Antiulcers

a. actions
i. decrease acetylcholine release
ii. block release of histamines
iii. inhibit secretion of pepsin
iv. inhibit proton pump

b. examples
i. anticholinergics; belladonna tincture, chlorodiazepoxide (Librax)
ii. h2 blockers - cimetidine (Tagamat), ranitidine (Zantac)
iii. pepsin inhibitor - sucralfate (Carafate)
iv. proton pump inhibitor - lansoprazole (Prevacid), omeprazole (Prilosec)

c. uses: management of peptic ulcer disease, gastroesophageal reflux disease(GERD), protects gastric mucosa from hydrochloric acid production

d. adverse reactions
i. dry mouth, decreased secretions, constipation, tachycardia, & urinary retention
ii. headaches, dizziness, constipation, skin reash, pruritis, impotence
iii. sucralfate is nonabsorbable, occasional constipation

e. contraindications
i. anticholinergics - narrow- angle glaucoma
ii. renal failure
iii. liver disease

f. nursing interventions
i. administer on empty stomach
ii. avoid antacids within 30 minutes of sucralfate
iii. avoid antacids within one to two hours of other antiulcer drugs
iv. administer other drugs one to two hours after sucralfate
v. teach clients
• avoid alcohol, spicy food, and caffeinated beverages
• eliminate smoking
• increase fluid intake
• medication can take up to two weeks for full effect
• report increasing abdominal pain, vomiting of blood, or passage of bloody stools