Antacids and Anti-ulcer Agents Flashcards
What are OTC antacids used for?
short-term, temporary relief of mild pain and Sx associated with PUD/GERD
mechanism of antacids
combine chemically with hydrogen ions
DON’T reduce acid secretion or production
Onset, DOA, and Acid neutralizing capacity of Calcium
Onset: rapid
DOA: long
ANC: very good
Onset, DOA, and Acid neutralizing capacity of Magnesium
Onset: rapid
DOA: long
ANC: good
Calcium antacid adverse effects
- constipation
- hypercalcemia
- hypophosphatemia
- calcium-based kidney stones
Instructions for taking antacids with other medications
take all antacids 1-2 hours before other medications OR 2-4 hours after other medications
prodrug of lansoprazole
dexlansoprazole
prodrug of omeprazole
esomeprazole
rare adverse effect of cimetidine
decreases testosterone binding to androgen receptor
drug interaction cimetidine
protypical inhibitor of several CYP450 isoenzymes
*LOTS of drug-drug interactions
What ion pump do PPIs inhibit?
parietal cell luminal H+/K+ ATPase
GI-related adverse effects of PPIs
- diarrhea/dyspepsia/nausea
- CDAD: clostridium difficile-associated diarrhea
drug interactions omeprazole
prototypical PPI for CYP450 inhibition
*MANY drug-drug interactions
Bismuth compounds adverse effects
- constipation
- black/dark stools
Treatment of H. pylori
combination therapy!
at least 2 antibiotics (clarithromycin and amoxicillin) and an acid reducer (PPI or H2 blocker)
What PUD drugs do you give a PPI with?
1) Helidac
2) Pylera
Components of Helidac and how often is it taken?
- Bismuth subsalicylate
- Metronidazole
- Tetracycline
- taken QID
Components of Pylera and how often is it taken?
- Bismuth subcitrate potassium
- Metronidazole
- Tetracycline
- 3 capsules taken QID
Treat H. pylori in a patient with a PCN allergy (amoxicillin)
- substitute metronidazole (consider bismuth quad)
Treat H. pylori with metronidazole resistance
- substitute tetracycline
- consider quadruple therapy (W/ clarithromycin & amoxicillin)
treat H. pylori with clarithromycin resistance
- substitute either amoxicillin or tetracycline
- consider bismuth quadruple therapy
Treat PUD in pregnant patient without H. pylori (normal Sx)
short course of antacids or sucralfate
Treat PUD in pregnant patient without H. pylori (moderate Sx)
ranitidine
Treat PUD in pregnant patient without H. pylori (severe Sx)
lansoprazole
Treat pain in PUD
NSAID not required: acetaminophen
NSAID Required: COX-2 NSAID and/or PPI or Misoprostol