Antacids

Reduce the volume of acid secreted into the stomach by competitively binding to parietal cells

Forms a protective barrier over the mucosal lining of the stomach
More effective than H2 Inhibitors for ulcers

1g QID 1hr before meals and at bedtime
Most common side effect is constipation
If you take any other antacids you will want to spread it out by an hour

-They are used with antacids for refractory duodenal ulcer pain.
-Decrease gastric acid and pepsin secretion
-they delay gastric emptying allowing the antacid to remain in the stomach longer

Belladonna
Atropine
Propantheline

Should be taken 30min before meals because it inhibits the acid secreted by eating

Anticholinergics will cause dry mouth, blurred vision, tachycardia, constipation, urinary retention

contraindicated in pts with gastric ulcers (because it delays stomach emptying)

narrow-angle glaucoma
urinary retention

misoprostol (Cytotec) is used for the prevention of gastric ulcers caused by NSAIDs

NSAIDs inhibit prostaglandin synthesis and this prostaglandin deficiency leads to decreased Bicarb and mucous secretion to protect the stomach lining.

Cytotec increases bicarbonate and mucous production to protect the stomach lining.

Misoprostol does have an abortifacient property so make sure no one else takes this medication

Main adverse effects with this are diarrhea and abdominal pain. The diarrhea usually subsides within 2 weeks and if you take it with food that helps minimize it.

200mcg QID with food

1) Medical termination of pregnancy of <49 days in conjunction with mifepristone
2)Cervical Ripening and Labor Induction(except in women with prior cesarean delivery or major uterine surgery)

omeprazole (Prilosec)
Lanzoprazole (Prevacid)
rabeprazole (Aciphex)
pantoprazole (Protonix)
esomeprazole (Nexium)

Binds to the H+/K+ ATPase pump irreversibly shutting off the pump
Should be taken before food. Food activates the pump. Optimal binding when the pumps are actively secreting.

Control symptoms more effectively and heal ulcers faster (trials show 4 wks vs 8 wks with H2 inhibitors)

Should be taken 30-60min before food QAM
Capsules should not be chewed/crushed (DR) but can be sprinkled on foods (applesauce)
Main adverse effects are HA, diarrhea, Abdominal pain

Omeprazole and Sodium Bicarbonate
First PPI approved by the FDA for the reduction in the risk of upper GI bleeding in critically ill patients

Aluminum hydroxide and Magnesium hydroxide
Liquid has more buffering effects, but tablets are more convenient