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Gastrointestinal System > Anti-ulcer drugs > Flashcards

Anti-ulcer drugs Flashcards

1
Q

role of gastric acid

A
  • digestion of proteins
  • activates proenzymes
  • absorption of calcium, iron, B12
  • suppresses bacterial growth
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2
Q

stimulation of parietal cells

A
  • ACh
  • gastrin
  • histamine
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3
Q

Ach function

A
  • major neural stimulatory of parietal cells
  • increases gastrin release
  • inhibits somatostatin
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4
Q

gastrin function

A
  • major endocrine regulator
  • release triggered by a protein meal and gastric distention
  • increases histamine release
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5
Q

histamine function

A
  • major autocrine/paracrine stimulator
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6
Q

inhibitors of parietal cells

A
  • somatostatin and prostaglandins
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7
Q

somatostatin function

A
  • inhibitor of acid secretion by inhibiting gastrin and histamine release
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8
Q

prostaglandin function

A
  • inhibit acid secretion by decreasing cAMP
  • stimulation secretion of mucin and bicarbonate
  • inhibited by NSAIDs
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9
Q

PPI MOA

A
  • irreversibly block active H/K ATPase pumps in parietal cells
  • if the pumps are inactive the drug will not work
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10
Q

PPI pharmacokinetics

A
  • highly protein bound
  • metabolized in the liver by P450, specifically CYP2C19 and CYP3A4
  • should be taken 20-30 minutes before breakfast
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11
Q

PPI adverse effects

A
  • diarrhea
  • increased gastrin level: hyperplasia of ECL cells, rebound hypersecretion of acid once PPI discontinued
  • risk factor for C. difficile colitis
  • risk factor for hip fracture and hypomagnesmia
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12
Q

PPI drug interactions

A
  • PPIs may inhibit CYP2C19 which decreases clopidogrels antiplatelet effect
  • dexlansoprazole is only PPI FDA approved for concominant use with clopidogrel
  • most are pregnancy B except omeprazole which is class C
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13
Q

common H2RB

A
  • ranitidine (Zantac)

- famotidine (Pepcid)

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14
Q

HR2B MOA

A
  • inhibit acid production by reversibly competing with histamine for binding to H2 receptors
  • give at night
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15
Q

H2RB pharmacokinetics

A
  • absorbed rapidly, peak concentration in 1-2 hours

- small % protein bound

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16
Q

H2RB drug interactions

A
  • mainly with cimetidine
  • cimetidine inhibits cytochrome P450 more so than do other agents of this class
  • pregnancy class B
17
Q

prostaglandin analogue MOA

A
  • stimulates secretion of mucin and bicarbonate

- acid suppression at cellular interface is most critical effect

18
Q

prostaglandin side effects

A
  • diarrhea

- abortion risk

19
Q

antacid MOA

A
  • neutralized the acid environment
20
Q

antacid side effects

A
  • careful in chronic renal disease
  • hypermagnesemia: N/V, weakness, hypocalemia, arrhythmias
  • milk- alkali syndrome: hypercalemia, alkalosis, renal impairment
21
Q

bismuth subsalicylate indications

A
  • used to treat diarrhea, heartburn, and upset stomach

- used in combo with other meds (PPIs, antibiotics) to treat H. pylori induced ulcers

22
Q

bismuth side effects

A
  • black stools, people may think upper GI bleed
23
Q

GERD severity stage I

A
  • sporadic uncomplicated heartburn
  • 2-3 episodes per week
  • treat with lifestyle modification and antacid or H2RB as needed
24
Q

GERD severity stage 2

A
  • more frequent symptoms
  • greater than 2-3 episodes per week
  • PPI more effective than H2RB
25
Q

GERD severity stage 3

A
  • chronic unrelenting symptoms
  • relapse off treatment
  • EGD shows complications: Barrett’s, stricture, ulcers
  • PPI once or twice daily: 30 minutes before breakfast and 30 before dinner
  • PPI and H2RB: PPI 30 minutes before breakfast, H2RB at bedtime
26
Q

PUD treatment

A
  • mainstay of treatment are PPIs
  • if H pylori present then:
  • PPI twice daily for 7-14 days AND
  • amoxicillin for 7-14 days AND
  • clarithromycin for 7-14 days
  • if allergic to penicillins then give metronidazole
27
Q

risk factors for acute GI bleeds secondary to PUD

A
  • mechanical ventilation more than 48 hours

- coagulopathy

28
Q

active ulcer or bleeding

A
  • low bp
  • high HR
  • low hemoglobin/ hematocrit
  • increased BUN/Cr ratio
29
Q

treatment for active bleeding

A
  • endoscopic therapy is mainstay

- plus pantoprazole (protonix)

30
Q

curling ulcer

A
  • associated with severe burns and volume depletion leading to ischemia and cell necrosis diminishing the mucosal barrier
31
Q

cushing ulcer

A
  • associated with increased intracranial pressure, and theorized to increase ACh stimulation of parietal cells
32
Q

risk factors for developing stress ulcers

A
  • mechanical ventilation for more than 48 8hours and coagulopathy
33
Q

treatment of ZES

A
  • PPIs twice daily

Gastrointestinal System (12 decks)

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