Week 4 notes 1 - T reatment of Acid-Related Illnesses...

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Treatment of Acid-Related Illnesses Treatment of acid-related disorders is mainly directed at neutralizing the hydrochloric acid produced by the parietal cells of the stomach, or blocking the production of gastric acid by several mechanisms. The categories of drugs that accomplish this include antacids, histamine-2 (H-2) receptor antagonists, and proton-pump inhibitors. In some situations peptic ulcer formation can be prevented by drugs known as cytoprotective agents. The role of antibiotics in treating peptic ulcer disease will also be discussed. Partial List of Available Antacids The available antacids are the single alkaline salts of four metallic cations or combinations of two or more of these salts. They are: - aluminum hydroxide - magnesium hydroxide - calcium carbonate - sodium bicarbonate Some of the commercially available antacids (including combinations) are: - aluminum hydroxide (AlternaGEL) (Amphojel) - calcium carbonate (TUMS) (Titralac) - magnesium hydroxide (Phillip's Chewables) (Milk of Magnesia) - sodium bicarbonate (bicarbonate of soda) (Alka-Seltzer) [Note: Alka-Seltzer also contains citric acid and aspirin] - aluminum hydroxide + magnesium hydroxide (Maalox) (Mylanta) - calcium carbonate + aluminum hydroxide + magnesium hydroxide (Camalox) (Tempo chewable tablets) - calcium carbonate + magnesium hydroxide (Rolaids) - and many other combinations Pharmacodynamics of the Antacids The antacid medications work by a physiochemical interaction between the drug and HCl acid produced by the gastric glands of the stomach. This reaction takes place entirely within the lumen of the stomach and does not involve cells or receptors of any kind. The therapeutic action of antacids is to neutralize gastric acid and prevent the damaging effects of acid on the wall of the stomach and also to prevent the acid-stimulated activation of the gastric enzyme, pepsin, which participates in gastric mucosal injury. Pharmacokinetics of the Antacids The antacid medications are administered orally. They are not appreciably absorbed 1
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Treatment of Acid-Related Illnesses when administered in usual doses but are consumed in the chemical reaction that takes place in the lumen of the stomach. If any of the drugs' components are absorbed, they are not metabolized and the cation components are excreted in the urine. Advantages of the Antacids - Available orally; an inducement to compliance - Multiple formulations offered; liquids, tablets, powders - therapy can be tailored to suit patient desires and needs. - Available over-the-counter; enhances convenience and compliance - Inexpensive; improves compliance - Minimal absorption (at usual doses); minimizes the risk for systemic adverse effects. - Great safety record; minimal adverse effects when used appropriately. - Rapid onset of antacid action (i.e., 30 min.); this means that if patients take them for pain relief, relief can begin this fast.
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