Antacids, H2 Blockers, PPIs

Question 1

Antacid Indications

Answer 1

• Gastritis
• PUD
• GERD

Question 2

Antacid Contraindications and Adverse Effects

• Aluminum Containing
• Calcium Containing
• Magnesium Containing
• Sodium Bicarb Containing

Answer 2

Aluminum: osteomalacia, OBD, constipation
> A/E: constipation, hypercalcemia, hypercalcemia, hypophosphatemia, loss of appetite, muscle weakness, bone pain, mood alterations

Calcium: osteomalacia, OBD, constipation
> A/E: constipation, hypercalcemia, headache, weakness, dysuria, bradypnea, n/v, anxiety, renal calculi

Magnesium: Diarrhea, impaired renal function
> A/E: diarrhea, hypermagnesemia, vertigo, lightheadedness, weakness, dysuria, irregular HR, mood alterations

Sodium Bicarb: use with caution in patients with sodium restriction
> A/E: polyuria, headache, weakness, muscle pain, loss of appetite, n/v, mood alterations

Question 3

** Key Clinical Considerations with Antacids **

Answer 3

• ALWAYS GIVE WITH 8OZ OF WATER
  > make sure tablets are chewed thoroughly before swallowing
  > shake liquids well before using
• TAKE OTHER MEDS 1-2HRS BEFORE OR AFTER TAKING THE ANTACIDS
  > DECREASE absorption of sucralfate, anticholinergics, H2 blockers, fluoroquinolones, iron, isoniazid, phenothiazines, tetracyclines, and -azole antifungals
• CAUSE premature dissolution of enteric-coated tablets
  > take enteric-coated tablets 1 hr before antacids
• Use with caution if on a low sodium diet such as patients with heart failure
• Should only be used for occasional relief of symptoms

Question 4

H2 Blockers Indications

+

Examples of Medications

Answer 4

Indications:

• PUD
• Dyspepsia
• GERD
• Prophy of stress ulcer
• Zollinger-Ellison Syndrome

Examples of Medications

• Cimetidine
• Rantidine
• Famotidine
• Nizatidine

Question 5

H2 Adverse Reactions

Answer 5

• Diarrhea, Constipation, Headache, Dizziness, Fatigue
• Pneumonia: elevation in gastric pH may increase risk of PNA
• Cimetidine may cause gynecomastia and loss of libido
  > Can cross blood brain barrier

Drug Interactions: warfarin, phenytoin, theophylline, lidocaine

ANTACIDS DECREASE ABSORPTION OF H2 BLOCKERS
> SHOULD BE ADMINISTERED 1 HOUR APART

Question 6

PPI medications

Answer 6

ALL -PRAZOLES

Question 7

Timing of Administration of PPI’s

Answer 7

Take PPIs 30-60min before meal to maximize inhibition of PPI

Dexlansoprazole: can take without meals

Esomeprazole: take at least 1 hour before meals

Question 8

** Indications of PPI **

Answer 8

Short Term
- GERD
- Gastric and Duodenal Ulcers
- H. Pylori 
- Stress Ulcer Prevention (ICU)
>> only with certain indications
>> rec discontinuation at discharge 

Long Term

• Erosive Gastritis
• Zollinger-Ellison Syndrome
• NSAID induced ulcers/prophy in long term use
• Chronic anticoagulation after GI Bleed
• Barrett’s Esophagus
• Rec using the lowest effective dose, including on-demand or intermittent therapy during maintenance therapy

Question 9

** Adverse Effects of PPI’s **

Answer 9

• METABOLIC CONSEQUENCES
  » stomach acid is necessary for digestion of nutrients
  »»»> Vitamin B12, proteins, iron, mag, ca
• Headache
• Abdominal Pain
• Nausea
• Fatigue
• Dizziness

Question 10

Long Term Use Consequences of PPI’s

Answer 10

Increase in C Diff infections

Question 11

** Tapering Off PPI’s **

Answer 11

USE ONLY IN PATIENTS THAT NEED THEM
- Chronic NSAID use, Barrett’s esophagus, anticoagulant use after GI bleed

For chronic use for GERD use short course of 2-4 weeks when symptoms occur

• Lower dose every week if needed
• Then increase the dosing interval each week to every other day. every third day etc
• Offer an H2 Blocker for breakthrough symptoms if needed