In addition to the considerations above, instruct patients to call their provider if their condition does not improve or gets worse, especially if bleeding occurs.

Sucralfate locally covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts. It is minimally absorbed by the gastrointestinal tract.

Administer sucralfate on an empty stomach, 2 hours after or 1 hour before meals. Constipation may occur. Sucralfate should be cautiously used with patients with chronic renal failure or those receiving dialysis due to impaired excretion of small amounts of absorbed aluminum that can occur with sucralfate.

In addition to the considerations above, instruct patients to call their provider if their condition does not improve or gets worse. Simethicone is an antiflatulent that is commonly found in other OTC antacids see Figure 7.

It is also safe for use in infants. Gas commonly occurs in the GI tract due to digestive processes and the swallowing of air. Gaseous distension can also occur postoperatively. Simethicone is used to treat the symptoms of gas such as uncomfortable or painful pressure, fullness, and bloating.

Simethicone works by altering the elasticity of the mucous-coated gas bubbles, which cause them to break into smaller bubbles, thus reducing pain and facilitating expulsion.

Simethicone is usually taken four times a day, after meals and at bedtime. For liquid form, shake drops before administering. Patients can be instructed about other measures to assist with gas expulsion such as changing position, ambulation, avoiding the use of straws, and tapering intake of beans and cruciferous vegetables.

Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.

Basic information related to each class of medication is outlined below. Detailed information on a specific medication can be found for free at Daily Med. On the home page, enter the drug name in the search bar to read more about the medication.

Use cautiously with renal disease Decreased symptoms of heartburn or sour stomach Constipation. Rebound hyperacidity when discontinued H2 blocker famotidine Administer 15 to 60 minutes before eating foods or drinking drinks that may cause heartburn. Preexisting liver and kidney disease may require dosage adjustment Decreased symptoms of heartburn or sour stomach.

Decreased pain if ulcers are present Side effects: headache, dizziness, constipation, and diarrhea. Administer granules with apple juice or applesauce Decreased symptoms of heartburn and pain Hypersensitivity; anaphylaxis and serious skin reactions.

Use cautiously used patients with chronic renal failure Healing of ulcer Constipation Antiflatulant simethicone Shake drops before administering Relief of gas discomfort None. A patient who recently underwent surgery has a medication order for daily pantoprazole.

The patient does not report any symptoms of heartburn, stomach pain, or sour stomach. The nurse reviews the physician orders for an indication for this medication before calling the provider to clarify.

cells in the gastric glands that produce and secrete hydrochloric acid HCl and intrinsic factor. Caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus. Occurs when gastric or duodenal ulcers are caused by the breakdown of GI mucosa by pepsin in combination with the caustic effects of hydrochloric acid.

A side effect of medication causing elevated levels of hydrochloric acid in the stomach after the medication is discontinued. Enzymes produced from the cytochrome P genes involved in the formation synthesis and breakdown metabolism of various molecules, chemicals, and medications within cells.

Nursing Pharmacology Copyright © by Open Resources for Nursing Open RN is licensed under a Creative Commons Attribution 4. Skip to content Pathophysiology The stomach contains cells that secrete different substances as part of the digestive process: parietal cells, chief cells, and surface epithelium cells.

Hyperacidity Medication Classes There are four major classes of medications used to treat hyperacidity conditions: antacids, H2-receptor antagonists, proton pump inhibitors, and mucosal protectants. Antacids Antacids see Figure 7.

Figure 7. Mechanism of Action Antacids neutralize gastric acidity and elevate the pH of the stomach. Specific Administration Considerations Calcium carbonate comes in various formations such as a tablet, a chewable tablet, a capsule, or liquid to take by mouth.

Specific Administration Considerations To prevent symptoms, oral famotidine is taken 15 to 60 minutes before eating foods or drinking drinks that may cause heartburn. Specific Administration Considerations Packets of delayed-release granules must be mixed with applesauce or apple juice and taken by mouth or given through a feeding tube.

Indications Sucralfate is used in the treatment of ulcers. Mechanism of Action Sucralfate locally covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts.

Specific Administration Considerations Administer sucralfate on an empty stomach, 2 hours after or 1 hour before meals. Mechanism of Action Simethicone works by altering the elasticity of the mucous-coated gas bubbles, which cause them to break into smaller bubbles, thus reducing pain and facilitating expulsion.

Specific Administration Considerations Simethicone is usually taken four times a day, after meals and at bedtime. Table 7. What is the likely indication for this drug therapy for this patient?

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Gastric Ulcers [Video]. jpg " by Midnightcomm is licensed under CC BY-SA 3. Medical Encyclopedia [Internet]. Atlanta GA : A. Heartburn; [reviewed May 10; cited October 27]. Pharmacology: A patient-centered nursing process approach.

National Library of Medicine in the public domain. Pharmacology: A Patient-Centered Nursing Process Approach. definition Cells found within the lining of the stomach that secrete mucus as a protective coating. Necessary for the absorption of vitamin B12 in the small intestine. A digestive enzyme.

A common condition in hospitalized patients that can lead to PUD. Medication to prevent the formation of stress ulcers. Elevated levels of calcium in the bloodstream. Previous: 7. Next: 7. License Nursing Pharmacology Copyright © by Open Resources for Nursing Open RN is licensed under a Creative Commons Attribution 4.

Share This Book Share on Twitter. calcium carbonate. The role of antacids is limited to the treatment of heartburn associated with mild intermittent gastroesophageal reflux disease. See "Medical management of gastroesophageal reflux disease in adults", section on 'Antacids'.

Adverse effects — Antacid side effects depend upon the quantity consumed and the duration of therapy. Magnesium-containing antacids cause diarrhea and hypermagnesemia; the latter only becomes important in patients with renal insufficiency.

Some antacids may also contain sodium, and volume overload can occur in susceptible patients. Ingestion of large amounts of calcium and absorbable alkali, particularly calcium carbonate , can lead to hypercalcemia, alkalosis, and acute or chronic renal injury, a constellation known as the milk-alkali syndrome [ 33 ].

See "The milk-alkali syndrome". Significant aluminum retention only occurs in patients with renal failure and may result in neurotoxicity and anemia following prolonged treatment with aluminum hydroxide. Aluminum hydroxide blocks intestinal absorption of phosphate; two weeks of therapy with moderate doses can result in significant hypophosphatemia, especially if the patient is on a low phosphate diet or is phosphate depleted for other reasons [ 34 ].

See "Aluminum toxicity in chronic kidney disease", section on 'Other medications'. Mechanism of action — Sucralfate is a sulfated polysaccharide, sucrose octasulfate, complexed with aluminum hydroxide.

It prevents acute, chemically-induced mucosal damage and heals chronic ulcers without altering gastric acid or pepsin secretion or significantly buffering acid [ 29,35 ].

Similar to aluminum-containing antacids, sucralfate stimulates angiogenesis and the formation of granulation tissue, possibly due to growth factor binding [ 29 ].

Sucralfate also binds to the injured tissue, thereby delivering growth factors and reducing access to pepsin and acid. Aluminum hydroxide mediates some of the actions of sucralfate, but the sucrose octasulfate moiety may also have a role by contributing sulfhydryl groups to reduce oxidant damage to epithelial cells.

Indication — Sucralfate has been reported to suppress H. pylori and inhibit acid secretion in infected patients with duodenal ulcers [ 36 ].

However, sucralfate is not used to treat peptic ulcers as proton pump inhibitors PPIs heal ulcers more rapidly and to a greater extent [ 37 ]. The use of sucralfate is limited to the initial management of gastroesophageal reflux disease in pregnancy.

See "Medical management of gastroesophageal reflux disease in adults", section on 'Pregnancy and lactation'. Adverse effects — Sucralfate has few adverse effects [ 35 ].

It can bind to other drugs if taken simultaneously. Similar to antacids, significant aluminum retention only occurs in patients with renal failure [ 3,38,39 ]. Sucralfate can also bind to phosphate and lead to hypophosphatemia [ 40 ]. Combining sucralfate and antacids can potentially amplify these effects.

See "Aluminum toxicity in chronic kidney disease" and "Hypophosphatemia: Causes of hypophosphatemia". Mechanism of action — Bismuth does not inhibit or neutralize gastric acid.

The most dramatic action of bismuth salts is the suppression of H. pylori [ 41 ]. Other actions that may promote ulcer healing include the following:. Indication — The role of bismuth preparations eg, bismuth subcitrate and bismuth subsalicylate [BSS] is limited to part of a quadruple antibiotic therapy regimen in H.

pylori- positive ulcers [ 45 ]. See "Treatment regimens for Helicobacter pylori in adults", section on 'Bismuth quadruple therapy'. Adverse effects — In the colon, bismuth salts react with hydrogen sulfide to form bismuth sulfide, which blackens the stools [ 41 ].

Bismuth toxicity is rare with CBS or BSS [ 41,46 ]. Bismuth absorption varies with the specific form of bismuth; absorption is much greater with CBS than with BSS or bismuth subnitrate [ 47,48 ]. Coadministration of histamine-2 receptor antagonists H2RAs increases bismuth absorption from CBS, but not from BSS or bismuth subnitrate [ 49 ].

Bismuth should be avoided or serum bismuth concentrations monitored in patients with renal failure [ 3 ]. The subsalicylate moiety in BSS is converted to salicylic acid and absorbed; however, salicylate in the absence of the acetyl group does not inhibit platelet function or appear to share the same high risk of aspirin for gastrointestinal bleeding [ ].

However, the salicylate from BSS will raise serum salicylate levels and can cause salicylate toxicity, and combination with other salicylate products should therefore be avoided. Mechanism of action — Misoprostol is a deoxyhydroxymethyl analogue of prostaglandin E1.

Prostaglandins, particularly of the E and I group, inhibit acid secretion by selectively reducing the ability of the parietal cell to generate cyclic adenosine monophosphate in response to histamine [ 54 ]. Prostaglandins also enhance mucosal defense mechanisms [ 55 ].

See "NSAIDs including aspirin : Primary prevention of gastroduodenal toxicity", section on 'Misoprostol'. Indication — The role of misoprostol in peptic ulcer disease is limited to the prevention of nonsteroidal anti-inflammatory drug NSAID -induced gastroduodenal ulcers.

It is contraindicated in women of childbearing potential who are not on contraception. See 'Pregnancy and lactation' below. Adverse effects — The most frequent side effects of misoprostol are dose-dependent cramping, abdominal pain, and diarrhea [ 56,57 ].

These side effects interfere with compliance in many patients. After oral doses, PCABs rapidly achieve high plasma concentrations and have linear, dose-dependent pharmacokinetics; therefore, they have a rapid onset of action and achieve a full effect with the first dose.

The effect is also seen with repeated doses. PCABs are not available outside of Asia [ ]. In randomized controlled trials, the efficacy with regard to ulcer healing and prevention of nonsteroidal anti-inflammatory drug NSAID -induced ulcers has been similar to proton pump inhibitor PPI therapy with a comparable safety profile [ ].

The PCAB vonoprazan has been approved for the prevention of NSAID-induced ulcers and treatment of peptic ulcer disease in Japan. Another PCAB, revaprazan, has been approved in Korea. Studies also suggest that vonoprazan may be more effective in combination with antibiotics for the eradication of H.

pylori [ 64,65 ]. Pregnancy and lactation — All histamine-2 receptor antagonists H2RAs appear to be safe in pregnancy, with cimetidine having the most safety data available [ 66 ]. Cimetidine is concentrated in breast milk but is compatible with breastfeeding.

Experience with proton pump inhibitors PPIs suggests that PPIs are safe in pregnancy [ ]. Omeprazole and pantoprazole are secreted in low concentrations in breast milk [ 70,71 ]. However, a large portion of them is likely to be destroyed by gastric acid in the infant's stomach [ 72 ].

Most antacids are considered safe in pregnancy and are compatible with breastfeeding [ 73 ]. However, antacids containing sodium bicarbonate and magnesium trisilicate should be avoided in pregnancy [ 74 ].

Sucralfate is likely safe during pregnancy and lactation because it is poorly absorbed [ 75 ]. Prostaglandins of the E group are uterotropic. Misoprostol has been given with or without mifepristone to induce abortion [ 69,72 ].

As a result, it is contraindicated in women of childbearing potential who are not on contraception. All patients should be informed of this risk to minimize the drug being inadvertently given by the patient to a pregnant woman.

See 'Introduction' above. Proton pump inhibitors PPIs effectively block acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump that resides on the luminal surface of the parietal cell membrane.

See 'Histamine-2 receptor antagonists' above and 'Proton pump inhibitors' above. PPIs are also more effective in preventing NSAID-induced gastroduodenal toxicity and in healing gastroduodenal ulcers associated with NSAIDs when they cannot be discontinued.

pylori antibiotic regimens and are used in the management of hypersecretory states eg, Zollinger-Ellison syndrome. The use of H2RAs is largely limited to the management of mild gastroesophageal reflux disease. See 'Indications and comparative efficacy' above. The role of bismuth preparations eg, bismuth subcitrate and bismuth subsalicylate is as part of a quadruple antibiotic therapy regimen in H.

pylori- positive ulcers. See 'Antacids' above and 'Sucralfate' above and 'Bismuth' above. Misoprostol is contraindicated in women of childbearing potential who are not on contraception. See 'Misoprostol' above.

PCABs are not widely available outside of Asia, and data on safety and comparative efficacy with antisecretory agents are limited.

Soll, MD, who contributed to an earlier version of this topic review. Standard therapy for acid-peptic diseases. Standard therapy for acid-peptic diseases 2. A model of the relationship between ulcer healing and acid suppression.

NSAID-Associated Gastric Ulcer Study Group. Is the quality of mucosal scar affected by treatment? A review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in peptic ulcer disease.

lansoprazole in patients with gastric or duodenal ulcers - results from two phase 3, non-inferiority randomised controlled trials. آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟. ﺧﺎﻧﻪ ﮐﺘﺎﺑﺨﺎﻧﻪ ﺁﻧﻼﯾﻦ ﺁﭘﺘﻮﺩﯾﺖ ﮊﻭﺭﻧﺎﻝ ویدیوی آموزشی خرید پکیج ﺁﭘﺘﻮﺩﯾﺖ ﮊﻭﺭﻧﺎﻝ کتابخانه آنلاین زبان اصلی کتابخانه آنلاین فارسی ویدیوی آموزشی نرم افزار مطب و کلینیک نوبت دهی درباره ما وبلاگ ﺗﻤﺎﺱ ﺑﺎﻣﺎ ورود ثبت نام en.

Version March Uptodate Reference Title. Go To Link. Antiulcer medications: Mechanism of action, pharmacology, and side effects Antiulcer medications: Mechanism of action, pharmacology, and side effects. Author: Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE Section Editor: Mark Feldman, MD, MACP, AGAF, FACG Deputy Editor: Shilpa Grover, MD, MPH, AGAF.

Literature review current through: Sep This topic last updated: Apr 19, Proton pump inhibitors Mechanism of action — The proton pump inhibitors PPIs eg, omeprazole , lansoprazole , dexlansoprazole , rabeprazole , pantoprazole , and esomeprazole effectively block acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump that resides on the luminal surface of the parietal cell membrane figure 1.

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