Prepare: Acid-Controlling Drugs

Stomach Areas

• Identify the areas of the stomach.

Gastric Glands

• Match the gastric gland cell with its function.

Parietal Cells

• Which receptors in the stomach are responsible for stimulating the secretion of acid from the parietal cells? Select all that apply.

Self-Check: Stomach Acid

Gastric Hyperacidity

• Gastric hyperacidity is the over production of stomach acid.

Stomach Acid

• The pH of stomach acid is 1-4.

Self-Check: Hyperacidity

Gastro esophageal Reflux Disease (GERD)

• Gastroesophageal reflux disease is when excessive acid backs up into the esophagus.

Acid-controlling Drugs

• Match the acid-controlling drugs with how they work.

Self-Check: H. Pylori (Helicobacter pylori)

Helicobacter pylori (H. pylori)

• Helicobacter pylori (H. pylori) is a Bacteria that can infect the gastric track.

Reflect: Acid-Controlling Drugs

Acid-controlling Drugs

• The telehealth nurse is responding to question send to the Hancock Healthcare Services’ social media page. Review the questions and choose the best response.

Mandy345 asks:

• I have heartburn and I am in the pharmacy. Do all acid controlling drugs work the same way?

Choose your best response from the choices given below.

MrTom2u wrote:

• I take a lot of prescribed daily medication, including digoxin. Is it safe to take any type of acid controlling drugs with my medications?

Choose your best response from the choices given below.

Mavis52 wrote:

• What lifestyle changes can I start that will prevent/reduce my heartburn (hyperacidity) symptoms? Choose the correct response from the choices given below.

Mavis52 wrote back:

• My husband said that smelling his food on the grill will make my stomach secrete digestive fluid. Is this true? Choose the correct response from the choices given below.

Mav12 asks:

• Do these work the same way to reduce acid in my stomach?

Acid-reducing medication

Effervescent tablet antacid

Choose your best response from the choices given below.

You just received a direct message (DM) from Twitter. Mary10 wrote:

• @HHSH My Dad was just admitted to the intensive care unit. Why was he given an acid-controlling drug? He is intubated and not eating.

Choose the best response from the choices given below.

Parietal Cells

• The secondary response of parietal cells activates the hydrogen–potassium–adenosine triphosphatase (ATP) pump.

Antacids (magnesium carbonate, aluminum hydroxide,

calcium carbonate, sodium bicarbonate)

Prepare: Antacids

Antacid

• Which salt compounds are contained in antacid? (Select all that apply.

Simethicone

• What is the purpose of simethicone?

Side Effect of Antacids

• Antacids are made of salt compounds. Magnesium antacid salt compound can cause the side effect of diarrhea.

Self-Check: Antacids

Therapeutic Effects of Antacids

• What are the expected therapeutic effects of antacids? Select all that apply.

Self-Check: Drug Interactions

• Match the interaction with the definitions.

Self-Check: Antacid Compounds

• Combining two salt compounds in an antacid has what beneficial effect?

Antacid Side Effects

• Drag the correct side effect for each of the antacid salt compounds given below:

Reflect: Antacids

Side Effects

• A client takes an aluminum-containing antacid, such as aluminum hydroxide, for which side effect?

Antacid Drug

• Mike has chronic renal failure. Magnesium-containing antacids may not be the best based on the patient's medical condition.

Antacid Table

• Complete the table below by dragging the appropriate choices into the blank cells.

Mechanism of Action

• Antacids are effective in the treatment of hyperacidity based on which mechanism of action?

Administration of Antacids

• Antacids should not be taken 1 hour before or 2 hours after any prescription medications.

Antacids

• A client called asking about antacids. The client asked,

"How fast and how long will they work?"

The nurse responded,

“Antacids start working within 15 minutes and last up to 4 hours.

Onset and Duration of Antacids

The onset and duration of action of antacids are onset 15 mins and duration 4 hours

Antacid Drugs

• Tums and Maalox are calcium containing antacids.

H2 Receptor Antagonists

Prepare: H2 Receptor Antagonists

H2 Receptor Antagonists (H2RA)

• Which statement about H2RA is correct?

Route of Administration

• Which routes can cimetidine be administered? Select all that apply.

H2 Receptor Antagonists

• Which of the following statements about H2 receptor antagonists (H2RA) is correct?

Self-Check: H2 Receptor Antagonists (H2RA)

Histamine 2 (H2) Receptor Antagonists

• Which type of cells do H2 receptor antagonists bind to inhibit acid production?

Histamine 2 (H2) Receptor Antagonist Administration

• Which statement about H2 receptor antagonists administration is true?

Self-Check: H2 Receptor Antagonists

Histamine 2 (H2) Receptor Antagonists – Caution

• Patients with renal and hepatic disease should use caution when taking H2 receptor antagonists.

Histamine 2 (H2) Receptor Antagonists

• Which statement(s) are correct concerning H2 receptor antagonists? (Select all that apply.)

Reflect: H2 Receptor Antagonists

Histamine 2 (H2) Receptor Antagonists: Drug Names

• A H2 receptor antagonist will be prescribed for a client. Which medications are H2 receptor antagonists? Select all that apply.

Histamine 2 (H2) Receptor Antagonist: Older Adult Population

• The H2 receptor antagonist dose in the older adult population should be decreased due to slower renal function.

Famotadine

• The client has an order for famotadine once daily. The nurse schedules the medications for which of the following times?

Cimetidine Dosing

• Complete the cimetidine dosing information by dragging the missing values to the correct cell.

Histamine 2 (H2) Receptor Antagonist Drugs

• Which H2 receptor antagonist has the highest risk for drug interactions?

Side Effects

• A 75-year-old client has been admitted for a gastrointestinal bleed. The client is confused and disoriented after receiving several medications. Which medication can worsen confusion and disorientation for this client?

Cimetidine Pharmacokinetics

• Complete the cimetidine pharmacokinetics table by dragging the missing values to the correct cell.

Proton Pump Inhibitors

Prepare: Proton Pump Inhibitors

Proton Pump Inhibitor: Indications

• Which of the following are indications for a proton pump inhibitor? Select all that apply.

Proton Pump Inhibitors

• Proton pump inhibitors work in which cells in the body?

Administration Routes

• What are the possible administration routes for pantoprazole? Select all that apply.

Self-Check: Proton Pump Inhibitors

Proton Pump Inhibitors (PPI)

• PPIs reduce acid in the stomach by blocking how hydrogen ions are released.

Proton Pump Inhibitor: Drug Interactions

• When should the nurse instruct the client to take their proton pump inhibitor?

Self-Check: Proton Pump Inhibitors (PPI) Drugs

Patient Teaching

• The patient was prescribed lansoprazole. Which statements indicate additional teaching is needed? Select all that apply.

Side Effects

• The client is receiving pantoprazole intravenously. The nurse monitors the client for which possible side effects? Select all that apply.

Self-Check: Proton Pump Inhibitor

Administration Routes

• The healthcare provider is considering ordering pantoprazole for the client. What are the possible administration routes for pantoprazole? Select all that apply.

Reflect: Proton Pump Inhibitors

Proton Pump Inhibitors

• Which statements about proton pump inhibitors are true? Select all that apply.

Proton Pump Inhibitor Medication

• The nurse is caring for a patient in the intensive care unit after a myocardial infarction. The nurse notices that the patient’s medication list includes a proton pump inhibitor, but there is no mention of any gastrointestinal (GI) disorders on his chart. Drag and drop the correct reason into the space below.

Proton Pump Inhibitor (PPI) Use

• A PPI is indicated for which of the following conditions? Select all that apply.

Omeprazole Dosing

• Complete the omeprazole dosing information by dragging the missing values to the correct cell.

Pantoprazole Pharmacokinetics

• Complete the pantoprazole pharmacokinetics table by dragging the missing values to the correct cell.

Proton Pump Inhibitor (PPI) – Mechanism of Action

• What is the mechanism of action of a PPI?

Medication

• A 68-year-old, post-menopausal female presents to urgent care with pain in her right arm that started after a recent fall. An x-ray confirms fractures in both the radius and ulna, with indications of osteoporosis. Which medication regularly taken by the patient may have contributed to the fracture?

Client Education

• Which statements indicate the client requires additional education about proton pump inhibitor (PPI)? Select all that apply.

Nursing Application: Acid-Controlling Drugs

Prepare: Nursing Application: Acid-Controlling Drugs

Medication for Hyperacidity

• famotidine treats symptoms of hyperacidity by preventing parietal cells’ stimulation from histamine.

Medication

• Which medication neutralizes acid in the stomach?

Hyperacidity Medication

• pantoprazole reduces hyperacidity by preventing the parietal cell from excreting acid (hydrogen ions).

Explore: Mary’s Case Study

Mary is a 54-year-old school administrator, being seen because antacids are not relieving her heartburn and abdominal pain. Mary describes her eating habits as follows: “I am so busy and my job is overwhelming , so stressful. I try to eat healthy, but all my meals are takeout and I am sure they are not healthy. I usually take my antacids during the day and before I go to bed. I started chewing 2 tabs with every dose and now the antacid is not working anymore. I am not sure what to take.” When asked about the medications she has tried to help her heartburn, Mary lists several. She said that one of them, she does not recall which, caused diarrhea so she stopped taking it. Of all that she tried, she still takes calcium carbonate for her bones, but it is not helping her stomach issues anymore. When asked, she explains that she forgot to take her calcium carbonate with her on a recent vacation and noticed her symptoms got worse. When she got home and started taking them again, they no longer helped her stomach.

• Which antacid would most likely have had caused Mary’s diarrhea?
• Which phenomenon explains the increased stomach pain when Mary stopped taking her calcium carbonate?
• Mary was tested for H. pylori infection in the office and asked what information the test will provide. What is the best response by the health care provider?
• Mary underwent further testing and was diagnosed with gastroesophageal reflux disease (GERD). Before prescribing pantoprazole, the health care provider screens for which contraindications for this medicine? (Select all that apply.)
• Mary asked the health care provider what changes are needed to her diet. Indicate which food items she should eat (i.e. foods that will promote less acid reflux) and which food items should be avoided (i.e. foods that will irritate acid reflux).

Reflect: Nursing Application: Acid-Controlling Drugs

Proton Pump Inhibitor (PPI)

• When educating an individual with a new prescription for omeprazole, what instruction is given for when to take the medication?

Client Education

• The client is in the pharmacy clinic to pick up her PPI prescription. As the pharmacist hands her the medicine, the client makes the following statement indicating that she needs additional education about her new prescription?

Proton Pump Inhibitors: Side Effects

• Which conditions are associated with long-term use of proton pump inhibitors? (Select all that apply.)

Client Education

• During the discussion with the client picking up their PPI medication, which statement should the pharmacist follow-up?

Therapeutic Effect

• For how long will PPIs have a therapeutic effect? 24 hours

Treatment Plan

• The client mentions that a friend uses famotidine for their acid reflux, and wants to know why she was prescribed pantoprazole? Which actions of PPI make them useful in the client's treatment plan? (Select all that apply.)

Antacids

• Antacids do not prevent the overproduction of acid in the stomach, they neutralize acids that are present.

Antacid Contraindication

• For each situation listed, select whether antacid therapy is or is not contraindicated.

Antiemetic and Antinausea Drugs

Prepare: Antiemetic Drugs

Categories Of Antiemetic Drugs

• There are seven categories of antiemetic drugs, which include anticholinergics, antihistamines, antidopaminergics, neurokinin receptor antagonists, prokinetics, serotonin blockers, and tetrahydrocannabinoids.

Antiemetic Mechanism of Action

• Though the seven categories of antiemetic drugs have different mechanisms of action, the majority work by blocking one of the vomiting pathways which block the neurologic stimulus that induces vomiting.

Medication to Relieve Vomiting

• Medications used to treat and relieve nausea and vomiting are called antiemetic drugs.

Self-Check: Medication Indication

• Anticholinergics are indicated for motion sickness, pre-op secretion reduction, nausea, and vomiting.

Self-Check: How Do They Work?

• Please drag and drop the correct site of action that block the neurologic stimulus that induces vomiting over the list of categories of antiemetic medications:

Self-Check: Dry Mouth

• Which categories of antiemetic medications may cause a dry mouth side effect? (Select all that apply.)

Reflect: Antiemetic Drugs

Antiemetics and CNS Depression

• Which of the following categories of antiemetic medications may cause CNS depression? (Select all that apply.)

Antiemetic Categories

• What are the seven categories of antiemetic drugs? (Select all that apply.)

Antiemetics and Motion Sickness

• Which antiemetic medications would be appropriate for motion sickness? (Select all that apply.)

Antiemetics and Gastroesophageal Reflux

• Which antiemetic medications would be appropriate for nausea associated with gastroesophageal reflux?

Therapeutic Effect of Antiemetics

• What is the therapeutic action of antiemetic medications?

Antiemetic Mechanism of Action

• What is the mechanism of action in the majority of antiemetic medications?

Antiemetics and Chemotherapy

• Which antiemetic medications would be appropriate for chemotherapy nausea and vomiting? (Select all that apply.)

How They Work

Please drag and drop the correct category of antiemetic medication under the correct site of action. Each category can include more than one medication class, and each class can be used more than once.

If you can’t read.

• Labyrinth (inner ear)
• Gastrointenstinal tract
• Cerebral cortex
• Chemoreceptor trigger zone (CTZ)
• Vomiting center (medulla)

Serotonin Blockers (ondansetron)

Prepare: Serotonin Blockers (ondansetron)

Classification of Serotonin Blockers

• To which class of medications do serotonin blockers belong?

Indications for Use of Serotonin Blockers

• Ondansetron is a serotonin blocker that works to prevent nausea and vomiting.

ondansetron Use

• ondansetron may be given for chemotherapy, radiation and postoperative nausea and vomiting.

Self-Check: Appropriate Usage

• Which of the following are appropriate times to give ondansetron for nausea and vomiting?

Self-Check: ondansetron

Effects at the 5-HT3 Receptor Sites

• Ondansetron works by blocking the serotonin effects at the 5-HT3 receptor sites, which are located in vagal nerve terminals and chemoreceptor trigger zone of the central nervous system.

Therapeutic Effect

• A therapeutic effect is clear when there is a(n) decrease in incidence and severity from nausea and vomiting after chemotherapy, radiation, and surgery.

Safety: ondansetron

• In general ondansetron is safe unless there is a known allergy to the medication. Contraindications include oral disintegrating tablets in patients with phenylketonuria, congenital long QT syndrome, and concurrent use of apomorphine.

Current Use with ondansetron

• Which of the following medication is safe to use with ondansetron?

Reflect: Serotonin Blockers (ondansetron)

Routes of Administration

• Which of the following are routes of administration available for ondansetron?

Half-Life: ondansetron

• Please drag and drop the correct half-life for ondansetron on the chart below:

Consult Health Care Provider

• Before administering ondansetron, which of the following conditions require further follow-up with the health care provider? (Select all that apply.)

ondansetron: Adverse Effects

• Which of the following are possible adverse effects of ondansetron? (Select all that apply.)

Adverse Drug Interaction

• Administering ondansetron to a patient taking which medications may result in an adverse drug to drug interaction? (Select all that apply.)

Pregnancy and Contraindication

• Which of the following times during pregnancy would be contraindicated to administer ondansetron for hyperemesis gravidarum?

Chemotherapy and Timing

• When administering ondansetron for chemotherapy-related nausea and vomiting. What is the best time for the patient to receive this medication?

Receptors Blocked

• Which receptors are blocked by ondansetron thereby reducing nausea and vomiting?

Nursing Application: Antiemetic and Antinausea Drugs

Prepare: Nursing Application: Antiemetic and Antinausea Drugs

Nausea and Vomiting Medications

• What medications are used to treat and relieve nausea and vomiting?

Antiemetic Medications

• Which of the following antiemetic medications may cause a patient to have CNS depressant interactions? (Select all that apply.)

Antiemetic Drug

• Which of the following is not a type of antiemetic drug?

Self-Check: Assessment

Assessment: Antiemetic Medications

• The nurse is caring for a patient with nausea and vomiting after an overdose of morphine. Which antiemetic medication class(es) should be avoided? (Select all that apply.)

Priority Assessments

• Which are the priority assessments when administering anticholinergics? (Select all that apply.)

Self-Check: Interventions

Medication Administration

• A patient is prescribed an antiemetic to be given sublingual route. The nurse knows that this medication will be administered where?

Subjective and Objective Data

• Which assessment findings should the nurse monitor in a client receiving antiemetic medications? (Select all that apply.)

Self-Check: Patient Teaching

Patient Teaching

• Which items should be included in your patient teaching regarding antiemetic medications? (Select all that apply.)

Reflect: Nursing Application: Antiemetic and Antinausea Drugs

Therapeutic Action

• A patient was prescribed an antiemetic and asks why he needs to take another pill. What is the nurse’s best response related to the therapeutic action of antiemetic medications?

Drug Interactions

• Please drag the potential interaction(s) that can affect each class.

Adverse Effects

• Please drag in the appropriate adverse effects for each medication class.

Medications

A 25-year-old patie