User:Doxycycle/sandbox

Drug Classes and Delivery Systems

 * Antacid
 * Requires addition of 'Drug-drug interactions' heading
 * Some grammar fixes required
 * Addition of section detailing other antacids than currently listed (ex. calcium carbonate tablets, milk of magnesia, etc.)
 * Possibly add in specific 'Liquid formulations'
 * Potentially add in manufacturing section, though this may be a stretch
 * Look into other possible indications for antacids
 * Anesthetic
 * Antibacterial soap
 * Antipyretic
 * Capsule (pharmacy)
 * Drug delivery
 * Not totally sure what needs to be done but we had learned about this for an entire semester so I'm sure I could find something to add or change. Article is pretty short and this is currently a relevant topic
 * Sedative
 * Article barely talks about mechanisms, doesn't really talk about side effects (focuses more on misuse), and the therapeutic use subheading is only 2 sentences. Could definitely use some work.
 * Amphetamine Dependence
 * Not sure what needs to be done but it's a pretty small article
 * Off-label use
 * Can potentially add a subheading about "common examples"
 * Pharmacy Technician
 * This article is a bit of a gongshow. So much of it is anecdotal and does not seem to flow. Does not clearly outline typical tasks and duties, and just overall could use some work. May be hard to find actual sources for info though.

Antacid *** Note that this is not my official draft. The official draft for the article with appropriate edits is in my draft sandbox.***
An antacid is a substance which neutralizes stomach acidity and is used to relieve heartburn, indigestion or an upset stomach. Currently marketed antacids contain weak bases paired with salts of aluminum, calcium, magnesium, or sodium. Some preparations contain a combination of two salts, such as magnesium carbonate and aluminum hydroxide.

Mechanism of action
When excess amounts of acids are produced in the stomach, the natural mucous barrier that protects the stomach can degrade, leading to pain and irritation. There is also potential for the development of acid reflux, which can cause pain and damage to the esophagus. Antacids contain alkaline ions that chemically neutralize stomach gastric acid, reducing damage to the stomach lining and esophagus, and relieving pain. Some antacids also inhibit pepsin, an enzyme that can damage the esophagus in acid reflux.

Antacids do not directly inhibit acid secretion, and thus are distinct from acid-reducing drugs like H2-receptor antagonists or proton pump inhibitors. Antacids do not kill the bacteria Helicobacter pylori, which causes most ulcers.

Medical uses
Antacids are available over the counter and are taken by mouth to quickly relieve occasional heartburn, the major symptom of gastroesophageal reflux disease and indigestion. Treatment with antacids alone is symptomatic and only justified for minor symptoms. Alternative uses for antacids include constipation, diarrhea, hyperphosphatemia, and urinary alkalization. Some antacids are also used as an adjunct to pancreatic enzyme replacement therapy in the treatment of pancreatic insufficiency.

Non-particulate antacids (sodium citrate, magnesium trisilicate) increase gastric pH with little or no effect on gastric volume, and therefore may see some limited use in pre-operative procedures. Sodium citrate should be given within 1 hour of surgery to be the most effective.

Side effects
Formulations containing magnesium salts may cause diarrhea, whereas those containing calcium or aluminum may cause constipation. Rarely, long-term of calcium carbonate may cause kidney stones. Long-term use of antacids containing aluminum may increase the risk of developing osteoporosis. In vitro studies have found a potential for acid rebound to occur due to antacid overuse, however the significance of this finding has been called into question.

Interactions
Antacids are known to interact with several oral medications, including fluoroquinolone and tetracycline antibiotics, iron, itraconazole, and prednisone. Metal chelation is responsible for some of these interactions (eg. fluoroquinolones, tetracyclines), leading to decreased absorption of the chelated drug. Some interactions may be due to the pH increase observed in the stomach following antacid ingestion, leading to increased absorption of weak acids, and decreased absorption of weak bases. Antacids also cause an increase in pH of the urine (alkalization), which may cause increased blood concentrations of weak bases, and increased excretion of weak acids.

A proposed method to mitigate the effects of stomach acidity and chelation on drug absorption is to space out the administration of antacids with interacting medications, however this method has not been well studied for drugs affected by urine alkalization.

There are concerns regarding interactions between delayed-release tablets and antacids, as antacids may increase the stomach pH to a point at which the coating of the delayed-release tablet will dissolve, leading to degradation of the drug if it is pH sensitive.

Liquids (under 'Formulations')
Several liquid antacid preparations are currently marketed. Common liquid preparations include milk of magnesia and magnesium/aluminum combinations. A potential advantage of using a liquid preparation over a tablet is that liquids may provide quicker relief, however this may coincide with a shorter duration of action.

Chewable tablets
Chewable tablets are one of the most common forms of antacids, and are readily available over-the-counter. Upon reaching the stomach, the tablet powder will dissolve in the stomach acid, allowing the cations to be released and neutralize excess stomach acid. Common salts available in tablet form include those of calcium, magnesium, aluminum, and sodium.

Effervescent tablets
Effervescent tablets are tablets which are designed to dissolve in water, and then release carbon dioxide. Common ingredients include citric acid and sodium bicarbonate, which react when in contact with water to produce carbon dioxide. Effervescent antacids may also contain aspirin, sodium carbonate, or tartaric acid. Those containing aspirin may cause further gastric irritation and ulceration due to aspirin's effects on the mucous membrane of the stomach.

Common brands of effervescent tablets include Alka-Seltzer, Eno and Andrews.

Algeldrate *Note that this was copied from the original article and I only made minor edits
Under the generic name algeldrate, aluminium hydroxide [Al(OH)3] is used as an antacid. Aluminium hydroxide is preferred over other alternatives such as sodium bicarbonate because Al(OH)3, being insoluble, does not increase the pH of the stomach above 7 and hence, does not trigger secretion of excess stomach acid. Brand names include Alu-Cap, Aludrox, Gaviscon, and Pepsamar. In 2016 Gaviscon was one of the best-selling branded over-the-counter medications sold in Great Britain, with sales reaching £62 million.

Algeldrate-containing products can cause constipation, because the aluminum ions inhibit the contractions of smooth muscle cells in the gastrointestinal tract, slowing peristalsis and lengthening the time needed for stool to pass through the colon. Some such products are formulated to minimize these effects by including equal concentrations of magnesium hydroxide or magnesium carbonate, which have counterbalancing laxative effects.