Suppress Gastric Acid: H2 Antagonists and Proton Pump Inhibitors (Nursing)

00:01 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.

00:13 Remember, I'm gonna give medications that will act kind of like substances are in my body, they will fit right into that receptor.

00:22 Remember, the purpose of H2 receptor is to increase gastric acid secretions.

00:27 So if I give a medication that's an H2 antagonist, that means it's uniquely fitted to...

00:34 lock right into that receptor and so it will block the production of acid.

00:40 That's why H2 antagonist help you have less gastric acid in your stomach.

00:45 So by blocking the histamine-2 receptors in your stomach lining or in the parietal cells, I'll have less acid.

00:52 Now these used to be only by prescription, now they're over the counter.

00:55 You can get them again at any drugstore in your neighborhood.

00:59 It will supress gastric acid secretion but it's not the most effective.

01:03 It's better that an antacid but it's not as good as a proton pump inhibitor.

01:08 Now you see the drug names at the bottom of your screen, look what they all have in common.

01:13 The last letters of them, -idine, right? Cimetidine, famotidine, so there's a good clue for you. Underline that i-d-i-n-e.

01:24 So that's a good way for you to kinda link those medications together to remember that they're H2 antagonists.

01:31 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.

01:43 Cool, and you can get those anywhere - you may know them as Tagamet but these are their generic names that you see on the screen.

01:51 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.

02:01 So if you're a guy watching this video, I'm just warning you, this is gonna be a little graphic.

02:06 Because cimetidine in particular can bind to androgen receptors and it's gonna give you some very unwanted side effects.

02:16 Gynecomastia is a development of breast tissue and in men, most people are not really looking for that.

02:24 It also can decrease your libido, your interest in sex and possibly even impotence.

02:30 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.

02:45 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.

03:08 Those are signs of CNS problems.

03:11 That's across the board.

03:13 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.

03:23 Now if you have renal or liver problems and you're taking an H2 antagonist, you're actually at risk for that.

03:29 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.

04:08 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.

04:24 Now you also increase risk for pneumonia because you have a decreased gastric environment.

04:30 Think about that for just a minute.

04:32 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.

04:45 So I'm usually counting on that gastric acid to destroy those bacteria.

04:50 If I have less gastric acid around, then I have less of a defense against those nasty bugs.

04:56 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.

05:07 These are the most effective ones in suppressing gastric acid.

05:11 So, you've got the names there and look at what they end in -azole.

05:16 So these two drugs have that in common.

05:19 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.

05:29 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.

05:41 So remember, C. diff. can cause that horrible diarrhea.

05:45 So those are some pretty significant adverse effects to be aware of.

05:50 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.

06:05 The longer you take the PPI's, the higher the risk is.

06:09 There's some thought that it also may impose a greater risk of gastric cancer which nobody is looking for that.

06:17 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.

06:26 So, we talked about antacids, where they work real quick but they're short term and they're not as effective.

06:33 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.

06:48 And when I do stop taking them, I might have a rebound effect so I'm gonna need to address that and treat that.