Anti-Ulcer Drugs Flashcards
What are the H2 receptor antagonists?
Cimetidine
Famotidine
Nizatidine
Ranitidine
What is the common suffix for H2 antagonists?
-tidine
What is the MOA of H2 antagonists?
Reversibly inhibit H2 receptors on baso-lateral membrane of parietal cells
what is cimetidine’s specific adverse effect?
Decreases testosterone binding to androgen receptors
- gynecomastia in men
- galactorrhea in women
Which H2 blockers are also CYP450 inhibitors?
Cimetidine***
Ranitidine
What is a relative contraindication for giving H2 blockers?
Pregnancy
What are the PPIs?
Omeprazole Esomeprazole Lansoprazole Dexlansoprazole Pantoprazole Rabeprazole
What is the common suffix for PPIs?
-prazole
What is the MOA of PPIs?
covalently bind to sulfhydryl groups of H+/K+ ATPase at parietal cell secretory sites
*full symptom effects seen in several days after onset
What are the adverse effects of PPIs?
C. diff associated diarrhea
AKI
Osteoporosis
CAD
What is the prototypical PPI for CYP450 inhibition?
omeprazole
What is a relative contraindication of giving PPIs?
pregancy
What is the MOA of sucralfate?
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
What are the clinical uses of sucralfate?
duodenal ulcers aphthous ulcers stomatitis radiation proctitis bile reflux gastropathy
What is an adverse effect of sucralfate?
Constipation due to Al(OH)3
What is a relative contraindication for giving sucralfate?
renal failure
What is the MOA of misoprostol?
It is a prostaglandin E1 analog
provides protective prostaglandin to gastric mucosa and reduces gastric acid secretion from parietal cells
provides cytoprotection
What is the primary use of misoprostol?
prevention of NSAID-induced gastric ulceration in patients at high risk of ulcerations
What is a contraindication for using misoprostol?
pregnancy
IBD
what is the MOA of bismuth subsalicylate?
Antibacterial
prevents microbial attachment to mucosa, possible inactivation of enterotoxins and disruption of bacterial cell wall
What are the OTC uses of bismuth compounds?
reflux, indigestion and diarrhea
What is the rx use of bismuth compounds?
H. pylori treatment
What are some adverse effects of bismuth compounds?
constipation
black/dark stools (regularly formed)
What are relative contraindications for bismuth compounds?
antiplatelets and anticoagulants
severe renal failure
What are absolute contraindications for bismuth compunds?
GI bleeding
salicylate hypersensitivity
What is the triple therapy for the tx of H. pylori?
- PPI
- Clarithromycin
- Amoxicillin or metronidazole
What is the quadruple therapy for the tx of H. pylori?
- PPI
- Metronidazole
- Tetracycline
- Bismuth subsalicyclate
