Chapter 32: Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Diseases

Which medication is used in the treatment of gastric reflux esophagitis and diabetic

gastroparesis?

a. Metoclopramide

b. Misoprostol

c. Pantoprazole

d. Ranitidine

ANS: A

Metoclopramide is a gastric stimulant used to relieve the symptoms of gastric reflux

esophagitis and diabetic gastroparesis, aid in small bowel intubation, and stimulate gastric

emptying and intestinal transit of barium after radiologic examination of the upper

gastrointestinal (GI) tract. Misoprostol is used to prevent and treat gastric ulcers caused by

NSAIDs, including aspirin. Pantoprazole and ranitidine do not treat gastroparesis.

The nurse is preparing to administer medications and notes that a patient has sucralfate

ordered qid. When is the best time to administer this medication?

a. 1 hour before meals

b. With meals

c. 1 hour after meals

d. With a bedtime snack

ANS: A

This medication should be administered on an empty stomach. Taking the medication with

meals, 1 hour after meals, or with a bedtime snack does not allow the medication to form its

protective coat of the gastric mucosa.

Which is a common adverse effect of magnesium based antacid preparations?

a. Heartburn

b. Rebound indigestion

c. Constipation

d. Diarrhea

ANS: D

Magnesium oxide, magnesium hydroxide, and magnesium trisilicate are used in antacid

preparations. All magnesium products can cause diarrhea. Milk of Magnesia is often taken for constipation. Antacids are given to relieve heartburn. Calcium based antacids are likely to

cause rebound indigestion. Magnesium is often given as a laxative, in antacid form or as

magnesium sulfate.

Cimetidine (Tagamet) is an example of which class of drug?

a. Protokinetic agent

b. Proton pump inhibitor

c. Histamine (H2) receptor antagonist

d. Coating agent

ANS: C

All H2 receptor antagonists end in " dine." Examples in this category include cimetidine,

ranitidine, famotidine, and nizatidine. An example of a protokinetic agent is metoclopramide.

An example of a proton pump inhibitor is omeprazole.

An example of a coating agent is sucralfate.

A postoperative appendectomy patient has a nasogastric tube and wonders why the

previous nurse told him that he was receiving an IV "ulcer preventing" medication called

ranitidine. The patient states that he has never had any stomach problems in his life. Which

is the best response by the nurse?

a. "This medication will cause the pH in your stomach to drop."

b. "This medication helps coat your stomach while the nasogastric tube is in place."

c. "Because you are not eating after surgery, this medication will help reduce the

hydrochloric acid your stomach is still secreting."

d. "The nasogastric tube will cause peptic ulcer disease. This medication will help prevent

that.

ANS: C

Patients who are not eating still secrete hydrochloric acid from the stomach's parietal cells.

H2 receptor antagonists block the H2 receptors, resulting in a decrease in the amount of acid

secreted. The pH of the stomach contents then becomes less acidic, which reduces the stress

of the mucosal lining of the stomach. Ranitidine causes the stomach contents to become less

acidic as the amount of acid secreted decreases; consequently, the pH of the stomach rises.

This is not a coating agent, and giving it parenterally will not work to coat the stomach.

Increased gastric acid, not nasogastric tubes, causes peptic ulcer disease (PUD).

Which explanation by the nurse is accurate to include when teaching a patient who is

beginning therapy for gastroesophageal reflux disease (GERD) with metoclopramide?

a. "This medication decreases esophageal muscle tone to reduce reflux."

b. "Peristalsis is increased, so food is digested more quickly."

c. "Gastric emptying is delayed, so you may feel full for longer intervals."

d. "This medication is an antikinetic agent, so you may have difficulty with motor skills."

ANS: B

Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis,

hastening emptying of the stomach to reduce reflux. Metoclopramide increases lower

esophageal sphincter pressure. Metoclopramide hastens gastric emptying. Metoclopramide

is a prokinetic agent and does not affect motor function.

A patient who is taking NSAIDs to treat arthritis asks the nurse why misoprostol has also

been prescribed. Which explanation by the nurse is accurate?

a. NSAIDs often cause GI irritation that can result in peptic ulcers.

b. NSAIDs promote the production of prostaglandins and reduce the incidence of gastric

irritation.

c. Antiulcer medications eradicate the presence of bacteria in the stomach that cause

ulcers.

d. Drug interactions are prevented when antiulcer medications are used in combination

with NSAIDs.

ANS: A

Misoprostol, a GI prostaglandin, is used to prevent and treat gastric ulcers caused by NSAIDs.

Prostaglandin inhibition is effective in reducing pain and inflammation, especially in arthritis,

but makes the patient more predisposed to peptic ulcers. Prostaglandins are normally

present in the GI tract to inhibit gastric acid and pepsin secretion to protect the stomach and

duodenal lining against ulceration. NSAIDs inhibit prostaglandin production. Bismuth

subsalicylate, metronidazole, and tetracycline combination (Helidac), as well as lansoprazole,

clarithromycin, and amoxicillin combination (Prevpac), are used to treat infections caused by

Helicobacter pylori. Drug interactions are not prevented by the presence of antiulcer

medications.

Which organism or disorder is responsible for many cases of PUD?

a. H. pylori

b. Candida albicans

c. Escherichia coli

d. Herpes zoster

ANS: A

Various combinations of antibiotics (e.g., amoxicillin, tetracycline, metronidazole,

clarithromycin), bismuth, and antisecretory agents (e.g., H2 antagonists, proton pump inhibitors) are used to eradicate H. pylori. C. albicans is the causative agent of candidiasis. E.

coli is a normal bowel flora. Herpes zoster is also known as shingles.

A patient with PUD asks the nurse about the action of prokinetic medications. Which

explanation by the nurse is accurate?

a. It blocks the formation of hydrochloric acid, reducing irritation of the gastric mucosa.

b. It increases the lower esophageal sphincter muscle pressure and peristalsis.

c. It reduces the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic

fluids.

d. It decreases the volume of hydrochloric acid produced, increasing the gastric pH.

ANS: B

Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis,

hastening emptying of the stomach to reduce reflux. Proton pump inhibitors block the

formation of hydrochloric acid, reducing irritation of the gastric mucosa. Antispasmodic

agents reduce the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic

fluids necessary for digestion and decrease GI motility and secretions. H2 antagonists

decrease the volume of hydrochloric acid produced, increasing the gastric pH, which results

in decreased irritation to the gastric mucosa.

Which is considered an acceptable time frame for a patient with gastric distress to self

medicate with over the counter antacids?

a. Hours

b. Days

c. Weeks

d. Months

ANS: C

For indigestion, antacids should not be administered for more than 2 weeks. If after this time

the patient is still experiencing discomfort, a health care provider should be contacted. A

time frame of hours or days is less than the acceptable time interval. A time frame of months

is greater than the acceptable time interval.

The nurse is instructing a patient recently diagnosed with GERD. Which statement by the

patient indicates a need for further teaching?

a. "I will avoid foods high in fat."

b. "I will eat small frequent meals and have a snack at bedtime."

c. "Orange juice may aggravate my symptoms."

d. "I will wait 2 hours after eating lunch before lying down for a nap."

ANS: B

Late night snacks need to be avoided to reduce increased gastric secretions. The patient with

GERD needs to avoid foods high in fat and should wait 2 hours after eating before lying down.

Orange juice may aggravate the symptoms of a patient with GERD.

The nurse is planning to administer an antacid to a patient diagnosed with PUD who will

receive an H2 antagonist at 8:00 AM. When is the most appropriate time for the nurse to

provide the antacid to this patient?

a. With the H2 antagonist

b. 30 minutes prior to the H2 antagonist

c. 2 hours after the H2 antagonist

d. Within an hour after the H2 antagonist

ANS: C

Because antacid therapy is often continued during early therapy of PUD, administer 1 hour

before or 2 hours after H2 antagonist dose.

A patient taking misoprostol (Cytotec) to treat a gastric ulcer reports recurrent diarrhea. The

nurse should encourage this patient to:

a. immediately discontinue misoprostol (Cytotec).

b. take with a magnesium containing antacid.

c. omit fresh fruits from diet.

d. take medication with meals.

ANS: D

Taking medication with meals may lessen diarrhea. Diarrhea associated with misoprostol

therapy is dose related. The patient should not discontinue therapy without first consulting

with the health care provider. Magnesium containing antacids should be avoided. Fresh fruits

are considered roughage and should be encouraged.

Which factor(s) prevent(s) breakdown of the body's normal defense barriers that protect

against ulcer formation? ( Select all that apply. )

a. Stomach pH

b. Prostaglandins

c. Intrinsic factor

d. Mucous cells

e. Hydrochloric acid

ANS: B, D

Prostaglandins play a major role in protecting the stomach walls from injury by stomach acids

and enzymes. They inhibit gastric acid secretion, maintain blood flow, and stimulate mucous

and bicarbonate production. Mucous cells secrete mucus that coats the stomach wall and

protects the stomach wall from hydrochloric acid and the digestive enzyme pepsin. For

decades, ulcer treatment focused on reducing acid secretions (anticholinergic agents, H2

antagonists, proton pump inhibitors), neutralizing acid (antacids), or coating ulcer craters to

hasten healing (sucralfate). Major changes in therapy have come about because the FDA has

approved antibiotics to eradicate H. pylori. Intrinsic factor is a glycoprotein secreted by

parietal cells of the gastric mucosa. It has an important role in the absorption of vitamin B12

(cobalamin) in the intestine, and failure to produce or use intrinsic factor results in the

condition termed pernicious anemia.

Which are important nursing considerations when administering prokinetic agents? ( Select

all that apply.)

a. These agents are used to treat esophagitis associated with gastric reflux.

b. They are used to treat GERD when lifestyle changes and diet are ineffective.

c. They may be useful in treating nausea associated with chemotherapy treatment.

d. They may be administered intravenously.

e. Administer the medication to diabetic patients after meals.

ANS: A, B, C, D

Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis. This agent is

used to treat GERD when lifestyle and diet modifications are ineffective. Metoclopramide is

used as an antiemetic in conjunction with chemotherapy. Prokinetic agents may be

administered intravenously and should be administered before meals.

Which factor(s) contribute(s) to the development of PUD? ( Select all that apply. )

a. Cigarette smoking

b. Stress

c. Genetics

d. Excessive ingestion of milk products

e. H. pylori

ANS: A, C, E

Cigarette smoking increases acid secretion and alters blood flow to the stomach. In addition,

cigarette smoking interferes with prostaglandin synthesis, which compromises defense

mechanisms. A genetic predisposition seems to exist for the development of PUD. Infection by H. pylori is thought to be associated with as many as 90% of duodenal and 70% of gastric

ulcers. Chronic emotional stress was previously believed to cause stress ulcer, and physicians

suggested that patients with this condition reduce their stress levels. However, patients who

took steps to reduce the stress in their lives saw no improvement. It is now known that

emotional stress does not cause ulcers, but it may make them worse. Bacteria have been

shown to cause a stress ulcer, which can be treated simply by taking a dose of antibiotics.

Dairy products do not contribute to the development of ulcers.

Which drug therapy is aimed at reducing gastric acid secretions? ( Select all that apply. ) a.

Prokinetic agents

b. Antacids

c. H2 antagonists

d. Proton pump inhibitors

e. Coating agents

ANS: C, D

H2 antagonists and proton pump inhibitors are used to reduce gastric acid secretion.

Prokinetic agents are used to hasten emptying of the stomach to reduce reflux. Antacids

neutralize gastric acid. Coating agents are given to form a barrier in the stomach.

Which information will the nurse include when teaching a patient with renal failure about

antacid therapy for treatment of heartburn? ( Select all that apply. )

a. Taking magnesium-based antacids prevents diarrhea.

b. Magnesium-based antacids are preferred for patients with renal failure.

c. Aluminum hydroxide antacids exacerbate constipation.

d. If the patient has coffee ground emesis or bloody stools, the frequency of antacids should

be doubled.

e. Antacids neutralize gastric acid.

ANS: C, E

Constipation is an adverse effect of aluminum based antacids. Antacids lower the acidity of

gastric secretions by neutralizing the acid. Magnesium has a laxative effect. Patients with

renal failure should not use antacids containing magnesium. Hematemesis or hematochezia

should be reported to the health care provider immediately.

The nurse is discussing dietary and lifestyle changes with a patient diagnosed with GERD.

When reviewing necessary modifications, the nurse will include information regarding:

( Select all that apply. )

a. limiting coffee intake to 2 cups/day.

b. smoking cessation.

c. avoiding NSAIDs.

d. decreasing protein foods.

e. using nonfat milk

ANS: B, C, E

Interventions to help relieve symptoms associated with GERD include cessation of smoking,

avoidance of NSAIDs, and use of nonfat milk. Coffee should be avoided completely. Protein

foods should be increased.