[Pharm] Antacids and Anti-Ulcer Drugs (Segars)

Question 1

Antacids are used only for?

Answer 1

Short-term and temporary relief of MILD pain and symptoms associated with PUD/GERD

Question 2

What are the two categories of antacids?

Answer 2

Low-systemic agents

High-systemic agents

Question 3

What are the low-systemic agents?

Answer 3

Aluminum salts

Calcium salts

Magnesium salts

Question 4

What is the high-systemic agent?

Answer 4

Sodium salts

Question 5

What is the major supplemental agent?

Answer 5

Simethicone

Question 6

Where within the GI tract to antacids act?

Answer 6

Within the gastric luman

Question 7

What is the mechanism of antacids?

Answer 7

Combine chemically with hydrogen ions

Question 8

T/F

Antacids reduce acid secretion and production

Answer 8

FALSE!!!!

Antacids DON’T reduce secretion or production

Question 9

What are the two rapid onset, long DOA antacid compounds?

Answer 9

Calcium

Magnesium

Question 10

What is the mechanism of simethicone?

Answer 10

A surfactant that decreases surface tension

Aids in expulsion of gas

*It decreases my tension to play SIMs (simethicone)

Question 11

What are the side effects of ALUMINUM?

Answer 11

Constipation

Hypophosphatemia

Question 12

What are the side effects of MAGNESIUM?

Answer 12

Diarrhea

Hypermagnesemia

Question 13

What are the side effects of CALCIUM?

Answer 13

Constipation

Hypercalcemia

Hypophosphatemia

Calcium-based kidney stones

Question 14

What are the side effects of sodium?

Answer 14

Gas/Flatulence

Hypernatremia

Metabolic alkalosis

Question 15

What are the factors you should consider when choosing the appropriate antacid?

Answer 15

• Dosage form & palatable
• Presence of renal or heart disease
• Electrolyte status
• Diseases associated w/ diarrhea and constipation

Question 16

What is the big advice for drug interactions with antacids?

Answer 16

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

Question 17

What are the 5 classes of anti-ulcer agents?

Answer 17

H2 Receptor Antagonists

Proton pump inhibitors

Surface Acting Agents

PGE1 Analogs

Bismuth Compounds

Question 18

What is the suffix associated with H2 receptor antagonists?

Answer 18

-tidine

Question 19

What are the 4 H2 Receptor Antagonists?

Answer 19

Cimetidine

Famotidine

Nizatidine

Ranitidine

Question 20

What is the suffix associated with Proton Pump Inhibitors?

Answer 20

-prazole

Question 21

What are the (6) proton pump inhibitors?

Answer 21

Lansoprazole

Dexlansoprazole

Omeprazole

Esomeprazole

Pantoprazole

Rabeprazole

Question 22

What is the (1) Surface acting agent?

Answer 22

Sucralfate

Question 23

What is the (1) PGE1 Analog?

Answer 23

Misoprostol

Question 24

What is the (1) bismuth compound?

Answer 24

Bismuth subsalicylate

Question 25

What are the side effects of **H2 blockers?**

Answer 25

(Relatively mild, transient and infrequent) - Primarily GI related (Nausea/Diarrhea/Constipation) - Headache

Question 26

What was the FIRST H2 blocker to be released? What was the problem with it?

Answer 26

Cimetidine TONS of drug-drug interactions; CYP450 inhibitor

Question 27

What is a relative contraindication for **H2 Blockers?**

Answer 27

Pregnancy

Question 28

What are the side effects of **PPIs?**

Answer 28

(mostly mild and infrequent) - Diarrhea/Dyspepsia/Nausea - **CDAD (Clostridium Difficile-Associated Diarrhea)** - Headache

Question 29

What was the first PPI put on the market? What's the problem with it?

Answer 29

Omeprazole MANY drug-drug interactions w/ inhibition of CYP450

Question 30

Whta is the best PPI to use in pregnancy?

Answer 30

Lansoprazole "Baby fetus **LANce** likes lansoprazole during pregnancy"

Question 31

What is the mechanism of action of **sucralfate?**

Answer 31

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)

Question 32

Does sucralfate affect pH?

Answer 32

NO!!!

Question 33

What is the major side effect of **Sucralfate?**

Answer 33

Constipation (Al(OH)3)

Question 34

What are the relative contraindications of **Sucralfate?**

Answer 34

Severe **renal failure** **Aluminum containing antacids** should be avoided

Question 35

What is the mechanism of action of **misoprostol?**

Answer 35

Prostaglandin E1 analog Provides **protective prostaglandin** to gastric mucosa and **reduces gastric acid release** from parietal cell

Question 36

What is important to note about the dual action of **misoprostol?**

Answer 36

EP3 receptors are on both the parietal cell and superficial epithelial cell

Question 37

What is a unique indication of **misoprostol?**

Answer 37

**Prevention of NSAID-induced gastric ulceration** in patients at **high risk of ulcerations** and complications

Question 38

What are the side effects of **Misoprostol?**

Answer 38

- Diarrhea - Headache/dizziness

Question 39

What do you use to treat **H. pylori?**

Answer 39

**Bismuth** Antibiotics

Question 40

What are the side effects of **bismuth compounds?**

Answer 40

Constipation **Black/dark** stools \***B**ismuth = **Black** dark stools

Question 41

What are the drug interactions of Bismuth?

Answer 41

TONS!!! Follow the same protocol. Don't take at the same time as other drugs

Question 42

What are **absolute contraindications** of **Bismuth?**

Answer 42

GI Bleeding Salicylate hypersensitivity

Question 43

How do you treat **H.pylori?**

Answer 43

COMBINATION THERAPY IS A MUST MUST be on at least **2 ANTIBIOTICS** Treat for **10-14 days**

Question 44

What are the go-to drugs used to treat **H.pylori?** Explain the combination of drugs you'd pick

Answer 44

PPI Clarithromycin Amoxicillin OR Metronidazole