When used with hyperacidic disorders of the stomach, antacids are given to elevate the gastric pH to:
A. 2.0
B. 4.0
C. 6.0
D. >8.0
Correct Answer: A. 2.0
Antacids are a group of drugs that have been on the market for many years. They were initially first-line defense against peptic ulcer disease; however, the discovery of proton pump inhibitors revolutionized the treatment of peptic ulcer disease. Currently, antacid use is restricted to the relief of mild intermittent gastroesophageal reflux disease (GERD) associated with heartburn.
Option B: The formulation of aluminum hydrochloride and water results in the neutralization of the acid in the stomach. It is also known to inhibit pepsin activity. Aluminum hydroxide is complexed with a sulfated polysaccharide sucrose octasulfate to form sucralfate. This complex does not have a significant buffering action against the acid or has no effect on the pepsin secretion and does not alter the gastric acid production in any way.
Option C: Calcium salts neutralize gastric acidity resulting in increased gastric and duodenal bulb pH; they additionally inhibit the proteolytic activity of pepsin if the pH is greater than 4 and increase lower esophageal sphincter tone. The calcium released from calcium carbonate is known to increase peristalsis in the esophagus, pushing the acid into the stomach and providing relief from symptoms of heartburn.
Option D: The dose for antacids depends upon the age of the patient, the purpose of administration (neutralization of acid or off-label use), and the presence of other comorbidities like renal or hepatic impairment. As all the forms of these medications are available as over-the-counter medication, the dosing recommendation varies by product/and or manufacturer.
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