NSG 511 Final
Peptic ulcer disease - answer inflammation of gastrointestinal tract
Balance with aggressive factors in excess of defense factors
Defensive factors - mucus, bicarbonate, blood flow, and prostaglandins
Aggressive factors - H. pylori, NSAIDs, acid, pepsin, and smoking
Pain associated with foods, when they lie down at night and gets better with eating
Antibiotics - answer Antibiotics for H. pylori require multiple drugs: Antibiotics in
combination with a PPI
Antibiotics if used alone are not effective and promote the development of resistant
strains of H. pylori
a. Amoxicillin -weakens H. pylori cell wall
b. Clarithromycin - a macrolide that inhibts H. pylori protein synthesis
c. Metronidazole - disruption of H. pylori DNA structure
Antacids - answer Neutralize the acid in the stomach
More for short term relief of heart burn
If magnesium based, they stimulate bowel motility
H/K+ ATPase pump - answerEnergy dependent pump on parietal cells that exchanges
hydrogen for potassium
Inhibiting this pump in one of many ways can inhibit HCl secretion
PPIs - answerProton pump inhibitors turn off hydrogen ion secretion into the stomach
itself
Omeprazole
Histamine 2 Receptor antagonists - answerWhen histamine 2 receptors are agonized
they have a positive impact on H/K+ ATPase pump
So we want to turn this off
, Ranitidine
Prostaglandin agonists - answerProstaglandin receptors have a negative impact on
pathway that positively impacts H/K+ ATPase pump
So we want to activate
Misoprostol
Misoprostol - answerMimics prostaglandin E2 creating gastric protection by increasing
HCO3 secretion, increasing mucus production, promoting mucosal blood flow and
decreasing HCl secretion
Category X drug - not to be used in women who are pregnant
Indications: men and non-pregnant women who must take long-term ulcerogenic
NSAIDs and glucocorticoids (example: patients with RA)
Sucralfate - answerActs as a cap over ulcers and protects it from HCl in the stomach
-"tidine" - answerHistamine 2 receptor antagonist
Ranitidine - answerH2RAs
MOA: blocks histamine receptors on parietal cells, downregulates H-K ATPase pump at
stomach lumen
Alone for treatment of prophylaxis of PUD
Main purpose: GERD or heartburn
-"prazole" - answerPPI
Omeprazole - answerPPI
MOA: Blocks the H-K ATPase pump at the stomach lumen
Indications: in combination with antibiotics for H. pylori, alone for treatment and
prophylaxis of PUD (in absence of H. pylori), and for GERD
Side effects: due to significant alkalization of the GI tract
-Inhibits WBCs and creates a favorable environment for bacterial growth (Pneumonia)
- Impairs absorption of calcium leading to osteoporosis and fracture risk
Nursing considerations: -Should be taken for short periods (4-8 week)
-Acid labile and should not be absorbed in the stomach but in the duodenum so do not
dissolve, crush or split
Peptic ulcer disease - answer inflammation of gastrointestinal tract
Balance with aggressive factors in excess of defense factors
Defensive factors - mucus, bicarbonate, blood flow, and prostaglandins
Aggressive factors - H. pylori, NSAIDs, acid, pepsin, and smoking
Pain associated with foods, when they lie down at night and gets better with eating
Antibiotics - answer Antibiotics for H. pylori require multiple drugs: Antibiotics in
combination with a PPI
Antibiotics if used alone are not effective and promote the development of resistant
strains of H. pylori
a. Amoxicillin -weakens H. pylori cell wall
b. Clarithromycin - a macrolide that inhibts H. pylori protein synthesis
c. Metronidazole - disruption of H. pylori DNA structure
Antacids - answer Neutralize the acid in the stomach
More for short term relief of heart burn
If magnesium based, they stimulate bowel motility
H/K+ ATPase pump - answerEnergy dependent pump on parietal cells that exchanges
hydrogen for potassium
Inhibiting this pump in one of many ways can inhibit HCl secretion
PPIs - answerProton pump inhibitors turn off hydrogen ion secretion into the stomach
itself
Omeprazole
Histamine 2 Receptor antagonists - answerWhen histamine 2 receptors are agonized
they have a positive impact on H/K+ ATPase pump
So we want to turn this off
, Ranitidine
Prostaglandin agonists - answerProstaglandin receptors have a negative impact on
pathway that positively impacts H/K+ ATPase pump
So we want to activate
Misoprostol
Misoprostol - answerMimics prostaglandin E2 creating gastric protection by increasing
HCO3 secretion, increasing mucus production, promoting mucosal blood flow and
decreasing HCl secretion
Category X drug - not to be used in women who are pregnant
Indications: men and non-pregnant women who must take long-term ulcerogenic
NSAIDs and glucocorticoids (example: patients with RA)
Sucralfate - answerActs as a cap over ulcers and protects it from HCl in the stomach
-"tidine" - answerHistamine 2 receptor antagonist
Ranitidine - answerH2RAs
MOA: blocks histamine receptors on parietal cells, downregulates H-K ATPase pump at
stomach lumen
Alone for treatment of prophylaxis of PUD
Main purpose: GERD or heartburn
-"prazole" - answerPPI
Omeprazole - answerPPI
MOA: Blocks the H-K ATPase pump at the stomach lumen
Indications: in combination with antibiotics for H. pylori, alone for treatment and
prophylaxis of PUD (in absence of H. pylori), and for GERD
Side effects: due to significant alkalization of the GI tract
-Inhibits WBCs and creates a favorable environment for bacterial growth (Pneumonia)
- Impairs absorption of calcium leading to osteoporosis and fracture risk
Nursing considerations: -Should be taken for short periods (4-8 week)
-Acid labile and should not be absorbed in the stomach but in the duodenum so do not
dissolve, crush or split
