NCLEX Medications Affecting Digestion and Nutrition (part 1)


(General Key Points)

  • GI tract is the route of administration and the target of action
  • GI effects are common (abdominal pain, constipation, nausea)
  • When peptic ulcers are caused by pylori, non-antibiotics promote healing but only antibiotics will cure the disease.
  • Drug therapy for peptic ulcers is directed at controlling symptoms, facilitating healing, lowering risk for complications, and preventing relapse
  • Prevention of emesis is more effective than treating it.


Histamine2 (H2) Receptor Agonists

Expected Action:

Selectively block H2 receptors in parietal cells to suppress gastric acid secretion


Example: ranitidine (Zantac) — Others: cimetidine (Tagamet), nizatidine (Axid), famotidine (Pepcid)

Therapeutic Uses:
OTC for heartburn, sour stomach, and indigestion
Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)
In conjunction with antibiotics to treat ulcers caused by H. pylori.


Adverse Effects: decreased libido / impotence, CNS effects (lethargy, depression, confusion) – increased frequent in elderly ĉ renal or liver dysfunction.



Pregnancy (B), danger of increased risk of bacterial colonization of stomach and respiratory tract



-Warfarin, phenytoin – metabolizing enzymes inhibited by cimetidine leads to increased levels

-Concurrent use of antacids ò absorption H2-receptor antagonists


Education: Stop drinking, stop smoking, eat smaller, more frequent meals, Ranitidine can be taken without regard to food


Proton Pump Inhibitor

  • Expected Action: decreases gastric acid secretion by irreversible inhibition of enzyme that produces it. Reduce basal and stimulated acid production


Examples: omeprazole (Prilosec) — Others: pantoprazole (Protonix), lansoprazole (Prevacid), esomeprazole (Nexium

Therapeutic Uses:

Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)

Adverse Effects: Insignificant ĉ short-term treatment

Contraindications/Precautions: Pregnancy (C), increased risk pneumonia d/t increased pH promoting bacterial colonization


Delayed absorption of Ampicillin, digoxin, iron, ketoconazole if concurrent


IV pantoprazole may cause thrombophlebitis, headache, or diarrhea.



Expected Action:

Acidic conditions Δ sucralfate to viscous gel that adheres to and protects ulcers.

Example: Sucralfate (Carafate)

Therapeutic Uses: Acute duodenal ulcers, Investigational use for gastric ulcers and GERD

Adverse Effects: No systemic effects, Avoid constipation by > 1500 cc water and increasing fiber

Contraindications/Precautions: Pregnancy (B)


Antacids interfere with absorption of sucralfate.
Decreased absorption of phenytoin, digoxin, warfarin, ciprofloxacin

Education: Take on empty stomach, 4x per day



Expected Action:

Neutralize gastric acid and inactivate pepsin
Mucosal protection through stimulation of prostaglandin production

Example: Al(OH)3 gel (Amphojel), Others: AlCO3, Mg(OH)2 (Milk of Magnesia), NaHCO3

Therapeutic Uses: Peptic ulcer disease and GERD

Adverse Effects:  (note leads to, means using these drugs can lead to..  Al/Ca compounds leads to constipation, Mg compounds leads to diarrhea

Na+-containing leads to fluid retention
Al(OH) 3 leads to hypophosphatemia
Mg2+ compounds leads to toxicity with renal impairment


Pregnancy (C), GI perforation or obstruction


Aluminum-compounds bind to warfarin, tetracycline and ò their absorption


Chew tablets thoroughly then take with 8 oz water or milk
Frequency of administration makes compliance difficult


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