[Pharm] Antacids and Anti-Ulcer Drugs (Segars) Flashcards
Antacids are used only for?
Short-term and temporary relief of MILD pain and symptoms associated with PUD/GERD
What are the two categories of antacids?
Low-systemic agents
High-systemic agents
What are the low-systemic agents?
Aluminum salts
Calcium salts
Magnesium salts
What is the high-systemic agent?
Sodium salts
What is the major supplemental agent?
Simethicone
Where within the GI tract to antacids act?
Within the gastric luman
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What is the mechanism of antacids?
Combine chemically with hydrogen ions
T/F
Antacids reduce acid secretion and production
FALSE!!!!
Antacids DON’T reduce secretion or production
What are the two rapid onset, long DOA antacid compounds?
Calcium
Magnesium
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What is the mechanism of simethicone?
A surfactant that decreases surface tension
Aids in expulsion of gas
*It decreases my tension to play SIMs (simethicone)
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What are the side effects of ALUMINUM?
Constipation
Hypophosphatemia
What are the side effects of MAGNESIUM?
Diarrhea
Hypermagnesemia
What are the side effects of CALCIUM?
Constipation
Hypercalcemia
Hypophosphatemia
Calcium-based kidney stones
What are the side effects of sodium?
Gas/Flatulence
Hypernatremia
Metabolic alkalosis
What are the factors you should consider when choosing the appropriate antacid?
- Dosage form & palatable
- Presence of renal or heart disease
- Electrolyte status
- Diseases associated w/ diarrhea and constipation
What is the big advice for drug interactions with antacids?
AVOID antacid + medication co-administration at the same time
Take all antacids 1-2 hours BEFORE other medications OR 2-4 hours AFTER other medications
What are the 5 classes of anti-ulcer agents?
H2 Receptor Antagonists
Proton pump inhibitors
Surface Acting Agents
PGE1 Analogs
Bismuth Compounds
What is the suffix associated with H2 receptor antagonists?
-tidine
What are the 4 H2 Receptor Antagonists?
Cimetidine
Famotidine
Nizatidine
Ranitidine
What is the suffix associated with Proton Pump Inhibitors?
-prazole
What are the (6) proton pump inhibitors?
Lansoprazole
Dexlansoprazole
Omeprazole
Esomeprazole
Pantoprazole
Rabeprazole
What is the (1) Surface acting agent?
Sucralfate
What is the (1) PGE1 Analog?
Misoprostol
What is the (1) bismuth compound?
Bismuth subsalicylate
What are the side effects of H2 blockers?
(Relatively mild, transient and infrequent)
- Primarily GI related (Nausea/Diarrhea/Constipation)
- Headache
What was the FIRST H2 blocker to be released?
What was the problem with it?
Cimetidine
TONS of drug-drug interactions; CYP450 inhibitor
What is a relative contraindication for H2 Blockers?
Pregnancy
What are the side effects of PPIs?
(mostly mild and infrequent)
- Diarrhea/Dyspepsia/Nausea
- CDAD (Clostridium Difficile-Associated Diarrhea)
- Headache
What was the first PPI put on the market?
What’s the problem with it?
Omeprazole
MANY drug-drug interactions w/ inhibition of CYP450
Whta is the best PPI to use in pregnancy?
Lansoprazole
“Baby fetus LANce likes lansoprazole during pregnancy”
What is the mechanism of action of sucralfate?
Cross-linking from interaction with stomach acid
Creates a viscous, sticky polymer which adheres to epithelial cells around ulcer’s crater
(***Acts like internal bandaid)
Does sucralfate affect pH?
NO!!!
What is the major side effect of Sucralfate?
Constipation (Al(OH)3)
What are the relative contraindications of Sucralfate?
Severe renal failure
Aluminum containing antacids should be avoided
What is the mechanism of action of misoprostol?
Prostaglandin E1 analog
Provides protective prostaglandin to gastric mucosa and reduces gastric acid release from parietal cell
What is important to note about the dual action of misoprostol?
EP3 receptors are on both the parietal cell and superficial epithelial cell
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What is a unique indication of misoprostol?
Prevention of NSAID-induced gastric ulceration in patients at high risk of ulcerations and complications
What are the side effects of Misoprostol?
- Diarrhea
- Headache/dizziness
What do you use to treat H. pylori?
Bismuth
Antibiotics
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What are the side effects of bismuth compounds?
Constipation
Black/dark stools
*Bismuth = Black dark stools
What are the drug interactions of Bismuth?
TONS!!!
Follow the same protocol. Don’t take at the same time as other drugs
What are absolute contraindications of Bismuth?
GI Bleeding
Salicylate hypersensitivity
How do you treat H.pylori?
COMBINATION THERAPY IS A MUST
MUST be on at least 2 ANTIBIOTICS
Treat for 10-14 days
What are the go-to drugs used to treat H.pylori?
Explain the combination of drugs you’d pick
PPI
Clarithromycin
Amoxicillin OR Metronidazole