Question

Case Study, Chapter 57, Drugs Affecting Gastrointestinal Secretions

A nursing student is preparing a presentation for an in-service to the staff nurses on the unit where the clinical rotation is done. The in-service is being presented on medications for gastrointestinal orders, which are among the most common complaints seen in clinical practice. (Learning Objectives 1, 2, 3, and 5)

a.What are the current theories about the pathophysiologic process responsible for peptic ulcer disease?

b.What are the therapeutic actions for drugs used to decrease acid content (H₂ receptor antagonists, antacids, proton pump inhibitors, and prostaglandins)?

c.How does acid rebound occur?

d.What are the therapeutic actions of sucralfate and misoprostol?

e.What are the considerations for older adults when using drugs that affect GI secretions?

f.What are the important teaching points to include for a patient receiving ranitidine?

Answer 1

Ans) a. The current theories about the pathophysiologic process responsible for peptic ulcer disease are:

- Increased acid production, decrease in the protective mucous lining of the stomach, infection with Helicobacter pylori bacteria, or a combination of these is the likely cause of peptic ulcers.

b.The therapeutic actions for drugs used to decrease acid content (H2 receptor antagonists, antacids, proton pump inhibitors, and prostaglandins) are:

• H2 antagonists block the release of acid in response to gastrin or parasympathetic release; adverse effects can include dizziness, confusion, cardiac arrhythmias, and galactorrhea.
• Antacids are used to chemically react with and neutralize acid in the stomach. They can provide rapid relief from increased acid levels. They are known to cause GI alterations such as diarrhea or constipation and can alter the absorption of many drugs.
• The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine triphosphatase (H+, K+-ATPase) enzyme system on the secretory surface of the gastric parietal cells. This action blocks the final step of acid production, lowering the acid levels in the stomach.
• Prostaglandin inhibits gastric acid secretion and increases bicarbonate and mucus production in the stomach; this action will protect the lining of the stomach.

c. Acid rebound occurs when the stomach produces more gastrin and more acid in response to lowered acid levels in the stomach, which commonly occurs with the use of antacids. Balancing the reduction of the stomach acid without increasing acid production is a clinical challenge.

d. The therapeutic action of sucrafalate:

• The GI protectant sucralfate forms a protective coating over the eroded stomach lining to protect it from acid and digestive enzymes to aid healing.

The therapeutic action of Misoprostol:
• The prostaglandin misoprostol blocks gastric acid secretion while increasing the production of bicarbonate and mucous lining in the stomach.