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29 Cards in this Set

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Stimulants of gastric acid
Gastrin, acetycholine, histamine.
Drugs to enchance protection
1. Sucralfate
2. Bismuth Compounds
3. Misoprostol
4. Antacids
Drugs to decrease attack on GI Tract
1. Misoprostol
2. Antacids
3. Antibiotics
4. Antimuscarnic drugs
5. Proton pump blockers
6. H2 antagonists
Sucralfate: Adverse Effects
(simulates local production of PG)
1. Constipation
2. Renal failure.
Drug - Sucralfate Interactions
Antacids: avoid use w/in 30 min.
Take on empty stomach & one hour before meal.
Take sucralfate 2 hours after the intake of drugs. (phenytoin, cimetidine, digoxin, ketoconazole, fluroquinolone.)
Bismuth subsalicylate
(Pepto Bismol)MOA
Binds to ulcer and provides a coating and protection from acid and pepsin
Bismuth subsalicylate simulates:
PG, mucus, and bicarbonate.
Bismuth subsalicylate A.E.
Blackening of stools
Darkening of tongue
Avoid in renal insufficiency
Can accumulate in pts w/ renal impairment.
Antacids: Weak bases that react with acid to form salt and water. PG production
1. Aluminum hydroxide
2. Mg hydroxide
3. Mg trisilicate
4. Ca carbonate
5. Na bicarbonate
Milk alkali syndrome:
Sodium Bicarbonate and Ca carbonate: Ca containing dairy products
Milk alkali syndrome characteristics:
1. hypercalcemia
2. Metabolic alkalosis
3. Nephrocalcinosis (calcium phosphate formation leading to kindey stone formation.
Acid Rebound
Persistent release or secretion of acid even though pH has come to normal
Tx: of Acid Rebound:
Low level of acid rebound
High level of acid rebound
Low: Al and Mg
High: Na bicarbonate and Ca Carbonate
Antacids Drug-Drug Interactions
1. Decrease absorption of
Digoxin
2. tetracycline, fluoroquinolones, fluconazole, and iron.
Aluminium a.e.
hypophosphatemia, relative c.i. in renal problem
Na bicarbonate and Ca Carbonate side effects:
Milk Alkali syndrome
Belching
Metabolic alkalosis
Acid rebound
What is Alginic acid + Al-Mg?
Gaviscon:
Serves as a barrier to protect the esophagus from teh corrosive effect of gastric reflux.
H2 receptor antagonists:
(Renally eliminated)

HIGHLY SELECTIVE
Cimetidine (TAGAMET)
Rantidine (ZANTAC)
Famotidine (PEPCID)
Nizatidine (AXID)
H2 receptor antagonists are most effective:`
NOCTURAL ACID SECRETION
A.E. of H2 receptor antagonist administered orally and I.V.:
- ORALLY: thrombocytopenia, neutropenia, leukopenia, myalgia.
- I.V.: mental status - confusion, hallucination, agitation.
A.E. OF CIMETIDINE
1. inhibits binding of DHT to androgen receptor
2. inhibits metabolism of estradiol
3. increases prolactin levels.
Overall adverse effect of cimetidine:
1. gynacomastia and men galactorrhea.
Drug interactions with cimetidine:
inhibit CYP-450 and increase levels of the substrates of the enzyme
1. warfarin
2. theophylline
3. phenytoin
4. cacb

Inhibits secretion of procainamide
Rantidine, famotidine, nizatidine decrease the absorption of:
itraconazole and fluconazole.
Proton Pump Inhibitors:

irreversibly inactivate the enzyme.
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Esomeprazole (Nexium) S
Bioavailability of PPI:

(CAUTIOUS ONLY IN SEVERE LIVER DISEASE)
Decreased 50% by food.
TAKE ON EMPTY STOMACH
Inhibition lasts 24 hrs
at least 18 synthesis of new molecules
FULL acid effect seen in 3-4 days.
RAPID first pass and hepatic metabolism
OMEPRAZOLE inhibits the metabolism:
Warfarin, diazepam, phenytoin
PPIs increase the pH, decrease pH needed for absorption of:
ketoconazole
Itraconazole
iron
digoxin
a.e. of ppi
increased risk of enteric infection -- increase serum gastrin