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GI > Anti-Ulcer Drugs > Flashcards

Anti-Ulcer Drugs Flashcards

1
Q

What suffix is a/w H2 receptor antagonists?

A

-tidine

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2
Q

What suffix is a/w Proton Pump Inhibitors?

A

-prazole

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3
Q

What drugs are H2 antagonists?

A

Cimetidine (tagamet)
Ranitidine (zantac)
Famotidine (pepcid)
Nizatidine

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4
Q

What is combined to make antacids?

A

calcium or magnesium

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5
Q

What is the MOA of H2 blockers?

A

reversibly - receptors on basolateral membrane of parietal cell

inhibits 20-50% acid production

0.5-2 hours onset, so longer than antacids but shorter than PPIs

ulcer healing 4-8 weeks

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6
Q

What should you consider if the drug regimen for ulcers is not working after 4-8 weeks?

A

think H pylori

–> ABX

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7
Q

Adverse effects of H2 blockers

A

mild, transient, infrequent

–> GI and CNS

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8
Q

Rare adverse effect of H2 blockers

A

long term, high dosing:

  • Cimetidine decreases testosterone binding
  • ——-> gynecomastia (M) and galactorrhea (F)

blood dyscrasias: neutropenia and thrombocytopenia

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9
Q

What H2 blocker is a prototypical inhibitor of several CYP450 enxzymes?

A

Cimetidine

–> LOTS of drug-drug interactions

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10
Q

What is a relative contraindication for H2 blockers?

A

Pregnancy

–> Ranitidine only if necessary

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11
Q

PPI examples

A 
Omeprazole
Esomeprasole (isoer)
Lansoprazole
Dexlansoprazole (isomer)
Pantoprazole
Rabeprazole
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12
Q

Can PPI completely stop acid production?

A

Yes with large doses since blocks H+/ K+ ATPase

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13
Q

PPI MOA

A

irreversibly bind H/K ATPase to inhibit gastric acid secretion

–>takes several days to create new steady-state pump activity

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14
Q

How long do PPI effects take?

A

full symptom effects in few-several days

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15
Q

How much acid do PPIs inhibit?

A

50-90%

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16
Q

Adverse effects of PPIs

A

*overall mild an infrequent
GI
–> C diff diarrhea
CNS

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17
Q

Associations with increased risk via use of PPIs

A

AKI
Osteoporosis/fx
MI

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18
Q

What PPI is prototypical inhibitor of CYP450 and has many drug-drug interactions?

A

omeprazole

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19
Q

Relative contraindications of PPIs

A

Pregnancy

–> use lansoprazole only if necessary

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20
Q

What is a sulfated polysaccharide (made of sucrose and aluminum) that is surface-acting, much like a band-aid?

A

Sucralfate (carafate)

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21
Q

MOA of Sucralfate

A

BAND-AID

cross-linking of damaged/ulcerated epithelial cells–> forms sticky polymer that prevents access to ulcer sites

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22
Q

What other effects does Sucralfate have

A

stimulates local prostaglandin and mucous production–> CYTOPROTECTION

does NOT affect pH

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23
Q

Sucralfate indications for use

A

Duodenal ULcer
other ulcers
mucositis/stomatitis

24
Q

Adverse effects of Sucralfate

A

constipation d/t aluminum

25
Q

Relative Contraindications for Sucralfate

A

severe renal failure d/t aluminum

—>avoid antacids with aluminum

26
Q

Drug interactions to Sucralfate

A

possible, so take Sucralfate 2 hours after other meds

27
Q

What drug is Misoprostol combined with?

A

NSAID diclofenac

–>prevents NSAID-induced ulcers

28
Q

MOA of Misoprostol/Cytotec

A

prostaglandin E1 analog

–>cytoprotection by increasing mucosal defenses and reduce gastric acid release from parietal cells

29
Q

Indication for Misoprostol use

A

prevention of NSAID-induced gastric ulceration in high-risk patients

30
Q

Other uses of Misoprostol

A

pregnancy termination when combined with mifepristone

cervical ripening if used alone

post-partum hemorrhaging with high dose

31
Q

Adverse effects of Misoprostol

A

GI and CNS

32
Q

Contraindications for Misoprostol use

A

pregnancy

IBD

33
Q

Common bismuth compounds

A

Pepto-Bismol

34
Q

MOA of BIsmuth

A

antimicrobial
–> prevent attachment to mucosa, inactivate enterotoxins, disrupt bacterial cell wall

also anti-diarrheal

35
Q

OTC use of BIsmuth

A

reflux/heartburn
indigestion
diarrhea

36
Q

Rx use of Bismuth

A

used in combo with Abx and acid suppressant for H pylori

37
Q

Adverse effects of Bismuth

A

constipation

black/dark and regularly formed stools

38
Q

Are there drug interactions with Bismuth?

A

lots

take 2 hours after other meds

39
Q

Relative contraindications of Bismuth

A

antiplatelets and anticoagulants
–> bismuth subsalicylate

Severe renal failure

40
Q

Absolute contraindications of Bismuth

A

GI bleeding

Salicylate hypersensitivity

41
Q

What combination therapy to use for H pylori

A

at least 2 abx with an acid reducer (PPI or H2 blocker)

42
Q

H pylori treatment recommendation timeline

A

10-14 days of triple drug regimen containing:

  • PPI
  • clarithromycin
  • amoxicillin OR metronidazole
43
Q

How to test for H pylori

A

gastric urease or urea breath tests

44
Q

How can you get false negative results when testing for H pylori

A

using bismuth, some antimicrobials and some PPIs

–> they suppress H pylori

Don’t test if pt has used these meds within 4 WEEKS prior to tests

45
Q

Triple therapy vs Quadruple therapy for H pylori

A

Triple: 14 days

  • **all BID dosing
  • PPI
  • Clarithromycin
  • Amoxicillin OR Metronidazole

Quadruple: 10-14 days

  • **PPI at BID, others at QID
  • PPI
  • Metronidazole
  • Tetracycline
  • Bismuth subsalicylate
46
Q

Prevpac vs Omeclamox Pak for H pylori

A

Prevpac (BID)

  • Amoxicillin
  • Clarithromycin
  • Lansoprazole

Omeclamox Pak (BID)

  • Amoxicillin
  • Clarithromycin
  • Omeprazole
47
Q

Helidac treatment pack for H pylori

A

QID

  • Bismuth subsalicylate
  • Metronidazole
  • Tetracycline

PLUS PPI not in pack

48
Q

Pylera pack for treatment of H pylori

A

3 capsules QID

  • Bismuth subcitrate potassium
  • Metonidazole
  • Tetracycline

PLUS PPI omeprazole

49
Q

Why use PPI in addition to packs for H pylori tmt

A

use PPI for few to several weeks after 10-14 day H pylori tmt pack for complete healing of ulcers

50
Q

H pylor tmt failure

A

failure with metronidazole-containing triple therapy is followed with non-metronidazole quadruple therapy

51
Q

H pylori with PCN allergy

A

no amoxicillin–> sub with metronidazole

52
Q

H pylori with metronidazole resistance

A

sub tetracycline and consider quadruple therapy with clarithromycin and amox

53
Q

H pylori with clarithromycin resistance

A

sub with amox or tetracycline

consider bismuth quadruple therapy

54
Q

Pregnant patient with ulcers without H pylori

A

short course of antacids or Sufralfate

moderate sx: ranitidine

severe sx: lansoprazole

55
Q

What to use if patient high risk with NSAIDS

A

if NSAID not required, use acetaminophen

if NSAID required, use COX 2 NSAID and/or PPI or misoprostol

GI (4 decks)

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