# A client who experiences epigastric pain when the stomach is empty has been prescribed cimetidine by the provider. When the client asks how this medication works, which response by the nurse is appropriate?

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> subject: Nursing

## 문제

A client who experiences epigastric pain when the stomach is empty has been prescribed cimetidine by the provider. When the client asks how this medication works, which response by the nurse is appropriate?

## 보기

1. "It directly neutralizes the stomach acid already secreted."
2. "It increases the peristaltic movement of your stomach."
3. "It suppresses the secretion of acid in your stomach." **✔ 정답**
4. "It eradicates the Helicobacter bacteria in your stomach."
5. "It forms a protective barrier over the gastric mucosa."

**정답: 3**

## 해설

Cimetidine is an H2 receptor antagonist that suppresses gastric acid secretion itself; neutralizing acid is the action of antacids, and eradicating bacteria is the action of antibiotics.

## 심화 해설

Understanding the pharmacologic action

Cimetidine is classified as an H2 receptor antagonist (histamine-2 receptor antagonist). Parietal cells in the gastric lining carry histamine, gastrin, and acetylcholine receptors that stimulate acid secretion; cimetidine blocks the H2 receptor to which histamine binds, thereby suppressing gastric acid secretion itself [1]. Its mechanism is therefore fundamentally different from an antacid that "directly neutralizes acid already secreted" (option 1) or a mucosal protectant that "forms a protective barrier over the gastric mucosa" (option 5).

Clinical considerations

Cimetidine is used to treat and prevent hypersecretory conditions such as duodenal ulcer, gastroesophageal reflux disease (GERD), and Zollinger-Ellison syndrome [1]. However, because the drug inhibits the hepatic CYP450 enzyme system, particular caution regarding drug interactions is needed when it is given with narrow therapeutic index medications such as warfarin, theophylline, and phenytoin [1]. It is also important to remember that gynecomastia may occur as an endocrine adverse effect [1].

Analysis of incorrect options and high-yield points

Distinguishing the mechanism described by each option is a frequently tested item format on the licensure exam.

- Option 1 (acid neutralization): This is the mechanism of antacids such as aluminum hydroxide and magnesium hydroxide.

- Option 2 (promoting peristalsis): This is the action of GI prokinetic agents (e.g., metoclopramide, mosapride).

- Option 4 (eradicating Helicobacter): This is the purpose of combination therapy with antibiotics (e.g., amoxicillin, clarithromycin). The evidence also confirms that Helicobacter pylori eradication has a favorable effect on preventing recurrence of peptic ulcer bleeding [2].

- Option 5 (forming a mucosal barrier): This is the mechanism of mucosal protectants such as sucralfate or bismuth preparations.

Epigastric pain on an empty stomach is the classic presentation of duodenal ulcer and occurs when gastric acid directly irritates the unbuffered mucosa. Cimetidine relieves the pain by blocking excessive acid secretion at its source, so option 3 is correct [1].References (research sources)

- [1]CimetidineResearch articlePino MA, Patel P. (2026)

- [2]Pharmacological Management of Peptic Ulcer Bleeding.Research articleLee H, Chung JW, Kim KO, Kwon KA, Kim JH. (2026) · DOI: 10.7704/kjhugr.2025.0075

## 임상 시나리오

Acid-Related Drugs: Sorting Them Out by MechanismComparing drug mechanisms for the client with fasting epigastric pain
Cimetidine is an H2 receptor antagonist that blocks histamine receptors on parietal cells, thereby suppressing gastric acid secretion itself. It reduces, at the source, the excess acid that causes epigastric pain on an empty stomach.

Antacids (such as aluminum hydroxide) neutralize acid that has already been secreted, mucosal protectants (such as sucralfate) form a protective barrier, and prokinetic agents enhance peristalsis. Antibiotics eradicate Helicobacter pylori.

CautionBecause cimetidine inhibits CYP450 enzymes, watch for drug interactions when it is combined with agents such as warfarin and theophylline, and be aware that endocrine adverse effects such as gynecomastia may develop.

## 핵심 개념

- **H2 receptor antagonist** — A drug class that suppresses gastric acid secretion by preventing histamine from binding to H2 receptors on gastric parietal cells.
- **Parietal cell** — A cell located in the gastric glands that secretes hydrochloric acid and intrinsic factor; the final common pathway of acid secretion.
- **Antacid** — A medication that uses an alkaline substance to neutralize acid already secreted, rapidly raising the gastric pH.
- **Mucosal protectant** — A medication that protects the gastric mucosa by forming a barrier over its surface or by stimulating mucus secretion.

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