Agents for PUD

Question 1

What 3 mediators can stimulate acid secretion from parietal cells?

Answer 1

1. ACh 2. Histamine (via H2 receptor) 3. Gastrin

Question 2

3 Causes of PUD

Answer 2

1. H pylori infxn (primary cause) 2. NSAIDs 3. Extreme physiological stress (ICU ventillator & burn pts)

Question 3

What type of pts do acute peptic ulcers occur in?

Answer 3

Hospitalized pts who are critically ill (stress ulcers)

Question 4

Syndrome characterized by hypersecretion of gastric acid secondary to a gastrin-secreting tumor?

Answer 4

Zollinger-Ellison Syndrome

Question 5

What treatment options are available to eradicate H.pylori?

Answer 5

• TRIPLE THERAPY
  
  • PPI
  • 2 Antimicrobial Agents
    
    • Metronidazole
    • Amoxicillin
    • Tetracycline
    • Clarithromycin
• 4-Drug Regimen
  
  • Triple Therapy
  • Bismuth Subsalicylate

Question 6

How to prostaglandins help treat PUD?

Answer 6

PGE2 & PGI2 inhibit gastric acid secretion & stimulated secretion of bicarbonate & mucus (cytoprotective activity) Used to treat NSAID induced peptic ulcers

Question 7

Which prostaglandin analog is commonly used as a cytoprotective agent for the treatment of PUD?

Answer 7

Misoprostol (synthetic PGE1 analog)⇒

• Increases production & secretion of gastric mucous barrier
• Decreases Acid Production

Question 8

Why should misoprostal not be given to a preterm preggo?

Answer 8

Induction of premature uterine contractions (abortifacient properties)

Question 9

Why should you not give bismuth subsalicylate to children?

Answer 9

May be associated with Reye Syndrome (contains salicyclates)

Question 10

What is Reye Syndrome?

Answer 10

Acute onset encephalopathy & fatty liver formation

Clinical:

• Symptoms begin with vomitting, lethary, & confusion
• Progresses to stupor
• Respiratory Distress
• Coma
• Seizures

Cause is unknown, but has been found to be associated w. ASA use in children

*ASA administration is to be AVOIDED in pediatric pts (EXCEPTION= Kawasaki Disease)

Question 11

What drugs bind to the ulcer base, providing physical protection & allowing HCO₃ secretion to reestablish pH gradient in the mucous layer?

Answer 11

1. Bismuth
2. Sucralfate

Question 12

What are the clinical uses of Bismuth & Sucralfate?

Answer 12

• Increase Ulcer Healing
• Traveler’s Diarrhea

Question 13

What are the clinical uses of Misoprostol?

Answer 13

• PREVENTION of NSAID-induced peptic ulcers
• Maintenance of PDA
• RIPENS cervix to induce labor

Question 14

What are the adverse s/e associated with Misoprostal?

Answer 14

• Diarrhea
• Abortifacient=contraindicated in women of childbearing potential

Question 15

What is the MOA of Octreotide?

What are the s/e of Octreotide?

Answer 15

MOA= LONG-acting SOMATOSTATIN analog

s/e:

• Nausea
• Cramps
• Steatorrhea

Question 16

What are the clinical uses for Octreotide?

Answer 16

• Acute Variceal Bleeds
• Acromegaly
• VIPoma
• Carcinoid Tumors