Heartburn_Dyspepsia Fall 2012 (1)

Antacids beneficial for symptomatic relief used for

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Antacids Beneficial for symptomatic relief Used for mild, infrequent heartburn or dyspepsia Provides rapid relief of symptoms MOA: acts as buffering agents in the esophagus, stomach, and duodenum i ncreases stomach pH Cations interact with Cl - Anions interact with H + → H 2 0 Onset: 5-10 minutes Liquid preparations work fastest Duration: 20-30 minutes
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Antacids Agents Aluminum salts (hydroxide) Magnesium salts (hydroxide, carbonate) Calcium carbonate Sodium bicarbonate Many are a combination of these salts Many also contain simethicone 2200 discomfort related to gas
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Antacids Aluminum salts Maalox ® , Mylanta ® , Alternagel ® , Gaviscon ® ANC: ++ Adverse effects: Constipation, hypophosphatemia Chronic use in renal failure should be avoided Aluminum toxicity
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Antacids Magnesium salts Mylanta ® , Maalox ® , Milk of Magnesia ANC: +++ Adverse effects: Diarrhea Hypermagnesemia accumulation in renal dysfunction Cautions: Renal dysfunction
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Antacids Calcium salts (carbonate) Tums ® , Rolaids ® Contains 40% elemental calcium ANC: ++++ Adverse effects: Related to Ca ++ : constipation, kidney stones, acid- rebound Related to CO 2 : belching, flatulence May be beneficial for use in patients with osteoporosis
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Antacids Sodium bicarbonate Alka Seltzer ® ANC: + Adverse effects: Na + related: sodium/fluid overload Related to CO 2 : belching, flatulence, metabolic alkalosis Cautions: Congestive heart failure, sodium-restrictions
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Antacids Bismuth subsalicylate Pepto Bismol ® ANC: ++ MOA: reacts with HCl in the stomach to form bismuth oxychloride and salicylic acid Adverse effects: Dark stools, black tongue Contraindications: Aspirin allergy Pregnancy Children < 12 yo
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Antacids Alginic acid Gaviscon ® MOA: interacts with NaHCO 3 - to form a viscous layer that floats on top of stomach contents → protective layer for the esophagus Not used as a individual agent, always in combination (FDA: inactive ingredient)
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Administration Take at onset of symptoms Should not be used regularly for more than 2 weeks Take with a full glass of water Separate by ≥ 2 hr from other medications May bind to and absorption of select medications Chelation (di- and trivalent cations): tetracyclines, fluoroquinolones ↑ gastric pH: ketoconazole, itroconazole, iron Dosed multiple times a day Do not exceed product-specific maximum daily dose
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Acid Suppression Therapy http://www.images.md.proxy1.lib.tju.edu:2048/users/image_show.asp
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H 2 Receptor Antagonists (H 2 RA) Useful for mild-moderate, infrequent symptoms MOA: Inhibits histamine 2 receptor mediated acid secretion Efficacy is variable Dependent upon severity of disease, dose, and duration Onset: 30-45 minutes Duration: 4-10 hours Cimetidine is the shortest Tachyphylaxis
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H 2 Antagonists Drug Dose ADR Drug Interactions
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