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GI 2 Final > Antacids and anti-ulcer > Flashcards

Antacids and anti-ulcer Flashcards

1
Q

indication for antacids

A

short-term, temporary relief of mild pain and symptoms associated with PUD/GERD

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2
Q

categories of antacids

A

low-systemic agents (aluminum, calcium, magnesium)
high systemic agents (sodium)
supplemental agents (simethicone)

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3
Q

low systemic antacids

A

aluminum
calcium
magnesium

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4
Q

high systemic antacids

A

sodium bicarbonate

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5
Q

MoA of antacids

A

combine chemically with hydrogen ions resulting in the generation of by-products - water, CO2, Cl

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6
Q

at higher doses of antacids, what happens to LES tone?

A

increases

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7
Q

T/F - antacids reduce acid secretion and production

A

no, dont reduce secretion or production

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8
Q

rapid onset antacids include

A

calcium and magnesium

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9
Q

slow onset antacids include

A

aluminum and sodium

S(low) A(ntacids)

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10
Q

long lasting antacids include

A

calcium and magnesium

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11
Q

best acid neutralizing capacity

A

calcium

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12
Q

surfactant that decreases surface tension and aids in the expulsion of gas

A

simethicone

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13
Q

aluminum adverse effects

A

constipation
hypophosphatemia ***
rare –> renal osteodystrophy, encephalopathy

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14
Q

magnesium adverse effects

A

diarrhea (stool-softening/laxative like activity)

hypermagnesemia

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15
Q

calcium adverse effects

A

contipation
hypercalcemia (milk-alkali syndrome resutling in nephrop)
hypophosphatemia (effective treatment for hyeprphosphatemia)
calcium based kidney stones

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16
Q

sodium adverse effects

A

gas/flatulence
hypernatremia
metabolic alkalosis

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17
Q

when prescribing antacids, what important information about TIMING should you educate them on

A

patients should take all antacids 1-2 hours BEFORE other medications or 2-4 hours AFTER
AVOID ANTACID AND MEDICATION CO-ADMINISTRATION

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18
Q

anti-ulcer drug families

A 
h2 receptor antagonists (-tidine) 
PPI (-prazole)
surface acting agent (sucralfate) 
PGE1 analog (misoprostol) 
bismuth compounds (bismuth subsalicylate)
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19
Q

nizatidine is unique of all the h2 blockers because

A

PO only

all others are IV/PO

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20
Q

MoA of H2 blockers

A

REVERSIBLY inhibit h2 recpetors on baso-lateral membrane of parietal cell
30min-2 hour onset (longer than antacids, shorter than PPIs)
ulcer healing occursin 4-8 weeks
inhibit 20-50% of acid production

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21
Q

H2 adverse effects

A

gi - nausea/diarrhea/constipatino
cns - headache
RARE - CEMETIDINE DECREASES TESTOSTERONE BINDING TO ANDROGEN RECPETOR – GYNECOMASTIA IN MEN AND GALACTORRHEA IN WOMEN
blood dyscrasias such as neutropenia and thrombocytopenia

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22
Q

H2 drug interactions

A

primarily with cemetidine
CEMETIDINE INHIBITS CYP450 AND INTERACTS WITH A SHIT TON OF DRUGS
Ranitidine ~10% CYP450 inhibition and other in the family have no inhibition

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23
Q

CI for H2 blockers

A

pregnancy

if you have to - use ranitidine or famotidine

24
Q

PPIs include

A 
omeprazole
esomeprazole
lansoprazole
dexlansoprazole 
pantoprazole
rabeprazole
25
PO ONLY PPIs
omeprazole lansoprazole dexlansoprazole rabeprazole
26
PO/IV PPIs
esomeprazole | pantoprazole
27
MoA of PPIs
covalently bind to sulfhydryl groups of H+/K+ ATPase at parietal cell secretory sites, thereby inhibiting gastric acid secretion by IRREVERSIBLY INHIBITING functioning -ase pumps takes several days to reach new steady state
28
PPIs are more effective than H2 blockers, reducing acid secretion by
50-90%, whereas H2 vblockers only reach 20-50% | however, H2 blockers have a more rapid onset than PPIs
29
PPIs adverse effects
``` GI- diarrhea/dyspepsia/nausea *****CDAD - clostridium difficile-associated diarrhea ***** CNS - HA/dizziness rare - generalized myalgias, fatigue, myopathies increased risk for kidney disease (AKI) bone fractures cardiovascular disease ```
30
PPI drug interactions
OMEPRAZOLE INHIBITS CYP450 | many drug-drug interactions
31
CI for PPIs
pregnancy only if necessary - lansoprazole or pantoprazole AVOID OMEPRAZOLE
32
what is sucralfate
a suflated polysaccharide | an octasulfate of sucrose with al(OH)3 added
33
MoA of sucralfate
cross-links when interacting with stomach acid, creating a viscious sticky polymer which adheres to epithelial cells around an ulcer's crater prevents acid access to ulcer sites stimulates local prostaglandin and mucous productino and epdiermal growth factor - cytoprotective DOES NOT AFFECT PH
34
indication of sucraflate
DUODENAL ULCERS | off-label uses: aphthous ulcers, mucosities/stomatitis, radiation proctitis/ulcers, bile reflux gastropathy, otehrs
35
adverse effects for sucraflate
CONSTIPATION
36
CI for sucralfate
severe renal failure d/t presence of aluinum | also avoid aluminum antacids
37
drug interactions with sucralfate
possible, take 2 hours after other medications | dosed QID for active ulcers so plan other meds accordingly
38
prostaglandin e1 analog
misoprostol
39
MoA of misorpostol
provides protective prostaglandin to gastric mucosa and reduces gastric acid release from parietal cell provides cytoprotection by increasing mucosal defenses stimulates bicarb and mucous production
40
indication for misoprostol
``` prevention of NSAID induced gastric ulceration in patients iwth high risk of ulceration and complications off-label uses pregnancy termination CERVICAL RIPENING post-partum hemorrhaging ```
41
adverse effects of misoprostol
GI - diarrhea **** | cns - HA/dizziness
42
CI for misoprostol
pregnancy - unless for off-label issues | IBD - avoid if possible
43
MoA of bismuth compounds
anti-diarrheal agent antimicrobial actions exact mechanism for PUD not known, might function similar to aspirin and inhbiit prostaglandin synthesis
44
what agent is used in combiination with antibiotics and acid suppression for h. pylori treatment
bismuth compounds
45
adverse effects of bismuth comounds
constipation BLACK/DARK STOOLS lots of drug interactions, take 2 hours after other medications
46
CI for bismuth
antiplatelets and anticoagulates | severe renal failure
47
ABSOLUTE ci for bismuth
GI bleeding | salicylate hypersensitivity
48
treatment of h pylori
combination treatment 2 ANTIBIOTICS AND AN ACID REDUCER (PPI or H2) 10-14 days BID
49
antibiotics for h pylori
clarithromycin | amoxicillin/metronidazole
50
in order to test for successful h pylori eradication, what hsould the patient discontinue
discontinue bismuth, antibiotics and PPIs within 4 weaks prior to breath test
51
triple therapy - 14 days
BID A PPI clarithromycin axomycillin/metronidazole
52
quadruple therapy - 10-14 days
``` PPI - BID, all other QID PPI metronidazole tetracycline BISMUTH subsalicyate ```
53
helidac and pylera contain what
all the shit plus a PPI
54
PCN allergy - no amoxicillin
substitute metrodiazole (consider bismuth quadruple therapy)
55
h pylor with metronidazole resistance
substitute tetracycline
56
h pylori with clarithromycin resistande
substitute either amoxicillin or tetracycline
57
managing a pregnant patient with PUD and no h pylori
short course of antacids or sucralfate moderate - ranitidine severe - lansoprazole

GI 2 Final (4 decks)

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