NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
NR_565_wk_7___8_Final_Exam_Study_G
uide.docx (1).
NR 565 Exam Final Study Guide
➢ Antacids: weak bases that react with hydrochloric acid to form salt & water.
o Used in the treatment of Hyperacidity, GERD, PUD, hyperphosphatemia, and calcium deficiency
o Contain combinations of
▪ metallic cation (aluminum, calcium, magnesium, and sodium)
▪ and basic anion (hydroxide, bicarbonate, carbonate, citrate, and trisilicate)
➢ Pharmacodynamics, Pharmacokinetics, Pharmacotherapeutics
o Neutralize Gastric Acidity (causes ^pH of the stomach and duodenal bulb)
o Inhibit proteolytic activity of pepsin
o Increase lower esophageal sphincter tone
o Acid-neutralizing capacity ANC varies between products expressed in mEqs
o If ingested in a fasting state, antacids reduce acidity for approximately 20 to 40 minutes
o If taken 1 hr after a meal, acidity is reduced for 2 to 3 hrs
o A second dose taken after a meal maintains reduced acidity for more than 4 hrs after the meal
o The action of antacids occurs locally in the GI tract with minimal absorption, minimal metabolism
o ALL antacids are contraindicated in the presence of severe abdominal pain of unknown cause, especially if
accompanied by fever
-HIGH SODIUM content: pts w/ HTN, CHF, marked renal failure, or on low-sodium diets need to use low sodium
preparation
-Concurrent administration with enteric-coated drugs, destroys the coating= alters absorption, ^ the risk for
adverse effects
-Administrations should be separated by at least 2 hours to decrease drug/drug interactions
1. Calcium based antacids: TUMS, Caltrate, Calcarb
• Prescribed to treat calcium deficient states, i.e. chronic renal failure, post-menopause, and osteoporosis
,NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
• Used to bind phosphates in CRF
• Require Vitamin D for absorption from the GI tract
• Excreted mainly in feces, 20% in urine
• ADR: Contraindicated in the presence of hypercalcemia and renal calculi
• Can cause constipation- increase bulk, fluids and mobility, stool softener
• Administered 30min- 1hr on empty stomach or 3hr after meals
• Should not be administered with food containing large amounts of oxalic acid (spinach, rhubarb), or
phytic acid (bran, cereals), they decrease the absorption of calcium
• Taking w/ foods containing phosphorus (milk, dairy) can lead to milk-alkali syndrome (N/V, confusion,
headache).
• Taking with acidic fruit juice improve absorption
2. Aluminum based: AlternaGEL, Amphojel, Mylanta
• Inhibit smooth muscle contraction and slow gastric emptying
• Used to bind phosphates in CRF
Aluminum is not easily
removed by dialysis b/c • Not absorbable with routine use
it is bound to albumin • Aluminum concentrated in the CNS
& transferrin = do not
cross dialysis • Bind with phosphate and excreted in feces
membrane • Prolonged use in patients with renal failure may result in dialysis osteomalacia
o Aluminum deposits in bone and osteomalacia occurs
• Elevated aluminum tissue levels contribute to the development of dialysis encephalopathy
• Used to treat hyperphosphatemia in pts w/ renal failure & phosphate renal stone prevention
• Can cause constipation- increase bulk, fluids and mobility, stool softener
,NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
3. Magnesium based: Milk of mag, Maalox, Mylanta
• Can be used to treat magnesium deficiencies from malnutrition, alcoholism, or mag-depleting drugs
• Contraindicated in patients with renal failure & used with caution in pts with renal insufficiency
The malfunctioning
kidney cannot • Not absorbable with routine use
excrete magnesium=
hypermagnesemia
• Excreted in the urine
• Contraindicated in patients with renal failure, use with caution for patients with any degree of renal
insufficiency
o Malfunctioning kidney is unable to excrete magnesium and hypermagnesemia may result
• Can cause diarrhea- increase fiber intake (Alkalosis may occur in renal impairment)
Clinical Use and Dosing
, NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
➢ Rational drug selection
o ANC, sodium content, and cost
o Combination products with aluminum hydroxide and magnesium hydroxide have the highest ANC (use is
moderate to severe disease
➢ Monitoring
o Serum phosphate, potassium, and calcium during chronic use
o These drugs may cause increased serum calcium and decreased serum phosphate
o Chronic magnesium hydroxide use may cause elevated Mg levels in patients with renal failure or the elderly
with decreased renal function
➢ Patient education
o Take as prescribed, especially related to mealtimes
o Take 1-3 hrs after meals and at bedtime
o Chewable tablets chew thoroughly and drink half a glass of water
o Shake suspensions before administration
o Many drug interactions, separate doses by 2 hours apart
o Calcium based antacids should not be administer with food containing large amounts of oxalic acid (spinach,
rhubarb) or phytic acid (brans, cereals) decrease absorption
o Avoid taking with food containing phosphorus (milk, dairy products) can cause milk-alkali syndrome (NV,
confusion, HA)
o Consult provider: before taking antacids for more than 2 weeks if a problem recurs, if relief is not obtained,
or if symptoms of GI bleeding (black, tarry stools, coffee ground emesis
o Aluminum and calcium antacids may cause constipation: increase bulk, increase fluid intake, and more
mobility, stool softened
o Magnesium antacids may cause diarrhea, increase fiber
o Avoid smoking, avoid flat lying body position while sleeping, foods that irritate the gastric mucosa (spicy
NR_565_wk_7___8_Final_Exam_Study_G
uide.docx (1).
NR 565 Exam Final Study Guide
➢ Antacids: weak bases that react with hydrochloric acid to form salt & water.
o Used in the treatment of Hyperacidity, GERD, PUD, hyperphosphatemia, and calcium deficiency
o Contain combinations of
▪ metallic cation (aluminum, calcium, magnesium, and sodium)
▪ and basic anion (hydroxide, bicarbonate, carbonate, citrate, and trisilicate)
➢ Pharmacodynamics, Pharmacokinetics, Pharmacotherapeutics
o Neutralize Gastric Acidity (causes ^pH of the stomach and duodenal bulb)
o Inhibit proteolytic activity of pepsin
o Increase lower esophageal sphincter tone
o Acid-neutralizing capacity ANC varies between products expressed in mEqs
o If ingested in a fasting state, antacids reduce acidity for approximately 20 to 40 minutes
o If taken 1 hr after a meal, acidity is reduced for 2 to 3 hrs
o A second dose taken after a meal maintains reduced acidity for more than 4 hrs after the meal
o The action of antacids occurs locally in the GI tract with minimal absorption, minimal metabolism
o ALL antacids are contraindicated in the presence of severe abdominal pain of unknown cause, especially if
accompanied by fever
-HIGH SODIUM content: pts w/ HTN, CHF, marked renal failure, or on low-sodium diets need to use low sodium
preparation
-Concurrent administration with enteric-coated drugs, destroys the coating= alters absorption, ^ the risk for
adverse effects
-Administrations should be separated by at least 2 hours to decrease drug/drug interactions
1. Calcium based antacids: TUMS, Caltrate, Calcarb
• Prescribed to treat calcium deficient states, i.e. chronic renal failure, post-menopause, and osteoporosis
,NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
• Used to bind phosphates in CRF
• Require Vitamin D for absorption from the GI tract
• Excreted mainly in feces, 20% in urine
• ADR: Contraindicated in the presence of hypercalcemia and renal calculi
• Can cause constipation- increase bulk, fluids and mobility, stool softener
• Administered 30min- 1hr on empty stomach or 3hr after meals
• Should not be administered with food containing large amounts of oxalic acid (spinach, rhubarb), or
phytic acid (bran, cereals), they decrease the absorption of calcium
• Taking w/ foods containing phosphorus (milk, dairy) can lead to milk-alkali syndrome (N/V, confusion,
headache).
• Taking with acidic fruit juice improve absorption
2. Aluminum based: AlternaGEL, Amphojel, Mylanta
• Inhibit smooth muscle contraction and slow gastric emptying
• Used to bind phosphates in CRF
Aluminum is not easily
removed by dialysis b/c • Not absorbable with routine use
it is bound to albumin • Aluminum concentrated in the CNS
& transferrin = do not
cross dialysis • Bind with phosphate and excreted in feces
membrane • Prolonged use in patients with renal failure may result in dialysis osteomalacia
o Aluminum deposits in bone and osteomalacia occurs
• Elevated aluminum tissue levels contribute to the development of dialysis encephalopathy
• Used to treat hyperphosphatemia in pts w/ renal failure & phosphate renal stone prevention
• Can cause constipation- increase bulk, fluids and mobility, stool softener
,NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
3. Magnesium based: Milk of mag, Maalox, Mylanta
• Can be used to treat magnesium deficiencies from malnutrition, alcoholism, or mag-depleting drugs
• Contraindicated in patients with renal failure & used with caution in pts with renal insufficiency
The malfunctioning
kidney cannot • Not absorbable with routine use
excrete magnesium=
hypermagnesemia
• Excreted in the urine
• Contraindicated in patients with renal failure, use with caution for patients with any degree of renal
insufficiency
o Malfunctioning kidney is unable to excrete magnesium and hypermagnesemia may result
• Can cause diarrhea- increase fiber intake (Alkalosis may occur in renal impairment)
Clinical Use and Dosing
, NR_565_wk_7___8_Final_Exam_Study_Guide.docx (1).
➢ Rational drug selection
o ANC, sodium content, and cost
o Combination products with aluminum hydroxide and magnesium hydroxide have the highest ANC (use is
moderate to severe disease
➢ Monitoring
o Serum phosphate, potassium, and calcium during chronic use
o These drugs may cause increased serum calcium and decreased serum phosphate
o Chronic magnesium hydroxide use may cause elevated Mg levels in patients with renal failure or the elderly
with decreased renal function
➢ Patient education
o Take as prescribed, especially related to mealtimes
o Take 1-3 hrs after meals and at bedtime
o Chewable tablets chew thoroughly and drink half a glass of water
o Shake suspensions before administration
o Many drug interactions, separate doses by 2 hours apart
o Calcium based antacids should not be administer with food containing large amounts of oxalic acid (spinach,
rhubarb) or phytic acid (brans, cereals) decrease absorption
o Avoid taking with food containing phosphorus (milk, dairy products) can cause milk-alkali syndrome (NV,
confusion, HA)
o Consult provider: before taking antacids for more than 2 weeks if a problem recurs, if relief is not obtained,
or if symptoms of GI bleeding (black, tarry stools, coffee ground emesis
o Aluminum and calcium antacids may cause constipation: increase bulk, increase fluid intake, and more
mobility, stool softened
o Magnesium antacids may cause diarrhea, increase fiber
o Avoid smoking, avoid flat lying body position while sleeping, foods that irritate the gastric mucosa (spicy
