Drugs for Peptic Ulcer

Disease
Peptic Ulcer
Disease
Drugs
Zantac
Proton pump inhibitors — also called PPIs —
reduce stomach acid by blocking the action of the
parts of cells that produce acid.

Prilosec
 BRAND NAME Ranitidine (ra-ni-ti-deen)
TIME/ACTION PROFILE
GENERIC NAME: Acid Reducer, Zantac, Zantac EFFERdose, Zantac 75, Zantac
150
ROUTE
CLASSIFICATIONS:
ONSET
Therapeutic: antiulcer agents
PEAK Pharmacologic: histamine H2 antagonists
DURATION
PREGNANCY CATERGORY: B

INDICATIONS: Short-term treatment of active duodenal ulcers and benign

gastric ulcers. Maintent-ance therapy for duodenal and gastric
ulcers after healing of active ulcer(s). Manage-ment of gastric
hypersecretory states (Zollinger-Ellison syndrome).
Treatment of and maintenace therapy for erosive esophagitis.
Treatment of gastroesophageal reflux disease (GERD).
PO Heartburn, acid indigestion, and sour stomach (OTC use).
IV: Pre-vention and treatment of stress-induced upper GI
unknown bleeding in critically ill patients.

1 – 3 hr
ACTION: Inhibits the action of histamine at the H2-receptor site located
8 – 12 hr primarily in gastric pa-rietal cells, resulting in inhibition of
gastric acid secretion.
IM
THERAPEUTIC EFFECTS: Healing and prevention of ulcers. Decreased symptoms of
unknown
gastroesophageal reflux. Decreased secretion of gastric acid.
15 min
PHARMACOKINETICS:
8 – 12 hr
Absorption: 50% absorbed after PO administration.
IV

unknown
Distribution: Enters breast milk and cerebrospinal fluid.
15 min

8 – 12 hr
Metabolism and Excretion: Metabolized by the liver, mostly on first pass; 30%
excreted unchanged by the kidneys after parenteral
administration.

Half-life: Neonates (on ECMO): 6.6 hr; Infants: 3.5 hr; Children: 1.8 –
2 hr; Adults: 2 – 2.5 hr (qin renal impairment to 4.8 hr).

CONTRAINDICATIONS/PRECAUTIONS:
ROUTE/DOSAGE: PO (Adults): Short-term treatment of active ulcers— 150 mg
twice daily or 300 mg once daily at bedtime. Duodenal ulcer
Lab Test Considerations: CBC with differential should
prophylaxis— 150bemg
monitored
once dailype-riodically
at bed-time. during
GERD— 150
therapy. mg twice daily. Erosive esophagitis— 150 mg 4 times daily
ini-tially, then 150 mg twice daily as maintenance. Gastric
hypersecretory condi-tions— 150 mg twice daily initially; up
to 6 g/dayduring
Antagonizes effects of pentagastrin and histamine have been used.
gastric acidOTC use— testing.
secretion 75 mg when
Avoid
symptoms occur (up to twice daily).
administration for 24 hr preceding the test.

PO (Children
May cause false-negative results in skin tests 1 mo-16
using allergenic yr): Treatment
extracts. Histamineofantagonists
active ulcers— 2–
should
be discontinued 24 hr before the test. 4 mg/kg/day divided twice daily, maximum 300 mg/day.
GERD and Erosive esophagitis— 4 – 10 mg/kg/

day divided twice daily, maximum 300 mg/day for GERD,

May cause anqin serum transaminases and serum
600 creatinine.
mg/day for erosive esophagitis.

May cause false-positive results for urine protein; test with sulfosalicylic acid.

PO (Neonates): 2 mg/kg/day divided q 12 hr.

Potential Nursing Diagnoses

IV, IM (Adults): 50 mg q 6 – 8 hr (not to exceed 400

mg/day). Continuous IV infu-sion— 6.25 mg/hr. Gastric
Acute pain (Indications)
hypersecretory conditions— 1 mg/kg/hr; may beqby 0.5
mg/kg/hr (not to exceed 2.5 mg/kg/hr).

Implementation
IV, IM (Children 1 mo— 16 yr): Treatment of active
ulcers— 2 – 4 mg/kg/day divided q 6 – 8 hr, maximum 200
Do not confuse Zantac (ranitidine) withmg/day.
XanaxContinuous
(alprazolam) or Zyrtec
infusion— (cetirizine).followed by
1 mg/kg/dose
0.08 – 0.17 mg/kg/hr.

If antacids or sucralfate are used concurrently for relief of pain, avoid administra-tion of antacids
within 30 min – 1 hr of ranitidine and take
IVsucralfate 2 hr1.5
(Neonates): after ran-itidine;load,
mg/kg/dose maythen
decrease
in 12 the
hr start
absorption of ranitidine. maintenance of 1.5 – 2 mg/ kg/day divided q 12 hr
Continuous IV infusion– 1.5 mg/kg/dose load followed by
0.04 – 0.08 mg/kg/hr infusion.
PO: Administer with meals or immediately afterward and at bedtime to prolong effect

Renal Impairment
Doses administered once daily should be administered at bedtime to prolong effect.

PO (Adults): CCr10– 50 mL/min—pdose to 50% of dose

recommended for indi-cation; CCr 10 mL/min—pdose to
Shake oral suspension before administration. Discard unused suspension after 30 days.
25% of dose recommended for indication; fur-ther reductions
 Patient/Family Teaching

BRAND NAME: Omeprazole (o-mep-ra-zole)

Instruct patient to take medication as directed for the full course of therapy, even if feeling better.
Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses.
GENERIC NAME: Losec, PriLOSEC, PriLOSEC OTC

CLASSIFICATIONS:
Advise patients taking OTC preparations not to take the maximum dose continu-ously for more than 2
wk without consulting health care professional.
Therapeutic: Notify
antiulcer health care professional if difficulty
agents
swallowing occurs or abdominal pain persists.
Pharmacologic: proton-pump inhibitors

PREGNANCY CATERGORY: C
Inform patient that smoking interferes with the action of histamine antagonists. Encourage patient to
quit INDICATIONS:
smoking or at least not to smoke afterGERD/maintenance
last dose of the day.of healing in erosive esophagitis.
Duodenal ulcers (with or with-out anti-infectives for
Helicobacter pylori). Short-term treatment of active benign
gastric ulcer. Pathologic hypersecretory conditions, including
May cause drowsiness or dizziness. Caution patient to avoid
Zollinger-Ellison driving orReduction
syn-drome. other activi-ties
of riskrequiring
of GI
alertness until response to the drug is known.
bleeding in critically ill patients. OTC: Heartburn oc-curring
twice/wk.

ACTION:
Advise patient to avoid alcohol, productsBinds to an aspirin
containing enzymeoronNSAIDs,
gastric parietal cells
excessive in the presence
amounts of of
acidicin
caffeine, and foods that may cause an increase gastric pH, pre-venting the final transport of hydrogen
GI irritation.
ions into the gastric lumen..

THERAPEUTIC EFFECTS: Diminished accumulation of acid in the gastric lumen with

Inform patient that increased fluid and fiber intake and exercise may minimize constipation.
lessened gastro-esophageal reflux. Healing of duodenal
ulcers.

Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash;
PHARMACOKINETICS:
confusion; or hallucinations to health care professional promptly.
Absorption: Rapidly absorbed following oral administration; immediate
release formulation contains bicarbonate to prevent acid
Evaluation/Desired Outcomes degradation.

Distribution:
Decrease in abdominal pain. Good distribution into gastric parietal cells.

Protein
Prevention of gastric Binding:
irritation 95%.Healing of duodenal ulcers can be seen by x-rays or
and bleeding.
endoscopy. Therapy is continued for at least 6 wk in treatment of ulcers but not usually longer than 8
wk.
Metabolism and Excretion: Mostly metabolized by the liver via the cytochrome
P450 (CYP) system (primarily CYP2C19 isoenzyme,
Decreased symptoms of esophageal reflux. but also the CYP3A4 isoenzyme) (the CYP2C19
enzyme system exhibits genetic polymorphism; 15
– 20% of Asian patients and 3 – 5% of Caucasian
and Black patients may be poor metabolizers and
Drug-Natural Products: TIME/ACTION
St. John’s wort mayplevels and maypresponse; avoid
concurrent use. PROFILE
(antisecretory
effects)

ROUTE/DOSAGE:
ROUTE PO (Adults): GERD/erosive esophagitis— 20 mg once daily.
Duodenal ulcers as-sociated with H. pylori— 40 mg once
ONSET daily in the morning with clarithromycin for 2 wk, then 20
mg once daily for 2 wk or 20 mg twice daily with
PEAK
clarithromycin 500 mg twice daily and amoxicillin 1000 mg
DURATION twice daily for 10 days (if ulcer is present at be-ginning of
therapy, continue omeprazole 20 mg daily for 18 more days);
PO-delayed release has also been used with clarithromycin and metronidazole.
Gastric ulcer— 40 mg once daily for 4 – 6 wk. Reduction of
within 1 hr
the risk of GI bleeding in critically ill patients— 40 mg
within 2 hr
initially, then another 40 mg 6 – 8 hr later, followed by 40
72 – 96 hr mg once daily for up to 14 days. Gastric hypersecretory
conditions— 60 mg once daily initially; may be in-creased up
to 120 mg 3 times daily (doses 80 mg/day should be given in
divided doses); OTC— 20 mg once daily for up to 14 days.
CONTRAINDICATIONS/PRECAUTIONS:

Contraindicated in: Hypersensitivity; Lactation: Discontinue omeprazole or

PO (Children
discontinue 1– 16
breast yr and 5– 9 kg): GERD/erosive
feeding.
esophagitis— 5 mg once daily.

PO (Children 1– 16 yr and 10– 19 kg): GERD/erosive e

Use Cautiously in: sophagitis—
Liver disease10 mg once daily.
(dosepmay be necessary); OB, Lactation, Pedi:
Safety not established in pregnant or breast feeding women,
PO (Children
or children 1 yr;1–Patients
16 yr and $20
using kg): GERD/erosive
high-doses for 1 year (qrisk of
esophagitis— 20 mg once daily.
hip, wrist, or spine fractures).

NURSING
ADVERSE IMPLICATIONS
REACTIONS/SIDE EFFECTS:

CNS: dizziness, drowsiness, fatigue, headache, weakness.

Assessment
CV: c hest pain.

Assess patient routinely for epigastric or GI: PSEU-DOMEMBRANOUS

abdominal COLITIS,
pain and frank or occult blood in the abdominal
stool,
emesis, or gastric aspirate. pain, acid regurgitation, constipation, diarrhea,
flatulence, nausea, vomiting.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be
F and E:ashypomagnesemia
reported to health care professional promptly (especially if treatment
a sign of pseudomembranous du-ration
colitis. May begin
up to several weeks following cessation$3 ofmo). Derm: itching, rash. MS: bone fracture.
therapy.

Lab Test Considerations: Monitor CBC Misc: allergic reactions.

with differential periodically during therapy.

May causeqAST, ALT, alkaline phosphatase, and bilirubin.

May cause serum gastrin concentrations toqduring first 1 – 2 wk of therapy. Lev-els return to normal
 Potential Nursing Diagnoses

Acute pain (Indications)

Implementation

Do not confuse Prilosec (omeprazole) with Prozac (fluoxetine) or Pris-tiq (desvenlafaxine). Do not
confuse omeprazole with fomepizole.

PO: Administer doses before meals, preferably in the morning. Capsules should be swallowed whole;
do not crush or chew. Capsules may be opened and sprinkled on cool applesauce, entire mixture
should be ingested immediately and fol-lowed by a drink of water. Do not store for future use.

Powder for oral suspension: Administer on empty stomach, as least 1 hr before a meal. For patients
with nasogastric or enteral feeding, suspend feeding for 3 hr be-fore and 1 hr after administration.
Empty packet contents into a small cup contain-ing 1 – 2 tablespoons of water. Do not use other
liquids or foods. If adminis-tered through a nasogastric tube, suspend in 20 mL of water. Stir well and
drink immediately. Refill cup with water and drink again.

May be administered concurrently with antacids.

Patient/Family Teaching

Instruct patient to take medication as directed for the full course of therapy, even if feeling better.
Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses.

May cause occasional drowsiness or dizziness. Caution patient to avoid driving or other activities
requiring alertness until response to medication is known.

Instruct patient to notify health care professional of all Rx or OTC medications, vi-tamins, or herbal
products being taken and consult health care professional be-fore taking any new medications.

Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an
increase in GI irritation.

Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache
to health care professional promptly