – RESULTS IN DECREASED GASTRIC ACID SECRETION. LOWER ACIDITY PROMOTES HEALING OF PEPTIC ULCERS AND RELIEF OF SYMPTOMS.

• ONSET OF ACTION: WITHIN AN HOUR. DURATION: MODERATE

• USES: PREVENT OR TREAT PEPTIC ULCERS (GASTRIC OR DUODENAL) AND GERD. OCCASIONAL HEARTBURN AND DYSPEPSIA RELIEF (DAY/NIGHT).

HISTAMINE2-RECEPTOR ANTAGONISTS OR H2 BLOCKERS (PROTOTYPE: FAMOTIDINE) - Precautions, interactions and nursing actions

• PRECAUTIONS: RENAL DISEASE, ELDERLY, INFANTS, PREGNANCY

• INTERACTIONS: ANTACIDS. CIMETIDINE HAS MULTIPLE DRUG INTERACTIONS & SIDE EFFECTS.

• NURSING ACTIONS:

• ASSESS FOR ALLERGIES AND HISTORY OF KIDNEY OR LIVER DISEASE

• FAMOTIDINE ADMINISTER PO OR IV (FOLLOW ADMINISTRATION GUIDELINES)

• MONITOR FOR THERAPEUTIC EFFECTS - RELIEF OF GI SYMPTOMS

Patient Education for H2 Blockers

Notify the nurse or provider if any signs of GI bleeding (coffee-ground emesis, bloody emesis, black tarry stools)

Avoid alcohol, smoking and foods that increase GI irritation

Avoid eating or drinking 2-4 hours before bedtime

Separate from antacids by 1 to 2 hours

Limit use of NSAIDs and ASA (increased risk of GI bleed)

May be used for occasional symptom relief (night-time symptoms) or daily to treat or prevent GI bleed

Cimetidine is associated with multiple adverse effects and drug interactions (metabolized by the liver). Famotidine preferred

Common types of proton pump inhibitors

• Prototype —> omeprazole

• other types include: pantoprazole, lansoprazole, esomeprazole

PPI - definition (omeprazole, pantoprazole, lansoprazole, esomeprazole)

medications used to alleviate acid reflux symptoms by reducing the amount of acid that’s produced by the glands within stomach’s lining

onset of action slow. Duration of Action: long

Short Term Therapeutic use of Proton Pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole)

• SHORT TERM THERAPY (6 TO 8 WEEKS) FOR GERD, EROSIVE ESOPHAGITIS, GASTRIC OR DUODENAL ULCERS (PUD), H. PYLORI INFECTION (COMBINED WITH ANTIBIOTIC THERAPY)

Long Term Therapeutic use of Proton Pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole)

FOR TREATMENT OF HYPERSECRETORY CONDITIONS (ZOLLINGER-ELLISON SYNDROME). SOME PATIENTS MAY

REQUIRE LONG TERM USE FOR PREVENTION OF ULCERS & BLEEDING

Adverse Effects and Interactions of PPI’s (omeprazole, lansoprazole, pantoprazole, esomeprazole)

• Osteoporosis and fractures: decreased calcium absorption can occur with decreased acid production when used long term

• C. difficile associated diarrhea: provide education regarding symptoms

• Pneumonia: monitor patient for respiratory symptoms

• Rebound acid hypersecretion: after stopping PPI, symptoms return

• Hypomagnesemia: monitor serum levels with long term use

Interactions: Can increase levels of digoxin, diazepam, phenytoin, warfarin and others. Nursing Action: check for interactions before administration, monitor patient’s digoxin and phenytoin serum levels if used together. Monitor for signs of bleeding if used with warfarin.

Contraindications/Precautions + Patient Ed for PPI’s

• Contraindicated with hypersensitivity to PPIs, Avoid with pregnancy and lactation. Use cautiously if high risk for pneumonia and with liver disease

Patient Education: Short term therapy is usually 6 to 8 weeks. If long term therapy indicated, use as low a dose as possible, taper off slowly to avoid rebound symptoms. Increase vitamin D and calcium intake if using PPI long term, daily supplements. Report adverse effects to provider, including fever, breathing changes, diarrhea, GI bleed, muscle or GI cramping, tremors. Do not crush, open or chew sustained-release capsules

• Take before the morning meal without food

• PPI’s do not provide immediate relief of GI

symptoms

Nursing Actions (omeprazole, lansoprazole, pantoprazole, esomeprazole)

• ASSESS FOR ALLERGIES AND MEDICAL HISTORY OF RESPIRATORY OR LIVER DISEASE

• ASSESS POTENTIAL FOR PREGNANCY AND LACTATION – AVOID USE

• REVIEW OTHER MEDICATIONS AND RISK FOR DRUG INTERACTIONS – MAY REQUIRE ADDITIONAL LAB MONITORING (SEE INTERACTIONS)

• LONG-TERM USE INCREASES RISK OF HYPOCALCEMIA, LOW VITAMIN D, HYPOMAGNESEMIA – MAY REQUIRE LAB MONITORING AND SUPPLEMENTATION

• MONITOR PATIENT FOR THERAPEUTIC RESPONSE AND ADVERSE EFFECTS (NOTIFY PROVIDER)

Nursing Admin for PPI (omeprazole, lansoprazole, pantoprazole, esomeprazole)

• DO NOT CRUSH, CHEW OR OPEN & SPRINKLE SUSTAINED- RELEASE CAPSULES

• ADMINISTER BEFORE MORNING MEAL ON EMPTY STOMACH

• SOME FORMULATIONS ARE AVAILABLE IV, ADMINISTER AS DIRECTED, MONITOR PATIENT IV SITE FOR INFLAMMATION

AND IRRITATION