Drugs for acid related disorders 2

Question 1

The 1st line treatment of heartburn and reflux

Answer 1

Gaviscon

Question 2

MoA of Alginates (Alginic acid): Gaviscon

Answer 2

Gaviscon
* 1st line for heartburn & reflux
* MoA: contact with gastric acid = precipitation – sponge-like matrix that floats on top of stomach contents

Question 3

Combination with antacids

Answer 3

Gelacid

Question 4

When to take Gelacid

Answer 4

Take after each meal and before bedtime

Question 5

Is Gelacid safe for pregnancy and lactation

Answer 5

yes

Question 6

GI for gelacid

Answer 6

Patient on salt-restricted diets

Question 7

MoA od H2 antagonist

Answer 7

MoA: Reduce gastric acid andnpepsin secretion by blocking the action of histamine at the H2- receptors in the parietal cells of the stomach

Question 8

Drug interation for H2 antagonists

Answer 8

Drug interactions:
Inhibits hepatic microsomal enzymes (cytochrome P450) and has the potential for multiple drug interactions

Question 9

Adverse effects for H2 antagonists

Answer 9

Adverse effects:
Headache, confusion, dizziness, diarrhoea, myalgia, skin rashes

Question 10

Explain the dosage of H2 antagonists and their intended aim

Answer 10

Cimetidine (Intended for short-term relief of heartburn, dyspepsia and hyperacidity, max 200mg/dose & 800mg/day for max 14 days)
Lenamet®
Ranitidine (Intended for short-term relief of heartburn, dyspepsia and hyperacidity, max 75mg/dose & 300mg/day for max 14 days)
Zantac

Question 11

Explain the dosage of proton pump inhibitors and their intended aim

Answer 11

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 12

MoA of Proton pump inhibitors

Answer 12

Most potent suppressors of gastric acid secretion
Mechanism of action:
Inhibiting the H+/K+-ATPase enzyme of the gastric parietal cells.

Question 13

Indications for Proton pump inhibitors

Answer 13

Indications:
* Short term management of PUD and GORD
* Long term prevention of relapse of GORD
* H. pylori eradication in combination with antibiotics
* Treatment of Zollinger-Ellison syndrome
* Treatment and prevention of NSAID-associated erosions and ulcers
* Omeprazole: children with severe ulcerative reflux oesophagitis

Question 14

RoA for proton pump inhibitors

Answer 14

IV or Oral

Question 15

DI for proton pump inhibitors

Answer 15

Drug interactions:
* Absorption of other drugs due to increased pH
* Agents metabolised in the liver via cytochrome P450 enzyme system

Question 16

Common adverse effects for proton pump inhibitors

Answer 16

Common adverse effects:
diarrhoea, constipation, vomiting, flatulence, headache, vertigo, abdominal discomfort.
Mask symptoms of gastric cancer

Question 17

List the proton pump inhibitors long term adverse effects

Answer 17

Consistent increased pH in stomach lead to reduced vitamin and mineral absorption:
* Iron (anaemia)
* Calcium (osteoporosis)
* Magnesium (muscle spasms)
* Vitamin B12 (anaemia)
Infections due to bacterial proliferation:
* C. diff infection
* Community acquired pneumonia
Alteration in pH-dependent drug
pharmacokinetics
CKD
Dementia

Question 18

List other GORD drugs

Answer 18

Domperidone and metoclopramide
Sucralfate
Bismuth subcitrate

Question 19

Explain what does Demperidone and metoclopramide do?

Answer 19

Domperidone & metoclopramide- facilitate gastric emptying (prokinetics) and increase gastrooesophageal tone, antiemetics. Used when other measures fail

Question 20

Explain what sucralfate do?

Answer 20

Sucralfate:
* cytoprotective, forms a vicious paste & adheres to the base of the ulcer
* Requires strict and frequent admin
* Requires acid environment, take 1 hr before meals & before bedtime
* Constipation

Question 21

Explain what does bismuth subcitrate do?

Answer 21

Bismuth subcitrate:
* has high affinity for damaged tissue
* forms a protective coating at the base of the ulcer
* Black discoloration of stool