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Esomeprazole (Nexium)

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by

Lisa Levander

on 11 October 2013

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Transcript of Esomeprazole (Nexium)

Medical Indications
Duodenal Ulcer
Esophagitis
Gastroesophageal Reflux Disease (GERD)
Helicobacter Pylori Eradication
NSAID-induced ulcer prophylaxis
Zollinger-Ellison Syndrome

Mechanism
Structure
Drug Target
H+,K+ ATPase enzyme pump
also known as the proton pump

Last step in gastric acid production
While the parietal cell is inactivated, the H+,K+ ATPase are located on vesicles inside the cell.

When the stimulated by gastrin, histamine, or acetylcholine, these vesicles move to and fuse into the acid secretory canaliculus of parietal cell's plasma membrane.

Using ATP for energy, the pump exchanges extracellular potassium (native ligand) with hydrogen ions within the cell.
Binding Site
Alpha subunit of the H, K-ATPase

Forms a disulfide bond with a cysteine
Proton-pump Inhibitor (PPI)
Enzyme Inhibitor

***Acid Pump Antagonist (APA)--is referred to as this, but Dr. Garrison said not really relevant for us***
Questions?
Esomeprazole. In: Clinical Pharmacology. Tampa, FL: Gold Standard. https://library1.unmc.edu/login?url=http://www.clinicalpharmacology-ip.com?id=852776.

Sachs G, Shin JM. Pharmacology of proton pump inhibitors. Los Angles California: Current Medicine Group LLC; 2008. 10.

Yan D, Hu Y, Li S, Cheng M. A model of 3D-structure of H+, K+-ATPase catalytic subunit derived by homology modeling. Acta Pharmacologics Sinica. 2004;25(4):474.
Alissa Stark
Erin Buse
Kai Zheng
Lisa Levander

Prodrug--becomes activated by pH--reaction produces a sulphenamide

Sulphenamide forms a covalent, disulfide bond with the sulfydryl group of a cysteine on the H+,K+ATPase

Binds irreversibly to H+,K+ATPase and inhibits hydrogen ion secretion into the gastric lumen


S-isomer
Lipophilic, weak base, is inactive at neutral pH

**optical isomer**
Esomeprazole
(Nexium)
Full transcript