Next, what are the medications that I can use to block
gastric acid so I have less gastric acid in my stomach?
Well I give medications called H2 antagonist.
Remember, I'm gonna give
medications that will act
kind of like substances are in my body,
they will fit right into that receptor.
Remember, the purpose of H2 receptor
is to increase gastric acid secretions.
So if I give a medication that's an H2 antagonist,
that means it's uniquely fitted to...
lock right into that receptor and so
it will block the production of acid.
That's why H2 antagonist help you have
less gastric acid in your stomach.
So by blocking the histamine-2
receptors in your stomach lining
or in the parietal cells, I'll have less acid.
Now these used to be only by prescription,
now they're over the counter.
You can get them again at any
drugstore in your neighborhood.
It will supress gastric acid secretion
but it's not the most effective.
It's better that an antacid but it's not
as good as a proton pump inhibitor.
Now you see the drug names at the bottom of
your screen, look what they all have in common.
The last letters of them,
Cimetidine, ranitidine, famotidine, so there's
a good clue for you. Underline that i-d-i-n-e.
So that's a good way for you to kinda link those medications
together to remember that they're H2 antagonists.
So kind of walk through this with me again,
how do H2 antagonist work?
You're gonna end up with less acid secretions because
they block those H2 receptors in your stomach lining.
Cool, and you can get those anywhere -
you may know them as Zantac or Tagamet
but these are their generic names
that you see on the screen.
Now, I know you can get them over the
counter but a lot of people don't know
that they can cause some really unusual,
let's say, memorable side effects.
So if you're a guy watching this video, I'm just
warning you, this is gonna be a little graphic.
Because cimetidine in particular
can bind to androgen receptors
and it's gonna give you some
very unwanted side effects.
Gynecomastia is a development of breast tissue and
in men, most people are not really looking for that.
It also can decrease your libido, your
interest in sex and possibly even impotence.
So this will be something that likely stands out for
all of us on this drug but I want you to remember,
cimetidine can bind to these androgen
receptors in addition to the H2
and you can have some really,
really unwanted side effects.
Now if you have renal or hepatic problems,
If the patient already has kidneys that
are kind of struggling - that's renal
or hepatic problems - that's your liver,
you want to watch for CNS effects
If somebody is taking an H2 antagonist and
they start to show you some CNS effects
like they can't remember where they put things, they
seem a little confused or they're kind of lethargic.
Those are signs of CNS problems.
That's across the board.
Whenever you're taking care of a patient and they seem
to be confused, they're not acting like themselves,
they seem sleepy or more lethargic, that means
they're having a negative neurological effect.
Now if you have renal or liver problems and you're taking
an H2 antagonist, you're actually at risk for that.
So when you're taking test
questions, they won't tell you
"This is a question about H2 antagonist and we're looking
to see if you recognize a problem with CNS effects."
They may give you a patient who's on multiple
different medications and ask you a question like,
"Which of the following patient statements is it most
important that the nurse follow up on immediately?"
When they may say lots of different things, but if
you know that the patient is on an H2 antagonist
and they show you any question about, "You know,
I can't remember where I put my car keys"
or "I'm having problem remembering where I
parked my car" or "I seem more tired"
ding, ding ding, ding - that's a red flag for you.
Yes, it's an over the counter medication,
but especially if they're elderly,
they have any renal or liver problems and they start
acting a little more confused or not like themselves,
that's a sign that the patient can be having
toxicity effects from the H2 antagonist.
Now you also increase risk for pneumonia because
you have a decreased gastric environment.
Think about that for just a minute.
Why does someone have an increased risk for
pneumonia because they have less gastric acid?
The answer is, gastric acid is one of
my natural defenses against bacteria.
So I'm usually counting on that gastric
acid to destroy those bacteria.
If I have less gastric acid around, then I
have less of a defense against those nasty bugs.
So, we've talke about H2 antagonists, they're
a little better than obviously than antacids
but they're not as effective
as proton pump inhibitors.
These are the most effective ones
in suppressing gastric acid.
So, you've got the names there and
look at what they end in -azole.
So these two drugs have that in common.
That will help you remember that these drugs
belong to the proton pump inhibitor family
and they are the rock stars when
it comes to blocking gastric acid.
But they come with a price tag okay, because
you take them over a long period of time,
it can increase your risk for fractures, pneumonia
and our ugly little friend, C. difficile.
So remember, C. diff. can
cause that horrible diarrhea.
So those are some pretty significant
adverse effects to be aware of.
Now, if I have any problems with kidney disease before,
really in my family or I have a history of it,
I wanna watch that carefully with this type of
medication because you're more likely or more at risk
to develop chronic kidney
disease if you take PPI's.
The longer you take the PPI's,
the higher the risk is.
There's some thought that it also may impose a greater
risk of gastric cancer which nobody is looking for that.
And when you stop taking this medication,
you can have this rebound effect
like, now suddenly your stomach is like
really good at making gastric acid.
So, we talked about antacids, where they work real quick
but they're short term and they're not as effective.
H2 antagonist which hey, those
can be a little bit better
but these are the most effective at suppressing
gastric acid but they come with a price tag,
fractures, pnuemonia, C. diff, chronic
kidney disease, possibly gastric cancer.
And when I do stop taking them,
I might have a rebound effect
so I'm gonna need to address
that and treat that.