Acid-peptic disorders

Question 1

What are examples of sodium bicarb antacids

Answer 1

baking soda

alka seltzer

Question 2

Unique ADE of sodium bicarb antacids

Answer 2

may exacerbate fluid retention in HF, HTN, and Renal insufficiency pts

Question 3

Example of Calcium carbonate antacids

Answer 3

tums

Question 4

2 ADEs of sodium bicarb and calcium carbonate antacids

Answer 4

• CO2 gastric distention

- belching

Question 5

If you want to advise your patient to take antacids but want to avoid the AED of belching, what kind of antacid do you prescribe?

Answer 5

Magnesium/aluminum hydroxide

Question 6

How do H2 receptor antagonists work?

Answer 6

• competitive inhibition of H2 cells
• reduce acid secretion and volume
• ALSO reduce acid secretion stimulated by histamines
• do not affect H1 receptors

Question 7

What 2 populations should H2 receptor antagonists be avoided in?

Answer 7

Pregnant/breastfeeding- crosses the placenta

elderly pts w/ renal dysfxn- can cause mental status changes

Question 8

Examples of H2 receptor antagonists

Answer 8

• cimetidine

- ranitidine

Question 9

Examples of PPIs

Answer 9

omeprazole

pantoprazole

Question 10

how do PPIs work?

Answer 10

inactivation of acid pumps, no effect on quiescent pumps

Question 11

What are some ADEs of PPIs

Answer 11

diarrhea
B12 deficiency
iron, calcium, magnesium deficiency
Nosocomial PNA
c. diff infection

Question 12

how long does it take for PPIs to wear off

Answer 12

takes 18 hrs for new H+ molecules to be formed

can last up to 24 hrs

Question 13

when instructing a pt on when to take PPIs, what is important about the time the medication is taken

Answer 13

bioavailability of decreased by ~50% w/ food, so take 30-60 mins before meal (usu breakfast)

Question 14

How does Sucralfate work?

Answer 14

forms a viscous paste that coats ulcers for 6 hrs

stimulated mucosal prostaglandin/bicarb secretion

prevents stress related bleeding

Question 15

Example of Prostaglandin analog

Answer 15

Misoprostol

Question 16

what are the primary GI mucosal prostaglandins?

Answer 16

E & F

Question 17

True or false:
Acid suppression is more dependent on irreversible inactivation of the proton pump than the pharmacokinetics of different agents

Answer 17

Trueeee

Question 18

Decreased gastric acidity from PPI may alter absorption of what drug?

Answer 18

digoxin

Question 19

Omeprazole may inhibit metabolism of what drug?

Answer 19

warfarin

Question 20

What PPI has no significant drug interactions?

Answer 20

Pantoprazole

Question 21

How do Prostaglandin analogs work?

Answer 21

inhibits acid secretion
and
protects the mucosa

Question 22

what are the uses of Prostaglandin analogs?

Answer 22

reduce NSAID-induced ulcers less than 3% and the incidence of ulcer complications by 50%

Question 23

What group of people should prostaglandin analogs not be used in and why?

Answer 23

Pregnant people!

stimulates contractions

Question 24

how does bismuth work?

Answer 24

coats ulcers and erosions, creating a protective layer against acid and pepsin

also has direct antimicribial effects- preventing and treating traveler’s diarrhea

Question 25

ADEs of bismuth

Answer 25

black stools
darkening of tongue
renal insufficiency
bismuth toxicity
salicylate toxicity

Question 26

AED of Sucralfate

Answer 26

constipation

Question 27

What is the FDA approved treatment for H pylori

Answer 27

Clarithromycin triple:

• PPI
• Clarithromycin
• Amoxicillin or Metronidazole