03.02 Drugs for Peptic Ulcer Disease

Question 1

Distal to the junction between antrum and acid secretory mucosa
High risk of malignancy
H. pylori, NSAID-induced
Gastric acid output normal or decreased
Burning or gnawing discomfort
Precipitated by food

Answer 1

Gastric ulcer

Question 2

First portion of the duodenum (within 3 cm of pylorus)
Rare risk of malignancy
H. pylori, NSAIDS
High gastric acid secretion, low bicarbonate secretion
Burning or gnawing, awakens at night
90 minutes to 3 hours after a meal, relieved by antacids or food

Answer 2

Duodenal ulcer

Question 3

Burning pain on epigastric region, often accompanied by a feeling of post-prandial fullness

Answer 3

Dyspepsia

Question 4

Protective factors of GI mucosa

Answer 4

Bicarbonate
Gastric mucosa
Prostaglandins
Nitric oxide

Question 5

Damaging factors of GI mucosa

Answer 5

Stress and trauma
NSAIDS
H. pylori
Caffeine
Acids
Skipping meals
Smoking, alcohol

Question 6

Rebound acidity, diarrhea, constipation, metabolic alkalosis, abdominal distension, gas flatulence

Answer 6

Antacids

Question 7

Dizziness, inhibition of CYP450, hormonal imbalances, Vit B12 supplementation

Answer 7

H2 receptor antagonists

Question 8

CYP450 inhibition, rebound acidity, Vit B12 supplementation

Answer 8

PPI

Question 9

Constipation, flatulence, dry mouth

Answer 9

Sulcralfate

Question 10

Blackening of tongue and stool

Answer 10

Bismuth chelate

Question 11

Empiric trial acid suppresion for ___ is the recommended line of therapy

Answer 11

4-8 weeks

Question 12

If initial acid suppression fails after ___, it is reasonable to step up therapy

Answer 12

2-4 weeks

Question 13

Most sensitive and specific approach for examining the upper GI tract
Direct visualization of the mucosa
Test for malignancy

Answer 13

Endoscopy

Question 14

Other diagnostic procedures for peptic ulcer diseases

Answer 14

Barium studies

H. pylori detection (urease test)

Question 15

Two types of antacids

Answer 15

Bicarbonates

Hydroxides

Question 16

Acid neutralizer only
Rapidly neutralizing HCl and reducing pepsin activity
Stimulate mucosal prostaglandin production
Weak bases that react with H+ to form a salt and water
Fast onset, short duration

Answer 16

Antacids

Question 17

Symptomatic relief of acid peptic disorders
Reduce the phosphorus levels among patients with renal insufficiency/failure
Ca2+ supplement for patients with osteoporosis or hypocalcemia

Answer 17

Antacids

Question 18

Adverse effects of antacids

Answer 18

Metabolic alkalosis
Rebound acidity
Increased acid secretion due to negative feedback
Milk-alkali syndrome
Flatulence, abdominal distention, bloating or belching

Question 19

CI in patients with cardiac or renal problems

Answer 19

Sodium bicarbonate

Question 20

Increase acid secretion due to negative feedback

Answer 20

Calcium carbonate

Question 21

Osmotic diarrhea
Hypermagnesemia
Flatulence

Answer 21

Mg(OH)2

Question 22

Constipation
Usually combined with Mg(OH)2
Hypophosphatemia
Flatulence

Answer 22

Al(OH)3

Question 23

Cimetidine, ranitidine, nizatidine, famotidine

Answer 23

H2 receptor antagonist

Question 24

Technically an antihistamine
Block H2 receptors of the parietal cells via competitive inhibition
Reduces the direct-stimulatory effect of gastrin and acetylcholine
Suppress basal gastric acid secretion
Longer effect than antacids

Answer 24

H2 receptor antagonist

Question 25

Indications of H2 receptor antagonists

Answer 25

``` Nocturnal acid secretion Stress ulcers NSAID-induced ulcers GERD Erosive esophagitis Non-ulcer dyspepsia First-line for bleeding from stress-related gastritis ```

Question 26

Adverse effects of H2 receptor antagonists

Answer 26

``` Mental status changes among the elderly Cross the placenta Secreted into breast milk Blood dyscrasias Arrythmia ```

Question 27

Prototype drug of H2 receptor antagonist | Rarely used because of its side effects (gynecomastia, galactorrhea, CNS effects)

Answer 27

Cimetidine

Question 28

Commonly prescribed Inhibit nocturnal gastric secretion Known to prevent stress ulcers

Answer 28

Ranitidine

Question 29

Ideal drug based on guidelines Most potent acid inhibitory agents Inhibits meal-stimulated acid secretion during the day as well as basal secretion overnight

Answer 29

PPI

Question 30

Irreversibly inhibits proton pump Rapid onset and duration Prodrug that require activation in an acidic environment

Answer 30

PPI

Question 31

Clinical uses of PPI

Answer 31

Gastric and duodenal ulcers, GERD, erosive esophagitis Zollinger-Ellison syndrome PPIs inhibit acid-secretion during fasting and during meals Progressive acid inhibitory effects

Question 32

Most common adverse effects of PPI

Answer 32

Headache and diarrhea

Question 33

Included in the Philippine Drug Formulary

Answer 33

Omeprazole

Question 34

Provide physical barrier over the surface of the ulcer | Increase secretion of protectant mucus, prostaglandin, bicarbonate

Answer 34

Mucosal resistance enhancers

Question 35

Combination of sulfated sucrose and aluminum Non-absorbable drug that provides a physical barrier unto the damaged mucosa to protect it against acid and pepsin Stimulates secretion of mucus, bicarbonate and mucosal prostaglandin Adminster on an empty stomach (acidic)

Answer 35

Sucralfate

Question 36

Clinical uses of sucralfate

Answer 36

Peptic ulcers | Reduce incidence of GI bleeding

Question 37

Protect gastric mucosa Important H. pylori theraphy Coats damaged mucosa, promotes secretion of bicarbonate and prostaglandins, and reduce peptic activity

Answer 37

Bismuth chelate

Question 38

Clinical use of bismuth chelate

Answer 38

Quadruple therapy for H. pylori | Hordes iron stores

Question 39

Increase mucus secretion | Reduces peptic activity

Answer 39

Carbenoxolone

Question 40

Prostaglandin E1 analogue Increase mucus production Enhancement of mucosal integrity and repair

Answer 40

Misoprostol

Question 41

Adverse effects of misoprostol

Answer 41

Diarrhea Uterine bleeding and contractions Abortifacient

Question 42

H. pylori eradication theraphy

Answer 42

OCA (most common) OCM (penicillin allergies) OCA/M + B (2nd line)

Question 43

Treatment duration of H. pylori

Answer 43

10-14 days