NTA Level 4 • Semester 2 • PST04211

Description of Antiacids and Antiulcer Drugs

Basic Pharmacology • Source Session/Topic 20

Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability.

Session 20: Description of Antiacids and Antiulcer Drugs

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Outline indications of antacids and antiulcer drugs

• List contraindication of antacids and antiulcer drugs

• Describe dose, dosage and course of antacids and antiulcer drugs

• List side effects and adverse effects of antacids and antiulcer drugs

• Describe interaction and precaution of antacids and antiulcer drugs

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Overhead projector and computer

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Objectives

Presentation/

2 20 minutes Indications of Antacids and Antiulcer Drugs

Buzzing

Presentation/ Contraindications of Antacids and Antiulcer

3 15 minutes

Brainstorming Drugs

Dose, Dosage and Course of Antacids and

4 30 minutes Presentation

Antiulcer Drugs

Presentation/ Side Effects and Adverse Effects of Antacids

5 20 minutes

Brainstorming and Antiulcer Drugs

Interactions and Precautions of Antacids and

6 20 minutes Presentation

Antiulcer Drugs

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

121

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Objectives (5 minutes)

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of Antacids and Antiulcer Drugs (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the indications of antacids?

• What are the indications of antiulcer drugs?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

• Antacids

o Antacids are weak bases that react with gastric hydrochloric acid to form a salt and

water

o Antacids have been used for centuries in the treatment of acid-peptic disorders

o Antacids (usually containing aluminium or magnesium Compounds) can often relieve

symptoms in ulcer dyspepsia and in non-erosive gastro-oesophageal reﬂux

o Antacids are also sometimes used in functional (non-ulcer) dyspepsia

o Aluminium hydroxide is used in management of dyspepsia and hyperphosphatemia

o Magnesium trisilicate is used in management of dyspepsia

• Anti-Ulcer Drugs

o Histamin (H2-receptor) antagonists (e.g. cimetidine, famotidine and ranitidine)

 These drugs are indicated for gastroesophageal reflux disease (GERD), peptic

ulcer disease, non-ulcer dyspepsia, acute gastritis, Zollinger-Ellison Syndrome

and prevention of bleeding from stress-related gastritis

o Proton Pump Inhibitors (PPI) (e.g. Omeprazole and Lansoprazole)

 These drugs are indicated for gastroesophageal reflux disease (GERD), H pylori-

associated ulcers, NSAID-associated ulcers, Prevention of re-bleeding from peptic

ulcers, nonulcer dyspepsia, acute gastritis, prevention of stress-related mucosal

bleeding, gastrinoma and other hypersecretory conditions

o Drugs for Treatment of Helicobacter Pylori

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

122

 Omeprazole + Amoxycillin + plus Metronidazole

 Lansoprazole + Clarithromycin + plus Tinidazole

 Then Lansoprazole for one month

STEP 3: Contraindications of Antacids and Antiulcer Drugs (15 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are the Contraindication of antacids and antiulcer drugs?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

• Antacids

o Magnesium Carbonate is contraindicated in hypophosphatemia

o Magnesium trisilicate is contraindicated in hypophosphatemia

o Aluminium hydroxide is contraindicated in hypophosphatemia, neonates

o and infants

o Both magnesium and aluminum are absorbed and excreted by the kidneys. Hence,

patients with renal insufficiency should not take these agents long-term

STEP 4: Dose, Dosage and Course of Antacids and Antiulcer Drugs (30

minutes)

• Antacids

o Magnesium trisilicate 250 mg 1–2 tablets chewed when required

o Magnesium Trisilicate Mixture/ Suspension 5% each of magnesium trisilicate,10–20

mL in water 3 times daily or as required

o Dried aluminium hydroxide 220 mg/5 Ml: 10–20 mL 3 times daily, 20–60 minutes

after meals, and at bedtime or when required

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

123

• Antiulcer Drugs

H-2 Antagonists

o Cimetidine 400 mg twice daily (with breakfast and at night) or 800 mg at night

(benign gastric and duodenal ulceration) for at least 4 weeks (6 weeks in gastric

ulceration, 8 weeks in NSAID-associated ulceration). When necessary the dose may

be increased to 400 mg four times daily

o Cimetidine is used in Prophylaxis of stress ulceration, 200–400 mg every 4–6 hours

o Ranitidine is administered as 150 mg twice daily or 300 mg at night for 4–8 weeks in

benign gastric and duodenal ulceration, up to 6 weeks in chronic episodic dyspepsia,

and up to 8 weeks in NSAID-associated ulceration

o In duodenal ulcer 300 mg Ranitidine can be given twice daily for 4 weeks to achieve a

higher healing rate

• Proton Pump Inhibitors

o Lansoprazole in Benign gastric ulcer, 30 mg daily in the morning for 8 weeks

o Lansoprazole in Duodenal ulcer, 30 mg daily in the morning for 4 weeks;

maintenance 15 mg daily

o Lansoprazole NSAID-associated duodenal or gastric ulcer, 30 mg once daily for 4

weeks

o Lansoprazole when used in eradication of Helicobacter pylori associated with

duodenal ulcer see eradication regimens below

o Omeprazole when used benign gastric and duodenal ulcers,20 mg once daily for 4

weeks in duodenal ulceration or 8 weeks in gastric ulceration; in severe or recurrent

cases increase to 40 mg daily; maintenance for recurrent duodenal ulcer, 20 mg once

daily

o Omeprazole when used for NSAID-associated duodenal or gastric ulcer and gastro

duodenal erosions, 20 mg once daily for 4 weeks, continued for further 4 weeks if not

fully healed

o Omeprazole in Duodenal or benign gastric ulcer associated with Helicobacter pylori,

see eradication regimens on below

• Drugs for Treatment of Helicobacter Pylori

o Omeprazole 40mg once daily+ Amoxycillin 500mg 8 hourly + plus Metronidazole

400mg 8 hourly for 7 days

o Lansoprazole 30mg once daily+ Clarithromycin 250mg 12 hourly + plus Tinidazole

500mg once daily for 7 days

o Then Lansoprazole 30mg once daily for one month

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

124

STEP 5: Side Effects and Adverse Effects of Antacids and Antiulcer Drugs

(20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are side effects and adverse effects of antacids and antiulcer drugs?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Antacids

• Constipation (Aluminium hydroxide) e may produce

• Diarrhoea (magnesium hydroxide)

• Sodium bicarbonate (systemic alkalosis and liberate Co2 causing belching and

flatulence)

Antiulcer Drugs

H2-Receptor Antagonists (e.g. cimetidine, famotidine and ranitidine)

• H2 antagonists are safe drugs (with an exception of cimetidine to some extent)

Adverse effects occur in fewer than 3% of patients and include diarrhoea, headache,

fatigue, myalgias, and constipation

• Mental status changes (confusion, hallucinations, agitation) may occur with

administration of intravenous H2 antagonists, especially in patients in the intensive

care unit who are elderly or who have renal or hepatic dysfunction. These events may

be more common with cimetidine

• Cimetidine when used long-term or in high doses, it may cause gynecomastia or

impotence in men and galactorrhea in women

• Alopecia may occur though rarely with cimetidine

• Rapid intravenous infusion may cause bradycardia and hypotension through blockade

of cardiac H2 receptors; therefore, intravenous injection should be given over 30

minutes

Proton Pump Inhibitors (PPI) (e.g. Omeprazole and Lansoprazole)

• Proton pump inhibitors are extremely safe and well tolerated. Diarrhoea, headache

and abdominal pain are reported in 1-5% of patients

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

125

STEP 6: Interactions and Precautions of Antacids and Antiulcer Drugs (20

minutes)

Antacids

• It is usually advisable to avoid concurrent administration of antacids and other drugs.

• By altering gastric and urinary pH or delaying gastric emptying, antacids can affect

rates of dissolution and absorption, bioavailability, and renal elimination of many

drugs

• By binding to drugs (for example, tetracycline), Aluminium compounds can form

insoluble complexes that are not absorbed

• On the other hand, antacids can increase the rate of absorption of some drugs, for

example levodopa

Antiulcer Drugs

H2-Receptor Antagonists (e.g. cimetidine, famotidine and ranitidine)

• Cimetidine can slow metabolism (and thus potentiate the action) of several drugs

(for example; warfarin, diazepam, phenytoin, quinidine; carbamazepine,

Theophylline, imipramine), sometimes resulting in serious adverse clinical effect

• Negligible interaction occurs with nizatidine and famotidine

• H-2 antagonists compete with certain drugs (e.g. procainamide) for renal tubular

secretion

• All of these agents except famotidine inhibit gastric first-pass metabolism of ethanol,

especially in women resulting to increased bioavailability of ethanol thus increased

blood ethanol levels

• H2-antagonists should not be administered to pregnant women unless absolutely

necessary

• The H2 antagonists are secreted into breast milk and may therefore affect nursing

infant

Proton Pump Inhibitors (PPI) (e.g. Omeprazole and Lansoprazole)

• Omeprazole interferes in the oxidation of warfarin, phenytoin, diazepam and

cyclosporine

• Lansoprazole is associated with minimal drug interactions

STEP 7: Key Points (5 minutes).

• Common antacids used are Magnesium trisilicate, magnesium hydroxide and aluminium

hydroxide

• Common Antiulcer drugs used are H-2 antagonists (mainly cimetidine and ranitidine) and

Proton pump inhibitors (particularly omeprazole and lansoprazole)

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

126

• Antiulcer Drugs are associated with significant drug interactions

• Antacids and Cimetidine may have serious adverse effects

• Special precaution may be needed when using Antacids and antiulcer drugs

STEP 8: Evaluation (5 minutes)

• What are the indications of antacids and antiulcer drugs?

• What are the contraindications of antacids and antiulcer drugs?

• Describe dose, dosage and course of cimetidine, omeprazole, lansoprazole and antacids.

• What drugs are used in the treatment regimen for eradication of?

• How are do we describe the dose, course and dosage for eradication of Helicobacter

Pylori in patients with ulcers

• What are side effects and adverse effects of antacids and antiulcer drugs?

• What are the interactions of Antacids and Antiulcer drugs?

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

127

References

Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines &

National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam,

Tanzania government printers.

Robert, L. T., Gary, C.Y., Gary, R.M, Barbara, G. W., Michael, L. (2014).

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill

Education.

Sally S.R, & Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed)

New York, Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook (2nd ed.).

Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: The Extra

Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary

(59th ed). London, BMJ Group and RPS Publishing.

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

128

← Previous Topic Next Topic →View all Basic Pharmacology topics Open Complete Full Notes

PDF / OFFLINE NOTES

Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP

WhatsApp: 255620339260