Module 5 -2 Flashcards
what are the three common forms of ARD?
Acid-related disorders (ARD)
- Dyspepsia - which is indigestion
- Heartburn - combination of acid + GERD
- Inflammation/Ulceration of the stomach lining by the proteolytic enzyme pepsin called PUD
these diseases are caused from over production of stomach acid
What are the contributing factors to GERD?
- aspiring and other NSAID use
- alcohol, cigarettes and caffeine
- H. pylori bacterial infection
- stress - both severe psychological and traumatic physical contributing factors worsening any of the ARDS
Drug therapy for ARD
- Oral antacids (tablets or liquids)
- they all neutralize excess HCL to varying degrees; calcium antacids can have the added benefit of supplementing those who need extra calcium in their diet (against osteoporosis)
1. aluminum and calcium antacids
2. magnesium salts like milk of magnesia
3. calcium salts like Tums - by combining various antacids the manufactures have tried to cut down on the tendency of single formulations to either produce loose stools or constipation(AL salt are constipating and Mg salts are laxating)
- Baking soda - very effective remedy but causes an acid rebound a few hours later
- simethicone is used for “gas”
- H2 blockers (1977) followed a little later by proton pump inhibitors
H2 Blockers
changed the entire face of ARD treatment. are antihistamines which work on the Histamine 2 rc rather than the Histamine 1 rc.
* Tagamet (cimetidine) introduced in 1977, was the first superstar drug of this class
ranitidine (Zantac)
H2 blockers drug to treat ARD - were introduced as $$$ Rx but now available OTC
Famotidine (Pepcid)
H2 blockers drug to treat ARD - were introduced as $$$ Rx but now available OTC
Proton Pump Inhibitors (PPIs)
are another way to decrease stomach acid, this time by shutting down the proton pump (H+ pump located in the stomach’s parietal cells) that puts the hydrogen in hydrochloric acid
PPIs drugs
- Prilosec (omeprazole) - first came to the market in 1988
- Prevacid (lansoprazole)
- Nexium (esomeprazole) - the purple pill
H2 blockers and PPIs drugs
are safe, reliable OTC remedies
What are the three rc that is activated will cause the release of stomach acid?
- Cholinergic - Acetycholine
- Gastrin
- Histamin type 2
Combination drugs for ARD
Pepcid complete (famotidine + Ca carbonate + Mg hydroxide)
but taking H2 blockers with PPIs can cause the condition called “Atrophic gastritis” - smooth lining of the stomach can be pre-cancerous
H. Pylori
Helicobactor Pylori is a bacterium which is highly associated with the development of Peptic Ulcers.
Treatment requires multiple antibiotics combined with either a PPI / H2 blocker and /or bismuth subsalicylate (Pepto-Bismol)
is now known to increase the amount of inflammation in the mucosal lining where it colonizes, thereby eroding the protective mucous barrier and exposing the underlying tissues to the harmful effects of the acid digestion. Through this combination of factors the stomach lining becomes damaged to the point of forming erosions, or ulcerations.
H. Pylori ulcerations
Not only do the ulcers cause pain and gastrointestinal distress, but they can bleed, sometimes silently, and sometimes very precipitously, requiring immediate blood transfusions and surgery to save the patient.
H. Pylori tests
H. pylori antibody test H. pylori antigen test H. pylori breatjh test CLO test Rapic urease test (RUT) for H. pylori
Combo drug to treat H. Pylori infections
PrevPac - blister pack combination of 3 drugs amoxicillin /clarithromycian and lansoprazole (Prevacid)
