Antacids

Antacids Nursing NCLEX Pharmacology

Antacids Nursing Pharmacology Study Notes and Care Plan

Nursing Pharmacology Study Guide: Antacids

Antacids are a group of gastrointestinal (GI) medication that contains inorganic salts that have the ability to neutralize stomach acid.

Several GI disorders can be treated with antacids, particularly indigestion and peptic ulcer disease.

Many antacids can be purchased over-the-counter (OTC) and do not require a prescription from a doctor; however, it is best for a patient to consult the physician for the most appropriate antacids as they can differ in absorption times and adverse effects.

Indications for Antacids

Peptic ulcers can arise from increased stomach acid that can erode the lining of the gastrointestinal tract.

They can manifest as burning stomach pain that usually happens after meals and at bedtime.

Antacids are indicated for patients who suffer from peptic ulcer disease to reduce the acidity of GI secretions, thus preventing further damage on the stomach lining and allowing the ulcers to heal at the same time.

Other GI disorders that can benefit from antacids include gastroesophageal reflux disease (GERD), esophagitis, gastritis, stress ulceration, GI bleeding, and hiatal hernia.

OTC antacids can be used to relieve GI symptoms such as hyperacidity, heartburn, and indigestion.

Antacids are also indicated for hyperphosphatemia or increased serum phosphate levels.

They can also be used to prevent the formation of phosphate urinary stones. 

They can also be used as supportive medication to prevent hypocalcemia or low serum calcium levels or to treat calcium deficiency.

Actions of Antacids

The mechanism of action of antacids varies on their ability to neutralize hydrochloric acid and effectively increase the pH of the stomach secretions. Regular administration of antacids ideally maintains the pH above 4 to 5.

Magnesium-containing antacids can induce laxative effects. Most aluminum-containing antacids have aluminum phosphate which make them insoluble and thus removed from the body through fecal route.

The most common ingredients for antacids include magnesium trisilicate, magnesium carbonate, magnesium hydroxide, sodium bicarbonate, calcium bicarbonate, and aluminum hydroxide.

Some antacids may be combined with other medications. For instance, those with simeticone may have the additional benefit of reducing flatulence, while those with alginate are able to provide coating for the esophageal lining.

Patients with ulcers typically receive antacid treatment for a period of 4 to 6 weeks.

Side Effects and Adverse Reactions of Antacids

If taken occasionally at recommended doses, most antacids will not give any prominent side effects.

Regular use of antacids may cause diarrhea or constipation, stomach cramps, increased flatulence, nausea, or vomiting.

The side effects usually improve once the patient stops taking antacids.

Adverse effects of antacids include systemic alkalosis, evidenced by fatigue, irritability, nausea, confusion, tetany, or headache. Other adverse effects are gastric rupture and hypokalemia.

Contraindications and Cautions for Antacids

Antacids should not be prescribed to a patient with a previous allergy to antacid containing products in order to prevent hypersensitivity.

Antacids should be prescribed in caution to a pregnant woman or lactating mother as these drugs can potentially harm the fetus or newborn.

They should also be used in extreme caution in patients with GI obstruction, due to possible systemic absorption.

Antacids should be used cautiously in patients with renal disorders or those with electrolyte imbalance, as there can be an electrolyte disturbance while the drug attempts to neutralize hydrochloric acid.

Drug Interactions with Antacids

Milk and other foods that contain calcium may interact with antacids and cause milk-alkali syndrome, manifested by hypercalcemia or high serum calcium levels, and metabolic alkalosis.

Antacids may potentially interact with magnesium hydroxide in the form of drug binding. Other medications that should be used cautiously with antacids by means of enhanced drug absorption include aspirin and diazepam.

Decreased drug absorption may occur when using antacids with digoxin, indomethacin, or chlordiazepoxide.

Nursing Care Plan for Patients on Antacids

Possible Nursing Diagnoses:

Risk for Diarrhea related to GI action of antacids

Risk for constipation related to GI action of antacids

Imbalanced nutrition: less than body requirements related to GI symptoms

Risk for imbalanced fluid volume related to systemic effects of antacids

Deficient knowledge related to Antacids

Nursing Assessment:

Nursing InterventionRationale
Assess the patient for signs and symptoms of stomach pain, indigestion, heartburn, stomach upset, nausea or vomiting, and GI bleeding.To confirm the indication for administering antacids. Heartburns that are not resolved by oral antacids may benefit from switching to proton pump inhibitors or PPIs.
Check the patient’s allergy status.Previous allergic reaction to antacids may render the patient unable to take them. Alternatives to antacids should therefore be considered in case of antacid allergy.
Assess if the patient is pregnant or lactating.Antacids should be prescribed in caution to a pregnant woman or lactating mother as these drugs can potentially harm the fetus or newborn.
Perform a focused physical assessment on the patient’s abdomen through inspection, palpation, and auscultation of bowel sounds.To confirm the indication for administering antacids, and to assess the patient’s GI motility.  
Assess the patient’s mucous membranes and his/her ability to swallow.To check for any potential problems with administration, hydration, and absorption.
To ensure that the right form of antacids is given.
Collect bloods for renal function tests and serum electrolyte levels.Antacids should be used cautiously in patients with renal disorders or those with electrolyte imbalance, as there can be an electrolyte disturbance while the drug attempts to neutralize hydrochloric acid.

Nursing Planning and Intervention:

Nursing InterventionRationale
Administer antacids between 1 to 3 hours after meals, and/or 1 hour before bedtime.To ensure optimal absorption and therapeutic action by antacids.
Administer antacids about 1 hour before or 2 hours after administering other oral medications, as prescribed.Ideal spacing of antacids and other oral medications will ensure adequate absorption of the drugs administered.  
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking antacids. Instruct the patient on how to self-administer antacids.To inform the patient on the basics of antacids, as well as to empower him/her to safely self-administer the medication.
Monitor the patient’s bowel movement and commence stool chart.Antacids may cause diarrhea or constipation. Early detection of either side effect can help institute a bowel program and relieve them effectively.

Nursing Evaluation:

 Nursing InterventionRationale
Ask the patient to repeat the information about antacids.To evaluate the effectiveness of health teaching on antacids.
Monitor the patient’s serum electrolyte levels and renal function.To ensure that the antacids did not cause any electrolyte imbalance of renal dysfunction.  
Monitor the patient’s response to antacids.To check for the relief of GI symptoms, as well as to see if the antacids are effective or should be shifted to other GI medications due to an allergic reaction, severe side effects or adverse reactions.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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