Ulcer, GERD

Question 1

Calcium carbonate (Rolaids, Tums)

Answer 1

Antacid
MOA: Chemical reaction

Ulcer treatment; GERD

SE: Milk-alkali syndrome, nephrocalcinosis, “rebound” acidity, digitalis antagonism, constipating effects

Question 2

Sodium bicarbonate

Answer 2

Antacid
MOA: Chemical reaction

Ulcer treatment; GERD

SE: Systemic alkalosis, thus rarely used

Question 3

Magnesium hydroxide, magnesium carbonate (Maalox, Mylanta)

Answer 3

Antacid
MOA: Chemical reaction

Ulcer treatment; GERD

SE: Diarrhea (laxative effects)
Hypokalemia, hypermagnesemia, iron deficiency

Magnesium tox mostly in context of renal disesae

Question 4

Aluminum hydroxide (Alternagel)

Answer 4

Antacid
MOA: Chemical reaction

Ulcer treatment; GERD

SE: Phosphate depletion and sequelae (weakness, anemia, tetany, apnea) Constipation
Safe for use in patients with renal failure

Question 5

Atropine sulfate

Answer 5

Anticholinergic
MOA: Reduce acid secretion, reduce spasm

Ulcer treatment

SE: Anti-cholinergic

Question 6

Propantheline; Metantheline bromide

Answer 6

Anticholinergic
MOA: Reduce acid secretion, reduce spasm

Ulcer treatment (taken 15-30 minutes before meals, and before bed)

SE: Anti-cholinergic

Question 7

-TIDINES

Cime, Rani, Famo, Niza

Answer 7

Histamine (H2) receptor blockers

MOA: Inhibit 50-80% of 24 hour acid production

Ulcer treatment (first class to satisfy all 4 requirements); prophylactically for stress ulcers; GERD

SE: Rebound acidity if stopped suddenly
Cime, Rani inhibit CYP 450

Question 8

Misoprostol

Answer 8

ProstaglandinE analog

MOA: Decrease acid production, increase mucous and bicarbonate secretion

Ulcer treatment when prostaglandin production decreased (RA patients taking lots of NSAIDs)

Not very effective, since endogenous prostaglandin levels are already high in duodenal ulcer patients

Question 9

-PRAZOLES

Ome, Lanso, Dexlanso, Rabe, Panto, Esome

Answer 9

H/K/ATPase inhibitor

MOA: Inhibit >90% of 24 hour acid secretion (better than H2 antagonists); requires acid environment to activate (don’t take with antacids)

Ulcers, GERD, Ome and Lanso used as part of triple therapy for H. pylori

SE: Headache, gynecomastia, gastric hyperplasia in humans and carcinoid tumors in rats long term (do not use long-term)

Ome: large CYP 450 inhibition
Lanso, Esome, Rabe: some CYP 450 inhibition
Panto: No CYP inhibition

Question 10

Sucralfate, Bismuth salts (Pepto-Bismol)

Answer 10

Mechanical protectors

MOA: Coat the ulcer crater, increase mucosal resistance (requires acid environment)

Ulcer treatment, treatment for H. pylori

SE: Aluminum toxicity possible in renal failure