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What three endogenous compounds stimulate the production of gastric acid?
What do prokinetic drugs do related to GI?
Block acetylcholine at the receptors
What to H2 receptor antagonists do related to GI?
block H2 receptors
What receptors is the substance gastrin related to?
gastrin (G) receptors
What 2 intracellular messengers are used to stimulate the H+/K+ ATPase pump?
How does prostoglandin decrease acid production?
Binds to the PgE2 receptors and suppresses the production of C-AMP
What blocks the action of prostoglandin?
Cytologic agents block the prostoglandin receptors
What is ATPace?
and enzyme that produces gastric acid?
- MOA: Neutralize Acid in the GI tract
- Indications: Heartburn, sour stomache, hydperphosphatemia in CKD, hypocalcemia in postmenopause or osteoporosis
examples of antacids?
- Aluminum hydroxide - stays in GI, may have a constipating effect
- Mag hydroxide- Stays in GI, may have a laxative effect
- Calcium carbonate- Strong acid neutralizer, not confined to GI, may cause alkelemia in high doses
- Sodium bicarbonate- Strong acid neutralizer, not confined to the GI, may cause alkelemia in high doses
True or False: Chronic use of Mg or Al based antacids may increase absorption of them?
True, they are not normally absorbed from the GI tract.
How are Ca++ containing antacids secreted from the body?
in the feces
What situation(s) would you want to avoid Ca++ containing antacids?
hypercalcemia or renal calculi
In what circumstances are Al or Mg containing antacids contraindicated?
- Mg-Pt's with RF or Renal insufficiency
- Al-Pt's with RF on dialysis
What are some common interactions antacids have?
- Effects absorption of most drugs
- administration of other drugs should be separated by two hrs
T or F:Antacids should be used for the symptomatic relief of heartburn.
True, not first line for chronic disease
How should antacids be used in Peptic Ulcer disease?
- as adjuncts in treatment
- administration should occur after meals and before bedtime
How should antacids be used in the treatment of GERD?
- maintenance after meals and prior to bedtime
- H2 receptors are first line treatment for GERD
Can Ca++ containing antacids be used for supplementation of Ca++?
- Yes, In CKD 1000 mg daily
- In osteoporosis prevention 1000 mg daily in postmenopausal and men
- -in postmenopausal 1500 mg daily
Are doses of Ca++ greater than 2000 mg/day recommend?
no, only so much can be absorbed
Are there any specific items to monitor when antacids are used by the elderly?
Mg levels in elderly pt's using Mg containing
What drugs should we be more cognizant of deccrease absrtion related to antacid use?
Sezure meds - dilantin and levodopa; Sinimet-alzhmrs, ASA, dig, quinidine, sulfonureas-DM, ticlid-stroke prevention, H2 receptors, TB drugs thyroid meds, ABX Iron
What should we teach pt's about the use of antacids?
- contact provider if used longer than two weeks
- report symptoms of GI bleed
- possible side effects (constipation, diarrhea)
- lifestyle changes to help prevent heartburn
- -smoking, elevate HOB, avoid spicy foods and alcohol; foods that decrease LES tone: chocolate, fatty food, caffeine.
Does diarrhea usually require treatment?