Antacids and Anti-ulcer Pharm

Question 1

Antacids 
Examples Low (3) and High (1) Systemic 
Mechanism of Action

Answer 1

Aluminum
Calcium
Magnesium

Sodium

Combine with secreted H+ ions

Question 2

Characteristics of Calcium and Magnesium Antacids (3)

Answer 2

Rapid onset
Longest half lives
Highest acid neutralizing capacity (ANC)

Question 3

Supplemental Antacid Agents

Example, Mechanism of Action (2)

Answer 3

Simethicone

Acts as surfactant to increase expulsion of gases

Question 4

Use for Antacids and Supplemental Agents

Answer 4

Short term, temporary relief of mild PUD/GERD symptoms

Question 5

Antacid Adverse Effects

Aluminum (2), Calcium (3), Magnesium (1) and Sodium (2)

Answer 5

Aluminum: Constipation, Hypophosphatemia

Calcium: Constipation, Hyposphosphatemia, Milk Alkali Syndrome

Magnesium: Diarrhea

Sodium: Flatulence and Metabolic Alkalosis

Question 6

Strategies for reducing drug interactions with Antacids (2)

Answer 6

Take antacids 1-2 hours BEFORE other meds
or
Take antacids 2-4 hours AFTER other meds

Question 7

Histamine Receptor Antagonists

Examples (4), Uses (2) and MOA (2)

Answer 7

Cimetidine, Ranitidine, Famotidine, Nizatidine

Prompt relief of GERD symptoms
Non-H pylori ulcer healing (4-8 weeks)

Inhibits H2 receptor on parietal cells to decrease H+ secretion

Question 8

Histamine Antagonists 
Adverse Effects (2) and Drug Interaction

Answer 8

Mostly mild GI symptoms and headache
Cimetidine can have anti-androgen effects

Cimetidine is prototypical CYTP450 inhibitor

Question 9

Proton Pump Inhibitors

Examples (6), Uses (2) and MOA (2)

Answer 9

Omeprazole, Esomeprazole, Lansoprazole, Dexlansoprazole, Pantoprazole, Rabeprazole

Maintenance of GERD
Non-H pylori ulcer healing (4-8 weeks)

Block H/K ATPase on parietal cells to decrease H+ secretion

Question 10

PPI's
Adverse Effects (2) and Drug Interactions

Answer 10

Drug Induced C Diff
Mild GI symptoms and Headache

Omeprazole is prototypical CYTP450 inhibitor

Question 11

Anti-Ulcer Drugs For Pregnancy (3)

Answer 11

Short term antacids or sucralfate (mild)
Ranitidine (moderate)
Lansoprazole (severe)

Question 12

Sucralfate

MOA (3), Uses (2)

Answer 12

Cross links HCO3/Mucus to form band aid attached to ulcers that protects them from acid

On label for Duodenal ulcers
Off label for all ulcers

Question 13

Sucralfate

Adverse Effect, Contraindication and Drug Interactions

Answer 13

Constipation

Severe renal failure

Possible, take 2 hours away from other meds

Question 14

Misoprostol

Drug Class, MOA (2), Indication, Adverse Effects (2) and COntraindications (2)

Answer 14

PGE1 analog

Provides cytoprotection by increasing mucosal defenses
Decreases H+ secretion

Prevention of NSAID-induced gastric ulcers

Mild GI symptoms and headache

Pregnancy (induces abortion)
IBD

Question 15

Bismuth Compounds

Indication, Adverse (2), Interactions, Contraindications (2)

Answer 15

H. pylori induced ulcers (antimicrobial)

Constipation
Very dark, regular formed stool

Lots, take 2 hours away from other meds

GI bleeding
Salicylate hypersensitivity

Question 16

1st Line Therapy for H. pylori

Drugs (3), Dosing and Duration

Answer 16

Proton Pump Inhibitor
Clarithromycin
Amoxicillin (or Metronidazole)

BID dosing

Triple therapy for 10-14 days

Question 17

H. pylori Quadruple Therapy

Drugs (4), Dosing (2), Duration

Answer 17

Proton Pump Inhibitor
Metronidazole
Tetracycline
Bismuth subsalicylate

BID for PPI, QID for the other 3

Given for 10-14 days

Question 18

Therapy if Metronidazole Resistance (3)

Answer 18

Proton Pump Inhibitor
Clarithromycin
Tetracycline

(Consider quadruple with clarithromycin and amoxicillin)

Question 19

Therapy if Clarithromycin Resistance (3)

Answer 19

Proton Pump Inhibitor
Amoxicillin or Tetracycline
Metronidazole

(Consider adding bismuth for quadruple therapy)

Question 20

Therapy if Penicillin Allergy (3)

Answer 20

Proton Pump Inhibitor
Clarithromycin
Metronidazole

(Consider adding bismuth for quadruple therapy)