Gastric mucosal protective agents: Nursing pharmacology

Mucosal protective agents are medications that protect the mucosal lining of the stomach from gastric acid, and are used to treat conditions like peptic ulcers, NSAID-induced ulcers, and gastroesophageal reflux disorder or GERD.

Mucosal protective agents are also used as a part of the combination treatment against the bacterium H. pylori.

Now, these medications can be broadly divided into three classes; prostaglandin analogues, sucralfate, and bismuth compounds.Starting with prostaglandin analogues, these include misoprostol, which is a synthetic analog of prostaglandin E1 that can be taken orally.

Once administered, misoprostol stimulates the production of gastric mucus, as well as bicarbonate, which helps neutralize the gastric acid.

At the same time, misoprostol acts directly on the parietal cells of the stomach to decrease their secretion of gastric acid.

Common side effects of prostaglandin analogues include stomach cramps and diarrhea. Other side effects may include diaphoresis, headaches, cardiac arrhythmias, and thrombotic events.As a boxed warning, prostaglandin analogues are contraindicated during pregnancy, since they can induce abortion.

They should also be avoided by clients of childbearing age that do not use contraception. In addition, prostaglandin analogues must be used with caution in clients with glaucoma, cardiovascular disease, respiratory disease like asthma, and hepatic or renal disease, since they can exacerbate these conditions.Next is sucralfate, this is taken orally.

The way it works is by forming a protective barrier over the ulcer, which prevents damage by gastric acid. In addition, similarly to prostaglandin analogues sucralfate also stimulates mucosal protective mechanisms and bicarbonate production.Now, sucralfate contains aluminum hydroxide, which can inhibit smooth muscle contraction in the gastrointestinal tract, leading to side effects like constipation.

Other side effects include headaches, dizziness, dry mouth, back pain, and hyperglycemia.In terms of contraindications, prolonged use of sucralfate should be avoided in clients with renal disease, since aluminum may build up and even cause toxicity!

Other contraindications include uncontrolled diabetes mellitus, and impaired swallowing or gag reflex. Finally, there’s bismuth compounds, which are usually given orally in the form of bismuth subsalicylate.

Much like sucralfate, bismuth forms a protective coating over the gastric lining and ulcerated tissue, and also increases the production of mucus, prostaglandins, and bicarbonate.

In addition, bismuth subsalicylate has antiinflammatory and antimicrobial properties. For side effects, bismuth subsalicylate can cause the tongue and stool to turn black temporarily.

In addition, since it contains salicylate, it is associated with ototoxicity, which may result in hearing loss and tinnitus.

Bismuth subsalicylate should be avoided in children recovering from a viral infection like the flu, since salicylate can cause a life-threatening encephalopathy called Reye syndrome.

Finally, bismuth subsalicylate should be used with caution in adult clients taking aspirin.Now, if your client with an NSAID-induced gastric ulcer is prescribed a mucosal protective agent, first ask your client about the symptoms they are experiencing, including pain location, quality, duration and severity, and as well as any triggers that bring on episodes of pain.

Also ask about symptoms that accompany their pain such as nausea, bloating, or gastric reflux. Next, perform a focused gastrointestinal assessment, noting the presence of epigastric tenderness.Finally, review their recent laboratory test results, including CBC and stool testing for occult blood, and check their most recent diagnostic test results, such as upper gastrointestinal endoscopy.

Be sure to teach your client about lifestyle modifications that can reduce gastrointestinal irritation, such as avoiding alcohol, spicy or greasy foods, excessive caffeine, and tobacco products.

Lastly, teach your client to immediately report symptoms that may indicate their condition is worsening, including increasing abdominal pain, bloody or coffee-ground emesis, black or tarry stools, as well as feeling dizzy or a fast heart beat.

Alright, if your client is prescribed sucralfate, remember to check their baseline laboratory test results for renal function and blood glucose level.

Be sure to explain how the medication protects their stomach by forming a protective coating over the ulcer. Then, teach them to take their medication on an empty stomach one hour before meals; to wait at least 30 minutes before also taking an antacid; and to separate sucralfate and other medications by at least 2 hours.

Lastly, let them know the medication can cause constipation, so advise them to increase their fluid and fiber intake as well as their physical activity.

Okay, if your client is prescribed bismuth subsalicylate, explain how the medication forms a protective coating over their stomach and reduces gastric inflammation.

If they’re prescribed chewable tablets, instruct them to chew them thoroughly and to let them completely dissolve in their mouth before swallowing; non-chewable tablets should be taken with a full glass of water; and the liquid medication should be shaken well and then dispensed using an oral medication syringe or medication cup.

Next, be sure to let your client know that bismuth subsalicylate can turn their tongue or stool black, and since this can be a scary finding, reassure them that this side effect is temporary and will resolve after the medication is discontinued.

Lastly, caution your client that ototoxicity is a potentially serious side effect, and advise them to contact their healthcare provider immediately if they experience hearing loss, tinnitus or ringing in the ears, or dizziness.Now, if your client is prescribed misoprostol, be sure to check their baseline laboratory test results for hepatic and renal function.

Also obtain a negative pregnancy test for your female clients; advise them to use a reliable form of birth control during therapy; and be sure to provide them with both verbal and written information cautioning them about the risk of pregnancy loss.

Next, explain how misoprostol helps protect their stomach by stimulating the production of gastric mucus and bicarbonate.

Teach them to take their medication four times each day, with meals and at bedtime. Lastly, let them know that the medication can cause stomach cramps, nausea, or diarrhea, and prompt them to report these symptoms to their healthcare provider.Finally, be sure to monitor your client for side effects and the resolution of their gastrointestinal symptoms, as well as for signs that their ulcer is worsening, like increased pain or indications of gastric bleeding.

Alright, as a quick recap …. Mucosal protective agents are used to protect the lining of the stomach from gastric acid and to treat conditions like peptic ulcers, NSAID-induced ulcers, GERD, and as a part of the combination treatment against the bacterium H.

pylori. When caring for a client who is prescribed a mucosal protective agent, nursing considerations involve conducting a focused baseline assessment and monitoring for side effects, signs of a worsening condition, as well as the desired therapeutic response of decreased pain and other gastrointestinal symptoms.

Finally nursing considerations are also focused on providing education on lifestyle modifications to decrease gastric irritation, safe self-administration of their prescription as well as side effects to report to their healthcare provider.

of their prescription as well as side effects to report to their health care