Anti-Ulcer Drugs

Question 1

Two acid related disorders

Answer 1

Ulcer

Gastro-esophageal reflux disease (GERD)

Question 2

Buffering agents

Answer 2

Calcium carbonate, magnesium, aluminum hydroxide

• add a base to acid to neutralize
• simple to use but not strong enough for many people

Question 3

Magnesium side effects

Answer 3

Diarrhea

Question 4

Calcium and aluminum side effects

Answer 4

Constipation

Question 5

H2 antagonists

Answer 5

Cimetidine

Question 6

Cimetidine

Answer 6

• reversible antagonists

- tolerance can develop

Question 7

Cimetidine down fall

Answer 7

Drug interactions, it is a CYP450 inhibitor

Question 8

Cimetidine side effects

Answer 8

• generally well tolerated
• gynecomastia: increase in the male breast
• galactorrhea: spontaneous flow of milk from the breast

Question 9

Proton Pump inhibitor

Answer 9

Omeprazole

Question 10

Omeprazole mechanism

Answer 10

Irreversible inhibition of the proton pump

• binds and inhibits active proton pumps
• potent acid suppression when used correctly

Question 11

Omeprazole side effects

Answer 11

Generally well-tolerated
Concerns over long term use
- Hypergastrinemia: increased gastrin release
- Osteoporosis

Question 12

Anticholinergic

Answer 12

Pirenzapine

Question 13

Pirenzapine mechanism

Answer 13

• blocks muscarinic receptors
• poor efficacy
• many side effects

Question 14

Mucosal defence agents

Answer 14

Prostaglandins 
- misoprostol
Coating agents
- sucralfate 
- bismuth subsalicylate (Pepto Bismol)

Question 15

Misoprostol mechanism

Answer 15

Promotes secretion of mucous/bicarbonate

Inhibits acid secretion

Question 16

Misoprostol side effects

Answer 16

Diarrhea
Abdominal cramping
Also induces abortion so contraindicated in pregnancy

Question 17

Sucralfate mechanism

Answer 17

Aluminum hydroxide + sucrose sulfate

• forms paste
• stimulates mucous and bicarbonate secretion

Question 18

Sucralfate side effects

Answer 18

Acts locally

Aluminum causeras constipation

Question 19

Bismuth subsalicylate mechanism

Answer 19

Forms protective barrier on ulcer
Enhances mucous and bicarbonate secretion
Inhibits growth of H Pylori and adherence to mucosa

Question 20

Main causes of Ulcers

Answer 20

H Pylori

NSAIDs

Question 21

H Pylori functions

Answer 21

• produces inflammatory changes in mucosa
• impairs mucosal défense
• increases acid secretion

Question 22

Common antibiotics used for H Pylori eradication

Answer 22

• Amoxicillin
• Clarithromycin
• Tetracycline
• Metronidazole
• Bismuth is often included in these regimens

Question 23

How to reduce GI side effects (NSAIDs)

Answer 23

• take them with food
• take with misoprostol
• take with a proton pump inhibitor