EBL W3 - Acid-suppressing medicines

Question 1

What does GORD stand for

Answer 1

Gastroesophageal reflux disease

Question 2

define GORD

Answer 2

• Inappropriate relaxation of the lower oesophageal sphincter (LOS) → reflux of stomach contents.
• Hydrogen ions damage the oesophageal mucosa → inflammation

Question 3

contributing factors of GORD

Answer 3

Obesity

High-fat diet

Alcohol, coffee, chocolate, smoking

Pregnancy

Question 4

Symptoms in GORD

Answer 4

Retrosternal heartburn

Acid regurgitation

Cough

Bloating

Painful swallowing (possible)

Question 5

why is ranitidine (H2 receptor antagonist) no longer available

Answer 5

Contaminated with NDMA, a probable human carcinogen.

NDMA forms due to instability of ranitidine in heat/acidic conditions.

Decomposition is time and temperature dependent

Question 6

dual mechanism of Gaviscon

Answer 6

1. Antacid Component (e.g. potassium bicarbonate):

• Neutralises gastric acid → symptom relief

2, Alginate Component (from brown seaweed):

• In low pH (~2), alginate precipitates and forms a raft over stomach contents.
• Cross-linked by calcium → physically blocks acid reflux

Question 7

Non-Pharmacological Advice for GORD

Answer 7

🥗 Diet:
Avoid triggers: spicy food, citrus, chocolate, caffeine, fatty meals

Eat smaller meals

No food 2–3 hours before bed

🧍 Lifestyle:
Weight loss (BMI = 32 → obesity contributes to reflux)

Avoid alcohol (especially in evenings)

Manage stress

Elevate head of bed during sleep

Question 8

chemical structure of Lansoprazole

Answer 8

• Similar core structure to omeprazole which contains a pyridine ring and a benzimidazole ring connected via a sulfoxide bridge.
• differs in substituents on the pyridine and benzimidazole rings

Question 9

mechanism on lansoprazole

Answer 9

Also a prodrug → activated in acidic environment → binds irreversibly to proton pump.

Question 10

key feature of all PPIs

Answer 10

All PPIs share the sulfoxide linkage