23. Drugs Affecting Acid Secretion Flashcards

1
Q

What are the defensive factors of the gastric mucosa?

A

Epithelial integrity, cell replication and restitution, mucous membrane barrier, vascular supply.

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2
Q

What are the aggressive factors of the gastric mucosa?

A

Acid, helicobacter pylori, drugs.

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3
Q

What are the targets for drugs to act on the parietal cell?

A

Stimulatory receptors of the baso-lateral membrane, and the proton pump.

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4
Q

What are the receptors on the baso-lateral membrane of the parietal cell?

A

Acetylcholine, cholecystokinine B (CCK-B), histamine 2 receptors.

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5
Q

What is the receptor of the apical membrane of the parietal cell?

A

HK ATPase exchanger - the proton pump.

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6
Q

What is the main target for drugs in peptic disorders?

A

Proton pump.

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7
Q

What is the action of PPI?

A

Blocks the HKATPase on apical membrane of parietal cells. The pump has to be active for it to work on it.

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8
Q

When do PPIs have maximum efficacy?

A

After 2-3 days.

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9
Q

Why do patients normally feel immediately better having taken H2 receptor antagonists?

A

Because they have a short half life so act quickly.

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10
Q

What is the dosing of H2 receptor antagonists?

A

Twice daily.

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11
Q

What are the neuroendocrine regulators that act on parietal cells?

A

Cholecystokinine B, histamine, dopamine, gastrin.

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12
Q

What percentage of duodenal ulcer cases have H. pylori infection?

A

96%.

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13
Q

What percentage of gastric ulcer cases have H. pylori infection?

A

75%.

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14
Q

What is the step up ladder used in drugs for peptic disorders?

A

Anatacids -> alginates -> H2 receptor antagonists -> PPIs.

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15
Q

What are the issues with using the H2RA cimetidine?

A

ADRs: gynaechomastia in men. DDIs: inhibits CYP450 metabolism.

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16
Q

Name four H2RA.

A

Cimetidine, ranitidine, nizatidine, famotidine.

17
Q

Name five PPIs.

A

Omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole.

18
Q

What are the two goals of GORD treatment?

A

Symptom control, and healing of the oesophagitis.

19
Q

What are the steps taken in managing GORD in primary care?

A

Lifestyle, antacids/alginates, H2RA, PPI.

20
Q

What are the steps taken in managing GORD in secondary care?

A

PPI, H2RA, antacids/alginates, lifestyle.

21
Q

What is the epithelial change in Barrett’s oesophagus?

A

Squamous to columnar.

22
Q

What are the risks of Barrett’s oesophagus and how can they be avoided?

A

Cancer and strictures. Use PPIs for life

23
Q

What actions should be taken in the case of peptic ulceration?

A

Stop NSAIDs, H2RA/PPI for 6 weeks, H pylori eradication.

24
Q

How is H pylori eradicated?

A

2 antibiotics (clarithromycin + amoxycillin) + full acid blockade with PPI.