A client with active GERD presents to clinic. Which statement by the client indicates they need additional education?

A) Omeprazole and clarithromycin: Omeprazole is a proton pump inhibitor (PPI) that reduces stomach acid production, and clarithromycin is an antibiotic used to target Helicobacter pylori (H. pylori), the bacteria responsible for many peptic ulcers. In dual therapy for H. pylori eradication, omeprazole is used to create a less acidic environment, enhancing the effectiveness of antibiotics like clarithromycin. This combination is one of the most commonly used regimens in the treatment of peptic ulcer disease caused by H. pylori.

B) Ciprofloxacin and sucralfate: Ciprofloxacin is an antibiotic, and sucralfate is a medication used to coat the stomach lining to protect it from acid. While ciprofloxacin may be effective against certain bacterial infections, it is not typically used in dual therapy for H. pylori infections. Sucralfate is not an antibiotic and does not directly treat the bacterial cause of peptic ulcers, so this combination would not be ideal for H. pylori eradication.

C) Cimetidine and amoxicillin: Cimetidine is an H2-receptor antagonist used to reduce stomach acid production, and amoxicillin is an antibiotic that could potentially target H. pylori. However, this combination is less commonly used compared to PPI-based therapies. Cimetidine does not reduce acid as effectively as omeprazole (a PPI), making this combination less ideal for eradicating H. pylori.

D) Tetracycline and metronidazole: Both tetracycline and metronidazole are antibiotics used to treat infections, including H. pylori, but they are typically used in triple therapy regimens along with a PPI, not in dual therapy. While they can be effective in treating H. pylori, the combination of a PPI like omeprazole with clarithromycin remains the preferred choice for dual therapy.

A) Peptic ulcer: Scopolamine is an anticholinergic medication that works by blocking acetylcholine, which can reduce nausea and motion sickness. While scopolamine can have anticholinergic effects that may slightly reduce gastric motility, it is not directly contraindicated in clients with a history of peptic ulcer. The medication does not significantly exacerbate the condition of peptic ulcers.

B) Asthma: While scopolamine can have anticholinergic effects that may lead to dry mouth and slight airway narrowing, it is not contraindicated in clients with asthma. However, the nurse should be cautious and monitor the client for any signs of respiratory distress, as anticholinergic medications can cause some bronchial smooth muscle relaxation, which could theoretically worsen asthma symptoms. It is not an absolute contraindication.

C) Heart disease: Scopolamine is not specifically contraindicated for individuals with heart disease, although caution should be used in patients with cardiovascular conditions due to its potential effects on heart rate and blood pressure. However, heart disease itself is not a direct contraindication for the use of scopolamine.

D) Glaucoma: Scopolamine is an anticholinergic medication, and anticholinergics can increase intraocular pressure. This is especially dangerous for clients with narrow-angle glaucoma, as the medication can exacerbate the condition, leading to a potential acute glaucoma attack. Therefore, individuals with a history of glaucoma, particularly narrow-angle glaucoma, should avoid scopolamine.