Acid Controlling Drugs Cardiac zone – Gastroesophageal sphincter Fundic zone – Contains the gastric glands Pyloric zone – Contains the pyloric glands Parietal cells – Produce and secrete hydrochloric acid Chief cells – Secrete pepsinogen which is a precursor to pepsin Mucosa cells - Provide a protective coating for the stomach Gastric hyperacidity is the over production of stomach acid. Gastroesophageal reflux disease is when excessive acid backs up into the esophagus. Antacids - reduce acid by neutralization within the stomach Histamine (H) 2 Blockers (H2 receptor agonist) – reduce acid by blocking signals to the parietal cells Proton Pump Inhibitors – reduce acid by working within the parietal cells Helicobacter pylori (H. pylori) is a bacteria that can infect the gastric track. Antacids Antacids can cause the formation of gas. Simethicone is given to reduce flatulence. Magnesium can cause diarrhea. The onset of antiacids is 15 minutes and duration can last 4 hours. H2 Receptors Antagonists Cimetidine can be administered intravenous (IV), Intramuscular (IM), by mouth (PO). Cimetidine cannot be administered transdermally. H2 Antagonist Receptor (H2RA) reduce hyperacidity by blocking receptors on specialized acid producing cells in the stomach. Patients with renal and hepatic disease should use caution when taking Histamine 2 (H2) receptor antagonists. H2 receptor antagonists are metabolized in the liver and excreted by the kidneys. Proton Pump Inhibitors Antacids do not prevent the overproduction of acid in the stomach, but by neutralizing the acids that are present. Antiemetic and Antinausea Drugs Antiemetic medications are used to relieve nausea and vomiting. In this concept we will explore this class of medications. Anticholinergic and antihistamine (H1) medications are indicated for motion sickness. Serotonin blockers and Tetrahydrocannabinoids are indicated for chemotherapy related nausea and vomiting. Serotonin Blockers Serotonin blockers are an antiemetic. Serotonin blockers are not an antidiarrheal, anti-inflammatory or laxative. Ondansetron is a serotonin blocker that works to prevent nausea and vomiting. Ondansetron may be given for chemotherapy, radiation and postoperative nausea and vomiting. Ondansetron is given for chemotherapy, radiation, and postoperative nausea and vomiting. Ondansetron would not be given peri-operatively. Ondansetron may be used in pregnant women with hyperemesis gravidarum, which is severe vomiting associated with pregnancy, however not during the first trimester due to increase of cleft palate in the infan Elimination Antidiarrheals The primary goal of antidiarrheal medications is to counter or combat diarrhea. It can also reduce pain associated with diarrhea but is not the primary goal. Increasing stool frequency and decreasing inflammation are not correct. Adsorbents are to be used with caution in children and teens because they contain aspirin and increase the risk for Reye’s syndrome. Adsorbents and probiotics do not have high risk of allergic response, but should be monitored if there is a known allergy. Probiotics do not have any known side effects. Laxatives Laxatives are medications used to treat constipation, which is a symptom not a disease. Laxatives are used to counteract constipation. Laxatives should not be used for long-term weight loss goals as this can cause bowel damage. Appendicitis is a contraindication for use. Antidiarrheal medications are used to decrease diarrhea, not laxatives. Laxatives are medications used to treat constipation, which is a symptom not a disease. The correct position for a patient who is receiving an enema is on their left side. Diuretics Diuretics are a class of medications designed to work in the kidneys. Diuretics are administered to increase the amount of urine expelled from the body. Loop diuretics and thiazide diuretics can be administered together. Within the nephron, these drugs work on the different locations to increase urine production. Loop diuretics have a rapid onset. Furosemide works on the ascending loop of henle by preventing the reabsorption of sodium and potassium. Sodium and Potassium are not reabsorb in the ascending loop. More water and electrolytes stay in the filtrate and expelled out the body. Osmotic Diuretics mannitol is an osmotic diuretic. It works indirectly on the kidneys to increase urine production. Womens Health Medications The most serious adverse effect is thrombosis (blood clots). Estrogens may also cause cardiovascular disorders and breast or endometrial cancers for which reason they carry a black box warning. Oxytocin is used to strengthen and increase the frequency of uterine contractions in labor. While prostaglandin is also a uterine stimulant; it is used to induce labor by ripening an unfavorable cervix. Estrogen and progesterone are used in hormone replacement therapy and not to augment or induce labor. Androgens Synthetic androgens stimulate the normal growth and development of male sex organs and the development and maintenance of the secondary sex characteristics. The clinical effects are weight gain and an increase in muscular strength. A primary use for androgens is hormone replacement therapy. Androgens stimulate the normal growth and development of male sex organs and development and maintenance of secondary sex characteristics by stimulating RNA synthesis at the cellular level. They also are essential for protein synthesis and stimulate the production of erythropoietin. 5-Alpha Reductase Inhibitors Alpha1-adrenergic blockers are most commonly used for symptomatic relief of obstruction secondary to BPH therefore helping to alleviate urinary retention symptoms. Unlike alpha1-adrenergic blockers, which work by reducing smooth muscle tone, 5-alpha reductase inhibitors improve lower urinary tract symptoms by reducing prostate volume. Unlike alpha1-adrenergic blockers, which work by reducing smooth muscle tone, 5-ARIs improve lower urinary tract symptoms by reducing prostate volume. Therefore, patients with larger prostates may achieve a greater benefit. One class of men’s health drugs are classified into 5-alpha reductase inhibitors. The two common drug names used are finasteride and dutasteride. One class of men’s health drugs are classified into 5-alpha reductase inhibitors. The two common drug names used are finasteride and dutasteride. One class of men’s health drugs are classified into 5-alpha reductase inhibitors. The two common drug names used are finasteride and dutasteride. Nursing Application: Men´s Health Medications Medications should be taken exactly as prescribed to maintain a consistent therapeutic index/level in the body. Understanding the right dose is implementing safe rights to medication administration. Apply dermal patches to clean, dry, and shaven skin per prescribed dose to maximize absorption. Wear gloves when handling men's health drugs or when implementing any drug therapy. Touching medications directly can inadvertently absorb into the skin and cause ill effects. Finasteride must not be handled by pregnant women, as absorption can have teratogenic effects to the unborn fetus. Finasteride is a category X drug.
