Drugs for PUD and GERD

Antibiotics for PUD and Gerd

• amoxicillin

• bismuth

• clarithromycin

• tetracycline

• metronidazole

Goal of antibiotics

eradication of H. pylori

H2 receptor blocker prototype

cimetidine

Cimetidine action

blocks H2 receptors which decreases gastric acid

Cimetidine use

• prevent/treat gastric/duodenal ulcers, GERD, heartburn

• use w/ antibiotics to treat ulcers r/t H. pylori

Cimetidine complications

• blocked androgen receptors

  • decreased libido, gynecomastia, impotence

• CNS effects

  • lethargy, hallucinations, confusion, restlessness

• constipation, diarrhea, nausea

Cimetidine contraindications/cautions

• caution = pregnancy/lactation, older adults, high risk pneumonia/COPD pts, kidney impairment

Cimetidine interactions

• can increase levels of warfarin, phenytoin, theophylline, lidocaine

• concurrent use of antacids can decrease absorption

• smoking can decrease effectiveness

Cimetidine interventions

• report N/D/C to provider

• monitor for GI bleeding if also on warfarin

• see provider if s/s persist

Cimetidine education

• REPORT ANY INDICATIONS OF GI BLEED TO PROVIDER IMMEDIATELY

• available OTC

• full effect might take 1-2 weeks

• do NOT take long term

• do NOT drink or smoke

• increase fiber and fluids

• limit use of NSAIDs and aspirin

• do not take an antacid 1 hr before or after

Proton pump inhibitor prototype

omeprazole

Omeprazole action

IRREVERSIBLY inhibits enzyme that produce gastric acid (decreases gastric acid) for duration of therapy

Omeprazole use

• short-term therapy of gastric/duodenal ulcers and GERD (4-8 weeks)

• prevention of stress ulcers for pts at risk of developing

• inactive until it undergoes metabolism

Omeprazole complications

• pneumonia

• osteoporosis, fractures

• rebound acid hypersecretion

• hypomagnesemia

• C. diff

Omeprazole administration

• take once daily BEFORE morning meal

• do NOT crush/chew extended-release tablets

• active ulcers should be treated for 4-6 weeks

Omeprazole interventions

• monitor for s/s of infection

• obtain baseline magnesium level and monitor during therapy

• administer magnesium supplements PRN

• highly protein bound - monitor protein levels

Omeprazole contraindications/cautions

• C/I = hypersensitivity, pregnancy/lactation

• caution = dysphagia, liver disease, high risk for pneumonia/COPD

• use during breastfeeding ONLY if benefits outweigh risks

Omeprazole interactions

digoxin, methotrexate, diazepam, tacrolimus, antifungal agents, phenytoin levels can increase

Omeprazole education

• notify provider for any indications of GI bleeding

• take ENTRIE course EXACTLY as prescribed

• increase vitamin D/calcium intake

• taper dose when discontinuing

• report fever, diarrhea, abd cramping, blood stools IMMEDIATELY

Mucosal protectant prototype

sucralfate

Sucralfate action

forms protective coating over ulcer

Sucralfate use

• protects against gastric acid and pepsin

• viscous substance can stick to ulcer for up to 6 hours

• treats acute duodenal ulcers and maintenance therapy

Sucralfate complications

• no systemic complications

• constipation

Sucralfate administration

• take 4x daily, 1 hr before meals and one more at bedtime

• can dissolve in water, but do NOT crush/chew

Sucralfate contraindications/cautions

• C/I = hypersensitivity

• caution = chronic kidney disease, DM

• safe in pregnancy/lactation

Sucralfate interactions

• can interfere with absorption of phenytoin, digoxin, warfarin, ciprofloxacin

• antacids interfere with effects

• binds with everything

Sucralfate interventions

• maintain 2hr interval between sucralfate and medications

• take sucralfate 30 mins before or after antacids

Sucralfate education

• increase fiber and fluid intake

• take the ENTIRE course EXACTLY as prescribed

• take BEFORE eating, otherwise will not be effective

Antacid prototype

aluminum hydroxide

Aluminum hydroxide action

neutralize/reduce acidity of gastric acid

Aluminum hydroxide use

Tx of PUD, prevention of stress-induced ulcers, relief of s/s of GERD

Aluminum hydroxide compilations

• constipation

• fluid retention

• electrolyte imbalances (hypophosphatemia)

• alkalosis

• toxicity

Aluminum hydroxide administration

• adherence is difficulty due to frequency

• can be given 7x/day

• monitor for CNS depression

Aluminum hydroxide contraindications/cautions

caution = GI perforation/obstruction, abd pain

Aluminum hydroxide interactions

• decrease absorption of several medications (cimetidine)

• bind to warfarin, digoxin, tetracycline (interfere w/ absorption, reduce effects)

Aluminum hydroxide education

• avoid antacids that contain sodium if you have HTN or HF

• report s/s of hypercalcemia

• if kidney function is impaired, avoid antacids that contain magnesium

• monitor for CNS depression

• chew tablets thoroughly and drink 8oz of water after

• shake liquid formulations thoroughly

• take all medications at least 1 hr before of after taking antacid

Magnesium-based antacid complications

• diarrhea

• hypermagnesemia

Prostaglandin E analog prototype

misoprostol

Misoprostol action

• acts as an endogenous prostaglandin in the GI tract that decreases acid secretion

• increase the secretion of bicarbonate and protective mucus

• promotes vasodilation to maintain submucosal blood flow

Misoprostol use

• prevent gastric ulcers in pts taking long-term NSAIDs

• induce labor (off-label)

Misoprostol complications

• diarrhea

• dysmenorrhea, spotting

Misoprostol administration

take with meals at bedtime

Misoprostol contraindications/cautions

• TERATOGENIC

• C/I = pregnancy, women of childbearing age

Misoprostol education

• notify provider of diarrhea or abd pain

• take additional contraceptive measures

• notify provider if pregnant IMMEDIATELY

Evaluation of effectiveness

• reduced frequency/absence of GERD s/s

• absence of GI bleeding

• healing of gastric/duodenal ulcers

• no recurrence of ulcer