Anti-Ulcer Agents Flashcards
What classes of drugs can be used as anti-ulcer agents?
- H2 receptor antagonists
- Proton pump inhibitors
- Surface acting agents
- PGE1 analogs
- Bismuth compounds
Which drugs are H2 receptor antagonists?
“-tidine”
- Cimetidine
- Famotidine
- Nizatidine
- Ranitidine
Which drugs are Proton Pump inhibitors?
“-prazole”
- Lansoprazole (dexlansoprazole)
- Omeprazole (esomeprazole)
- Pantoprazole
- Rabeprazole
Which drugs are Surface acting agents?
- Sucralfate
Which drugs are PGE1 analogs?
- Misoprostol
Which drugs are Bismuth compounds?
- Bismuth subsalicylate
H2 receptor antagonist MOA
reversibly inhibit H2 receptors on baso-lateral membrane of Parietal cell
Which H2 receptor antagonist has rare adverse effects and what are they?
Cimetidine
- decrease testosterone binding (gynecomatia, galactorrhea)
- blood dyscrasias (neutropenia, thrombocytopenia)
Which H2 receptor antagonist inhibits many CYP450 enzymes?
Cimetidine
Which H2 receptor antagonist is recommended for pregnancy?
Ranitidine
Proton pump inhibitor MOA
inhibit H/K ATPase at parietal cell secretory sites by binding to its sulfhydryl groups
Adverse effects of PPI?
- Clostridium Difficile-Associated Diarrhea
Which PPI is prototypical for CYP450 inhibition?
omeprazole
Which PPIs are used for pregnant women?
- lansoprazole
- pantoprazole
Sulcralfate MOA
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
Adverse effect of sulcralfate?
constipation due to it using Al(OH)3
Contraindications for sulcralfate?
severe renal failure
because it uses aluminum
Misoprostol MOA
- reduce gastric acid release from parietal cell
- increase HCO3 and mucous production
- increase mucosal blood flow
Indication for Misoprostol?
Contraindications?
Indication:
- prevention of NSAID-induced gastric ulceration
Contraindication:
- pregnancy
- IBD
Bismuth indications
- reflux
- heartburn
- diarrhea
- H. pylori (when combined with abx and acid suppressants)
Bismuth compound adverse effects?
- constipation
- black/dark stools
Contraindications for bismuth compounds?
- patients on antiplatelets or anticoagulants
- GI bleeds
- salicylate hypersensitivity
How do you treat H. pylori?
At least 2 antibiotics and an acid reducer (PPI/H2 blocker)
How long is the treatment for H. pylori?
10-14 days for triple drug regimen
What antibiotics are recommended for treatment of H. pylori?
- clarithromycin
- amoxicillin
- metronidazole
- tetracycline
What tests can you do for H. pylori and when should you test?
Gastric urease or urea breath test
4 weeks before you start any therapy
A typical triple therapy for H. pylori is what?
- PPI
- clarithromycin
- amoxicillin (metronidazole if PCN allergy)
BID dosing for 14 days
What is a typical quadruple therapy for H. pylori?
- PPI
- metronidazole
- tetracycline
- bismuth salicylate
BID for PPI, everything else at QID for 10-14 days
If you fail to eradicate H. pylori with triple therapy that had metronidazole, what do you do?
use non-metronidazole quadruple therapy
Pt presents - pregnant - no H. pylori - PUD how do you treat?
- short course antacids or sucralfate
- moderate sx: ranitidine
- severe sx: lansoprazole
