Chapter 24
Agents Used to Treat
Hyperacidity and
Gastroesophageal Reflux
Disease
Secretory Functions of the
Stomach Lining



Parietal cells secrete hydrochloric (HCl)
acid
Chief cells secrete pepsinogen
Mucoid cells secrete mucus
24 - 2
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Stomach Hyperchlorhydria

Produced from:



Eating high-fat meals
Increased alcohol intake
Emotional turmoil
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Goal of Antacid Therapy




Neutralize the acid
Inhibit pepsin activity
Increase resistance of the stomach lining
Increase tone of the lower esophageal
sphincter
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Antacids
Three Forms
1.
Aluminum
2.
Magnesium
3.
Calcium

Mechanism of action


Neutralization of gastric acidity
Low doses promote gastric mucosal
defensive mechanisms
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Systemic Antacids



Useful in short-term therapy
Rapid onset
Prolonged use causes an overload on the
kidneys

Example: sodium bicarbonate
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Nonsystemic Antacids



Remain in gastrointestinal tract; useful in
long-term therapy
Most of the dose remains in the
gastrointestinal tract
Will not alter acid-base system

Examples: calcium carbohydrate (Tums,
Rolaids), aluminum carbonate (Basaljel),
magaldrate (Riopan), etc.
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Side Effects and Adverse Effects



Magnesium: diarrhea
Aluminum: constipation
Calcium: constipation
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Antacid Interactions



Binding of other drugs to the antacid
causes reduced availability of the other
drugs to the client.
Chemical inactivation
Increases stomach and urine pH
(alkaline), which decreases the absorption
and excretion of certain drugs
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Nursing Interventions

Monitor for side effects



Nausea, vomiting, abdominal pain, diarrhea
With calcium-containing products:
constipation, acid rebound
Monitor for therapeutic response

Notify heath care provider if symptoms are
not relieved.
24 - 10
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Histamine (H2) Receptor
Antagonists

Examples




Cimetadine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)
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Proton Pump Inhibitors

Omeprazole (Prilosec)


Indicated for clients with:



Blocks the final step of acid production in the
stomach
Gastroesophageal reflux disease (GERD)
Gastric hypersecretory condition
Interactions

Causes warfarin (an anticoagulant) action to
be increased
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Helicobacter Pylori


An organism associated with the
development of peptic ulcer disease
Treatment

Metronidazole (Flagyl), an antimicrobial
agent, along with bismuth subsalicylate
(Pepto-Bismol) and tetracycline
(antimicrobial) for 4 weeks to eradicate
Helicobacter pylori
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Metoclopramide (Reglan)


A drug that stimulates the motility of the
upper GI tract without stimulating the
production of gastric, biliary, or pancreatic
solutions
Action


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Increases peristalsis in the duodenum and
jejunum
Decreases gastroesophageal reflux
(continues)
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(continued)
Metoclopramide (Reglan)

Adverse effects



Produces extrapyramidal (Parkinson-like
symptoms) effects
Central nervous system depression
Gastrointestinal upset
24 - 15
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