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GI/GU II Exam 1 > Anti-Ulcer Agents > Flashcards

Anti-Ulcer Agents Flashcards

1
Q

How do you treat clarithromycin resistant H. pylori

A

substitute either amoxicillin or tetracycline

consider adding bismuth

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2
Q

What are the adverse effects and contraindications of misoprostol

A

adverse effect: primarily GI and CNS related

contraindication: pregnancy - bc induce labor & IBD- bc diarrhea complication

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3
Q

What is the MOA for misoprostol

A

A PGE1 analog

provide protection for prostaglandin to gastric mucosa & reduces gastric acid release from parietal cell

==> cytoprotection by increasing mucosal defense ((+) HCO3- & mucous production, increase mucosal blood flow)

standard dose –> reduce basal & nocturnal acid output

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4
Q

What are the adverse effects for sucralfate

what should you do to prevent drug interactions

A

adverse effect = constipation (Al(OH3))

drug interaction - take 2 hours AFTER other medications to prevent interaction w/ crosslinking

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5
Q

what is Omeclamox-Pak

A

Combo pack used BID

Amoxicillin 1,000 mg

Clarithromycin 500 mg

Omeprazole 20 mg

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6
Q

What is the MOA for PPIs

A

Covalently bind to sulfhydryl groups of H/K ATPase at parietal cells secretory sites –> (-) gastric acid secretion by irreversibly inhibiting fxn of “-ase” pumps

  • (-) pump-induced egress of gastric acid – take several days to create new steady-state of pump activity
  • full effect seen in few-several days

(-) 50-90% acid

ulcerations healed w/i 4-8 wks (if not, test for H. pylori)

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7
Q

what are drug interactions and contraindications for H2 antagonists

A

drug- cimetidine prototypical (-) of several CYP450 isoenzymes ==> lots of drug interactions!

ranitidine - only 10% CYP450 inhibition

relative contraindication: pregnancy -only if necessary (ranitidine)

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8
Q

what is Helidac

A

combo pack used QID

Bismuth subsalicylate 525 mg

Metronidazole 250 mg

Tetracycline 500 mg

plus add PPI! (not in the pack)

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9
Q

what are the indications and contraindications for sucralfate

A

indications: Duodenal Ulcers; but also off-label fo aphthous ulcers, mucositis/stomatitis, radiation proctitis/ulcers (enema), bile reflux gastropathy, etc
contraindications: severe renal failure - avoid Al-containing antacids

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10
Q

What are the indications for misoprostol

A

indication: prevention of NSAID-induced gastic ulceration in pts at high risk of ulcerations & complications

off-label - w/ or w/o mifepristone (pregnancy termination), alone for cervical ripening, post-partum hemorrhaging

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11
Q

What is the MOA for Sucralfate

A

=sulfated polysaccharide (an octasulfate of sucrose w/ Al(OH)3 added

  • undergo cross-linking from interaction w/ stomach acids, creates viscous, sticky polymer –> adheres to epithelial cells around ulcer’s crater ==> prevent acid access to ulcer site
  • might also stimulate prostaglandin & mucous production & epidermal GF ==> cytoprotection
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12
Q

What is the ideal treatment for H. pylori

A

triple drup regimen 10-14 days

  1. at least 2 ABx (clarithromycin & amoxicillin or metronidazole)
  2. and an acid reducer (PPI or H2 blocker)
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13
Q

how do you treat ulcers related w/ pregnancy

A

short course of antacids or sucralfate

moderate symptoms: ranitidine

severe symptoms: lansoprazole

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14
Q

what is the MOA of H2 antagonists

A

reversibly (-) H2 receptor on basolateral membrane of parietal cells

relief of GERD symptoms - 0.5-2 hrs

ulcer healing occurs in 4-8 weeks (if doesnt - test for H.pylori)

only (-) 20-50% acid production (depends on dose & duration)

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15
Q

What is prevpac

A

combo pack, used BID

Amoxicillin 1,000 mg -2 caps

Clarithryomycin 500 mg

Lansoprazole 30 mg

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16
Q

What are drug interactions and contraindications for PPIs

A

drug interactions - omeprazole - prototypical PPI for CYP450 inhibition –> many drug interactions

contraindications - pregnancy - if necessary give lansoprazole or pantaprazole

17
Q

How do you treat metronidazole resistant H. pylori

A

substitute w/ tetracylcine

consider quadruaple therapy (w/ clarithromycin & amoxicillin)

18
Q

what is the common suffix for PPI’s?

list the drugs and mode of delivery

A

“-prazole”

Omeprazole (can be combined w/ NaHCO3) (po) - (isomer = Esomeprazole; can be combined w/ Naproxen (po/iv))

Lansoprazole (po) - (isomer = Dexlansoprazole (po))

Pantoprazole (po/iv)

Rabeprazole (po)

19
Q

What are adverse effects of H2 antagonists

A

relatively mild, transient, infreq - primarily GI and some-CNS related

rare: (more likely w/ long term, high dose)

    • Cimetidine- decrease testosterone binding to androgen receptor ==> gynecomastia in men & galactorrhea in women
  • -blood dyscrasia - neutropenia, thrombocytopenia
20
Q

What is the triple therapy for H. pylori

A

a PPI

Clarithromycin

Amoxicillin (use if metronidazole resistant) or Metronidazole (use if penicillin allergy)

all BID

21
Q

What are the indications and contraindications of Bismuth Compounds

A

indication:

  • OTC: reflux (heartburn), indigestion & diarrhea
  • Rx: combo w/ ABx & acid suppressant for H. pylori

contraindications:

  • Relative: antiplatelets & anticoagulants (bismuth sub_salicylate)_ & severe renal failure
  • Absolute: GI bleeding & Salicylate hypersensitivity
22
Q

What is Pylera

A

3 capsules QID

Bismuth subcitrate potassium 140 mg

Metronidazole 125 mg

Tetracycline 125 mg

PLUS addition of PPI (omeprazole)

23
Q

What are adverse effects pertaining to PPIs

A

GI-related

additional risk - CDAD - clostridium difficile-associated diarrhea - on PPI & get watery diarrhea/malaise

CNS-related

24
Q

What is the common suffix for H2 receptor antagonists

list the drugs and mode of delivery

A

“-tidine”

Cimetidine - po/iv

Ranitidine - po/iv

Famotidine - po/iv

Nizatidine - po

25
Q

how do you treat H. pylori if pt is PCN allergy

A

substitute amoxicillin w/ metronidazole

consider adding Bismuth

26
Q

What is the reason for false-negative results when testing for H. pylori

A

ingestion of bismuth, some antimicrobials & some PPIs w/i 4 weeks bc they can suppress H. pylori

27
Q

What is the MOA of Bismuth compounds

A

-prevent microbial attachment to mucosa, possible inactivation of enterotoxins & disruption of bacterial cell wall

pepto-bismol/kaopectate/LOTS of others

also in combo pack for H. pylori

developed as anti-diarrheal agent & well known for its anti-microbial actions

28
Q

What is quadruple therapy for H. pylori

A

QID

  1. Metronidazole
  2. Tetracycline
  3. Bismuth Subsalicylate
  4. PPI (BID)
29
Q

What should you do if H. pylori is not eradicated w/ metronidazole-containing triple-therapy

A

use non-metronidazole containing quadruple therapy

(Bismuth, PPI and 2 ABx - non metrodazole)

30
Q

how do you treat ulcers related to NSAID

A

if NSAID not required –> D/C NSAID and give acetaminophen

if NSAID required - consider COX-2 NSAID &/or consider PPI/Misoprostol

GI/GU II Exam 1 (16 decks)

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