Antasids & H2

Receptor Blockers
 OBJEKT
IF
• Menerangkan definisi dan
tindakan ubat ‘antacids’ dan
‘H2 Blockers’.
• Menerangkan kesan
sampingan ubat.
• Menyatakan contoh, dos dan
cara pemberian ubat.
• Menyatakan indikasi dan
kontraindikasi ubat.
• Menyatakan nasihat yang
relevan semasa penggunaan/
pemberian ubat.
Antacids
 Antacids
• Ubat yang digunakan untuk
melegakan kesakitan akibat
rembesan asid gastric yang
banyak (gastritis atau ulcer
peptic).
 Tindakan
• Neutralize or reduce acidity of
stomach and duodenal content
by combining with
hydrochloric acid and produce
salt and water.
Antacids + Hydrochloric acid = Salt + Water
• TINDAKAN ANTACID
– Mengurangkan keasidan gaster
– Mengurangkan inflammasi
lapisan mukosa gaster
– Menampan dan melindungi
lapisan mukosa gaster
– Memberi masa supaya mukosa
yang tercedera pulih semula
 General Indication

• Merawat hyperacidity
– Dyspepsia
– Peptic ulcer
– Gastritis
– Gastroesophageal reflux
– Heartburn (pedih hulu hati)
 Contoh ubat
• Aluminum hydroxide
(Alutab)
• Calcium carbonate
• Magnesium hydroxide
(Milk of magnesia)
• Magnesium Trisilicate
(Gelusil)
• Magnesium Trisilicate
Mixture
• Sodium bicarbonate
1. Aluminum hydroxide
600mg tablet
(Alutab)
Category: A
 Dose
• 1-2 tab (600-1200mg) qid
(chewed) PO
• 10-20ml q 8 hr PO
 2. Calcium carbonate
500mg capsule

Category: A

Dose
• 0.5-2g PO (as needed)
• 10-20ml q 8 hr PO
3. Magnesium hydroxide
(Milk of magnesia)
Category: C

Dose
• Adult & peads > 12 yrs
– 10-20ml q 8 hr PO
4. Magnesium Trisilicate
tablet
(Gelusil)
Category: C
 Dose
• Adult:
– 1-2 tab (chewed) 6
times/day before meals
• Peads > 6yr:
– 1 tab tds-qid before meals
5. Magnesium Trisilicate
Mixture
Category: C

Dose
• 10-20ml tds-qid
PO (before meal)
6. Sodium bicarbonate
Mixture
(Mist Carminative
Peads)

Category: C
 Dose
• Peads up to 1 yr:
5ml/day
• 1-5 yr: 10ml
 Kesan sampingan

• Aluminum containing
antacids
– Constipation
– Anorexia
– Weakness
– Tremor
• Magnesium containing
antacids
– Severe diarrhea
– Dehydration
– Hypermagnesemia (nausea
& vomiting)
• Calcium containing
antacids
– Metabolic alkalosis
– Headache
– Hypercalcemia
– renal calculi
– Neurologic impairment
 • Sodium containing
antacids
– Systemic alkalosis
– GI cramps

Note: Have wide margin of safety when

used as prescribed
 Contraindication

• Aluminum containing
antacids
– Allergic to drug
– Hypophosphatemia
– Lactation
• Magnesium containing
antacids
– Allergic to drug
– Hypophosphatemia
– Lactation
• Calcium containing
antacids
– Allergic to drug
– Hypercalcemia
– Renal calculi
– Lactation
• Sodium containing
antacids
– Allergic to drug
– Hypernatremia
– Sodium-restricted diets
– CVS problem
– Lactation
 Cautious
• Pregnancy
• Renal impairment
• Cardiac disease
• Renal calculi
 Interactions
• Antacid mengurangkan
kesan ubat berikut:
– Corticosteroids
– Digoxin
– Chlorpromazine
– Oral iron
– Isoniazid
– Ranitidine
– Phenytoin
– Tetracycline
 Soalan
1. Beri definisi ubat antacids?
2. Terangkan cara tindakan ubat
antacids?
3. Senaraikan contoh ubat
antacids?
4. Nyatakan kesan sampingan dan
kontraindikasi ubat antasid?
H2 Receptor
Blockers/
Antagonist
H2 Receptor Blockers

• Ubat yang digunakan untuk

mengurangkan rembesan
asid dalam gaster.
 Tindakan

• Bersaing dengan histamin

untuk reseptor H2 dalam
gaster.
• Menghalangkan tindakan
histamine, gastrin dan saraf
vagal.
• Maka pegeluaran asid
berkurang sebanyak 70%
• Juga mengurangkan
rembesan pepsin.
• Memberi masa untuk ulcer
gaster sembuh (4-6 minggu)
 General Indication
• Gastric ulcer
• Duodenal ulcer
• Gastroesophageal reflux
• Heartburn (pedih hulu hati)
• Healing of ulcer (gaster &
duodenum)
 Contoh ubat

• Cimetidine (Tagamet)
• Ranitidine (Zantac)
1. Cimetidine 200mg/2ml Inj
(Tagamet)
Category: B
 Dose
• Adult:
– 200mg q 4-6 hr IM, IV
– 200mg slow IV over at least 2
mins
– 400mg in 100ml normal saline
IV infusion over ½ - 1 hr
– All doses may repeat q 4-6 hr if
necessary
– Max: 2g/d
• Peads < 1 yr:
– 20mg/kg/day IV infusion
(divided dose)
• Peads > 1 yr:
– 25-30mg/kg/day IV infusion
(divided dose)
2. Cimetidine 400mg/ 800mg
tablet (Tagamet)

Category: B

Dose
• Active peptic ulcer:
– 800mg hs PO (at least for 4-8
weeks) hora somni (at
bedtime)
• Maintenance:
– 400mg hs PO (at least 6
months)
• Non-ulcer Dyspepsia:
– 800mg PO (2 - 4 divided
doses) – do not exceed 4
weeks
3. Cimetidine 200mg/5ml
suspension
(Tagamet)

Category: B
 Dose
• Gastroesophageal reflux:
– Peads < 1 yr: 20mg/kg/day IV
infusion (divided dose)
– Peads > 1 yr: 25-30mg/kg/day
IV infusion (divided dose)
4. Ranitidine 50mg/2ml Inj
(Zantac)
Category: B
 Dose
• Adult:
– 50mg diluted in 20ml slow IV
given at least 2 mins
– 50mg IM
– 25mg/hr for 2 hr IV infusion
– All doses may repeated q 6-8 hr
• Peads:
– 1mg/kg/dose q 6-8 hrs
5. Ranitidine 150mg/ 300mg
tablet
(Zantac)
Category: B
 Dose

• Peptic ulcer:
– 150mg bid OM & ON or
300mg ON (4-8 weeks)
• Maintenance:
– 150-300mg ON
• Gastroesophageal reflux:
– 150mg bid or 300mg ON (8-12
weeks)
• Non-Ulcer dyspepsia:
– 150mg/day or bid
5. Ranitidine 150mg/10ml
syrup
(Zantac)
Category: B

Dose
• Peptic ulcer:
– Peads: 2-4mg/kg bd
– Max: 300mg/day
Kesan sampingan
• Diarrhea
• Dizziness
• Headache
• Confusion
• Impotence
• Muscle pain
• Rashes
Contraindication

• Allergic to drug
• Renal failure
 Cautious

• Renal & hepatic impairment

• Elderly
• Diabetes (Cimetidine)
• Pregnancy
• Lactation
 Interactions
• Terlalu banyak interaksi
dengan ubat lain
• Yang berikut adalah
beberapa contoh interaksi
ubat H2 receptor blockers/
antagonist.
• Antacids & Metoclopramide
– Kurangkan penyerapan H2
receptor blockers
• Digoxin
– Kurangkan paras serum
digoxin
• Alkylating drugs
– Kurangkan bilangan sel
darah putih
• Morphine
– Risiko ‘respiratory
depression’
• Meningkatkan risiko
toxicity ubat berikut
– Oral anticoagulants
– Phenytoin
– Quinidine
– Lidocaine
– theophylline
Pirenzepine
 Pirenzepine
• Kumpulan ubat yang
menguatkan rintangan
mukosa terhadap serangan
asid gaster dengan
membentuk lapisan
perlindungan.
 Tindakan
• Forms a complex with
exudates of the stomach
lining.
• This complex forms a
protective layer over a
duodenal ulcer, thus aiding in
healing of the ulcer.
 General Indication

• Active peptic ulcer

(gastric & duodenal)
 Contoh ubat

• Sucralfate (Carafate)
Sucralfate 1g tablet
(Carafate)
Category: A
 Dose
• Prophylaxis ulcer:
– 1g 6 times/day
– Max: 8g/day
• Peptic ulcer:
– 2g bd or 1g qid (4-6 weeks)
– Resistant case: up to 12
weeks
– Max: 8g/day
 Kesan sampingan
• Constipation & Diarrhea
• Nausea
• GI discomfort
• Indigestion
• Dry mouth
• Drowsiness & dizziness
• Rashes
Contraindication
• Allergic to drug

Cautious
• Chronic renal failure
• Pregnancy
• Lactation
 Interactions
• Tetracycline
• Warfarin
• Phenytoin
• Digoxin
• Ranitidine
• Cimetidine
• Theophylline
 Soalan
1. Berikan definisi ubat H2 reseptor
blockers?
2. Terangkan cara tindakan ubat
H2 reseptor blockers?
3. Senaraikan contoh ubat H2
reseptor blockers?
4. Nyatakan kesan sampingan dan
kontraindikasi ubat H2 reseptor
blockers?