Agents For PUD And GERD - Dr. Segars

Question 1

3 H2 Receptor Antagonists

Answer 1

1. Cimetidine
2. Famotidine
3. Nizatidine

Question 2

4 proton pump inhibitors

Answer 2

1. Lansoprazole (Dexlansoprazole)
2. Omeprazole (esomeprazole)
3. Pantoprazole
4. Rabeprazole

Question 3

Surface Acting Agent

1

Answer 3

Sucralfate

Question 4

PGE1 Analogs

1

Answer 4

Misoprostol

Question 5

Bismuth Compound

1

Answer 5

Bismuth Subsalicylate

Question 6

Parietal cell receptors on side facing to BS (basal)

Answer 6

1. M3
2. CCK2
3. H2
4. EP3 (PGE stimulated)

Question 7

Parietal cell receptors on side facing into lumen of stomach (apical)

Answer 7

1. Cl- and K+ channel

2. H+/K+ ATPase (pumps H+ to lumen, PP inhibitors come here)

Question 8

Superficial epithelial cell receptors facing out towards BS (basal)

Answer 8

1. EP3 (PGE)

2. M

Question 9

Superficial epithelial cell receptors facing in towards lumen (apical)

Answer 9

1. Mucus out

2. HCO-3 out

Question 10

What 2 pathways are in the parietal cell and which receptor activates which

Answer 10

1. Ca+2 dependent pathway : M3 and CCK2 (Gastrin)
2. cAMP dependent pathway : H2 (histamine), EP3 INHIBITS
   * *** ——> both go to the H+/K+ pump

Question 11

H2 blocker
Onset relief
Effects
How much acid decrease

Answer 11

0.5hr-2hr (shorter then PPI, and longer then antiacids)
Decrease acid + heal ulcers in 4-8weeks*
20%-50% acid

Question 12

H2 blocker
Adverse effects
And specifically one of these drugs has something

Answer 12

1. GI related
2. Some CNS
   = CIMETIDINE: decreased testosterone binging to androgen R —> weak androgen effect and gynomastia (men) + glactorrhea (women), and Neutro/thrombopenia

Question 13

H2 blocker

Drug interactions

Answer 13

** only cimetidine : inhibits CYTP450 = MANY drug- drug interactions

Question 14

H2 blocker contraindication

Answer 14

Pregnancy , not nizatidine if needed

Question 15

PPI 
MOA
Time relief 
Acid reduction 
Effects

Answer 15

Covalent inhibition of H+/K+ pump
Longer then H2s
50% - 90% acid
Lower acid + heal ulcers in 4-8 weeks

Question 16

PPI
adverse effects main
And and effects rare

Answer 16

1. GI and some CNS

2. CDAD : C. Diff Associated D = NEED TO STOP MEDICATION

Question 17

Risk of CDAD

Answer 17

When taking PPI

• AKI
• Osteoporosis, bone fracture
• MI, CAD

Question 18

PPI

Drug interactions

Answer 18

Omeprazole : CYP450 inhibitor = MANY drug-drug interactions

Question 19

PPI

Contraindications

Answer 19

Pregnancy, not omeprazole if needed

Question 20

Sucralfate
MOA
Effect

Answer 20

1. Cross links acid making sticky polymer that sticks to epithelial cells around an ulcer crater = prevents acid to ulcer sites
2. Can stimulate PGEs, + HEAL ULCERS

Question 21

Sucralfate

Used specifically mostly for

Answer 21

Duodenal ulcer

Can be for aphthous ulcer, mucositis, stomatitis, radiation elder, bile reflux

Question 22

Sucralfate
Adverse effects
Contraindication

Answer 22

1. Constipation (form Al(OH)3 made*)

2. Renal failure due to aluminum in the drug

Question 23

Sucralfate

Drug interactions

Answer 23

Not known, still take after 2hrs of another drug (you take this dru 4 times a day**)

Question 24

Misoprostol
MOA
Effects
Time

Answer 24

Agonist to PGE
Reduce acid from parietal cells + CYTOPROTECTION (by increasing mucosal defense also)
Less then PPI and H2

Question 25

Misoprostol

When do you give this mostly

Answer 25

Prevention for someone taking NSAIDs
= also for cervical ripening
= post-partum hemorrhaging

Question 26

Misoprostol
Adverse effects
Contraindication

Answer 26

1. GI and some CNS

2. PREGNANCY : will induce contractions**, IBD

Question 27

Bismuth compounds Subsalicylate
MOA
Off brand names
Used for

Answer 27

1. Anti-microbial actions, prevent microbe attachment to mucosa, anti-D also
2. Pesto-Bismol, Kaopectate
3. H. Pylori

Question 28

Bismuth compounds Subsalicylate

Adverse effects

Answer 28

** Black stools (not blood, if form is normal), constipation

Question 29

Bismuth compounds Subsalicylate

D-D interactions

Answer 29

MANY, take 2hrs after another drug

Question 30

Bismuth compounds Subsalicylate

1. Relative contraindications
2. Absolute contraindications

Answer 30

1. pt with anti-plt and anti-coag, Revere renal problems

2. GI bleeding, Salicylate hypersensitivity