H₂-Blockers

ACTIONS

Histamine H₂-antagonists inhibit histamine action on H₂-receptors, which are found on the gastric parietal cells. This action reduces the secretion of gastric acid, as well as hydrogen ion concentration.

USES

• Prevention and treatment of gastric and duodenal ulcers

• Heartburn, acid indigestion, and gastroesophageal reflux disease

CONTRAINDICATIONS AND PRECAUTIONS

• Hepatic and renal dysfunction

• Caution in older adult patients

SIDE EFFECTS

• ^**Diarrhea,^** constipation

• Older adults: ^**confusion,^** agitation

• Decrease in stomach acid may increase growth of Candida and bacteria in stomach, resulting in increased risk for pneumonia.

• Cimetidine: May bind with androgens to cause gynecomastia and impotence.

NURSING IMPLICATIONS

1. ^*Oral medications may be taken without regard to meals.^*

2. ^‡Teach patient to avoid alcohol.^‡

3. ^‡Smoking may decrease effectiveness.^‡

4. ^‡Teach patient the signs of gastric bleeding and to notify health care provider if any occur.^‡

5. ^‡Teach patient to notify health care provider for any indication of respiratory problems.^‡

Psyllium (Metamucil)

CLASSIFICATION

Bulk-forming laxative

ACTIONS

Acts similar to dietary fiber. This medication is not digested or absorbed. After ingestion, it will swell to form a viscous solution or gel, softening the fecal mass and increasing the bulk. A fecal mass stretches the intestinal wall to stimulate peristalsis and passage of a soft-formed stool in 1 to 3 days.

USES

• Treats constipation.

• Prevents constipation and straining after myocardial infarction or rectal surgery.

CONTRAINDICATIONS

• Fecal impaction

• Bowel obstruction or undiagnosed acute abdominal pain

PRECAUTIONS

• Narrowing of the esophagus

• Intestinal adhesions, ulcers

SIDE EFFECTS

• Abdominal discomfort

• Impaction and obstruction if not given with adequate liquids

NURSING IMPLICATIONS

1. ^*Mix powder with at least 8 ounces of water; mix at the bedside immediately before administration.^*

2. ^‡Instruct patient to drink at least 8 ounces of water after each dose and drink at least 6 to 8 glasses of water each day to facilitate peristalsis and to prevent obstruction.^‡

3. Bowel movement should occur in 12 to 36 hours.

4. ^*Administer at least 2 hours before or after medications.^*

Metoclopramide Hydrochloride (Reglan)

CLASSIFICATION

Peristaltic stimulant, antiemetic

ACTIONS

Suppresses emesis by blocking dopamine receptors in the chemoreceptor trigger zone; increases tone and accelerates intestinal transit and gastric emptying by enhancing action of acetylcholine.

USES

• Provides antiemetic properties for suppressing nausea and vomiting associated with cancer therapy and postoperatively.

• Suppresses gastroparesis in patients with diabetes.

• Suppresses gastroesophageal reflux.

CONTRAINDICATIONS

• Gastrointestinal obstruction or perforation; gastrointestinal hemorrhage

• Concurrent use with medications that produce extrapyramidal reactions

PRECAUTIONS

• Impaired renal function, congestive heart failure, cirrhosis

SIDE EFFECTS

• ^**Drowsiness, restlessness, fatigue, lethargy^**

• Dizziness, headache, insomnia, dry mouth

• ^†Extrapyramidal symptoms (toxic)^†

NURSING IMPLICATIONS

1. Assess status of hydration.

2. ^*Monitor for anxiety, restlessness, extrapyramidal symptoms.^*

3. Monitor pattern of bowel response.

4. Monitor for therapeutic response.

5. ^*To prevent nausea, administer 30 minutes before chemotherapy; give 30 minutes before meals and at bedtime for gastroparesis.^*

6. Monitor renal function, blood pressure, and heart rate.

Proton Pump Inhibitors

EXAMPLES

• omerprazole (Prilosec)

• esomeprazole (Nexium)

• lansoprazole (Prevacid)

• pantoprazole (Protonix)

ACTIONS

Suppress the secretion of gastric acid by combining with an enzyme on the gastric parietal cells; block the final common pathway for gastric acid formation; decrease hydrogen ion transport into the gastric lumen.

USES

• Short-term (4 to 8 weeks): Duodenal ulcers associated with Helicobacter pylori, gastric ulcers, erosive gastritis, and gastroesophageal reflux disease

• Long-term: Hypersecretory conditions (Zollinger-Ellison syndrome)

CONTRAINDICATIONS AND PRECAUTIONS

• Long-term use may predispose patient to the risk of developing gastric cancer.

• Long-term therapy may predispose patient to the risk of osteoporosis and fractures.

SIDE EFFECTS

• ^**Headache^**

• Diarrhea

• Nausea and vomiting

NURSING IMPLICATIONS

1. ^‡Instruct patient to avoid opening, chewing, or crushing capsules.^‡

2. ^‡Instruct patient to return for follow-up if symptoms are unresolved after 4 to 8 weeks of therapy.^‡

3. ^‡Should be taken before meals.^‡

4. ^*Notice that the generic names end in “zole.”^*

5. ^‡Encourage patients to maintain adequate intake of calcium and vitamin D.^‡

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