Anti-Ulcer Agents

Question 1

H2 receptor antagonist suffix

Answer 1

-tidine

Question 2

Proton pump inhibitor suffix

Answer 2

-prazole

Question 3

Four most common Histamine Type-2 Blockers

Answer 3

Cimetidine, ranitidine, famotidine, nizatidine

Question 4

H2 Receptor antagonist MOA

Answer 4

inhibit H2 receptors on baso-lateral membrane of parietal cell

Question 5

H2 antagonist onset of relief/ulcer healing

Answer 5

0.5-2 hours, healing in 4-8+ weeks

Question 6

How much acid production is inhibited by H2 receptor antagonists?

Answer 6

20-50+% , but dependent on dose and duration

Question 7

AE of H2 receptor antagonist

Answer 7

mild and infrequent, but may include primarily GI-related and some CNS-related, rarely may include blood dyscrasias (neutropenia and thrombocytopenia)

Question 8

AE cimetidine

Answer 8

decrease testosterone binding to androgen receptor, may cause gynecomastia in men and galactorrhea in women

Question 9

Cimetidine drug interactions

Answer 9

inhibitor of several CYP450 isoenzymes, so will have many interactions

Question 10

Ranitidine drug interactions

Answer 10

~10% of CYP450 inhibition compared to cimetidine

Question 11

Relative contraindications of H2 blockers

Answer 11

pregnancy (ranitidine if necessary)

Question 12

MOA PPIs

Answer 12

covalently bind to sulfhydryl groups of H/K ATPase at parietal cell secretory sites, inhibiting gastric acid secretion by irreversibly inhibiting functioning of -ase pumps

Question 13

Onset of relief with PPI

Answer 13

several days to create new steady-state

Question 14

Acid inhibition of PPIs

Answer 14

50%-90+% depending on dose, frequency, duration

Question 15

AE PPi

Answer 15

GI related - C. diff-associated diarrhea, CNS

Question 16

PPI drug interactions

Answer 16

Omeprazole is a prototypical CYP450 inhibitor

Question 17

Relative contraindication of PPI

Answer 17

pregnancy (may use lansoprazole)

Question 18

Sucralfate MOA

Answer 18

cross-linking from interaction with stomach acid, creates a viscous, sticky polymer that adheres to epithelial cells around the ulcer; prevents acid access to ulcer sites, may also stimulate local prostaglandin and mucous production and EDGF

Question 19

Off-label uses of sucralfate

Answer 19

aphthous ulcers, mucositis, radiation ulcers/proctitis, bile reflux gastropathy

Question 20

AE sucralfate

Answer 20

constipation

Question 21

Relative contraindications sucralfate

Answer 21

severe renal failure

Question 22

Drug interactions sucralfate

Answer 22

possible (may affect absorption), take 2-hours after other medications

Question 23

Misoprostol MOA

Answer 23

prostaglandin E1 analog, provides protective prostaglandin to gastric mucosa and reduces gastric acid release from parietal cell, stimulates bicarbonate and mucous production, increases mucosal blood flow

Question 24

Misoprostol indication

Answer 24

prevention of NSAID-induced gastric ulceration if patients are at high risk of ulcerations and complications

Question 25

Off-label uses misoprostol

Answer 25

pregnancy termination, cervical ripening, post-partum hemorrhaging

Question 26

AE misoprostol

Answer 26

primarily GI and CNS

Question 27

Contraindications for misoprostol

Answer 27

pregnancy, IBD

Question 28

MOA Bismuth compounds

Answer 28

anti-diarrheal agent and antimicrobial actions

Question 29

Antibacterial actions of bismuth compounds

Answer 29

prevent microbial attachment to mucosa, inactivate enterotoxins, and disruption of bacterial cell wall

Question 30

AE bismuth compounds

Answer 30

constipation, black/dark regularly-formed stools

Question 31

Drug interactions of bismuth compounds

Answer 31

Many! take 2 hours after other medications

Question 32

Relative contraindications of bismuth compounds

Answer 32

antiplatelet and anticoag use, severe renal failure

Question 33

Absolute contraindications of bismuth compounds

Answer 33

GI bleeding, salicylate hypersensitivity

Question 34

Treatment of H. pylori

Answer 34

combination therapy: 2 abx and an acid reducer

Question 35

Triple-drug regimen of H. pylori

Answer 35

PPI, clarithromycin, and amox or metronidazole; BID 14 days

Question 36

Possible cause of false negative gastric urease breath-test

Answer 36

use of bismuth preparations, antimicrobials and some PPIs that suppress H. pylori within four weeks prior to test

Question 37

Quadruple therapy regimen of H. pylori

Answer 37

PPI, metronidazole, tetracycline, bismuth subsalicylate; PPI at BID, all others at QID for 10-14 days

Question 38

Combo/pack drugs for H. pylori

Answer 38

Prevpac, Omeclamox-Pak, Helidac + PPI, Pylera + PPI

Question 39

Drugs included in helidac and pylera

Answer 39

Bismuth subsalicylate, metronidazole, tetracycline

Question 40

Drugs included in prevpac, omeclamox

Answer 40

amoxicillin, clarithromycin, lansoprazole/omeprazole

Question 41

Failure of eradication with metronidazole-containing triple-therapy should be followed with….

Answer 41

non-metronidazole containing quadruple therapy

Question 42

Treating H. pylori with PCN allergy

Answer 42

substitute amox for metronidazole

Question 43

Treating H. pylori with metronidazole resistance

Answer 43

sub tetracycline, consider quad therapy with clarithromycin and amox

Question 44

Treating H. pylori with clarithromycin resistance

Answer 44

substitute amoxicillin or tetracycline, consider bismuth quad therapy

Question 45

Pregnant patient with PUD (not H. pylori)

Answer 45

short course antacids or sucralfate, may consider ranitidine or lansoprazole

Question 46

Patient with PUD NSAID-at risk

Answer 46

if not required, consider acetaminophen and D/C NSAID; if required, consider COX-2 NSAID and/or PPI or misoprostol