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Pharmacology · chapter 31 · Hyperacidity and Antiulcer Drugs

Histamine Blockers and Proton-Pump Inhibitors

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. What both classes treat

    These medications find widespread application in the treatment of conditions associated with heightened gastric acid secretion, encompassing gastroesophageal reflux disease (GERD), peptic ulcers, and heartburn.

  2. How H2 blockers work

    By blocking the H2 receptors, drugs in this classification suppress gastric acid secretions and lower the hydrogen ion concentration of the gastric contents by attaching to the histamine (H2) receptor sites on gastric cells.

  3. H2 blockers with antibiotics for H. pylori

    H2 blockers are often used concurrently with antibiotics to treat H. pylori- associated peptic ulcer disease (PUD).

  4. Famotidine as prophylaxis

    Famotidine is an effective prophylactic drug for stress ulcers and perioperative aspiration pneumonia. It is available orally and intravenously.

  5. Nizatidine once a day at bedtime

    The medication is generally given twice per day for up to 8 weeks. If nizatidine is ordered daily, it is generally given at bedtime.

  6. Adverse effects of H2 blockers

    Typical adverse effects of histamine blockers include diarrhea, headaches, mental confusion, agitation, depression, gynecomastia, neutropenia, agranulocytosis, increases in serum transaminase, arthralgia, rash, and alopecia.

  7. How PPIs work

    Gastric acid secretions are reduced by irreversibly blocking gastric hydrogen and potassium ATPase, an enzyme that produces gastric acid.

  8. PPIs for ventilated trauma clients

    Prophylactic use of PPIs is administered for clients at risk for stress ulcers, such as trauma clients on mechanical ventilation.

  9. Giving oral omeprazole

    Oral capsules and delayed-released tablets are best administered 30–60 minutes before breakfast. These must be swallowed whole and should not be opened, chewed, or crushed.

  10. Omeprazole takes days to work

    It may take several days for omeprazole to take effect. In these cases, occasionally omeprazole is administered along with antacids until the omeprazole takes effect.

  11. Pantoprazole granules: apple juice or applesauce

    Oral suspension and granules may only be administered in apple juice or applesauce; the medication should not be mixed with water or other liquids or foods (Pfizer, 2023).

  12. Esomeprazole pellets in applesauce

    If a client cannot swallow capsules, the capsule may be opened and the capsule pellets mixed in applesauce The nurse should emphasize that the applesauce, once mixed, must be swallowed promptly without chewing the pellets to ensure the medication remains effective.

  13. PPIs and pneumonia

    Monitor for respiratory infection and/or pneumonia with PPI administration as these may lead to an overgrowth of bacteria in the upper GI tract that can migrate to the lungs.

  14. Report cough, fever, shortness of breath

    Reports effects such as cough, fever, and shortness of breath to the health care provider as these may be symptoms of a severe adverse reaction.

Terms to know

Proton pump inhibitors (PPIs)
Proton pump inhibitors (PPIs) are antisecretory drugs that block both basal and stimulated gastric acid production.
Cimetidine
Cimetidine is an antisecretory medication used for short-term treatment of heartburn, erosive GERD, and gastric or duodenal ulcers.
Omeprazole
Omeprazole is the prototype antisecretory PPI that suppresses the secretion of gastric acid by inhibiting the gastric proton pump found within the parietal cells.
Esomeprazole
Esomeprazole is a weak base isomer of omeprazole that is converted to its active form in a highly acidic gastric environment.

Practice questions

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  1. A client is prescribed omeprazole delayed-release capsules for GERD. Which instruction should the nurse give?

    1. Take it 30–60 minutes before breakfast and swallow it whole.
    2. Take it at bedtime with a snack.
    3. Open the capsule and sprinkle it on food.
    4. Chew the capsule for faster relief.

    Answer: Take it 30–60 minutes before breakfast and swallow it whole.

    Omeprazole capsules and delayed-release tablets are best given 30–60 minutes before breakfast and must be swallowed whole, not opened, chewed or crushed. Opening or chewing damages the delayed-release form.

  2. A nurse needs to give pantoprazole granules to a client. Which vehicle is correct?

    1. Milk
    2. Orange juice
    3. Applesauce
    4. Water

    Answer: Applesauce

    Pantoprazole oral suspension and granules may only be given in apple juice or applesauce, not mixed with water or other liquids or foods. Small sips of water afterward help wash the granules down.

  3. A client on long-term PPI therapy develops cough, fever, and shortness of breath. What should the nurse suspect?

    1. Rebound hyperacidity
    2. Gynecomastia
    3. Respiratory infection or pneumonia
    4. An expected, harmless side effect

    Answer: Respiratory infection or pneumonia

    PPIs may lead to bacterial overgrowth in the upper GI tract that can migrate to the lungs, so the nurse monitors for respiratory infection and pneumonia. Cough, fever and shortness of breath may signal a severe reaction and must be reported.

  4. A client cannot swallow esomeprazole capsules. Which instructions are correct? Select all that apply.

    1. Mix the pellets in hot tea and let it stand.
    2. The capsule may be opened and the pellets mixed in applesauce.
    3. Crush the pellets into a powder first.
    4. Do not chew the pellets.
    5. Swallow the mixture promptly.

    Answer: The capsule may be opened and the pellets mixed in applesauce., Do not chew the pellets., Swallow the mixture promptly.

    If capsules cannot be swallowed, they may be opened and the pellets mixed in applesauce, which must be swallowed promptly without chewing. Crushing or leaving the pellets to stand would make the drug less effective, since it is destroyed by acid.

  5. Which clients are appropriate candidates for prophylactic acid suppression described in this section? Select all that apply.

    1. A client taking rilpivirine
    2. A trauma client on mechanical ventilation
    3. A client taking NSAIDs who needs gastric ulcer prevention
    4. A client with a hypersensitivity to PPIs
    5. A client at risk for stress ulcers

    Answer: A trauma client on mechanical ventilation, A client taking NSAIDs who needs gastric ulcer prevention, A client at risk for stress ulcers

    PPIs are given prophylactically to clients at risk of stress ulcers, such as ventilated trauma clients, and omeprazole prevents NSAID-related gastric ulcers. Hypersensitivity to PPIs and rilpivirine are contraindications.

  6. A male client on cimetidine reports breast enlargement. How should the nurse interpret this?

    1. It is unrelated to any medication.
    2. It is a listed adverse effect of histamine blockers.
    3. It is a sign of pneumonia.
    4. It means the dose is too low.

    Answer: It is a listed adverse effect of histamine blockers.

    Gynecomastia is among the typical adverse effects of histamine blockers, and it is listed for cimetidine. It is not a sign of underdosing or pneumonia.

Where every quote comes from

Section 31.2 Histamine Blockers and Proton-Pump Inhibitors of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.