Antacids

 Use for the relief of symptoms associated with hyperacidity and peptic ulcer disease
 Initial drug of choice for PUD
 Primary goal is the relief of pain through their ability to
o Neutralize acid
o Improve the resistance of the stomach lining
o Increase the tone of the lower esophageal sphincter
o Inhibit protein-digesting ability of pepsin
 Alkaline in nature.

Characteristics of ideal antacid (may not be present on some antacid)

 Effective neutralizer even in small dose

 Does not cause acid rebound
 Has prolonged action
 Does not interfere with the digestion or the absorption of nutrients or drugs
 Does not cause GI upset such as diarrhea, constipation or bloating
 Palatable
 Inexpensive

Types

1. Systemic
a. Readily absorbed in the circulation
b. Long term use can lead to:
i. Systemic alkalosis
ii. Gastric distention
iii. Hypernatremia and water retention
iv. Causes rebound hypersensitivity
c. Ex: NaHCO3 (Alka-Seltzer, Bell/Ans)
2. Non-systemic
a. Poorly absorbed systematically
b. Adverse effects include:
i. Al Prep –constipation, Hypophosphatemia
ii. Mg Prep –diarrhea, hypermagnesemia, phosphate depletion (displacement of
phosphate in the phosphate site)
iii. CaCO3 –hypercalcemia, constipation, milk-alkali syndrome (if there is
hypercalcemia resulting to metabolic alkalosis)
iv. Na Prep –Na toxicity
c. Single substance
i. CaCO3 (Tums)
ii. Al(OH)3 (Amphogel)
iii. Mg(OH)2
iv. MgCO3
v. AlPO4
 d. Mixture of CaCO3, Al(OH)3, and Mg(OH)3:
i. Camalox
ii. Ducon
e. Mixture of Al(OH)3 and Mg(OH)3
i. Cremalin
ii. Maalox
iii. Mylanta
iv. Gelucil
3. Nursing Implications:
1. Antacids given on an empty stomach has duration of action lasting 30 minutes
2. Do not give Na prep to patients on Na restricted diet, with HPN, cardiac/renal
disease
3. Instruct the patient on proper administration:
i. Shake well before administration (liquid prep)
ii. Chew tablet well and followed with H2O
iii. If effervescent tablet is used, allow bubbled to settles before administration
iv. Monitor patient for serum electrolyte and acid-base imbalances
v. Provide thorough patient teachings:
1. Drug interactions
2. Check bowel habits frequently
3. Relaxation techniques
4. Avoid foods and liquids that can cause gastric irritation
4. Anticholinergics
a. Antimuscarinics, Parasympatholytics
b. Antagonizes the action of Ach at the postganglionic receptor in the PNS
c. Decrease gastric motility and secretion
d. Therapeutic Uses:
i. Decrease gastric motility
ii. Relaxation of sphincter muscles in the eye
iii. Treatment of GI spasm, biliary colic
iv. Decrease bronchial secretion
v. Inhibit vagus nerve
vi. Affects cardiac muscles (symphatetic)
e. Examples:
i. Atropine sulphate (AtSO4)
ii. Belladonna tincture
iii. Scopolamine
iv. Hyoscine-N-Butylbromide (HNBB)
f. Adverse effects:
i. Decrease saliva, sweat and bronchial secretions
ii. Blurred vision
iii. Drowsiness/dizziness
iv. Dysuria
v. Palpitations
 g. Contraindications/Caution:
i. Certain conditions:
1. Narrow-angle glaucoma
2. Bronchial asthma
3. Atherosclerosis
4. Prostatic hypertrophy
5. Urinary retention
ii. High environmental temperatures
h. Nursing Implications:
i. Administer 30-60 minutes before mels
ii. Monitor for constipation, decreased urine output, eye pain, s/sx of IOP
(intraocular pressure)
iii. Patient Teachings:
1. Contain sedatives
2. DO NOT CHEW
3. Give hard candies, gums, ice chips (for dryness)
4. Antidote: Physostigmine: an acetylcholinesterase inhibitor
5. Drug interactions:
a. Decreased absorption with antacids
b. Increased IOP with corticosteroids
c. Increased ventricular arrhythmias with cyclopropane
d. Increased effect and absorption digoxin
5. Histamine blocking agents/ H2 receptor blocker
a. Blocks histamine receptors at the parietal cells of the stomach
b. Results to decrease HCL production, pepsin production
c. Promotes healing of ulcer
d. Indications:
i. Active ulcer
ii. Hypersecretory conditions (e.g. Zollinger Ellison Syndrome)
iii. Prophylaxis for susceptible patients
iv. Erosive GERD (Gastroesophageal reflux)
v. Relief symptoms of heartburn, sour stomach (OTC prep)
e. Examples
i. Cimetidine (Tagamet) –most commonly given (parentera/oral- 50 mg 1v or 1m ;
150 mg oral
ii. Famotidine (Pepcid)- oral
iii. Ranitidine (Zantac) –IV oral
iv. Nizatidine (Axid) –IV/oral
f. Adverse effects
i. Diarrhea
ii. Gynescomastia
iii. Headache
iv. Rashes
v. Impotence
 vi. Arrythmia
vii. Confusion
viii. Dizziness
g. Nursing Implications
i. Administer before meals, should be swallowed whole
ii. Monitor liver enzymes
iii. Ulcer relief is evident in 1 week
iv. Thorough patient teaching to enhance knowledge about drug therapy
6. Proton pump inhibitor
7. Prostaglandin Analogue
a. Exerts protective effect on the mucosal surface of the stomachand suppress gastric acid
secretion
b. Indicated for the prevention of NSAID-Induced gastric ulcer
c. Pregnancy category X
8. Pepsin Inhibitor
a. Combined with proteins