Chapter 40 Peptic Ulcer Disease

What is PUD, what are the risk factors of PUD, and which PUD is more common?
*peptic ulcer refers to a lesion located in either the stomach (gastric) or small intestine (duodenal).
*Peptic ulcer disease (PUD) is associated with the following risk factors: close family history of PUD blood group; smoking tobacco; consuming beverages and food containing caffeine; use of drugs, particularly glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin; excessive psychological stress; and infection with Helicobacter pylori.
*Gastric ulcers are less common than the duodenal type and have different symptoms. Loss of appetite, known as anorexia, as well as weight loss and vomiting are more common.
What is the primary and secondary cause of PUD?
primary cause of PUD is infection by the gram-negative bacterium Helicobacter pylori. Secondary factors include secretion of excess gastric acid and hyposecretion of adequate mucous protection.
What is a symptom of duodenal ulcers?
characteristic symptom of duodenal ulcer is a gnawing or burning upper abdominal pain that occurs 1 to 3 hours after a meal.
*The pain is worse when the stomach is empty and often disappears on ingestion of food. *Erosion into the mucosa may lead to bleeding that may be evident as either bright red blood in vomit or black, tarry stools.
What is GERD, what are the symptoms and causes?
*Gastroesophageal reflux disease (GERD) is a common condition in which the acidic contents of the stomach move upward into the esophagus.
*GERD causes an intense burning (heartburn) sometimes accompanied by belching. In severe cases, untreated GERD can lead to complications such as esophagitis, or esophageal ulcers or strictures.
*The cause of GERD is usually a weakening of the lower esophageal sphincter. The sphincter may no longer close tightly, allowing the contents of the stomach to move upward when the stomach contracts.
*GERD is associated with obesity, and losing weight may eliminate the symptoms.
*Other lifestyle changes that can improve GERD symptoms include elevating the head of the bed, avoiding fatty or acidic foods, eating smaller meals at least 3 hours before sleep, and eliminating tobacco and alcohol use.
Compare and contrast duodenal ulcers and gastric ulcers. (duodenal)
*Peptic ulcer disease (PUD) is caused by an erosion of the mucosal layer of the stomach or duodenum.
*A duodenal ulcer is more common than a gastric ulcer. It occurs most commonly in the 30 to 50 age group.
*The usual symptom is a gnawing or burning upper abdominal pain from 1 to 3 hours after a meal.
*The pain is worse when the stomach is empty.
*Patients also complain of nocturnal pain, nausea, and vomiting. *Bleeding may occur and exhibit itself as bright red blood in the vomit or black, tarry stools.
Compare and contrast duodenal ulcers and gastric ulcers.(gastric)
*Gastric ulcers are the less common type of ulcer.
*They are more common in the over-60 age group.
*Symptoms include pain that may be relieved after food or may continue after a meal, anorexia, weight loss, and vomiting. Remissions are infrequent or absent.
*Gastric ulcers are more commonly associated with cancer and require longer follow-up.
Describe treatment goals for the pharmacotherapy of gastroesophageal reflux disease.
*The treatment of gastroesophageal reflux disease and peptic ulcer disease is similar.
*The primary goal is to reduce gastric-acid secretion.
*Classifications of drugs used to treat these problems include H2-receptor blockers, antacids, and proton pump inhibitors. Surgery may be necessary in some cases.
Identify the classification of drugs used to treat peptic ulcer disease. (the purpose)
*H2-receptor antagonists *proton pump inhibitors *antacids *antibiotics *and miscellaneous drugs.
Identify the classification of drugs used to treat peptic ulcer disease. (proton pump inhibitors)
*Proton pump inhibitors act by blocking the enzyme responsible for secreting hydrochloric acid in the stomach.
*They are the drugs of choice for short-term therapy of PUD and GERD.
Identify the classification of drugs used to treat peptic ulcer disease. (H2-receptor antagonists)
*H2-receptor antagonists suppress the volume and acidity of parietal cell secretions.
*They are used to treat PUD and GERD.
Identify the classification of drugs used to treat peptic ulcer disease. (antacids)
*Antacids are alkaline substances that neutralize stomach acid.
*They provide temporary relief from heartburn, but do not promote healing of the ulcer or help eradicate H pylori.
Identify the classification of drugs used to treat peptic ulcer disease. (Antibiotics)
*Antibiotics are used to eradicate H. pylori.
*Two or more antibiotics are given concurrently to increase the effectiveness of therapy and to lower the potential for bacterial resistance.
Identify the classification of drugs used to treat peptic ulcer disease. (miscellaneous drugs)
*Miscellaneous drugs include Sucralfate, which produce a gel-like substance that coats the ulcer, protecting it against further erosion and promoting healing.
*Misoprostol inhibits gastric acid secretion and stimulates the production of protective mucus.
*Metoclopramide causes the upper intestine to contract, resulting in fasting emptying of the stomach, and blocks food from re-entering the esophagus from the stomach.
Explain the pharmacologic strategies for eradicating Helicobacter pylori.
*The primary goal of treatment for H. pylori is complete eradication of the bacteria.
*Other treatment goals include interventions that cause the ulcer to heal more rapidly and remain in remission longer.
*There is a very high reoccurrence of peptic ulcers when H. pylori is not completely eradicated.
*Infection can remain active for life if not treated.
*Antibiotics are used to eradicate H pylori.
Describe the nurse’s role in the pharmacologic management of patients with peptic ulcer disease.
(H2-receptor antagonist therapy)
*Assess the patient’s use of OTC formulations to avoid duplication of treatment.
*If using OTC formulations, patients should be advised to seek medical attention if symptoms persist or reoccur. Persistent epigastric pain or heartburn may be a symptom of more serious disease that requires different medical treatment.
*IV preparations of H2-receptor antagonists are occasionally utilized. Because dysrhythmias and hypotension have occurred with IV cimetidine, ranitidine (Zantac) or famotidine (Pepcid) is administered if the IV route is necessary.
*Assess kidney and liver function. Evaluate the patient’s CBC for possible anemia during long-term use of these drugs.
Describe the nurse’s role in the pharmacologic management of patients with peptic ulcer disease. (Proton pump inhibitor therapy for PUD)
*are usually well tolerated for short-term use. With long-term use, liver function should be periodically monitored as well as serum gastrin, because oversecretion of gastrin occurs with constant acid suppression.
*Assess for drug-drug interactions.
*Proton pump inhibitors will affect the absorption of medications, vitamins, and minerals that need an acidic environment in the stomach.
*Obtain the patient’s history of smoking, because smoking increases stomach-acid production.
*These drugs should be taken 30 minutes prior to eating, usually before breakfast.
*These drugs may be administered at the same time as antacids. *Proton pump inhibitors are often administered in combination with clarithromycin (Biaxin) for the treatment of H. pylori.
Describe the nurse’s role in the pharmacologic management of patients with peptic ulcer disease. (Antacid therapy for PUD)
*Obtain a medical history, including the use of OTC and prescription drugs.
*Assess the patient for signs of renal insufficiency; magnesium-containing antacids should be used with caution in these patients. *Hypermagnesemia may occur because the kidneys are unable to excrete excess magnesium.
*Magnesium- and aluminum-based products may cause diarrhea, and those with calcium may cause constipation.
For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their
mechanism of drug action, describe primary actions, and identify important adverse effects. (H2-receptor blockers)
*Prototype drug—ranitidine (Zantac).
*mechanism of action is to block H2-receptors in the stomach to decrease acid production.
*primary use is to treat peptic ulcer disease.
*adverse effects although rare, severe reductions in the number of red and white blood cells and platelets are possible; thus, periodic blood counts may be performed. High doses may result in impotence or loss of libido in men. (See Table 40.2 in the text.)
For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their
mechanism of drug action, describe primary actions, and identify important adverse effects (Proton pump inhibitors:)
*Prototype drug—omeprazole (Prilosec).
*mechanism of action is to reduce acid secretion in the stomach by binding irreversibly to the enzyme H1, K1-ATPase.
*primary use is for the short-term, 4- to 8-week treatment of peptic ulcers and GERD. It is also used for patients who have Zollinger-Ellison syndrome, a chronic hypersecretion of gastric acid.
*Adverse effects are generally minor and include headache, nausea, diarrhea, rash, and abdominal pain. Although rare, blood disorders can occur, and atrophic gastritis and hypomagnesemia have been reported rarely with prolonged treatment.
For each of the classes listed in Drugs at a Glance, know representative drugs, and explain their
mechanism of drug action, describe primary actions, and identify important adverse effects (Antacids)
*Prototype drug—aluminum hydroxide (AlternaGEL, others).
*mechanism of action is to neutralize stomach acid
*Adverse effects include constipation; at high doses it can cause phosphate depletion. (See Table 40.3 in the text.)