Antacids and Anti-ulcer Agents

Question 1

What are OTC antacids used for?

Answer 1

short-term, temporary relief of mild pain and Sx associated with PUD/GERD

Question 2

mechanism of antacids

Answer 2

combine chemically with hydrogen ions

DON’T reduce acid secretion or production

Question 3

Onset, DOA, and Acid neutralizing capacity of Calcium

Answer 3

Onset: rapid
DOA: long
ANC: very good

Question 4

Onset, DOA, and Acid neutralizing capacity of Magnesium

Answer 4

Onset: rapid
DOA: long
ANC: good

Question 5

Calcium antacid adverse effects

Answer 5

• constipation
• hypercalcemia
• hypophosphatemia
• calcium-based kidney stones

Question 6

Instructions for taking antacids with other medications

Answer 6

take all antacids 1-2 hours before other medications OR 2-4 hours after other medications

Question 7

prodrug of lansoprazole

Answer 7

dexlansoprazole

Question 8

prodrug of omeprazole

Answer 8

esomeprazole

Question 9

rare adverse effect of cimetidine

Answer 9

decreases testosterone binding to androgen receptor

Question 10

drug interaction cimetidine

Answer 10

protypical inhibitor of several CYP450 isoenzymes

*LOTS of drug-drug interactions

Question 11

What ion pump do PPIs inhibit?

Answer 11

parietal cell luminal H+/K+ ATPase

Question 12

GI-related adverse effects of PPIs

Answer 12

• diarrhea/dyspepsia/nausea

- CDAD: clostridium difficile-associated diarrhea

Question 13

drug interactions omeprazole

Answer 13

prototypical PPI for CYP450 inhibition

*MANY drug-drug interactions

Question 14

Bismuth compounds adverse effects

Answer 14

• constipation

- black/dark stools

Question 15

Treatment of H. pylori

Answer 15

combination therapy!

at least 2 antibiotics (clarithromycin and amoxicillin) and an acid reducer (PPI or H2 blocker)

Question 16

What PUD drugs do you give a PPI with?

Answer 16

1) Helidac

2) Pylera

Question 17

Components of Helidac and how often is it taken?

Answer 17

• Bismuth subsalicylate
• Metronidazole
• Tetracycline
• taken QID

Question 18

Components of Pylera and how often is it taken?

Answer 18

• Bismuth subcitrate potassium
• Metronidazole
• Tetracycline
• 3 capsules taken QID

Question 19

Treat H. pylori in a patient with a PCN allergy (amoxicillin)

Answer 19

• substitute metronidazole (consider bismuth quad)

Question 20

Treat H. pylori with metronidazole resistance

Answer 20

• substitute tetracycline

- consider quadruple therapy (W/ clarithromycin & amoxicillin)

Question 21

treat H. pylori with clarithromycin resistance

Answer 21

• substitute either amoxicillin or tetracycline

- consider bismuth quadruple therapy

Question 22

Treat PUD in pregnant patient without H. pylori (normal Sx)

Answer 22

short course of antacids or sucralfate

Question 23

Treat PUD in pregnant patient without H. pylori (moderate Sx)

Answer 23

ranitidine

Question 24

Treat PUD in pregnant patient without H. pylori (severe Sx)

Answer 24

lansoprazole

Question 25

Treat pain in PUD

Answer 25

NSAID not required: acetaminophen

NSAID Required: COX-2 NSAID and/or PPI or Misoprostol