COMMON ANTI-ACIDS AND

ANTICHOLINERGIC
DR.E.MASSAWE
 Learning Tasks

At the end of this session a learner is expected to

be able to:
 Define anti-acids and anticholinergic
 Identify common anti-acids and anticholinergic
 Explain mechanism of action and side effects
anti-acids and anticholinergic
 Explain management of side effects of anti-
acids and anticholinergic
 
 Brainstorming
Define
 Anti-Acids
 Anticholinergic
• Anti-acid
– Is a substance which neutralizes stomach acidity
and is used to relieve heartburn, indigestion or an
upset stomach.

• Anticholinergic
– Are drugs that block the action of acetylcholine
– Acetylcholine is a neurotransmitter, or a chemical
messenger.
 Common Anti-Acids And Anticholinergic

Common Ant Acids

 Aluminium Hydroxide and Magnesium
Trisilicate
 Magnesium hydroxide insoluble and forms
magnesium chloride in the stomach
 Aluminium hydroxide gel forms aluminium
chloride in the stomach
 Sodium Bicarbonate and Alginates
 Common Anticholinergic

 Atropine
 Antipsychotic like clozapine
 Itratropium
 Mechanism of Action and Side
Effects of Common Anti-Acids and
Anticholinergic
 Anti-Acids Drugs

Antiacids
Commonly used for heartburn ,excessive
eating and for peptic ulcer disease.
Mechanism of action
– These are weak alkalis and so they partly
neutralize free acid in the stomach and partly
they stimulate mucosal repair mechanisms
around the ulcers possibly by stimulating local
prostaglandin release
 CONT…..
This is by buffering the hydrochloric acid
(Normal pH1 to 2) to a lower hydrogen ion
concentration with pH of 3 to 4 which is highly
desired because the proteolytic action of
pepsin is reduced and the gastric loses its
corrosive effect
Aluminium Hydroxide and Magnesium Trisilicate
It acts by raising the gastric pH, this also has the
effect of inhibiting the activity of pepticenzymes,
which practically ceases at pH 5
Given in sufficient quantity for long enough, they
can produce healing of duodena lulcers but are
less effective for gastric ulcers
 CONT…..
They do not reduce the volume of hydrochloric
acid secreted
Therapeutic uses
• Antacids are used to relieve the pain of gastric and
duodenal ulcers and refluxoesophangitis by neutralising
hydrochloric acid in gastric
 Magnesium hydroxide insoluble and forms
magnesium chloride in the stomach

It does not produce systemic alkalosis, because

Mg2+ is poorly absorbed from the gut
Another salt, magnesium trisilicate, is also
insoluble that it reacts slowly with the gastric
juice, forming magnesium chloride and colloidal
silica
This agent has a prolonged antacid effect, and it also
adsorbs pepsin which is believed to be a mediator for
acid secretion
 Sodium Bicarbonate and Alginates
These are also used as antiacids and now mixed in
some preparation
Sodium bicarbonate is a very popular home
remedy for dyspepsia and is taken alone or in
mixtures
It reacts with hydrochloric acid and neutralizes it,
therefore affording a speedy relief
Sodium bicarbonate is not recommended for use
as an antacid because it is absorbed and if ingested
in large amounts can cause systemic alkalosis
Aluminium hydroxide gel forms aluminium
chloride in the stomach

Aluminium hydroxide raises the pH of the gastric

juice to about 4, and also adsorbs pepsin
Dosage
• When using aluminium hydroxide gel BP (mixture), give
a dose of 7.5-15 ml and repeat according to the needs
of the patient
• With aluminium hydroxide gel BP (powder), give 0.5-1
gram and repeat according to the needs of the patient
- With magnesium trisilicate BP, give a dose of 0.5-2
grams and repeat according to the patient's needs
 Side Effects of Acids
1. Antacids that contain aluminum hydroxide may cause
– Constipation
– Aluminum-intoxication
– Osteomalacia
– Hypophosphatemia
2. Antacids that contain magnesium may cause
– Diarrhea
• This is because they have a laxative effect
– Increased magnesium level in blood
• In patients with renal failure they may cause increased magnesium levels
in the blood, because of the reduced ability of the kidneys to eliminate
magnesium from the body in the urine
3. Chalky taste
 Anticholinergic

• The ant cholinergic drugs are used clinically

for treatment of the gastro intestinal and
opthalamic disorders
 Mechanism of action
 These drugs act by occupying receptors sites at the
parasympathetic nerve ending
 Which then prevent the action of acetylcholine
 The parasympathetic response is reduced ,depending
on the amount of anti-cholinergic drug activity
 The effect includes mydriasis of the pupil with
increased intraocular pressure in patients with
glaucoma, dry tenacious secretions of the mouth ,
throat ,nose and bronchi and increased heart rate
and gastrointestinal tract motility
Atropine
– Atropine is used as pre-operative medications
• The usual dosage is 0.5 to 1 mg IV push, may repeat
every 3 to 5 minutes up to a total dose of 3 mg
(maximum 0.04 mg/kg)
• An action is on the parasympathetic nervous system
inhibits salivary and mucus glands hence reduce saliva
and bronchial secretions during surgery.
• Also for treatment of pylorospasm and spastic
condition on the gastrointestinal tract
– Also atropine is used in the examination of the eye
to dilate the pupil
 Side effects of Anticholinergic

1. Sensory
– Blurred vision
2. Gastrointestinal
– Constipation
– Dryness of the mucus of the mouth, nose and
throat
3. Genitourinary
– Urinary retention
 CONT…..
4. Psychological
– Confusion
– Depression
– Nightmares
– Hallucinations
5. Cardiovascular
– Orthostatic hypotension
– Palpitation,dysrhythmias
 Management of Side Effects of Common
Anti-Acids and Anticholinergic

Coping with anti-acid drug Side Effects

• Encourage adequate fluids intake to alleviate
constipation
• Stop the drug in case of toxicity
 Management of side effects of
Anticholinergic

1. Encourage adequate fluids intake to alleviate

constipation
2. Give the patient stool softener
3. Encourage sucking ice chips or hard candy for
the dryness
4. Reduce the dose in case of psychological effects
5. Monitor the patient’s blood pressure daily in
both supine and standing position
 Key Points

• Anti-acid is a substance which neutralizes

stomach acidity and is used to relieve
heartburn, indigestion or an upset stomach
• Anticholinergic are drugs that block the action
of acetylcholine
• Acetylcholine is a neurotransmitter, or a
chemical messenger
 Session Evaluation

• What are the commonly used antacids?

• What are the effects of anti-cholinergic?
 References
• Champe, P. C. (2008). Lippincott's illustrated reviews:
Pharmacology.
• Clayton, B. D., & Willihnganz, M. (2013). Basic Pharmacology
for Nurses16: Basic Pharmacology for Nurses. Elsevier Health
Sciences
• Katzung, B. G., Masters, S. B., & Trevor, A. J. (2012). Basic and
Clinical Pharmacology (LANGE Basic Science). McGraw-Hill
Education
• Rang, H. P. (1995). Pharmacology (3rd ed.). London: Churchill
Livingstone.
• Rang, H., & Dale, M. (2007). Pharmacology (6th ed.).
Edinburgh: Livingstone Churchill