Pharm 3-Antacids & H2 blockers/PPI

Created by aligoss 

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types of antacids (MC)

1) Ca*
2) sodium bicarbonate
3) aluminum
4) magnesium
5) combinations

indications

1) hyperacidity
2) aluminum-hyperhosphatemia
3) magnesium-magnesium deficiency, malnutrition

unlabeled uses

1) GERD (immediate relief of intermittent heartburn)
2) osteoporosis

how do they work

-weak bases that neutralize HCl acid
-raise pH which inactivates pepsin
-increase LES tone decreasing reflux
-do NOT coat stomach lining

goal of tx

1) sx relief
2) lifestyle modification needed
-raise head of bed
-limit caffeine
-stop smoking
-weight loss
-diet (increase fiber)

duration of action

2 hours

what to use if sx >2 hours or occur at HS

H2 blockers

takes how long to work

30 min.

use in what severity

mild

mod sx=

sx several times/week or daily

tx

H2 blockers BID for 8-12 wks

tx in severe or erosive dz

PPI q daily

if uneffective

PPI BID for 8-12 wks

whats common when trial off of meds (%)

relapse (80%)

what if that happens

maintenance tx needed (use lower dose than initial tx)

caffeine's effect

1) decrease LES press.
2) increase acidity
3) makes GABA less effective

AA w/ highest acid-neutralizing capacity (ex.)

1) sodium bicarbonate (ex. alka-seltzer)
2) calcium bicarbonate (tums & rolaids)

why should you try not to use sodium bicarbonate

increase Na which if bad for fluid retention & CHF

which formulation has highest acid-neutralizing capacity

1) gels
2) suspensions

pt. education with tablets

chewed thoroughly & take w/ full glass of water

when to take

1 hour after meals

when to take to avoid interaction w/ other meds

1 hour before or 2 hours after other meds

Calcium & aluminum AA SE

1) constipation
2) precipitate stone (Ca ones)

Magnesium AA SE

diarrhea

what can help balance the SE

give them together

what AA to give pt. w/ renal insufficiency

magnesium AA

monitor

check electrolytes periodically

prego cat

none

when can happen when AA are discont.

acid rebound

risk for what if use Ca carbonate or sodium bicarbonate AA chronically (can lead to)

-milk-alkali syndrome
1) alkalosis
2) increase Ca
3) renal impairment

sx

1) HA
2) nausea
3) irritability
4) weakness

max. effect occurs when

taken 1 hour after meals

effects if taken on empty stomach

20-40 min.

tums/rolaid dose

PRN

amphojel dose

600mg po TID or QID

maalox dose

30cc po QID

MOM dose

15-30 cc QID

what AA have more SE

Na bicarbonate

indications for H2 blockers

1) GERD
2) PUD
3) hypersecretory conditions (ZE)

indications for PPI

1) GERD
2) PUD
3) hypersecretory conditions
4) H. pylori

actions

decrease amount of acid produced by stomach

which are more powerful (how)

PPI (decrease acid to greater extent)

nonpharms

1) balanced meals at regular intervals
2) avoid foods that exacerbate sx
3) high fiber diet
4) avoid caffeine & alcohol
5) stop smoking

goal of tx w/ H2 & PPI

relieve sx & heal ulcers

1st line tx in mild-mod dz

H2 blockers

tx for severe PUD

PPI

what if no improvement in 1 week

increase dose or change to PPI

length of tx for hypersecretory or erosive conditions

long-term

longer tx for H2 or PPI?

H2 blockers

tx h. pylori

H2 or PPI + antibiotics & sometimes Bismuth

SE of bismuth

changes to dark stool

when are H2 dosed

early evening or after meals

when to take PPI

30 min. prior to meal

T/F shouldn't use PPI & H2 blockers together

true

monitor

1) check stools/vomit for blood
2) LFT
3) BUN/crea
4) don't crush or chew PPI's

how long does it take for blood to clear tract

72 hours

H2 blockers ex.

zantac prototype

why are there less SE w/ axid (H2)

doesn't induce P450 system

which H2 has lots of SE & drug interactions

cimetidine

PPI 1/2 life

long (72 hours)

who has more SE, H2 or PPI?

H2

what drugs can PPI interfere with (ex.)

drugs that need acid environ. for absorption (ex. iron)

cheapest PPI

protonix & aciphex

longer 1/2 life PPI

nexium

zantac dose

150mg BID or 300 mg po Q HS

pepcid dose

20mg BID or 40mg po Q HS

axid dose

150mg BID or 300 mg Q HS

prilosec dose

20 mg q daily or 20 mg BID

prilosec tx w/ h. pylori

-40 mg q daily x 2 weeks
-then 20 mg w daily x 2 weeks + antibiotic

prevacid dose

15 mg q daily x 8 weeks

prevacid dose in h. pylori

30 mg BID x 2weeks + 2 antibiotics

aciphex dose

20mg po q daily

nexium dose

20-40mg po q daily

protonix dose

40 mg po q daily x 8-16 weeks

dexilan dose

-30 mg q daily
-60 mg q daily if more erosive

can increase gastrin level while on PPI to around what range

200-300

how long once PPI's are stopped to return to N gastric level

3-5 days

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