Anti-Ulcer Drugs

Question 1

What are the H2 receptor antagonists?

Answer 1

Cimetidine
Famotidine
Nizatidine
Ranitidine

Question 2

What is the common suffix for H2 antagonists?

Answer 2

-tidine

Question 3

What is the MOA of H2 antagonists?

Answer 3

Reversibly inhibit H2 receptors on baso-lateral membrane of parietal cells

Question 4

what is cimetidine’s specific adverse effect?

Answer 4

Decreases testosterone binding to androgen receptors

• gynecomastia in men
• galactorrhea in women

Question 5

Which H2 blockers are also CYP450 inhibitors?

Answer 5

Cimetidine***

Ranitidine

Question 6

What is a relative contraindication for giving H2 blockers?

Answer 6

Pregnancy

Question 7

What are the PPIs?

Answer 7

Omeprazole
Esomeprazole
Lansoprazole
Dexlansoprazole
Pantoprazole
Rabeprazole

Question 8

What is the common suffix for PPIs?

Answer 8

-prazole

Question 9

What is the MOA of PPIs?

Answer 9

covalently bind to sulfhydryl groups of H+/K+ ATPase at parietal cell secretory sites

*full symptom effects seen in several days after onset

Question 10

What are the adverse effects of PPIs?

Answer 10

C. diff associated diarrhea
AKI
Osteoporosis
CAD

Question 11

What is the prototypical PPI for CYP450 inhibition?

Answer 11

omeprazole

Question 12

What is a relative contraindication of giving PPIs?

Answer 12

pregancy

Question 13

What is the MOA of sucralfate?

Answer 13

undergoes cross-linking from interactions with stomach acid creating a polymer that adheres to epithelial cells around an ulcer’s crater

may also stimulate cytoprotection via prostaglandins, mucous, and EGF

Question 14

What are the clinical uses of sucralfate?

Answer 14

duodenal ulcers
aphthous ulcers
stomatitis
radiation proctitis 
bile reflux gastropathy

Question 15

What is an adverse effect of sucralfate?

Answer 15

Constipation due to Al(OH)3

Question 16

What is a relative contraindication for giving sucralfate?

Answer 16

renal failure

Question 17

What is the MOA of misoprostol?

Answer 17

It is a prostaglandin E1 analog

provides protective prostaglandin to gastric mucosa and reduces gastric acid secretion from parietal cells

provides cytoprotection

Question 18

What is the primary use of misoprostol?

Answer 18

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

Question 19

What is a contraindication for using misoprostol?

Answer 19

pregnancy

IBD

Question 20

what is the MOA of bismuth subsalicylate?

Answer 20

Antibacterial

prevents microbial attachment to mucosa, possible inactivation of enterotoxins and disruption of bacterial cell wall

Question 21

What are the OTC uses of bismuth compounds?

Answer 21

reflux, indigestion and diarrhea

Question 22

What is the rx use of bismuth compounds?

Answer 22

H. pylori treatment

Question 23

What are some adverse effects of bismuth compounds?

Answer 23

constipation

black/dark stools (regularly formed)

Question 24

What are relative contraindications for bismuth compounds?

Answer 24

antiplatelets and anticoagulants

severe renal failure

Question 25

What are absolute contraindications for bismuth compunds?

Answer 25

GI bleeding

salicylate hypersensitivity

Question 26

What is the triple therapy for the tx of H. pylori?

Answer 26

1. PPI
2. Clarithromycin
3. Amoxicillin or metronidazole

Question 27

What is the quadruple therapy for the tx of H. pylori?

Answer 27

1. PPI
2. Metronidazole
3. Tetracycline
4. Bismuth subsalicyclate