A

TERM PAPER OF
ECE
On

TOPIC: THE DFFERENTINAL

AMPLIFIER

Submitted To: Submitted By:

M/s. Shifali Shrivastava
Lovely Institute of RK6004B48
Technology
Regd.No:11005797

Jalandhar-Delhi G.T. Road (NH-1), Phagwara, Punjab (INDIA) - 144402. TEL:

+91-1824-404404 Toll Free: 1800 102 4431 info@lpu.co.in
 ACKNOWLEDGEMENT

With regards I would like to thanks my Lect. M/s. …………… who helped me
in completing my Term Paper on the topic “THE DFFERENTINAL
AMPLIFIER.”. Of subject “ECE”. Due to his proper guidance and under the
shower of his eternal knowledge I was able to complete my Term Paper
comfortably which might not be possible without his efforts.
I must say thanks to my friend who helped me in the completion of my Term
paper. I must say sorry for the errors if I have committed in my Term Paper.

Shifali Shrivastava

Date: -11-2010
 INDEX
[1] Introduction
[2] Mechanism of action
[3] Indications
[4] Side effects
[5] Some famous antacid brands
[6] Additional information
[7] Interactions
[8] Problems with reduced stomach acidity
[9] Drug names
[10] References
Antacid

A bottle of antacid tablets

An antacid is any substance, generally a base or basic salt, which neutralizes stomach acidity.

Antacids
Antacids are medicines that neutralize stomach acid. They are used to relieve acid
indigestion, upset stomach, sour stomach, and heartburn.

Antacids are taken by mouth and work by neutralizing excess stomach acid. They contain
ingredients such as aluminum hydroxide, calcium carbonate, magnesium hydroxide, and
sodium bicarbonate, alone or in various combinations. Antacid products may also contain
other ingredients such as simethicone, which relieves gas.

Antacids differ in how quickly they work and how long they provide relief. Those that
dissolve rapidly in the stomach, such as magnesium hydroxide and sodium bicarbonate, bring
the fastest relief. Antacids that contain calcium carbonate or aluminum dissolve more slowly
and can take up to 30 minutes to beginworking. The longer an antacid stays in the stomach,
the longer it works. Those that contain calcium carbonate or aluminum work longer than
those that contain sodium bicarbonate or magnesium. Also, taking any kind of antacid aftera
meal, instead of on an empty stomach, provides longer-lasting relief because the medicine
stays in the stomach.
Among the brands of antacid products on the market are Alka-Seltzer, Maalox,Mylanta,
Tums, and Rolaids. Generic forms are also available. These productscan be bought without a
prescription and come in tablet (regular and chewable), lozenge, and liquid forms.

Antacids are meant to be used only occasionally. They should not be taken continuously for
more than two weeks unless under a physician's directions. Taking antacids over long periods
could mask the symptoms of a serious stomach orintestinal problem, such as peptic ulcer
disease. Older people should be especially careful, as they may have ulcers without showing
the typical symptoms.

If any signs of appendicitis or inflamed bowel are present, antacids should not be taken.
Symptoms of appendicitis include cramping, pain, and soreness inthe lower abdomen,
bloating, and nausea and vomiting.

Anyone whose symptoms do not improve after taking antacids or who has black,tarry stools
should call a physician. These symptoms could be signs of a serious condition that needs
medical attention.

Antacids may interact with many other medicines. When this happens, the effects of one or
both drugs may change, or the risk of side effects may be greater. Anyone taking a
prescription drug should check with his or her physician before taking antacids. Antacids may
affect the results of some medical tests.When scheduling a medical test, ask whether it is all
right to take antacidsbefore the test.

Side effects are very rare when antacids are taken as directed. They are morelikely when the
medicine is taken in large doses or over a long time. Minorside effects include a chalky taste,
mild constipation or diarrhea, thirst, stomach cramps, and whitish or speckled stools. These
symptoms do not need medical attention unless they do not go away or they interfere with
normal activities.

Other uncommon side effects may occur. Anyone who has unusual symptoms aftertaking
antacids should get in touch with his or her physician.

Mechanism of action
Antacids perform a neutralization reaction, i.e. they buffer gastric acid, raising the pH to
reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the
gastrointestinal mucosa, they signal pain to the central nervous system. This happens when
these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the
esophagus or the duodenum.

Indications

Wyeth amphojel tablets of aluminum hydroxide.

Antacids are taken by mouth to relieve heartburn, the major symptom of gastroesophageal
reflux disease, or acid indigestion. Treatment with antacids alone is symptomatic and only
justified for minor symptoms. Peptic ulcers may require H2-receptor antagonists or proton
pump inhibitors.

Side effects
Excess calcium from supplements, fortified food and high-calcium diets, can cause the milk-
alkali syndrome, which has serious toxicity and can be fatal. In 1915, Bertram Sippy
introduced the "Sippy regimen" of hourly ingestion of milk and cream, the gradual addition
of eggs and cooked cereal, for 10 days, combined with alkaline powders, which provided
symptomatic relief for peptic ulcer disease. Over the next several decades, the Sippy regimen
resulted in renal failure, alkalosis, and hypercalcaemia mostly in men with peptic ulcer
disease. These adverse effects were reversed when the regimen stopped, but it was fatal in
some patients with protracted vomiting. Milk alkali syndrome declined in men after effective
treatments were developed for peptic ulcer disease. But during the past 15 years, it has been
reported in women taking calcium supplements above the recommended range of 1200 to
1500 mg daily, for prevention and treatment of osteoporosis, and is exacerbated by
dehydration. Calcium has been added to over-the-counter products, which contributes to
inadvertent excessive intake.

The New England Journal of Medicine reported a typical case of a woman who arrived in the
emergency department vomiting and in altered mental status, writhing in pain. She had
consumed large quantities of chewable antacid tablets containing calcium carbonate. She
gradually recovered.

Compounds containing calcium may also increase calcium output in the urine, which might
be associated with kidney stones. Calcium salts may cause constipation.

Other adverse effects from antacids include:

 Carbonate: regular high doses may cause alkalosis, which in turn may result in altered
excretion of other drugs, and kidney stones. A chemical reaction between the
carbonate and hydrochloric acid may produce carbon dioxide gas. This causes gastric
distension which may not be well tolerated. Carbon dioxide formation can also lead to
headaches and decreased muscle flexibility.
 Aluminum hydroxide: may lead to the formation of insoluble aluminium-phosphate-
complexes, with a risk for hypophosphatemia and osteomalacia. Although aluminium
has a low gastrointestinal absorption, accumulation may occur in the presence of renal
insufficiency. Aluminium-containing drugs may cause constipation.
 Magnesium hydroxide: has laxative properties. Magnesium may accumulate in
patients with renal failure leading to hypermagnesemia, with cardiovascular and
neurological complications. See Milk of magnesia.
 Sodium: increased intake of sodium may be deleterious for arterial hypertension, heart
failure and many renal diseases.

Side effects from antacids vary depending on individual and other medications they may be
taking at the time. Those who experience side effects most commonly suffer from changes in
bowel functions, such as diarrhea, constipation, or flatulence.
Although reactions to any drug may vary from person to person, generally those medications
that contain aluminum or calcium are the likeliest to cause constipation, those that contain
magnesium are the likeliest to cause diarrhea. Some products combine these ingredients,
which essentially cancels them out, to forestall unpleasant side effects.

Some famous antacid brands

 Alka-Seltzer – NaHCO3 and/or KHCO3
 Brioschi - CHNaO3 (only FDA approved All-Natural)
 Equate – Al(OH)3 and Mg(OH)2
 Gaviscon – Al(OH)3
 Maalox (liquid) – Al(OH)3 and Mg(OH)2
 Maalox (tablet) – CaCO3
 Milk of Magnesia – Mg(OH)2
 Pepto-Bismol – C7H5BiO4
 Pepto-Bismol Children’s – CaCO3
 Rolaids – CaCO3 and Mg(OH)2
 Tums – CaCO3
 Mylanta - contains Al(OH)3
 Eno
 Gelusil (tablet,syrup)

Additional information
Heartburn, reflux, indigestion, and sour stomach are a few of the common terms used to
describe digestive upset. Self-diagnosis of indigestion does carry some risk because the
causes can vary from a minor dietary indiscretion to a peptic ulcer. The pain and symptoms
of gastric esophageal reflux disease, GERD or simply "reflux", may mimic those of a heart
attack. Misdiagnosis can be fatal. A bleeding ulcer can be life threatening. GERD, and pre-
ulcerative conditions in the stomach are treated much more aggressively since both, if
untreated, could lead to esophageal or stomach cancer. It is primarily for this reason that the
histamine-2 (H2) blockers including cimetidine (Tagamet), famotidine (Pepcid), and
ranitidine (Zantac), and the proton pump inhibitor (PPI) omeprazole (Prilosec) were made
OTC. These drugs stop production of stomach acid and provide longer lasting relief but they
do not neutralize any stomach acid already present in the stomach. For example, Pepcid
Complete includes calcium carbonate in its formulation so it can claim instant relief.

Interactions
Altered pH or complex formation may alter the bioavailability of other drugs, such as
tetracycline. Urinary excretion of certain drugs may also be affected. Chelation of
tetracycline with aluminium hydroxide can cause nausea, vomiting, and phosphate excretion,
and cause phosphate deficiency.

Problems with reduced stomach acidity

Reduced stomach acidity may result in an impaired ability to digest and absorb certain
nutrients, such as iron and the B vitamins. Since the low pH of the stomach normally kills
ingested bacteria, antacids increase the vulnerability to infection. It could also result in
reduced bioavailability of some drugs. For example, the bioavailability of ketoconazole
(antifungal) is reduced at high intragastric pH (low acid content).

Drug names
Examples of antacids (brand names may vary in different countries).

 Aluminium hydroxide (Amphojel, AlternaGEL)

 Magnesium hydroxide (Phillips’ Milk of Magnesia)
 Aluminum hydroxide with magnesium hydroxide (Maalox, Mylanta, Diovol)
 Aluminum carbonate gel (Basaljel)
 Calcium carbonate (Alcalak, TUMS, Quick-Eze, Rennie, Titralac, Rolaids)
 Sodium bicarbonate (Bicarbonate of soda, Brioschi)
 Hydrotalcite (Mg6Al2(CO3)(OH)16 · 4(H2O); Talcid)
 Bismuth subsalicylate (Pepto-Bismol)
  Magaldrate with Simethicone (Pepsil)

References
1. Gabriely, I.; Leu, J. P.; Barzel, U. S. (May 1, 2008). "Clinical problem-solving, back
to basics". New England Journal of Medicine 358 (18): 1952–6.
2. Cooke, N.; Teitelbaum, Ss; Avioli, L. V. (1978). "Antacid-induced osteomalacia and
nephrolithiasis". Archives of Internal Medicine 138 (6): 1007–9.