Anti-Ulcer Agents

Question 1

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

Answer 1

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

Question 2

Which drugs are H2 receptor antagonists?

Answer 2

“-tidine”

• Cimetidine
• Famotidine
• Nizatidine
• Ranitidine

Question 3

Which drugs are Proton Pump inhibitors?

Answer 3

“-prazole”

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

Question 4

Which drugs are Surface acting agents?

Answer 4

• Sucralfate

Question 5

Which drugs are PGE1 analogs?

Answer 5

• Misoprostol

Question 6

Which drugs are Bismuth compounds?

Answer 6

• Bismuth subsalicylate

Question 7

H2 receptor antagonist MOA

Answer 7

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

Question 8

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

Answer 8

Cimetidine

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

Question 9

Which H2 receptor antagonist inhibits many CYP450 enzymes?

Answer 9

Cimetidine

Question 10

Which H2 receptor antagonist is recommended for pregnancy?

Answer 10

Ranitidine

Question 11

Proton pump inhibitor MOA

Answer 11

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

Question 12

Adverse effects of PPI?

Answer 12

• Clostridium Difficile-Associated Diarrhea

Question 13

Which PPI is prototypical for CYP450 inhibition?

Answer 13

omeprazole

Question 14

Which PPIs are used for pregnant women?

Answer 14

• lansoprazole

- pantoprazole

Question 15

Sulcralfate MOA

Answer 15

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

Question 16

Adverse effect of sulcralfate?

Answer 16

constipation due to it using Al(OH)3

Question 17

Contraindications for sulcralfate?

Answer 17

severe renal failure

because it uses aluminum

Question 18

Misoprostol MOA

Answer 18

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

Question 19

Indication for Misoprostol?

Contraindications?

Answer 19

Indication:
- prevention of NSAID-induced gastric ulceration

Contraindication:

• pregnancy
• IBD

Question 20

Bismuth indications

Answer 20

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

Question 21

Bismuth compound adverse effects?

Answer 21

• constipation

- black/dark stools

Question 22

Contraindications for bismuth compounds?

Answer 22

• patients on antiplatelets or anticoagulants
• GI bleeds
• salicylate hypersensitivity

Question 23

How do you treat H. pylori?

Answer 23

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

Question 24

How long is the treatment for H. pylori?

Answer 24

10-14 days for triple drug regimen

Question 25

What antibiotics are recommended for treatment of H. pylori?

Answer 25

- clarithromycin - amoxicillin - metronidazole - tetracycline

Question 26

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

Answer 26

Gastric urease or urea breath test 4 weeks before you start any therapy

Question 27

A typical triple therapy for H. pylori is what?

Answer 27

- PPI - clarithromycin - amoxicillin (metronidazole if PCN allergy) BID dosing for 14 days

Question 28

What is a typical quadruple therapy for H. pylori?

Answer 28

- PPI - metronidazole - tetracycline - bismuth salicylate BID for PPI, everything else at QID for 10-14 days

Question 29

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

Answer 29

use non-metronidazole quadruple therapy

Question 30

``` Pt presents - pregnant - no H. pylori - PUD how do you treat? ```

Answer 30

- short course antacids or sucralfate - moderate sx: ranitidine - severe sx: lansoprazole