Management of GI Discomfort
Click on each category below to explore its characteristics further.
ANTACIDS
Antacids neutralize acids in the gastrointestinal (GI) tract. Different
combinations have differing acid neutralizing capacities. Sodium
bicarbonate and calcium carbonate have the highest absolute neutrophil
count (ANC).
Pharmacodynamics
Antacids neutralize gastric acid in the gastrointestinal (GI) tract. Causing an
increased pH in the stomach and the duodenal bulb. Antacids contain
various combinations of metallic cation.
• Metallic cation + basic ion
• Common metallic cation
• Aluminum
• Calcium
• Magnesium
• Basic anion
• Hydroxide
• Bicarbonate
• Carbonate
• Different combinations have differing acid neutralizing capacities.
• Sodium bicarbonate and calcium carbonate have the highest absolute
neutrophil count (ANC).
Pharmacokinetics
Aluminum- and magnesium-based antacids are not absorbed with normal
routine use. Chronic use increases absorption by 5%-20%. Renally excreted.
Calcium-containing antacids require vitamin D for absorption. Excreted in
feces
Clinical Uses:
• Hyperacidity: antacids used for symptomatic relief of heartburn
• May take four times per day (QID) or more
• Discuss maximum dosages with patient
• Peptic ulcer disease
• May be used as adjunct to peptic ulcer disease (PUD) triple therapy
treatment
• Used after meals and at bedtime
• Gastroesophageal reflux disease (GERD)
, • Antacids are over-the-counter (OTC) and often-used first before
patient seeks care.
• May be given every 30 to 60 minutes until symptoms subside
• Maintenance after meals and bedtime
• Histamine2 receptor antagonists or proton pump inhibitors (PPIs)
are first-line therapy.
• Calcium deficiency
• Chronic renal failure: 1,000 mg
calcium carbonate daily
• Osteoporosis prevention
• Men and premenopausal women: 1,000 mg daily
• Postmenopausal women: 1,500 mg daily
• Doses higher than 2,000 mg/day not recommended
Rational Drug Selection
• Combination products have the highest ANC
• Sodium content
• Cost
• OTC
• Inexpensive, but may vary
• Generics OK
• Monitoring
• Magnesium level in elderly patients who use magnesium-
containing products chronically
Precautions and contraindications
• Abdominal pain of unknown cause
• Calcium-based antacids contraindicated if patient is hypercalcemic
or has renal calculi.
• Magnesium-based antacids are contraindicated in patients with
renal failure or renal insufficiency.
• Aluminum-based antacids should not be used in patients with renal
failure on dialysis.
• Sodium content may affect patients with hypertension, congestive
heart failure, or renal failure.
Adverse drug reactions (ADRs)
• Magnesium-based antacids may cause diarrhea.
• Aluminum- and calcium-based antacids may cause constipation.
Drug interactions
, • Antacids have many drug interactions; may affect the absorption of
most drugs
• Separate antacid administration with other drugs by at least 2 hours.
Administration Tips
• Usually taken 1 to 3 hours after meals and at bedtime
• Chewable tablets must be chewed.
• Antacids affect absorption of other drugs.
• Separate by 2 hours.
• Do not use antacids without consulting with provider.
• Calcium-based antacid absorption is decreased by oxalic acid and
phytic acid and increased by acidic fruit juice.
•
Patient Education
• Contact provider if using longer than 2 weeks.
• If you experience extreme pain, cramping or see any blood in your
stool contact your medical provider; these may be symptoms of GI
bleed.
• Aluminum- and calcium-based antacids cause constipation; May
need a stool softener
• Magnesium-based products cause diarrhea.
• Lifestyle changes: Stop smoking, elevate head while sleeping, avoid
spicy foods, alcohol, or foods that affect lower esophageal sphincter
tone (fatty food,
chocolate, caffeine).
ANTIDIARRHEALS
Diarrhea is commonly treated with over the counter medications and can be
resolved with or without any treatment. Most diarrhea if seen in the clinical
setting is caused by an infection, food or drug ingestion, or inflammatory
bowel disease. Infections are either from food or a drug that the patient has
ingested. Most diarrhea does not require medication but can be use in acute
and chronic diarrhea and inflammatory bowel disease. Clinicians seek to
treat the source of diarrhea.
Pharmacodynamics
There are three main classes of drugs used to treat diarrhea. Absorbents
(kaolin-pectin or bismuth subsalicylate) are administered after each loose
stool. Opioids are also utilized in the treatment of diarrhea. Maintaining
hydration is of utmost importance in children and the elderly. Electrolyte
solutions are used in infants and young children and flat soda or water in
adults.
Absorbent preparations
• Kaolin and pectin- Kaolin is a clay-like powder that attracts and
holds onto bacteria. Pectin: thickens stool.
• Bismuth subsalicylate have antisecretory and antimicrobial effects.
Click on each category below to explore its characteristics further.
ANTACIDS
Antacids neutralize acids in the gastrointestinal (GI) tract. Different
combinations have differing acid neutralizing capacities. Sodium
bicarbonate and calcium carbonate have the highest absolute neutrophil
count (ANC).
Pharmacodynamics
Antacids neutralize gastric acid in the gastrointestinal (GI) tract. Causing an
increased pH in the stomach and the duodenal bulb. Antacids contain
various combinations of metallic cation.
• Metallic cation + basic ion
• Common metallic cation
• Aluminum
• Calcium
• Magnesium
• Basic anion
• Hydroxide
• Bicarbonate
• Carbonate
• Different combinations have differing acid neutralizing capacities.
• Sodium bicarbonate and calcium carbonate have the highest absolute
neutrophil count (ANC).
Pharmacokinetics
Aluminum- and magnesium-based antacids are not absorbed with normal
routine use. Chronic use increases absorption by 5%-20%. Renally excreted.
Calcium-containing antacids require vitamin D for absorption. Excreted in
feces
Clinical Uses:
• Hyperacidity: antacids used for symptomatic relief of heartburn
• May take four times per day (QID) or more
• Discuss maximum dosages with patient
• Peptic ulcer disease
• May be used as adjunct to peptic ulcer disease (PUD) triple therapy
treatment
• Used after meals and at bedtime
• Gastroesophageal reflux disease (GERD)
, • Antacids are over-the-counter (OTC) and often-used first before
patient seeks care.
• May be given every 30 to 60 minutes until symptoms subside
• Maintenance after meals and bedtime
• Histamine2 receptor antagonists or proton pump inhibitors (PPIs)
are first-line therapy.
• Calcium deficiency
• Chronic renal failure: 1,000 mg
calcium carbonate daily
• Osteoporosis prevention
• Men and premenopausal women: 1,000 mg daily
• Postmenopausal women: 1,500 mg daily
• Doses higher than 2,000 mg/day not recommended
Rational Drug Selection
• Combination products have the highest ANC
• Sodium content
• Cost
• OTC
• Inexpensive, but may vary
• Generics OK
• Monitoring
• Magnesium level in elderly patients who use magnesium-
containing products chronically
Precautions and contraindications
• Abdominal pain of unknown cause
• Calcium-based antacids contraindicated if patient is hypercalcemic
or has renal calculi.
• Magnesium-based antacids are contraindicated in patients with
renal failure or renal insufficiency.
• Aluminum-based antacids should not be used in patients with renal
failure on dialysis.
• Sodium content may affect patients with hypertension, congestive
heart failure, or renal failure.
Adverse drug reactions (ADRs)
• Magnesium-based antacids may cause diarrhea.
• Aluminum- and calcium-based antacids may cause constipation.
Drug interactions
, • Antacids have many drug interactions; may affect the absorption of
most drugs
• Separate antacid administration with other drugs by at least 2 hours.
Administration Tips
• Usually taken 1 to 3 hours after meals and at bedtime
• Chewable tablets must be chewed.
• Antacids affect absorption of other drugs.
• Separate by 2 hours.
• Do not use antacids without consulting with provider.
• Calcium-based antacid absorption is decreased by oxalic acid and
phytic acid and increased by acidic fruit juice.
•
Patient Education
• Contact provider if using longer than 2 weeks.
• If you experience extreme pain, cramping or see any blood in your
stool contact your medical provider; these may be symptoms of GI
bleed.
• Aluminum- and calcium-based antacids cause constipation; May
need a stool softener
• Magnesium-based products cause diarrhea.
• Lifestyle changes: Stop smoking, elevate head while sleeping, avoid
spicy foods, alcohol, or foods that affect lower esophageal sphincter
tone (fatty food,
chocolate, caffeine).
ANTIDIARRHEALS
Diarrhea is commonly treated with over the counter medications and can be
resolved with or without any treatment. Most diarrhea if seen in the clinical
setting is caused by an infection, food or drug ingestion, or inflammatory
bowel disease. Infections are either from food or a drug that the patient has
ingested. Most diarrhea does not require medication but can be use in acute
and chronic diarrhea and inflammatory bowel disease. Clinicians seek to
treat the source of diarrhea.
Pharmacodynamics
There are three main classes of drugs used to treat diarrhea. Absorbents
(kaolin-pectin or bismuth subsalicylate) are administered after each loose
stool. Opioids are also utilized in the treatment of diarrhea. Maintaining
hydration is of utmost importance in children and the elderly. Electrolyte
solutions are used in infants and young children and flat soda or water in
adults.
Absorbent preparations
• Kaolin and pectin- Kaolin is a clay-like powder that attracts and
holds onto bacteria. Pectin: thickens stool.
• Bismuth subsalicylate have antisecretory and antimicrobial effects.
