Drugs for acid related disorders

Question 1

Define Dyspepsia

Answer 1

any symptoms referable to the upper GIT… including upper abdominal pain or discomfort, heart burn, acid reflux, nausea & vomiting

Question 2

Symptoms of dyspepsia arises from 5 main conditions
list those conditions

Answer 2

Symptoms arise from 5 main conditions:
* Non-ulcer / functional dyspepsia (indigestion)
* Gastro-oesophageal reflux disease (GORD)
* Gastritis
* Duodenal ulcers
* Gastric ulcers

Question 3

List the Indigestion clinical features

Answer 3

• Vague abdominal discomfort associated with belching
• Bloated
• Flatulence
• Feeling of fullness
• Nausea / vomiting
• Heartburn

Question 4

Explain the aetiology for GORD

Answer 4

Lower oesophageal sphincter incompetence - ↓ muscle tone via medicine / over treating

Question 5

Explain the aetiology for Gastritis

Answer 5

Increased acid production → inflammation of stomach, attributed to Helicobacter pylori infection, NSAIDs /
acute alcohol ingestion

Question 6

What causes heart burn

Answer 6

• GORD:
• Lower oesophageal sphincter incompetence - ↓ muscle tone via medicine / over treating
• Gastritis:
• Increased acid produc􀆟on → inflammation of stomach, attributed to Helicobacter pylori infection, NSAIDs /
  acute alcohol ingestion

Question 7

Explain what causes peptic ulcer disease

Answer 7

• Duodenal & gastric ulceration
• H. pylori present in 95% and 70% of ulcers respec􀆟vely → thought to secrete chemical factors which cause gastric mucosal damage.

Question 8

List the conditions to eliminate

Answer 8

• Peptic ulceration – main consideration
• Medicine-induced dyspepsia
• Irritable bowel syndrome
• Gastric / oesophageal carcinoma
• Atypical angina

Question 9

List when to refer the patient

Answer 9

• Anaemia
• Loss of weight / Anorexia
• Recent onset of progressive symptoms
• Severe pain (at night)
• Dysphagia (difficulty in swallowing) and haematemesis
• Persistent vomiting (with / without blood)
• Referred pain
• Treatment failure

Question 10

List the non-pharmacological advice

Answer 10

Lifestyle advise:
* Move to a lower fat diet (decrease spicy food and chocolate)
* Eat smaller frequent meals
* Reduce alcohol & caffeine intake
* Smoke cessation
* Lose weight

Question 11

List the examples of antacids drugs

Answer 11

Aluminium, Magnesium and calcium compounds

Question 12

List the H2 receptors antagonists

Answer 12

Cimetidine
Ranitidine

Question 13

List the proton pump inhibitors (PPIs)

Answer 13

Dexlansoprazole,
Esomeprazole,
Lansoprazole,
Omeprazole,
Pantoprazole,
Rabeprazole

Question 14

List the prostaglandins drugs

Answer 14

Misoprostol

Question 15

MoA of Antacids

Answer 15

Neutralise stomach acid

Question 16

List and explain the active ingredients for Antacids

Answer 16

Active ingredients:
* Sodium, potassium = quick acting, quick action
* Magnesium (diarrhoea), aluminium (constipation) = less soluble, prolonged action
* Calcium (constipation) = quick acting, prolonged action

Question 17

Explain why Antacids products usually combined with salts?

Answer 17

Products usually a combination of salts:
1. quick onset & long duration,
2. minimise AE

Question 18

Explain the direct use of Antacids

Answer 18

Take 1 hpur after meals and at bedtime

Question 19

Explain the DI for Antacids

Answer 19

DI: affect absorption of drugs – tetracyclines, fluoroquinolones, iron, digoxin, indomethacin - esp enteric coated tablets – leave gap of 2 hours between medications

Question 20

Explain the CI of Antacids

Answer 20

CI: patients on salt-restricted diets / cardiovascular disorders (hypertension), children under 12 years