The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy?
A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
B. “Sucralfate (Carafate) will change the fluid in my stomach.”
C. “Antacids will coat my stomach.”
D. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”
Correct Answer: A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. The H2-receptor antagonist cimetidine competitively blocks histamine from stimulating the H2-receptors located on the gastric parietal cells (these cells are responsible for hydrochloric acid secretion and secretion of the intrinsic factor). The effect results in reducing the volume of gastric acid secretion from stimuli, including histamine, food, caffeine, and insulin.
Option B: Sucralfate (Carafate) promotes healing by coating the ulcer. By forming a polyanion gel, it acts as a physical barrier between luminal contents and mucosa. It also increases the production of mucus by increasing prostaglandin production. Sucralfate prevents the breakdown of mucus by pepsin A, reducing ulcerogenesis.
Option C: Antacids neutralize acid in the stomach. The antacids reduce the acid reaching the duodenum by neutralizing the acid present in the stomach. The salts’ mechanism of neutralization of acid varies, and each salt has a different mechanism with the ultimate goal of acid neutralization.
Option D: Omeprazole (Prilosec) inhibits gastric acid secretion. Omeprazole is a proton pump inhibitor. It inhibits the parietal cell H+ / K+ ATP pump, the final step of acid production. In turn, omeprazole suppresses gastric basal and stimulated acid secretion. The inhibitory effects of omeprazole occur rapidly within 1 hour of administration, with the maximum effect occurring in 2 hours.
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