Part II: Gastric Medication

PART II: GASTRIC MEDICATION

In Part I of Gastric Medication, we have discussed about the definition and possible causes of gastric as a brief understanding for everyone. If you would like to refer back, kindly click into the following link: https://storyofdrugs.blogspot.my/2016/07/part-i-understanding-gastric.html.

Now, here in Part II, we would like to convey some important information on gastric medications. Currently, there are 3 main classes of gastric medication, ranging from fast-acting antacids to a mild agent of histamine H₂ blockers, and the strongest gastric medication, proton pump inhibitors (PPI).

Three main classes of gastric medication: Antacids, H2 blockers and Proton Pump Inhibitors (PPIs).

ANTACIDS

• Available over-the-counter for fast, short-term relief of gastric pain.
• May used alone or together with other gastric medication (H₂ blockers and PPI)
• Available in liquid & tablets. Liquid antacids work faster than tablets.
• Mechanism of Action: It neutralizes gastric hydrochloric acid by forming salt and water; decreases amount of gastric acid; decreases pepsin activity through inactivation from alkaline conditions.
• There are various antacids available in the market. The following are some examples of products containing antacids.

Maalox Plus

Maalox plus contains a balanced mixture of 2 antacids (Aluminium hydroxide, Magnesium hydroxide) and an anti-flatulent, simethicone. Antacids (Aluminium and magnesium salts) are effective to neutralize our stomach acid, hence help with heartburn and indigestion. Aluminium salts may cause constipation, but the effect is balanced by magnesium salts which may cause diarrhea when used in combination. Besides, the salts are not well absorbed by our guts, hence it minimizes the possible systemic side effects. Simethicone is added to breaks up gas bubbles in the gut, therefore it solves the problem of flatulence and hiccup.

Mechanism of Action of antacids

Maalox Plus is available in both tablets and liquid bottle, as well as in liquid sachet form.

Tablets: Chew 2-4 tablets, 30 minutes after each meals and at bedtime (maximum 4 tablets 4 times a day).

Liquid bottle: Take 5-10ml 30 minutes after each meal and at bedtime.

Liquid sachet: 1-2 sachets (10-20ml) after each meal and at bedtime (maximum 4 times a day)

                              

Take note…

• Do not use more than 2 weeks. Long-term use may cause calcium loss.
• Wait at least 1 hour before taking Maalox Plus if you are taking other medication.
• Do not store Maalox in the freezer.
• Not recommended for kidney failure patients (easily develop toxicity to brain and heart), pregnant women (safety not established), and children (table should not be given to children below 12 years old, a maximum of 5ml liquid 3 times a day should be given only on medical advice).
• Minimal amount of antacids will be excreted in breast milk, but there are no expected side effects on breastfed infants.

Gaviscon Peppermint

Gaviscon Double Action

Gaviscon Advance

Gaviscon is a combination of antacids and alginate. Sodium bicarbonate and calcium carbonate are antacids that provide rapid action. Calcium carbonate provides longer duration of action compared to sodium bicarbonate. The side effect of these antacids is belching. The additional ingredient of alginate forms a protective barrier on the surface of stomach contents which helps to prevent acid reflux.

There are 3 types of Gaviscon with their respective contents:

Peppermint: Alginic acid with antacids (aluminium hydroxide, magnesium trisilicate, sodium bicarbonate)

Double Action: Sodium alginate with antacids (sodium bicarbonate, calcium carbonate)

Advance: Sodium alginate and antacid (potassium hydrogen carbonate)

Gaviscon is available in tablets, liquid sachets, and liquid bottles.

Tablets: Chew 2-4 tablets, 30 minutes after each meals and at bedtime (maximum 4 tablets 4 times a day).

Liquid sachet: 1-2 sachets (10-20ml) after each meals and at bedtime (maximum 4 times a day)

Liquid bottle: Take 5-10ml 30 minutes after each meals and at bedtime.

Take note…

• Gaviscon are highly effective and suitable to use during pregnancy and whilst breast feeding. These include Gaviscon Original, Gaviscon Double Action and Gaviscon Advance in both liquid and tablet form. This is because they act physically rather than entering the bloodstream. Gavilast however is not suitable for use during pregnancy. *Medicines can affect the unborn baby. Always talk to your doctor or pharmacist before taking any medicine in pregnancy.*
• Not recommended for patient with kidney failure (side effect more severe especially when taken with milk which known as milk-alkali syndrome), heart failure, hypertensive patient (sodium salts), and children (below 12 years old).
• Long-term use may cause alkalosis, with the symptoms of numbness and nausea. If experience dizziness and difficulty in breathing, please seek for medical help immediately.
• Liquid bottle can store up to 6 months after opening. It should not be stored in the refrigerator.

Dentinox Colic Drops; Woodwards GripeWater

These are simethicone with or without antacid-containing products for infants who have gastric reflux and wind problem. The summary is shown as below:

If there is any allergy reaction on the infants, stop using the product immediately and seek for medical advice from your physician or pharmacist. Other than medications, you can take note on the feeding pattern of the milk for your infant. It is recommended to feed frequently, by administering small volume of the milk. You can always opt for special milk formulation for wind and gastric problem too.

I guess that you must be tired reading this article. Hope that you enjoy our informative blog and have a good rest. To be continued…

Author:

Lok Ker Yee

BPharm (Hons) (IMU)

Editors:

Chang Jen Nee

BPharm (Hons) (IMU)

Grace Ho Mee Yan

BPharm (Hons) (IMU)

Bring The Men’s Spark Back --- Viagra

What is Viagra?

    Viagra is a prescribed medicine containing sildenafil citrate. It is used to treat male impotence or erectile dysfunction (ED) (inability to maintain or develop erection of penis during sexual activity). Sildenafil increases the blood flow to the penis and thus helps in the erection. It is NOT for women and children.

What are the different strengths and dosages of Viagra?

• Three different strengths of Viagra are available in the market: 25mg, 50mg and 100mg. In Malaysia, only 50mg and 100mg are available.
• The initial dosage for adults is usually 50mg once daily. However, the dosage may be increased to 100mg or decreased to 25mg based on the response to treatment, medical conditions and other medications you are taking.
• The initial dosage for elderly (>65 years old) is 25mg once daily. The dosage can be increased or decreased based on the Viagra’s performance and the tolerability of the person.
• Stage four and five kidney failure patients (creatinine clearance < 30ml/min) and/or impaired liver patients are merely 25mg once daily as the clearance of Viagra is reduced.
• A dose of 25mg once daily should be given in patients who are receiving concomitant medications such as oral fungal medications (eg: itraconazole, ketonazole), some antibiotics (eg: erythromycin, clarithromycin) and Human Immunodeficiency Virus (HIV) protease inhibitor medications (eg: saquinavir, atazanavir).
•  The recommended maximum dosage for patients who are concomitantly taking HIV medication ritonavir is 25mg within two days time. Ritonavir significantly reduces the clearance of Viagra.

How to use Viagra?

•           Take the dosage orally on an as-needed basis, as directed by your doctor. Not taking more than once a day.
•       Take it approximately one hour before sexual activity, with or without food. However, Viagra may be taken 30 minutes to 4 hours before sexual intercourse.
•      Avoid high-fat meal as it will delay the effectiveness of Viagra.

Who should not take Viagra?

• Viagra can only be obtained with the doctor’s prescription.

DO NOT take Viagra if you are:-

• Allergic to sildenafil (allergic reaction including rashes and itchiness)
• Concurrently or intermittently taking nitrates-containing medications (often prescribed for chest pain)

What are the precautions while taking Viagra?

Use Viagra in caution in the following conditions:

•  Had a heart attack, stroke or life-threatening arrhythmia (irregular heart rate) within the last 6 months
•  Heart disease
• Unstable angina (chest pain)
• Heart artery disease
• Concomitantly taking blood pressure medications
• Any deformation of penis
• Bleeding disorders
• Stomach ulceration/bleeding
• Grape fruit juice may increase the effect of Viagra which cause low blood pressure, dizziness and prolonged erection.

How long do the effects of Viagra last?

• It can last from one to four hours, vary from person to person.

What are the side effects of Viagra?

• Common side effects: Headache, flushing, blurred vision, blue vision (seeing everything tinted with blue), stuffy nose, nausea, dizziness, back pain
• Rare side effects: priapism (erection that lasts longer than four hours), sudden hearing reduced or loss, sudden vision reduced or loss

Any generic form of Viagra?

• In Malaysia, the generic of Viagra are Axcel Sildenafil, Iqnyde and Elonza.

What are the alternatives apart from Viagra?

Alternatives other than Viagra are Cialis, Levitra and Zydena which are also used to treat ED. However, they do not contain the same medicine as Viagra. They are all prescribed medications.

Authors:

1.   Loh Pui Yee 

      BPharm (Hons) (IMU)

Editors:

1.  Tee Ai Ven    

     BPharm (Hons) (IMU)

2.  Ong Jijien

     BPharm (Hons) (IMU)

Treating my wound with a first aid kit – Part 1

Ouch!! There is a time where you might accidentally cut your finger, burn yourself while cooking or fell down while riding a bicycle. What is the first thing that comes to your mind? We all know that we should clean the wound with water and proceed to treat it with an antiseptic cream or solution. Now the question is, where are these antiseptic creams or solutions usually stored? The first aid kit will usually pops out first in your mind. Here, let me explain to you briefly what a first aid kit is and why every family is encouraged to have a first aid kit. 

A first aid kit should contain all the equipment needed for minor accidents, such as cuts, burns, bruises, bites and muscle sprains. Since accidents may occur at times, it is important to have a well-stocked first aid kit ready for you and your family in case of any emergencies. You can also keep a small first aid kit under the seat of your car and bring it along with you on a vacation.

Keep your first aid kit in a cool and dry place at home where it is visible and out of the reach of children. If you choose to put a first aid kit in your car, you may keep it in a suitcase, backpack or dry bag and remember to put it away from sunlight. You can choose to buy an equipped or non-equipped first aid kit in any pharmacy. If you buy a non-equipped first aid kit, you can tailor your kit according to your activities and needs. If you do not want to purchase one, you can assemble the items in any type of container, preferably a durable plastic box. However, it is best to make sure the kit comes in a clean and waterproof condition to keep the items safe and aseptic. The contents should be checked routinely and restocked if the items have expired or been used up.

Now please allow me to introduce to you on what you should have in your first aid kit. First-aid kit's content has to be tailored according to your activities and needs.

A basic first aid kit should include:

Items	Example	Function
Dressings
2 absorbent compress dressings (10x10cm)	MELOLIN Absorbent Dressings	-Cover cuts, grazes and minor burns to prevent germs from entering the wound. -Absorb wound fluid while minimizing adherence to wound bed.
20 adhesive bandages (assorted sizes)	NEXCARE bandages	-For minor cuts and skin injuries. It is used to cover and protect the wound from water, dirt and germs to prevent infection as well as promote healing. -Never use adhesive dressing on burnt or abraded skin.
5 sterile gauze swabs (7.5cmx7.5cm)	Gauze Swab (7.5cm x 7.5cm) from Winner Medical Co. Ltd	-Primarily used as a swab with an antiseptic to clean wound. -As a dressing to cover wound.
5 sterile gauze swabs (10cmx10cm)	Gauze Swab (10cm x 10cm) from Winner Medical Co. Ltd	-Primarily used as a swab with an antiseptic to clean wound. -As a dressing to cover wound.
Bandages
1 three-inches wide roller bandage (crepe or conforming bandage)	SMITH & NEPHEW Elastic Conforming Bandage	Hold dressings in place, create pressure to stop bleeding and reduce swelling as well as provide some support.
1 four-inches wide roller bandage (crepe or conforming bandage)	SMITH & NEPHEW Crepe Bandage	Hold dressings in place, create pressure to stop bleeding and reduce swelling as well as provide some support.
2 triangular bandages	SMITH &NEPHEW Triangular Bandage	Used for slings, hold splints in place and restrict movement.
Antiseptic preparation and Over-the-counter medicines
4 Alcohol pads		-To sanitize equipment such as scissors and tweezers. -To clean unbroken skin before applying adhesive bandage.
1 antiseptic wash	-Dettol antiseptic liquid -Normal Saline -DermacynTM (for diabetic wound care)	Clean wound by washing away dirt and germs as well as relieve itch temporarily.
1 antiseptic solution	Acriflavine solution 30ml	-Used as a topical disinfectant in small scrapes, bruises and cuts (applied by using cotton wool or bud).
1 burn antiseptic cream	Burnol antiseptic cream (10g)	-For prevention and treatment of infection in burn cases. -Provide immediate relief in burns and aid in healing process. -Can also be used in minor wounds, cuts and insect bites.
Burn Treatment -Aloe vera gel -Lidocaine cream or ointment		Apply to the area around the burns (NOT on the burned area) to provide cooling effect and reduce the pain.
1 Methyl Salicylate liniment	Tiger Liniment	-Rubbed onto the skin to provide symptomatic relief of strains, sprains and muscular pains.
1 Hydrocortisone cream	Xepa Hydrocortisone cream	To relieve allergic reaction such as itchiness, redness and swelling. It can be applied on the face and armpits as well. Recommended Dosage: Apply a thin layer on the affected area two to three times a day. Do not apply on open wound.
Other instruments
2 breathing barrier	Face mask	To reduce chances of airborne infection transmission.
2 pairs large disposable non-latex gloves		To avoid direct contact with blood or wound fluids (exudate).
1 instant cold compress		To reduce pain and swelling which are caused by sprains, strains, minor burns and insect bites.
Scissors		For cutting bandages, removing clothes from wounds.
Tweezers		To remove splinter, glass or insect stinger.
1 adhesive tape	3M™ Micropore™ Surgical Tape	-To hold the dressing in place. -To hold the loose end of a bandage.
12 safety pins		To secure slings and bandages in place.
First Aid booklet		Provide comprehensive information on most minor wound care in first aid condition.
Hand sanitizer	Dettol Hand Sanitizer	Clean hands before and after the wound care is done.
1 pack of cotton balls / cotton swabs		For applying antiseptic cream or solution.

Some comprehensive kits may contain pharmacological agents to alleviate emergency condition such as fever, pain, allergies and gastrointestinal issues. The medicines included are shown as below:

Condition	Medications
Fever or pain Be aware that there are people allergic to painkillers, such as paracetamol, ibuprofen and others. If you experience any facial swelling, skin itchiness/redness, difficulty in breathing, please stop taking the medication and please rush to the hospital (emergency department) as soon as possible.	Paracetamol 500mg Dosage: Adult (above 12 years old): 2 tablets 4 times a day, maximum dose is 8 tablets. Only take it when necessary. Children: Dosage depends on age. Please consult doctor or pharmacist. Or Ibuprofen 400mg Dosage: Adult (above 12 years old): 1 tablet three times a day, maximum dose is 6 tablets. Only take it when necessary. Children: Dosage depends on age. Please consult doctor or pharmacist.
Allergic reaction (Feeling itchy or swelling)	Cetirizine 10mg (Brand name: Adezio®, Zyrtec®) Dosage: Adult & children >6 yrs : one tablet once daily Children 2-5 years: 2.5ml of suspension once daily.
Food Poisoning	Please refer to our blog article My Travel Health Kit Part I for more information.
Indigestion or heart burn

Note: You might need syrup form for children below 6 years old. If you have any current health condition, please consult your doctor or pharmacist before taking any medicine mentioned above.

*Please store some of your personal medication such as asthma inhaler in the kit as well.

You are advised to have a first-aid kit available at all times. In case of a medical emergency, you should call 999 and at the same time, you can use your first aid kit to treat injuries promptly to minimize further complications.

            That’s all for this week article. Stay tune for our next article on how to use the equipment in the first aid kit for wound healing. Have a great day ahead.

Authors:

1.   Lau Hie Hie

      BPharm (Hons) (IMU)

2.   Jamie Lim Jo Shin

      BPharm (Hons) (IMU)

Editors:

1. Jordy Wong Der Yuan

    BPharm (Hons) (IMU)

2. Chang Jen Nee

           BPharm (Hons) (IMU)

      2. Tee Ai Ven

          BPharm (Hons) (IMU)