1. Aluminum - Constipation, nausea, stomach cramps; fecal impaction, hypophosphatemia

2. Calcium - constipation, flatulence;

fecal impaction, metabolic alkalosis, hypercalcemia,renal calculi.

3. Magnesium - diarrhea, N&V, abdominal cramping;

hypermagnesemia, dysrhythmias (when given parenterally).

4. Sodium bicarbonate (Alka-Seltzer, baking soda) -

abdominal distention, belching, flatulence

Metabolic alkalosis, fluid retention, edema, hypernatremia.

• Keep all scheduled lab visits for phosphorus and calcium levels
• Do NOT take Magnesium (Mg) if you have kidney disease.
• Do NOT take Sodium (Na) if you have heart failure or high BP.
• Take antacids at least 2 hours before other oral meds, becaus absorption may be affected.
• Note number & consistency of stools because antacids may alter bowel activity.
• Medications may make stools appear white.

Antacid : Aluminum Hydroxide (Amphojel) [Pr]

1. What are actions and uses?
2. What are administration alerts?
3. What are adverse effects?
4. What are contraindications
5. What are the drug-drug interactions?
6. What are lab tests interactions?

1. Aluminum compounds are minimally absorbed, unlike calcium-based which can be absorbed and cause side effects.
2. Administer at least 2 hours before or after drugs.
3. Increased doses may interfere with phosphate metabolism and cause constipation.
4. Should not be used in clients with bowel obstruction.
5. Aluminum compounds should not be taken with other meds as they may interfere with absorption.  Use with sodium polystyrene sulfonate may cause systemic alkalosis.
6. Values for serum gastrin & urinary pH may ↑, serum phosphate may ↓.

• > 40 years of age.
• Infants
• Obesity (losing weight may eliminate symptoms)

• amoxicillin (Amoxil)
• clarithromycin  (Biaxin)
• metronidazole (Flagyl)
• tetracycline (Achromycin)
• bismuth subsalicylate (Pepto-Bismol) or ranitidine bismuth citrate (Tritec)

Two or more antibiotics are given concurrently to ↑ effectiveness of therapy and to lower potential for bacterial resistance

H. pylori treatment:

Antibiotics are also combined with:

Misc. drugs for PUD:

sucralfate (Carafate)

• Consists of sucrose plus aluminum hydroxide
• Produces a thick, gel-like substance that coats ulcers
• Does not effect the secretion of gastric acid
• Side-effects: constipation (little is absorbed from the GI tract)
• Must be taken four times a day
• Should be administered before meals to be effective.  Administering after meals will inhibit its ability to adhere to the ulcer.
• Administering with milk will inhibit its actions
• Administering with 8 oz of water will ↓ its bioavailability and effectiveness
• It does NOT decrease or neutralize stomach acid,  or inhibit bacterial growth

Misc. drugs for PUD:

misoprostol (Cytotec)

• Inhibits gastic acid secretion and stimulates the production of protective mucus.
• Its primary use is for the prevention of peptic ulcers in clients taking high doses of NSAIDs or glucocorticoids.
• Diarrhea and abdominal cramping are relatively common.
• contraindicated during pregnancy (sometimes used to terminate pregnancies).

Pharmacotherapy for Peptic Ulcers

(categories)

• H₂-receptor antagonists
• Proton pump inhibitors
• Antacids
• Antibiotics
• Misc. drugs.

Mechanisms of Action:

1. ________  binds to enzyme H⁺, K⁺-ATPase and prevents acid from being secreted.
2. ________ occupy the histamine receptors and prevent acid secretion.
3. ________ chemically combine with acids to lower stomach pH.
4. ________ eradicate H. Pylori.

1. Proton pump inhibitors
2. H₂-receptor antagonists
3. Alkaline antacids
4. Antibiotics.

• Clients taking high doses or renal or hepatic disease confusion may experience confusion, restlessness, hallucinations, or depression.

• diarrhea, constipation, headache, or fatigue

• Hepatitis, blood dyscrasias, anaphylaxis, dysrrhythmias (nizatidine, cimetidine, confusion or psychoses (cimetidine)

• Most frequently in males age 30-50 years
• Gnawing, burning, upper-abdominal pain, occurs 1-3 hours after a meal.
• Pain is worse with empty stomach & often disappears w/ingestion of food.
• Night time pain, N&V are UNcommon.
• If erosion progress deep into mucosa, bleeding occurs (brigh red vomitus or black, tarry stools).
• Many heal spontaneously, although frequently recur after months of remission.
• Long-term medical follow-up is usually not needed.

• Relieved by food, but pain may continue w/meals.
• Loss of appetite (anorexia), weight loss, and vomiting.
• Remissions are infrequent or absent.
• Medical follow up should continue for several years, b/c small percentage of erosion can become cancerous.
• Severe ulcers may penetrate the wall of the stomach and cause death.
• Most common in women over age 60.