Drugs for acid-related disorders

Question 1

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 arise from 5 main conditions:

Answer 2

• Non-ulcer / functional dyspepsia (indigestion) * Gastro-oesophageal reflux disease (GORD) * Gastritis * Duodenal ulcers
• Gastric ul

Question 3

Indigestion: clinical features (impaired GIT)

Answer 3

Abdominal discomfort.
Bloated.
flatulence.
feeling
Nausea
vomiting
Heartburn.

Question 4

Duodenal & gastric ulceration

Answer 4

• H. pylori present in 95% and 70% of
  ulcers respecƟvely → thought to secrete
  chemical factors which cause gastric
  mucosal damage

Question 5

GORD:

Answer 5

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

Question 6

Gastritis:

Answer 6

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

Question 7

Location

Answer 7

Generally; pain above the umbilicus and centrally located
* Pain behind sternum; heartburn
* Not likely to have lower abdomen pain

Question 8

Radiation

Answer 8

Pain radiating to other areas of body = more serious pathology – refer ? Cardiovascular
esp down inside aspect of left arm.

Question 9

Associated symptoms

Answer 9

Persistent vomiting with /without blood = ulceration / cancer – refer
Black and tarry stools indicate a bleed in GIT – refer

Question 10

Antacid

Answer 10

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

Question 11

Drug Interaction of Antacids

Answer 11

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

Question 12

Alginates (alginic acid)

Answer 12

Gaviscon - 1st-line treatment for heartburn and reflux.
alginates form a protective sponge-like matrix barrier over the gastric contents preventing reflux

they must be taken 1 hour after a meal and before bedtime

safe to use in pregnancy and lactation
be cautious of salt-restricted diet people.

Question 13

H2 antagonists

Answer 13

Reduce gastric acid and
pepsin secretion by blocking
the action of histamine at the
H2- receptors in the parietal
cells of the stomach

Question 14

H2 antagonist drugs

Answer 14

Ranitidine, cimetidine and famotidine

Question 15

Drug interaction of H2 antagonists ( ranitidine and cimetidine)

Answer 15

With liver enzymes CYP450

Question 16

Adverse effects:

Answer 16

Headache, confusion, dizziness, diarrhoea, myalgia, skin rashes

Question 17

Proton pump inhibitors

Answer 17

Omeprazole (Losec )
Esomeprazole (Nexiam )
Lansoprazole (Intended for short-term relief of heartburn, dyspepsia and
hyperacidity, max 15mg/day for max 14 days)
Lanzor
Lansoloc OTC®
Pantoprazole (Intended for short-term relief of heartburn, dyspepsia and
hyperacidity, max 20mg/day for max 14 days)
Pantoloc®
Topzole

Question 18

Proton pump inhibitor, route of administration

Answer 18

Administered IV or oral

Question 19

Common adverse effects:

Answer 19

diarrhoea, constipation, vomiting, flatulence, headache, vertigo,
abdominal discomfort

Question 20

Prostaglandin analogues

Answer 20

Refresher: Prostaglandins E2 and I2 inhibit acid, stimulate mucus and
bicarbonate secretion, and dilate mucosal blood vessels
Misoprostol, prostaglandin analogues
Used with NSAIDs
AE: abdominal cramp, diarrhoea
CI in pregnancy- uterine contractions, premature abortion

Question 21

Common causes of Peptic ulcer

Answer 21

Heliobacteria Pylori infection.
Nonsteroidal anti-inflammatory drugs
Critical illness

Question 22

Peptic ulcer disease: pathophysiology

Answer 22

• Helicobacter pylori infection causes release of enzymes (urease,
  lipases, proteases) that cause gastric inflammation and mucosal
  injury. * NSAIDs cause gastric mucosal damage by: * Direct irritation of gastric epithelium
• Systemic inhibition of endogenous mucosal prostaglandin synthesis
• Cigarette smoking impairs ulcer healing and may be associated with
  ulcer-related GI complications.
  Peptic ulcer disease: pathophysiology
  Love B.L. (2023). Peptic ulcer disease and re

Question 23

NSAID-Induced Ulcer Risk Factors

Answer 23

Age >65
* Previous peptic ulcer * High-dose NSAIDs
* Multiple NSAID use
* Selection NSAID (COX-1 vs COX2) * Aspirin
* Chronic debilitating disorders
(cardiovascular disease,
rheumatoid arthritis)
* Concomitant use of: * NSAID + aspirin
* Oral bisphosphonates
* Corticosteriods
* Anticoagulants
* Antiplatelets
* SSRIs
* Helicobacter pylori infection
* Cigarette smoking
* Alcohol consumption