Acid Related Disorders (OTC Treatment)

Acid Related Disorders

  • Peptic Ulcer Disease (PUD)
    • Disruption of the upper GI lining (mucosa) that must be diagnosed by a physician
    • Characterized by possible blood in vomit or stool (GI bleeding)
    • Usually caused by bacteria
    • Treated w/ H2 antagonists & antacids
  • Heartburn
    • Burning, pain in esophagus (upper GI as opposed to peptic ulcer which is lower GI)
    • Major symptom of GERD
    • Treat w/ antacids, milk of magnesia, PPIs, pepto-bismol
  • Indigestion is a general term that describes discomfort in your upper abdomen
    • It’s not a disease but is characterized by bloating, belching & nausea
  • GERD
    • Frequent or constant heartburn
    • Symptoms:  more severe or persistent burning in the chest
    • Can be treated OTC if its occasional or mild
      • CAN’T be treated if heartburn is frequent & persistent
    • GERD is due to an open lower esophageal sphincter
    • Causes: eating fatty meals, caffeine, tea, chocolate, lack of exercise, smoking, PUD, gastroparesis, drugs
      • Some drugs that can cause heartburn (dyspepsia):  Ca channel blockers, tricyclic antidepressants, opioids, theophylline, valium
  • Antacids
    • Mg, Al, Ca, Na bicarb, magaldrate (Mg + Al)
      • Constipation may be caused by Al or Ca
      • Diarrhea may be caused by Mg  (this is why Milk of mag has a duel effect as an antacid and laxative)
        •  combo antacid products are used to counteract diarrhea and constipation
      • Gas/bloating can be caused by any antacid
    • Neutralize stomach pH (raise pH)
    • Provide rapid relief but have a short duration of action
    • People with impaired renal function are at risk
    • May act as a chelator and reduce the absorption of certain drugs  (tetracyclines, quinolones)
    • May cause a problem for some drugs that require a low pH for absorption (iron, ketoconazole, itraconazole)
      • Want to separate the antacid from the drug by 2 or more hours
    • Enteric coated drugs may have a premature release due to the use of antacids (due to the higher pH)
  • H2RAs
    • Cimetidine (tagamet HB), famotidine (pepcid), nizatidine (axid AR), ranitidine (zantac)
      • Cimetidine has the most drug-drug interactions than the other H2RAs b/c it binds to 3A4, 2D6, 2C9 & 1D2
      • Pepcid complete is a combo product of H2RAs and antacids
    • Bind to H2 receptors on parietal cells in the stomach & prevent the release of acid (doesn’t affect existing acid like antacids)
    • Doesn’t completely block all pathways to acid release
    • Used to prevent/relieve heartburn associated with acid indigestion and sour stomach (may be associated with eating or drinking certain foods or beverages)
      • Must take 30 min before eating certain products in order to prevent or at the time of onset of symptoms to relieve
    • Takes longer to work than antacids but also lasts longer
    • Side effects of H2RAs are generally rare
    • Elderly are at risk and people w/ liver or kidney problems may require dosage reduction
  • PPIs
    • Omeprazole, lansoprazole
    • Irreversibly blocks the final step of gastric acid secretion at the proton pump
      • Block acid production (& allow esophageal tissue to heal)
    • Most potent & prolonged antisecretory effect of all antacids
    • Used for the treatment of frequent heartburn > 2(+) days a week
      • Not intended to get immediate relief, PPI’s take 1-4 days to achieve full effect
    • PPIs may interfere with some drugs that require low pH for absorption (like antacids) (ex.  Iron, B12, ketoconazole, etc)
    • Ppl w/ heartburn or stomach pain for over 3 months are at risk or heartburn with lightheadedness or dizziness
      • Or heartburn w/ wheezing or unexplained weight loss, n/v
    • Don’t take for more than 14 days or repeat regimen more often that q 4 months
    • Some PPIs (like zegerid) are administered with sodium bicarb in order to raise the pH of the stomach and prevent the omeprazole
    • All PPIs besides rabeprazole are metabolized by CYP
    • Rebound acid reflux is possible upon the discontinuation of PPIs
  • Anti-Gas
    • Simethicone (mylicon, phazyme) & alpha-galactosidase (beano)
      • Simethicone reduces surface tension on existing bubbles allowing them to burst and release gas  (doesn’t prevent gas)
      • Alpha-galactosidase prevent gas formation by rupturing (hydrolyzing) polysaccharides before the bacteria do & create gas
        • May increase the amount of sugar absorbed by ppl possibly causing a problem for diabetics
  • Bismuth Subsalicylate (pepto-bismol)
    • Antisecretory via stimulation of Na and Cl reabsorption & inhibition of gastric prostaglandins
    • Used as an antacid, antidiarrheal and for indigestion
    • May cause black stools or a black tongue
    • Anyone with an allergy to salicylates is at risk when taking Pepto
      • Children are particularly at risk due to the possibility of the development of Reye’s Syndrome

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