What is the mechanism of action for antacids and what does that tell us about when to use antacids?
Reacts with hydrochloric acid to form water and respective salt, thereby neutralizing acid.
Does not decreaseacid production.
USE antacids when you already have heartburn.
What other medications (besides antacids) treat mild to moderate GERD?
Histamine (H2) Antagonists
Mainly used for heart-burn (not inflammation or damage)
Does NOT heal the inflammation
What is the mechanism of action for H2 antagonists and what does that tell us about when to take them?
Bind H2 receptors on parietal cellpreventinghistamine-induced activation
Best if taken 30 minutes before a meal
How well do H2 antagonists work?
12 weeks of therapy = symptomatic improvement in 60% of patients
What are the H2 Antagonists?
Which medications treat moderate to severe GERD?
Proton Pump Inhibitors
Shuts off acid productionfor longer periods of time
Protects esophagus so it can HEAL
May also strengthen the LES
What is the proton pump inhibitor mechanism of action and what does that tell us about when to take them?
Blocks the secretion of acid into the stomach by the acid-secretingparietal cells
Take 1 hour before meals
What is an important patient education counseling point for proton pump inhibitors?
Avoid alcohol due to GI irritation
What are the Proton Pump Inhibitors?
What is an ulcer?
Ulcers: break in the lining of the esophagus that occurs in an area of inflammation
How do ulcers form?
Acid reflux into the esophagus damages the cells that line the esophagus.
The body responds with inflammation (esophagitis)
If the damage issevere, an ulcer forms.
May erode into the esophageal blood vessels and give rise to bleeding into the esophagus
What bacteria commonly causes ulcers?
Bacteria that infects the mucus lining of stomach and upper intestines
Commonly cause ulcers, gastritis
2/3 of the world are infected
Most are Asymptomatic
What is a commonly used class of medications that could cause ulcers?
NSAIDS also can cause ulcers: decrease prostaglandins, which increase risk of ulcers.
What are the two primary therapy options for treating H-Pylori?
What types of stimuli will cause nausea and vomiting?
Emetogenic (substance that causes vomiting) stimuli to chemoreceptor trigger zone (CTZ) through blood or CSF
Vestibular stimuli causing motion sickness
Direct irritation of GI tract sending stimuli to vomiting center in brain and CTZ
CNS associated with psychiatric disorders, stress, anticipation
What do pro-motility drugs do?
Increase the pressure in the lower esophageal sphincter (LES) and strengthen the contractions (peristalsis) of the esophagus
Speeds up the emptying of the stomach
Does NOT heal inflammation
When should a patient take a pro-motility agent?
Take 30 minutes before a meals and at bedtime
L.P. a 45 yo male, visits your community
pharmacy today complaining of burning in his chest after eating. He is awaken by the pain at night and wants to know what you can do to fix his problem. What do you recommend for L.P.?
First ask about his diet and recommend any needed changes.
Recommendany other needed lifestyle recommendations.
Recommend an antacid for 2 weeks.
If pain does not subside after 2 weeks, ask which medications he is on.
For severe nocturnal heartburn, recommend an H2 at night and a PPI during the day.