1. Adverse effects of Antacids
    • Diarrhea when taken with magnesium hydroxide.
    • Constipation when taken with aluminum hydroxide.
    • Belching occurs because of CO2 production.
  2. What are the -dines and explain what they do.
    • Cimetidine
    • Ranitidine
    • Famotidine
    • Nizatidine
    •  - Are H2 receptor antagonists, bind to H2 receptors on the parietal cells so when ECL cells releases histamine, there is no effect.
  3. Why do you use the -dines at night?
    Which -dine has adverse effects?
    • Use at night to reduce nocturnal acid secretion, as well as after meals when acid secretion rises.
    • Cimetidine gives some diarrhea, very rare though.
    • Cimetidine also acts as an androgen receptor antagonist, inhibiting estradiol and elevating prolactin.  Gynecomastia and galactorrhea may occur.
  4. Omeprazole
    • Are proton pump inhibitors.
    • They bind irreversibly to proton pumps.
    • One dose/day may inhibit 95% of acid secretion.
    • Use before meals since food in GIT reduces bioavailability.
    • May even have some healing.
    • Drugs of choice for zollinger-ellison syndrome, surgery is best option though.
  5. What are the mucosal protective agents?
    Sucralfate - give 1 hour before meal at least.  Do not give until at least 30 minutes before PPI or H2 antagonist administration as sucralfate needs acid pH.

    Bismuth like agents - similar to sucralfate but also may inhibit pepsin and stimulate mucus and bicarb productin.  Also antibacterial and active against H. Pylori.  Combine with antibiotics, ulcer healing rates up to 98%

    Misoprostol (prostaglandin E1 analog) - inhibits gastric acid secretion.  Prevents ulcers in patients on chronic NSAIDS.  Short t1/2 so requires multiple daily dosing.
  6. Major side effects of Misoprostol.
    Diarrhea, abdominal pain, uterine muscle contraction.  Birth defects and uterine rupture have been reported.  Higher adverse effects than the others.
  7. Treatment of choice for H. Pylori
    PPI plus 2 antibiotics (clarithro and amoxacillin or metronidazole) for 2 weeks.  PPI should be continued for 4-6 more weeks to insure healing.  Remember PPI have a healing action.
  8. Drug of choice for zollinger-ellison syndrome and other hypersecretory pathologies.
    • Surgery is best treatment.  PPI is best alternative treatment.
    • ZES is caused by a gastrinoma in the pancreas or duodenum.  Massive acid secretion results in erosive esophatitis, ulceration, and dietary malabsorption.
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