ppi

• Proton Pump Inhibitors (PPIs)

  • Nexium
  • Exonar
  • Eso Tad
  • Esomeprazole
• Esomeprazole


  Irreversibly blocking of the H+/K+ ATPase enzyme or the gastric proton pump, which is found within the parietal cells of the stomach and is the final step of acid production
• Main Side Effects of PPIs

  • Headache
  • Dizziness
  • Nausea
  • Diarrhea
  • Constipation
  • Flatulence
• Prolonged Side Effects of PPIs

  • Osteopenia
  • C. difficile infection
  • Increased LFT (mild)
  • Respiratory infections
• Esomeprazole


  Less drug-drug interactions compared to omeprazole
• Polymorphic gene variation ("slow versus rapid metabolizers") affects PPI metabolism
• Other PPI Brands


  • Gastrimut
  • Gastrisec
  • Risek
  • Ulcesep
  • Omeprazole
• Lansoprazole Brands


  • Lansazol
  • Peptazole
  • LPZ-30
• Pantoprazole Brands


  • Gastropan
• Rabeprazole Brands


  • Pariet
  • Razole
• Dexlansoprazole


  ADV can be taken without regards to meals (even with food)
• H2 Blockers


  • Famodar
  • Axid
  • APO-Ranitidine
  • Zantac
• Famotidine

  Inhibit histamine stimulation of the gastric parietal cell, most effective in suppressing nocturnal acid secretion
• H2 Blocker Side Effects

  • Headache
  • Dizziness
  • Fatigue
  • Somnolence
  • Confusion
  • Gynecomastia
• H2 blockers may develop tachyphylaxis with prolonged use, so they are used for short-term courses
• Cimetidine has the most drug-drug interactions, is a potent CYP3A4 inhibitor, and can cause QT prolongation
• Antacids


  • Maalox
  • Maalox Plus
  • Gaviscon
  • Rennie
  • Diovol Plus
• Maalox


  Aluminum hydroxide and magnesium hydroxide, neutralize acid and raise intra-gastric pH, which results in decreased activation of pepsinogen and increased LES pressure, decrease absorption of agents requiring acid
• Antacid Side Effects


  • Constipation (by aluminum and calcium salts)
  • Diarrhea (by magnesium salts)
  • Bone demineralization
  • Electrolyte imbalances
  • Neurotoxicity (with aluminum containing antacids)
• Antacids should be taken 1 hour before and 4 hours after other medications that require an acidic medium
• In renal disease, antacids containing magnesium and aluminum can accumulate and cause neurotoxicity</b>
• Maalox Plus


  Contains dimethicone for bloating, aluminum hydroxide, and magnesium hydroxide
• Gaviscon Components


  • Sodium alginate
  • Sodium bicarbonate
  • Calcium carbonate
• Gaviscon can increase levels of digoxin and decrease levels of some HIV medications
• Antacids can decrease absorption of drugs requiring an acidic medium, so they should be spaced by 2 hours
• Antacids are used for symptomatic relief, not as a cure
• Prostaglandin Analogues


  • Cytotec (Misoprostol)
• Misoprostol


  E1 analogue, stimulation of prostaglandin receptors in the stomach reduces gastric acid secretion, while stimulating these receptors in the uterus and cervix can increase the strength and frequency of contractions and decrease cervical tone
• Misoprostol Side Effects


  • Diarrhea
  • Nausea
  • Vaginal bleeding or spotting for pregnant women
  • Abdominal cramping
  • Abortion (abortifacient)
• Misoprostol is used intravaginally and orally to stimulate contraction of uterus and promote labor and cervical ripening
• Misoprostol should be taken with meals and at bedtime
• Antacids may enhance the adverse/toxic effects of misoprostol, especially magnesium-containing antacids increasing the risk of diarrhea
• Avoid concomitant use of misoprostol and magnesium containing antacids
• Mucosal Protectants


  • Sucrate gel
  • Ulcar (Sucralfate)
• Sucralfate


  Locally acting substance that in an acidic environment (pH < 4) reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose, binds to gastric mucosa to form a protective layer
• Sucralfate Side Effects


  • Constipation
  • Dry mouth
  • Black stool
  • Diarrhea
  • Blockage of the intestinal track
  • Nausea
  • Vomiting
  • Upset stomach
  • Itching
  • Rash
  • Dizziness
  • Drowsiness
  • Bezoar formation clogging in stomach
  • Sleep problems
• Sucralfate should be taken with water and fibers