1. SUBTOPICS: ANTACIDS AND DRUGS USE TO TREAT IBD
GROUP PARTICIPANTS:
AMMAR HUSSAIN (PHM-073)
MUHAMMAD ZAID (PHM-091)
ROMAN AHMAD (PHM-078)
USMAN FAROOQ (PHM-089)
BIBI TAZEEM (PHM-076)
KHIZAR MASOOD (PHM-109)
2. • Antacids have been used for centuries in the
treatment of patients with dyspepsia and acid-peptic
disorders.
• Antacids are weak bases that react with gastric
hydrochloric acid to form a salt and water.
• They continue to be used commonly by patients as
nonprescription remedies for the treatment of
intermittent heartburn and dyspepsia.
3. • The antacids act by neutralizing the acid in the
stomach and by inhibiting pepsin, which is a
proteolytic enzyme.
• Each of these cationic salts has a
characteristic pharmacological property that
determines its clinical use.
• The main therapeutic objectives are:
• Alleviating pain
• Relieving pylorospasms
• Avoid digestion and corrosion by acid chyme
4. • Antacids have therapeutic use for the following.
• Heartburn symptoms in GERD
• Duodenal and gastric ulcers
• Stress gastritis
• Pancreatic insufficiency
• Non-ulcer dyspepsia
5. • Sodium bicarbonate reacts rapidly with hydrochloric
acid (HCL) to produce carbon dioxide and sodium
chloride. Formation of carbon dioxide results in
gastric distention and belching.
• Calcium carbonate is less soluble and reacts more
slowly than sodium bicarbonate with HCl to form
carbon dioxide and calcium chloride (CaCl2 ). Like
sodium bicarbonate, calcium carbonate may cause
belching or metabolic alkalosis.
6. • Formulations containing magnesium hydroxide or
aluminum hydroxide react slowly with HCl to form
magnesium chloride or aluminum chloride and water.
7. • All antacids may affect the absorption of other
medications by binding the drug (reducing its absorption)
or by increasing intragastric pH so that the drug’s
dissolution or solubility (especially weakly basic or acidic
drugs) is altered.
• Therefore, antacids should not be given within 2 hours of
doses of tetracycline, fluoroquinolones, itraconazole, and
iron.
• PROLONGE USE CAUSES:
• Acid rebound: Antacids cause your body to produce more
acid, which worsens symptoms.
• Microcytic anemia: Iron deficiency.
8. • Inflammatory bowel disease (IBD) comprises two distinct
disorders: ulcerative colitis and Crohn’s disease.
• The etiology and pathogenesis of these disorders remain
unknown.
• For this reason, pharmacologic treatment of inflammatory
bowel disorders often involves drugs that belong to
different therapeutic classes and have different but
nonspecific mechanisms of anti-inflammatory action.
• Drugs used in inflammatory bowel disease are chosen on
the basis of disease severity, responsiveness, and drug
toxicity.
9. • Drugs that contain 5-aminosalicylic acid (5-ASA) have
been used successfully for decades in the treatment
of inflammatory bowel diseases.
• These include sulfasalazine, olsalazine, balsalazide,
and various forms of mesalamine.
• Mechanism of Action: The aminosalicylates may
maintain remission in inflammatory bowel disease
by preventing leucocyte recruitment into the bowel
wall.
10. • CLINICAL USES:
• 5-ASA drugs induce and maintain remission in ulcerative
colitis and are considered to be the first-line agents for
treatment of mild to moderate active ulcerative colitis. Their
efficacy in Crohn’s disease is unproven, although many
clinicians use 5-ASA agents as first-line therapy for mild to
moderate disease involving the colon or distal ileum.
• ADVERSE EFFECTS:
• Overall, aminosalicylates are well tolerated and safe. All 5-
ASA agents may cause headache, nausea, abdominal pain
and cramping, loss of appetite, vomiting, rash, or fever. In
addition, 5-ASA agents may cause diarrhea (less than 1% of
users), which may be difficult to distinguish from increased
IBD activity.
11. • In gastrointestinal practice, prednisone and
prednisolone are the most commonly used oral
glucocorticoids. These drugs have an intermediate
duration of biologic activity allowing once-daily
dosing.
• CLINICAL USES:
• Glucocorticoids are commonly used in the treatment
of patients with moderate to severe active
inflammatory bowel disease. Active disease is
commonly treated with an initial oral dosage of 40–
60 mg/d of prednisone or prednisolone.
12. • ADVERSE EFFECTS:
• These adverse effects include ecchymosis, skin
thinning and atrophy, acne, mild hirsutism,
facial erythema, stria, impaired wound
healing, thinning of hair, and perioral
dermatitis.
13. • Methotrexate is another antimetabolite that has
beneficial effects in a number of chronic
inflammatory diseases, including Crohn’s disease and
rheumatoid arthritis.
• Methotrexate may be given orally, subcutaneously, or
intramuscularly. Reported oral bioavailability is 50–
90% at doses used in chronic inflammatory diseases.
14. • CLINICAL USES:
• Methotrexate is used to induce and maintain
remission in patients with Crohn’s disease. Its efficacy
in ulcerative colitis is uncertain.
• To induce remission, patients are treated with 15–25
mg of methotrexate once weekly by subcutaneous
injection.
• If a satisfactory response is achieved within 8–12
weeks, the dose is reduced to 15 mg/wk.
15. • ADVERSE EFFECTS:
• At higher dosage, methotrexate may cause bone
marrow depression, megaloblastic anemia, alopecia,
and mucositis.
• In patients with psoriasis treated with methotrexate,
hepatic damage is common; however, among
patients with inflammatory bowel disease and
rheumatoid arthritis, the risk is significantly lower.
• Renal insufficiency may increase risk of hepatic
accumulation and toxicity.
