Proton Pump Inhibitors Research Paper

While antacids are used largely by the general public, there are no studies showing that they help or are effective in treating GERD. They are simply mechanisms to treat symptoms of a larger problem. PPI are the most effective for the treatment of GERD. The medication is orally administered as an inactive counter-part. It is converted to the active form by parietal cells in the stomach. Once active the drug causes irreversible deactivation of the enzyme that generates gastric acid. Because the deactivation is irreversible, the decrease is acid is effective until more enzyme can be produced. The goal for PPIs is to reduce stomack acid and to prevent stomach ulcer and further exacerbation of esophagitis. The medication may cause headache, diarrhea, nausea, and vomiting thought the incidence of occurrence is very low. PPIs do increase the likely hood of the development of pneumonia due to the altered GI flora. Another major adverse effect is the rebound hypersecretion of acid. Patients who discontinue taking PPIs may experience dyspepsia due to acid rebound. This can be minimized by using the lowest dose and tapering the medication. Histamine receptor antagonists, though indicated for the treatment of GERD are not as effective at decrease stomach acid. PPI can decrease acid content by 90% whereas H2RAs only decrease by 65%. The medication works by blocking H2 receptors on parietal cells in the

Esomeprazole magnesium trihydrate (Nexium) is a proton pump inhibitor that is used to treat acid reflux which occurs when acid moves back into the esophagus from the stomach. When we swallow food, it goes through the esophagus into the stomach. There is a round muscle at the bottom of the esophagus known as the sphincter that works like a valve. It relaxes when we swallow in order for food to pass through to the stomach. Proton pumps then release acid to help digest the food. The valve is closed tightly by the diaphragm in order to prevent acid from flowing back into the esophagus. At certain times, a small amount of acid flows back into the esophagus in what is called reflux. This is not very dangerous, but might be very harmful if acid continually splashes back into the esophagus for many years. A good treatment for acid reflux is Nexium, which is a proton pump inhibitor that binds to the parietal cell of the stomach lining and prevents H+/K+ ATPase from making acid.

If the symptoms don’t get better within a few weeks, the doctor suggests other treatments, which can include medication and surgery. Treatment can start with OTC antacids like Maalox, Mylanta, Rolaids and Tums to neutralize stomach acid. To reduce the production of stomach acid, H-2-receptor blockers, which containing cimetidine, can be used. Some of these medications are Tagamet HB, Pepcid AC, and Zantac. The antacids offer instant relief, whereas the H-2-receptor blockers don’t act as quickly, but can decrease acid production up to 12 hours to provide longer relief. They usually have to be taken on a daily basis to be effective. If a stronger dose is needed, a prescription from the doctor is required. Prevacid 24 HR, Prilosec and Zegerid OTC are proton pump inhibitors and are stronger blockers of acid production than the H-2-receptor blockers and allow the damaged esophageal tissue time to heal. If these medications are needed longer than two to three weeks or the symptoms are not relieved a doctor should be consulted. Your doctor may suggest prescription medications if heartburn continues. These can include prescription-strength H-2-receptor blockers; Tagamet, Pepcid and Zantac, and prescription-strength proton pump inhibitors; Nexium, Prevacid, Zegerid, Protonix, Aciphex and Dexilant. The use of these medications is generally tolerated. A slight increase in

2 Patients must demonstrate no response to acid suppression (high-dose PPI for 6-8 weeks), while symptoms should improve with dietary eliminations and/or corticosteroids. Esophageal biopsy must demonstrate at least 15 eosinophils/high-power field and normal mucosa in the stomach and duodenum, and other causes of esophageal eosinophilia must be excluded. 2 Of note, there is a subgroup of patients with PPI-responsive eosinophilia. In this group, GERD is excluded but histopathology demonstrates eosinophil-predominant inflammation. Less is known regarding this condition and treatments for this subgroup.

Description/Synopsis: Proton pump inhibitors (PPIs) are used for the treatment of gastroesophageal reflux disease (GERD) and Laryngopharyngeal reflux (LPR) due to their potential to inhibit gastric acid production. Unfortunately, high doses of PPIs are associated with adverse health outcomes. The use of PPIs has been shown to affect the absorption of minerals and vitamin-like calcium, iron and vitamin B12. Not only the risk of other severe conditions like hyperparathyroidism, diarrhea and pneumonia increases upon the long-term use of PPIs but the negative effects also extend to coronary heart disease and atherosclerotic diseases. PPIs reduce the efficacy of the drug clopidogrel which inhibits platelet activation thereby contributing to coronary heart disease and myocardial

Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients.

Nitroglycerin is well absorbed through the oral, buccal and sublingual mucosa. Nitroglycerin administered orally is rapidly metabolized leading to decrease bioavailability. Nitroglycerin is metabolized rapidly through the liver as well as enzymes in the bloodstream, and has a half-life of 1-4 minutes. For acute angina, 0.4 mg is administered sublingual. In the event the initial dose does not decrease the pain, a second dose can be administered sublingually after 5 minutes up to a third dose. If the pain persists after administering the third dose, the patient is instructed to call 911. Topical doses can be administered 0.5-2 inches from the site of administration

•     Lose weight. Excess weight increases pressure on the stomach and helps push acid in to the esophagus.

When found in the pyloric antrum H. pylori causes duodenal ulcers and when in the corpus, or body of the stomach, H. pylori can cause gastric ulcers and gastric carcinoma (“Helicobacter pylori,” Wikipedia). Helicobacter pylori can be detected by a blood test, urea breath test, stool antigen test, and/or stomach biopsy done during an endoscopy (“Helicobacter Pylori Tests”). When treating Helicobacter pylori, patients will typically be given three medications (“Helicobacter pylori,” Wikipedia). The use of the three medications is called triple therapy (“Helicobacter pylori,” Wikipedia). One example of a triple therapy used to treat H. pylori is the use of Omeprazole, a proton pump inhibitor, along with clarithromycin and amoxicillin, antibiotics (“Helicobacter pylori,” Wikipedia). However, a patient may be given substitute proton pump inhibitors, such as pantoprazole or rabeprazole, if they are allergic to omeprazole (“Helicobacter pylori,” Wikipedia). Substitute antibiotics may also be prescribed if the patient is allergic to amoxicillin, such as, metronidazole (“Helicobacter pylori,” Wikipedia). Through research, triple therapies have been found to have better results in curing H. pylori than monotherapies or dual therapies (Fuccio et al. 746-747). The triple therapy must be taken for at least seven days and in some cases up to 14 days (“Helicobacter pylori,” Wikipedia). Eating yogurt that contains Lactobacillus and Bifidobacterium has also been shown to increase the rate at which H. pylori is cured (“Helicobacter pylori,”

Antacids, like Tums, may treat the symptoms. Proton pump inhibitors are a group of drugs that stop the production of gastric acid. Histamine 2 receptor antagonists are used to block the action of histamine on parietal cells in the stomach by decreasing the production of acid by these cells. These two medications help to treat GERD. (Davis, 2011). Any age group can take these medications, and the dose is prescribed by the doctor. Acceleration of gastric emptying is managed by prokinetics. If medication cannot resolve the GERD, then surgery may be necessary. One type of surgery is a Fundoplication. This is when a wrap to the stomach fundus is made around the distal esophagus to restore the competence of the lower esophageal sphincter. If it is needed, a gastrostomy can be performed at the same time as the Fundoplication if decompression of the stomach is needed after the surgery. For the child who has problems with gastric emptying, another procedure is a pyloroplasty with the Fundoplication. Silvestri, 2011). The nurse will have to monitor the patient for abdominal complications after surgery like bleeding, and pain management. The child will have to start out with clear liquids and slowly move toward a regular diet. Instruct the parents to avoid giving their child a heavy solid

Therefore, somatostatin works inhibiting the acid secretion acting directly in the parietal cell and in that same way blocking the regulation of gastrin and histamine (Washington.edu, n.d.). Additionally, somatostatin can also inhibit other gastrointestinal hormones like vasoactive intestinal polypeptide (VIP) and cholecystokinin (CCK) (Utiger, 2011). The clinical use of somatostatin as a drug to reduce the production of gastric acid it is limited due to two critical factors: first, somatostatin has a very short half-life with less than three minutes of action and second, somatostatin can only be produced by the body (Huang, 1997). However, some studies suggest the use of somatostatin analogues in the treatment of reduction of gastric acid. According to Ritz, et al., (1999) Vapreotide, a somatostatin analog was used as testing trial to treat intragastric acidity without positive outcome in the regulation of acidity and mediation of gastrin. Also, they found that Vapreotide can also diminish the contraction of the gallbladder reducing the effects of the biliary functions (Ritz, et al.,

Maalox is an antacid - a drug comprised of aluminum hydroxide, magnesium hydroxide, and simethicone; it is designed to neutralize stomach acid (Lilley, Collins, & Snyder, 2017). Lowering the level of acidity in the stomach usually provides pain relief for patients suffering from gastritis and/or gastric ulcers. The patient needs to be informed that the presence of antacids in the stomach reduces the efficacy of tetracycycline. This might be the reason why his condition is not improving. The patient needs to be advised that for peptic ulcer antacids should be taken atleast 2 hours apart from other medication usually 1 and 3 hours after meals and at bedtime for 4-6 weeks (Saunders, 2017).

Protonix (pantoprazole) is used to treat such conditions where there is too much acid in the stomach. It is also use to treat heartburn caused by gastroesophageal reflux disease (GERD), a condition where the acid in the stomach comes back up into the esophagus. Side effects protonix may include such symptoms of low magnesium such as fast or uneven heart rate; jerking muscle movements; feeling jittery; diarrhea that is watery or bloody; muscle cramps, muscle weakness or limp feeling; cough or choking feeling; or headache, trouble concentrating, memory problems, weakness, loss of appetite. Before taking protonix (pantoprazole) inform the doctor of any allergies or any other drugs similar to do it. This drug is to be swallowed it is a delayed-released tablet. Do not split, crush, or chew it. You can take the tablet with or without

The purpose of writing this review was to investigate, compile, recent, current and past literatures. In recent years several advancements has been made in research and development of oral drug delivery system. Various drugs, which are unstable in alkaline pH, soluble in acidic pH, having narrow absorption window, site of action specific to stomach can be developed by using this technique. Gastro-retentive drug delivery systems (GRDDS) can improve the controlled delivery of drugs that have an absorption window by continuously releasing the drug for a prolonged period of time before it reaches to absorption site. These include floating system, swelling system, expanding system, low density systems, high density system, bioadhesive and mucoadhesive systems etc. In fact the buoyant dosage unit enhances gastric residence time (GRT) without affecting the intrinsic rate of emptying. GRDDS is an approach to prolong gastric residence time, thereby targeting site-specific drug release in upper gastro intestinal tract improving the oral sustained delivery of drug. For minimizing the limitations and achieving better gastric retention various combinational approaches floating and swelling, floating and bio-adhesion, etc., multi-particulate systems, super porous hydrogel etc., have been discussed. The present review addresses briefly about suitable drug candidates, formulation considerations, physiological difficulties and classification, factors effecting gastric retention, merits,