Question

ant'd Case Study Ms. McKelvey has been taking over-the-counter (OTC) famotidine for her indigestion for 2 weeks without significant relief. She decided to contact her healthcare provider because the symptoms continued to occur, particularly her heartburn symptoms. Now, however, the healthcare provider has added a proton pump inhibitor. When the healthcare provider leaves the room, Ms. McKelvey tells the nurse she is unhappy about this, because she has prided herself on keeping her "medical costs” down by using only home remedies and OTC drugs. "If they're both for ulcers," she says, "then what's the dif- ference? Why can't I just double my dose of the antacid?" 1. What are the major differences between proton pump inhibitors and H2 receptor antagonists? 2. What should the nurse teach Ms. McKelvey regarding the use of home remedies and OTC drugs? 3. What strategies will you use to ensure that Ms. McKelvey adheres to her new prescription?

Answer 1

1) The major differences between proton pump inhibitors and H2 receptor antagonists are:

a. Onset of action is within one hour for H2 blockers, but can take two to four days to take effect in the case of PPIs.

b. Duration of action for H2 blockers is about 9-12 hrs, but for PPIs this is 24 hours to three days.

c. The end result of action for both H2 blockers and PPIs is the suppression of gastric acid secretion but their mechanism of action is different. H2 blockers block the acid production stimuli called histamine but PPIs block the proton pump and prevent the pumping of protons into the stomach.

d. H2 blockers block the histamine receptors present in parietal cells and decrease the acid production, but PPIs shuts down the proton pumps present in these cells and prevent the secretion of acid into the stomach.

e. Compared to H2 blockers PPIs yield better acid suppression.

2) The nurse should teach Ms. Mckelvey regarding the use of home remedies and OTC drugs. She should teach that the use of home remedies and OTC drugs might not be effective in all cases. The effect could vary from person to person depending on their health conditions. So to get more effective timebound remedies the patient should always use prescription drugs.

3) Strategies to be used to ensure that Mckelvey adheres to her new prescription is to give her adequate patient education and request her to make a call for any doubt. Alternatively, the nurse can also make calls between follow-ups to ensure that Ms. Mckelvey follows the prescription.