31.2 Histamine Blockers and Proton-Pump Inhibitors

Histamine blockers and proton-pump inhibitors are key players in managing stomach acid issues. They work differently but share the common goal of reducing acid production, helping with conditions like GERD and ulcers.

These meds can be game-changers for people struggling with heartburn or stomach pain. While they're generally safe, it's important to know about potential side effects and drug interactions. Proper use and regular check-ins with your doctor are crucial for getting the most benefit.

Histamine Blockers and Proton-Pump Inhibitors

Mechanisms of action

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Top images from around the web for Mechanisms of action

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  G cell - wikidoc View original

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  Fisiología gástrica - Enfermeria Buenos Aires View original

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• Histamine blockers (H2 receptor antagonists)
  • Block histamine action at H2 receptors in stomach reducing gastric acid secretion by parietal cells (cimetidine, ranitidine, famotidine, nizatidine)
• Proton-pump inhibitors (PPIs)
  • Inhibit H+/K+ ATPase enzyme (proton pump) in parietal cells preventing final step of gastric acid secretion resulting in more potent and longer-lasting acid suppression compared to histamine blockers (omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole)

Indications, side effects, and drug interactions

• Indications for both histamine blockers and PPIs
  • Treat gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and Zollinger-Ellison syndrome
• Side effects
  • Histamine blockers: headache, dizziness, fatigue, diarrhea, constipation, gynecomastia (cimetidine)
  • PPIs: headache, diarrhea, abdominal pain, vitamin B12 deficiency and increased risk of osteoporosis and fractures with long-term use
• Drug interactions
  • Histamine blockers may interact with warfarin, phenytoin, theophylline, and lidocaine
  • PPIs may interact with clopidogrel, digoxin, and methotrexate

Nursing considerations

• Assess for medication allergies
• Monitor for adverse reactions
• Administer histamine blockers with or without food as directed and PPIs before meals for optimal absorption
• Encourage reporting of new or worsening symptoms
• Monitor for vitamin B12 deficiency signs with long-term PPI use
• Assess for potential drug interactions and consult prescriber if necessary

Patient education

• Educate on medication purpose and expected benefits
• Instruct on proper administration timing and techniques
• Advise to report adverse effects to healthcare provider
• Encourage completing full treatment course as prescribed
• Discuss importance of not abruptly stopping medication without consulting prescriber
• Advise informing healthcare provider about all medications to avoid potential interactions
• Emphasize need for regular follow-ups to monitor treatment effectiveness and potential side effects