Common stomach acid problems
- GERD
- Heartburn
- Erosive espophagitis
- Ulcers
What causes stomach acid problems?
- helicobactor pylori (bacteria causes 60-75% of ulcers)
- NSAIDs
- Gastric Acid
- Pepsin
- Smoking
Does alcohol cause stomach acid problems?
no
Does spicy food cause stomach acid problems?
no
Does stress/anxiety cause stomach acid problems?
no
Antiulcer Medication Classes
- Proton Pump Inhibitors (-prazole)
- Histamine 2 blockers (-tidine)
- Sucralfate
- Antacids
Major Proton Pump inhibitors
- OmePRAZOLE
- EsomePRAZOLE
- PantoPRAZOLE
- LansoPRAZOLE
- DexlansoPRAZOLE
Adverse effects of Proton Pump Inhibitors
very well tolerated
Acid rebound is a problem (can persist for several months)
How do you prevent Acid Rebound when discontinuing a proton pump inhibitor
- taper off
- take an Antacid or H2 Blocker (-tidine)
What are some controversial adverse effects of proton pump inhibitors?
- Pneumonia
- Clostridium difficile
- Nutritional deficits (vit. B12, Fe3+, Mg2+, Ca2+)
- Osteoporosis/fractures
When should a proton pump inhibitor be taken?
before breakfast
Teaching regarding Proton Pump Inhibitors?
Take before breakfast
Don’t crush (delayed release)
Major Histamine-2 Blockers.
famoTIDINE
raniTIDINE
Adverse effects of H-2 Blockers
- Tolerance
- Rebound Effect
- Confusion (if levels are too high)
Teaching regarding H-2 Blockers?
separate antacids (1 hour)
—– works by creating a protective barrier over the ulcer. (think pepto bismal commercial)
sucralfate
- requires pH
—- work by raising stomach pH and require frequent dosing.
antacids
—– lead to frequent electrolyte and pH changes.
antacids
Which receptors do antacids work on?
none, they are receptorless drugs
GERD means:
Gastro-esophogeal Reflex Disease
In GERD and Erosive Esophagitis, what is the cause?
cardiac sphincter (upper stomach sphincter) fails and stomach acid backs up into esophagus (Barrett’s Esophagus)
Which bacteria causes most ulcers?
helicobactor pylori
causes 60-75% of ulcers
Is there any difference b/t esomeprazole and omeprazole?
no, they just changed the name to lengthen the patent and make $$
MOA: Stomach Acid
Gastrin activates —— receptors and also causes —– cells to activate —— receptors. These actions cause —— to work, increasing stomach —- and decreasing stomach ——.
CCK2 ECL Cells Histamine 2 H+/K+ ATPase pump increasing H+ (acid) decreasing K+
MOA: Proton Pump Inhibitors (-prazole)
Blocks the ———– pump, decreasing —– in the stomach, thereby lowering stomach —–.
H+/K+ ATPase pump
decreasing H+
lowering stomach acid
Why is a -prazole drug better than a -tidine drug?
- prazole blocks the H+/K+ ATPase pump (irreversably)
- tidine only blocks H2 receptors (CCK2 receptors can still be activated and pump can go on)
Main adverse effect of -prazole (Proton Pump Inhibitor).
Acid Rebound (b/c we’ve been hitting brakes so hard)
Main adverse effect of -prazole drugs is —– —–.
How is it managed?
Acid Rebound
Managed by:
- tapering off (instead of cold turkey)
- antacid or H2 blocker (-tidine)
How long will the -prazole drug adverse effect of —– —— last?
Acid Rebound
can last for several months
What are the controversial effects of -prazole drugs (Proton Pump Inhibitors)?
- Pneumonia
- Clostridium difficile (bacteria that causes really bad diarrhea)
- Nutritional deficits
- Osteoporosis/fractures
These are controversial b/c most patients on PPI are in ICU, and they already had these types of issues to begin with
How often, and at what times, should a -prazole be taken?
Q day
Breakfast so that it is ready to act when the stomach gets first meal of the day
Patient teaching about -prazole meds?
- Don’t crush (they are delayed release)
- Once a day BEFORE breakfast (to maximize effect)
Why do we want to take -prazole med before breakfast?
it takes 1-2 hours to reach peak effect and the drug can only block the H+/K+ ATPase pump when it’s pumping (ie: when there is food in the stomach)
TOLERANCE is an issue w/ which antiulcer meds?
Histamine 2 Blockers (-tidine)
because body adjusts and just activates the CCK2 receptor more, eventually recovering to full stomach acid production
REBOUND EFFECT is an issue w/ which antiulcer meds?
- prazole (Proton Pump Inhibitors)
- tidine (H2 Blockers)
Why? remember the BRAKES have been pressed and now they are removed and the body is responding overzealously
How long should you separate a -tidine from an antacid?
~ 1 hr
antacids decrease absorption of -tidines, thus take -tidine an hour before gives it time to absorb
Which med cannot be take with an antacid?
sucralfate
it won’t work if taken w/ an antacid b/c antacids raise pH and sucralfate requires a pH
Which drug can only be given at a specific pH range?
sucralfate
requires pH
What does sucralfate do and how long does it last?
puts a protective layer (like pepto bismol commercial) over an ulcer
lasts ~ 6 hrs
Rolaids and Tums are examples of —– and they work by —– stomach pH.
Antacids
raising stomach pH
—— are receptorless drugs that work by —— stomach ——-
Antacids
raising
pH
—— can cause systemic —– in pH, which means what?
Antacids
systemic rise in pH
can eventually lead to metabolic alkalosis
