H2 Blockers and PPIs Flashcards
Symptoms of GERD
Heartburn Regurgitation, Vomiting, Pain on swallowing, Hoarseness
Less common: Stomach pain, non-burning chest pain, difficulty swallowing, chronic sore throat, cough
Antacids
Pharmacological Use
Short term relief of GERD symptoms
List a few antacids
Tums
Maalos
Mylanta
Antacids
Adverse Effects
Overdose can cause Milk-alkali Syndrome with Hypercalcemia, Alkalosis, and Renal impairment
H2 Antagonists
List them
Rantidine, Famotidine, Cimetidine, Nizatidine
H2 Antagonists
Indications
Reduce production of acid in stomach
Used for peptic ulcer disease
Prevents NSAID induced ulcers and allows for peptic ulcers to heal
H2 Antagonists
Adverse Effects
Very safe
Rare renal and hepatic toxicity
H2 Antagonists
When do they reach peak serum conc?
1-3 hours after dosing
PPIs
MOA
Block acid secretion by irreversibly binding to and inhibiting the H+/K+ ATPase pump on luminal surface of parietal cells
Needs to first be activated in acidic stomach environment
PPIs
When should they be taken?
Most effective 30-60 min before meals so they are in bloodstream when the parietal cells are stimulated
PPIs
List them
Omeprazole Lansoprazole Rabeprazole Pantoprazole Esomeprazole
PPIs
Indications
DOC for Zollinger-Ellison Syndrome and GERD that is not responsive to H2 antagonists
Used in combo treatment of H Pylori
Duodenal ulcers
PPIs
Drug Interactions
Should NOT be given simultaneously with H2 antagonists
Reduce absorption of ketoconazole
Increase digoxin absorption
Metabolized by CYP450 and can decrease metabolism and clearance of benzodiazepines, warfarin, and phenytoin
PPIs
Adverse Effects
Very mild- diarrhea, headache, drowsiness, muscle pain, constipation
Prolonged use may lead to B12 deficiency
What is the major mucosal protective agent?
Sucralfate