PUD treatment

H2- receptor blockers
Proton pump inhibitors
Antibiotics for H. pylori

Classification Anti-acid

aluminum hydroxide with magnesium hydroxide

Anti-acids with systemic effects

aluminum compound

Anti-acids Usues

Hyperacidity: heartburn, GERD, PUD
Prevention of a stress ulcer (long surgery)
Indigestion
Upset stomach
Hiatal hernia
Gastritis
Esophagitis

Antacid Mechanism of Action

Neutralizes gastric hydrochloric acid and pepsin activity
Anacid neutralize the acids immediately when it hits the stomach
Increase lower esophageal sphincter
Does NOT coat the lining
Does NOT prevent overproduction of acid

Kinetics of antacids

Onset: immediate
Duration:
On empty stomach 20-60 min
With food: 3hrs

Cautions of antacids

Renal disease�bc of magnesium
Hypercalcemia
Hypomagnesaemia
Pregnancy

Calcium salts or calcium carbonate are also known as

TUMS, Rolaids

Examples of sodium bicarbonate

alka seltzer

Sodium bicarbonate descritption

Highly soluble
Quick onset, but short duration
May cause metabolic alkalosis
Sodium content maybe an issue for hypertensive, CHF, and renal pts

Calcium salts or calcium carbonate

May cause constipation
Produce gas � belching and flatulence
Can lead to kidney stones
Long duration of acid action � increase of gastric acid secretion
Extra source of dietary calcium

Classification: antacid

aluminum compound

Classification: antacid

magnesium compounds

Classification: antacid

calcium carbonate

Classification: antacid

sodium bicarbonate

aluminum salts are also known as

Aluminum carbonate

Side effect of antacids only for calcium

Flatulence

Milk alkali syndrom

Headache
Nausea
Irritability
Weakness
Can lead to renal failure

Milk alkali syndrome is associated with

ingestion of calium and bile salt

Histamine -2 receptor antagonists (H2 blockers)

ranitidine (Zantac)

Histamine -2 receptor antagonists (H2 blockers)

cimetidine (Tagamet)

Histamine -2 receptor antagonists (H2 blockers)

famotidine (pepcid)

Histamine -2 receptor antagonists (H2 blockers)

nizatidine (Axid)

H2 Blockers uses:

Active duodenal ulcers
Benign gastric ulcers,
Hypersecretory conditions,
GERD, Erosive esophagitis,
Prevention of stress ulcers , Upper GI bleeding

H2 Blockers mechanism of actions:

Displaces histamine form the H2- receptor preventing stimulation of
acid secretion

H2 Blockers:

Variable first pass effect
Low protein binding
Renal excretion
Hepatic metabolism

What two H2 blocker drugs do you need good kidney function for?

Tagamet, Zantax

H2 blockers � drug interactions: increase

Increased effect of alcohol, salicylates, warfarin, narcotics, CCB,
caffeine, theophylline

H2 blockers � drug interactions: decrease

Decreased effect of azole antifungals, digoxin, smoking

H2 blockers � drug interactions

May inhibit the absorption of drugs that require an acidic GI
environment for absorption