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16. On gastric secretion
Suppress all phases
Basal Psychic Neurogenic Gastric
Very effective in inhibiting nocturnal acid
secretion
Modest impact on meal stimulated acid
secretion
↓ 60-70% of acid output
29. Proton Pump Inhibitors – Kinetics
Given as enteric coated tablets
Pantoprazole ,Rabeprazole, Omeprazole--
intravenously
Half life – 1.5 hrs
Given ½ -1 hr before meals
Other acid suppressing agents not co-
administered
30. Now answer this question
It is given in the previous slides that the half life of
proton pump inhibitors is 1.5 hours only and these
drugs are generally given once daily. How this can be
justified ?
Answer :
P.P.I - Irreversible inhibitors of H+K+ATPase
(Hit and run drugs)
39. Non systemic antacids
Insoluble ,
Poor
absorption
React
with HCl
No acid
base
disturbance
Inhibit
formation
of pepsin
OTC
drug
40. Mg salts
MgOH-quick long acting efficacious laxative
Mg trisilicate- low solubility and reactivity
• Silicate-gelatinous-adsorb and inactivate pepsin, protect ulcer
base
Magaldrate
• Hydroxy magnesium aluminate
• Prompt sustained action
41. AlOH
Polymerize into less reactive form
delay gastric emptying
at pH> 3 adsorb pepsin, toxin, gas & bacteria
Bind phosphate -used in hyperphosphatemia and phosphate stones
Al toxicity-encephalopathy, osteodystrophy
42. CaCO3
Milk alkali syndrome-headache, anorexia weakness,
abdominal discomfort, abnormal Ca deposits and renal
stones
Can cause constipation/loose motion
Directly stimulate parietal cell -acid rebound
Potent and rapid action
43. Antacids
Duration of
action
30 min when
taken in empty
stomach
2 hrs when taken
after a meal
Side
effects
Al3+ antacids –
constipation
Al3+ antacid – Al
toxicity,
Encephalopathy
in RF
Mg2+ antacids –
Osmotic
diarrhoea
44. Antacid - Interactions
Adsorb drugs and form insoluble complexes
that are not absorbed
Clinical importance :
Interactions can be avoided by taking antacids
2 hrs before or after ingestion of other drugs .
45. Now answer this question
Is it rational to combine Aluminium
hydroxide and Magnesium hydroxide in
antacid preparations ?
46. Answer
Combination provides a relatively fast and sustained
neutralising capacity
(Magnesium Hydroxide – Rapidly acting
Aluminium Hydroxide - Slowly acting )
Combination preserves normal bowel function.
(Aluminium Hydroxide – constipation
Magnesium hydroxide – diarrhoea )
Gastric emptying least affected
Dose Reduction
47. Use
1. Intercurrent pain relief and
acidity
2. Non ulcer dyspepsia
3. Mild heartburns
Limitations
1. Large frequent dose
2. Acid rebound---↑ gastrin
3. Belching ,fullness, nausea
can occur
48. Systemic antacids
• Soluble instant short duration
• But cause systemic alkalosis
• So other uses
– Metabolic acidosis
– Alkalinisation of urine
– Antipruritic lotion,eye wash,mouth wash
49. Ulcer protectives
Augment mucosal PG synthesis
Acts as physical barrier
Precipitate surface protein
Sticky gel and hence adheres
Cause cross linking
Polymerisation at pH<4
Basic Al salt of sulfated sucrose
50. • No antacids with sucralfate?
• Adverse effects-constipation,
hypophosphatemia
• Other uses
–Bile reflux Gastritis Stomatitis
–Prophylaxis of stress ulcers
51. Colloidal Bismuth Subcitrate
Water soluble, precipitate at pH<5
Increase mucus,HCO3, PGE2
Precipitate mucous glycoproteins and coat
Detaches and kills H. pylori
Use-gastritis ,non ulcer peptic dyspepsia
Adverse effects- osteodystrophy, encephalopathy,
black tongue, dentures, stool
61. Now you have learnt about drugs used for treating
peptic ulcer ?
Are there any drugs that can cause peptic ulcer ?
Non Steroidal Anti Inflammatory Drugs
(NSAIDs)
Glucocorticoids
Cytotoxic agents
62. Stress induced ulceration after head
trauma
Cushing’s ulcer
Stress induced ulceration after severe
burns
Curling’s ulcer
63. Re-Cap
1. Anticholinergics used for peptic ulcer
2. Prostaglandin analogues for peptic ulcer
3. Drugs used in NSAID induced ulcer
4. H+-K+ inhibitors inhibitors
5. Two drug which decrease acid secretion and
are enzyme inhibitors
64. a .Cimetidine and Warfarin
b. Sucralfate and Antacid
c. Omeprazole and Itraconazole
d. Aluminium hydroxide and Magnesium Hydroxide
2. Short notes
a. Proton pump inhibitors
b. Triple drug Regimen
What is the drug interaction between
