Anti-Ulcer Agents Flashcards

1
Q

What classes of drugs can be used as anti-ulcer agents?

A
  • H2 receptor antagonists
  • Proton pump inhibitors
  • Surface acting agents
  • PGE1 analogs
  • Bismuth compounds
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2
Q

Which drugs are H2 receptor antagonists?

A

“-tidine”

  • Cimetidine
  • Famotidine
  • Nizatidine
  • Ranitidine
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3
Q

Which drugs are Proton Pump inhibitors?

A

“-prazole”

  • Lansoprazole (dexlansoprazole)
  • Omeprazole (esomeprazole)
  • Pantoprazole
  • Rabeprazole
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4
Q

Which drugs are Surface acting agents?

A
  • Sucralfate
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5
Q

Which drugs are PGE1 analogs?

A
  • Misoprostol
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6
Q

Which drugs are Bismuth compounds?

A
  • Bismuth subsalicylate
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7
Q

H2 receptor antagonist MOA

A

reversibly inhibit H2 receptors on baso-lateral membrane of Parietal cell

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8
Q

Which H2 receptor antagonist has rare adverse effects and what are they?

A

Cimetidine

  • decrease testosterone binding (gynecomatia, galactorrhea)
  • blood dyscrasias (neutropenia, thrombocytopenia)
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9
Q

Which H2 receptor antagonist inhibits many CYP450 enzymes?

A

Cimetidine

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10
Q

Which H2 receptor antagonist is recommended for pregnancy?

A

Ranitidine

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11
Q

Proton pump inhibitor MOA

A

inhibit H/K ATPase at parietal cell secretory sites by binding to its sulfhydryl groups

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12
Q

Adverse effects of PPI?

A
  • Clostridium Difficile-Associated Diarrhea
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13
Q

Which PPI is prototypical for CYP450 inhibition?

A

omeprazole

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14
Q

Which PPIs are used for pregnant women?

A
  • lansoprazole

- pantoprazole

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15
Q

Sulcralfate MOA

A

cross-link with stomach acid to make polymer that sticks to epithelial cells around ulcer crater
- creates shell around ulcer, prevent acid interaction

  • Dosed as QID, take 2 hrs after other meds
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16
Q

Adverse effect of sulcralfate?

A

constipation due to it using Al(OH)3

17
Q

Contraindications for sulcralfate?

A

severe renal failure

because it uses aluminum

18
Q

Misoprostol MOA

A
  • reduce gastric acid release from parietal cell
  • increase HCO3 and mucous production
  • increase mucosal blood flow
19
Q

Indication for Misoprostol?

Contraindications?

A

Indication:
- prevention of NSAID-induced gastric ulceration

Contraindication:

  • pregnancy
  • IBD
20
Q

Bismuth indications

A
  • reflux
  • heartburn
  • diarrhea
  • H. pylori (when combined with abx and acid suppressants)
21
Q

Bismuth compound adverse effects?

A
  • constipation

- black/dark stools

22
Q

Contraindications for bismuth compounds?

A
  • patients on antiplatelets or anticoagulants
  • GI bleeds
  • salicylate hypersensitivity
23
Q

How do you treat H. pylori?

A

At least 2 antibiotics and an acid reducer (PPI/H2 blocker)

24
Q

How long is the treatment for H. pylori?

A

10-14 days for triple drug regimen

25
Q

What antibiotics are recommended for treatment of H. pylori?

A
  • clarithromycin
  • amoxicillin
  • metronidazole
  • tetracycline
26
Q

What tests can you do for H. pylori and when should you test?

A

Gastric urease or urea breath test

4 weeks before you start any therapy

27
Q

A typical triple therapy for H. pylori is what?

A
  • PPI
  • clarithromycin
  • amoxicillin (metronidazole if PCN allergy)

BID dosing for 14 days

28
Q

What is a typical quadruple therapy for H. pylori?

A
  • PPI
  • metronidazole
  • tetracycline
  • bismuth salicylate

BID for PPI, everything else at QID for 10-14 days

29
Q

If you fail to eradicate H. pylori with triple therapy that had metronidazole, what do you do?

A

use non-metronidazole quadruple therapy

30
Q
Pt presents
- pregnant
- no H. pylori
-  PUD
how do you treat?
A
  • short course antacids or sucralfate
  • moderate sx: ranitidine
  • severe sx: lansoprazole