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77 terms

Pharm 3-Antacids & H2 blockers/PPI

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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