Ulcers, peptic antacids

Antacids are neutralizing agents. Examples are magnesium hydroxide, magnesium trisylicate and aluminium hydroxide. Prior to the introduction of histamine-H2 receptor antagonists and proton pump inhibitors, they were the standard drugs for the treatment of duodenal/ peptic ulcers. Today their clinical use is limited to the treatment of dyspepsia and the symptomatic relieve for patients with peptic ulcers. 

Chemical changes in the cellular environment include inactivation of cellular functions or the alteration of the chemical components of body fluid, such as a change in the pH. For example, antacids neutralize gastric acidity in patients with peptic ulcers. 

Antiflatulents are used for die relief of painful symptoms of excess gas in the digestive tract. These drugs are useful as adjunctive treatment of any condition in which gas retention may be a problem (ie, postoperative gaseous distention, air swallowing, dyspepsia, peptic ulcer, irritable colon, or diverticulosis). In addition to its use for tiie relief of intestinal gas, charcoal may be used in the prevention of nonspecific pruritus associated with kidney dialysis treatment and as an antidote in poisoning. Simethicone is in some antacid products, such as Mylanta liquid and Di-Gel liquid. 

Take antacids between meals to help prevent peptic ulcer. 

Localised upper abdominal pain is the most common symptom of peptic ulcer disease. The pain is relieved by antacids, proton pump inhibitors and H2 antagonists. The pain may or may not be relieved by food and is often v/orse during the night. Peptic ulceration may be accompanied by occasional vomiting, anorexia and weight loss. Diffuse abdominal pain is not a characteristic symptom of peptic ulcer disease. 

Bismuth, discovered in 1753, has a long history of medical uses ranging from treatment of syphilis and malaria to diarrhea. More recently, antibacterial properties of bismuth-containing antacids have been used to treat peptic ulcers. In general the medical use of bismuth has declined with the advent of new drug therapies. 

Aluminum Hydroxide + Magnesium Hydroxide (Maalox) [OTC] [Antacid/Aluminum Magnesium Salts] Uses Hyper-acidity (peptic ulcer, hiatal hernia, etc) Action Neutralizes gastric acid Dose Adults. 10-20 mL or 2-4 tabs PO qid or PRN Feds. 5-15 mL PO qid or PRN Caution [C, ] Disp Tabs, susp SE May cause t Mg in renal insuff, constipation, D Interactions In addition to AlOH, X effects OF digoxin, quinolones, phenytoin, Fe supl, ketoconazole EMS None OD May cause constipation, loss of appetite, painful urination, heart rhythm changes, muscle weakness, and peripheral edema symptomatic and supportive... 

Calcium Acetate (PhosLo) [Calcium Supplement/ Anti arrhythmic/Mmeral/ Electrolyte] Uses ESRD-associated hyper-phos-phatemia Action Ca " supl w/o aluminum to X P04 absorption Dose 2-4 tabs PO w/ meals Caution [C, ] Contra t Ca Disp Gelcap SE Can t Ca, hypophosphatemia, constipation Interactions t Effects OF quinidine X effects W/ large intake of dietary fiber, spinach, rhubarb X effects OF atenolol, CCB, etidronate, tetracyclines, fluoroquinolones, phenytoin, Fe salts, thyroid hormones EMS Pts have reduced renal Fxn, monitor ECG for signs of electrolyte disturbances OD S/Sxs of hypercalcemia (confusion, weakness, GI upset, constipation, N, V, and cardiac arrhythmias) give IV fluid for diuresis symptomatic and supportive Calcium Carbonate (TumS/ Alka Mints) [Antacid/ Calcium Supplement/Mineral/ Electrolyte] [OTC] Uses Hyperacidity associated w/ peptic ulcer Dz, hiatal hernia, etc Action Neutralizes gastric acid Dose 500 mg—2 g PO PRN -1- in renal impair Caution [C, ] Disp Chew tabs, susp SE t -1- PO constipation Interactions X Effect OF tetracyclines, fluo-... 

Uses Acute chronic gout Action X Renal tubular absorption of uric acid Dose 100-200 mg PO bid for 1 wk, T PRN to maint of 200—400 mg bid max 800 mg/d take w/ food or antacids plenty of fluids avoid salicylates Caution [C (D if near term), /-] Contra Renal impair, avoid salicylates peptic ulcer blood dyscrasias, near term PRG, allergy Disp Tabs, caps SE N/V, stomach pain, urolithiasis, leukopenia Interactions T Effects OF oral anticoagulants, oral hypoglycemics, MTX X effects W/ ASA, cholestyramine, niacin, salicylates, EtOH X effects OF acetaminophen, theophylline, verapamil EMS T Effects of anticoagulants and oral hypoglycemic X effects of verapamil OD May cause N/V, loss of coordination, dyspnea, Szs symptomatic and supportive... 

ANTACIDS. These are formulations widely used in the treatment of excessive gastric secretions and peptic ulcer. Several factors determine the efficacy of antacids, including (1) tile ability and capacity of the stomach to secrete add 12) the duration of lime the antacid is retained in the stomach and (3) the nature of tile gastric response upon eating. 

Meadowsweet is reputed to have stomachic, mild urinary antiseptic, antirheumatic, astringent, and antacid properties. Traditionally, it has been used for atonic dyspepsia with heartburn and hyperacidity, acute catarrhal cystitis, rheumatic muscle and joint pains, diarrhea in children, and specifically for the prophylaxis and treatment of peptic ulcers. 

Q12 Pharmacological treatment of peptic ulcers aims to restore the balance between mucosal defence and mucosal damage by acid and pepsin in the stomach wall. The general mechanisms of drug action include (i) inhibition of acid secretion, (ii) neutralization of the acid with antacid preparations, (iii) eradication of H. pylori with antibiotics and (iv) enhancement of the mechanisms which protect the mucosa. 

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