1. drugs
   1. anti acids
      1. oral
         1. we want them in neutral
      2. mild base
   2. antisecretory medication
      1. anti cholinergics
         1. atropine
            1. diffuse drug
            2. s/s
            3. secretions increased
            4. lacrimation
            5. mydriasis
            6. dry mouth
            7. heart effects
         2. pirenzepine
      2. H2 receptor blockers
      3. PPI
         1. best drug as it blocks terminal effect
   3. surface protective drugs
      1. sucralfate
      2. misoprostol
      3. colloid bismuth sulphate
   4. Tx of GERD PUD
      1. antibiotics
2. cells
   1. cardia
      1. foveolar cell
         1. mucus
   2. fundus n body
      1. ECL cell
      2. parietal cell
         1. receptors
            1. M3
            2. CCK
            3. binds gastrin
            4. H1
            5. histamin
   3. pyloric
      1. g cell
         1. gastrin
            1. secreted from pylorus, duodenal 1st part, pancreas
         2. zollinger elisson syndrome
3. Ix
   1. ch gastritits
   2. Dyspepsia
   3. ulcer
      1. PUD
      2. Stress ulcer
   4. ZES
   5. GERD
4. H2 receptor antagonist
   1. name
      1. cimetidine, ranitidine, famotidine
   2. competitive antagonism
      1. tolerance develop risk as reversible bind
   3. mainly lessens basal acid secretion
      1. because parasymp activation at night
         1. ECL stimulated
            1. Histamine secretion
   4. DOA 12 hrs\
      1. take effect within 1 hr
         1. so intake before food
   5. drugs
      1. Cimetidine
         1. Drug interaction
            1. inhibits cyt p450
            2. major enzyme of drug metabolism in liver
            3. increases doa of othe drugs
            4. so dose komay deya hoy Benzodiazepine, Warfarin
         2. anti androgenic effect
         3. adverse effect
            1. common
            2. cns
            3. confusion
            4. hallucination
            5. cvs
            6. bradycardia
            7. hypotension
5. Antacid
   1. weak base
   2. can use iv for acidosis
      1. systemic antacid
         1. 8% NaHCO3
   3. non systemic antacid
      1. neutralizes HCL in lumen
   4. side effects
      1. alum
         1. smooth muscle contraction
            1. constipation
            2. Al and Ca compete
            3. osteoporosis
      2. mg
         1. hygroscopic
            1. laxative
            2. hypotension
6. acid secretion
   1. basal acid secretion
   2. meal ass. acid secretion
7. PPI
   1. formulations
      1. oral
         1. prodrug
      2. iv
         1. active
            1. pantoprazole
            2. esomeprazole
   2. inhibits basal awa meal ass. secretion
   3. Side effects
      1. conutionl feature
      2. enteric infection
      3. resp tract infection
      4. Lowered absorption
         1. VT b12
         2. Ca Mg
         3. Digoxin Ketoconazole
   4. why given with pain medication
      1. PG inhibits cGMP
         1. NSAID dile PG synth hoyna
            1. more hcl secretion
            2. ppi inhin=bit acid
8. Thiophilic Sulphonamide Cation
   1. irreversible bind
   2. after a certain time, cell endocytose receptor- drug complex
      1. as signal ashtese na
   3. tolerance doesnt develop
9. Floating Topic