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GI Week 1 > Anti-ulcer drugs > Flashcards

Anti-ulcer drugs Flashcards

1
Q

Cimetidine, Famotidine, Nizatidine, and Ranitidine make up what class of medication?

A

Histamine (H2) Receptor Antagonists

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2
Q

Some of the H2 receptor antagonists are made with?

A

Antacids including calcium/magnesium

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3
Q

Where do H2 receptor antagonists act on?

A

Basolateral membrane of parietal cell

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4
Q

How long is the onset of action for H2 receptor antagonists?

How does this compare to antacids and PPIs?

How long does it take ulcers to heal?

Does it completely inhibit all acid production?

A

1) 0.5 to 2 hours
2) Longer than antacids, shorter than PPIs
3) 4-8 weeks
4) No, it only inhibits about 20-50%

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5
Q

Which H2 receptor antagonists adverse effect decreases testosterone binding to androgen receptor?

How does this affect men and women?

A

1) Cimetidine

2) Gynecomastia in men and galactorrhea in women

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6
Q

Why does cimetidine have a lot of drug-drug interactions?

A

Because it is a prototypical inhibitor of several CYP450 isoenzymes

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7
Q

Which H2 receptor antagonists should be used during pregnancy only if necessary?

A

Ranitidine and Famotidine

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8
Q

Lansoprazole, Dexlansoprazole, Omeprazole, Esomeprazole, Pantoprazole, and Rabeprazole make up what class of medication?

A

Proton Pump Inhibitors (PPIs)

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9
Q

What is the MOA of PPIs?

How long does it take to create a new steady state of pump activity?

A

1) Binds to sulfhydryl groups of H+/K+- ATPase at parietal cell secretory sites, thereby inhibiting gastric acid secretion
2) Several days

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10
Q

How long does it take for full symptom effects with PPIs?

How does this compare to H2 antagonists?

Does it completely inhibit all acid production?

How long does it take ulcers to heal?

A

1) Several days
2) Takes longer
3) Comes very close to it (up to 90%)
4) 4-8 weeks

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11
Q

What serious adverse effect can PPIs cause?

A

CDAD (Clostridium Difficile-Associated Diarrhea)

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12
Q

Why does omeprazole have a lot of drug-drug interactions?

A

Because it is a prototypical PPI for CYP450 inhibition

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13
Q

Which PPI should be used during pregnancy only if necessary?

A

Lansoprazole and pantoprazole

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14
Q

Sucralfate makes up what class of medications?

A

Surface Acting Agents

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15
Q

What is sucralfate made up of chemically?

A

An octasulfate of sucrose with Al(OH)3 added

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16
Q

What is the MOA for sucralfate?

What does it ultimately prevent?

What was Dr. Segars analogy of this to help cement its MOA?

A

1) Undergoes cross-linking due to stomach acid which creates a viscous, sticky polymer that adheres to epithelial cells around the ulcer
2) Prevents acid access to ulcer sites
3) It is the band-aid drug

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17
Q

How long should sucralfate be used for?

A

Short term therapy

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18
Q

What may sucralfate also stimulate?

What effect do the stimulated substances have?

How does it affect pH?

A

1) Local prostaglandin and mucus production and epidermal growth factor
2) Cytoprotection
3) It doesn’t

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19
Q

What site is sucralfate indicated for?

Can it be used for ulcers in other regions?

A

1) Duodenal ulcers

2) Yes

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20
Q

Why can sucralfate cause constipation or severe renal failure?

A

Because it contains aluminium

21
Q

Because of possible drug interactions when should sucralfate be taken?

How is it dosed for active ulcers?

A

1) Two hours after other meds

2) QID

22
Q

Misoprostol makes up what class of medications?

A

PGE1 Analog

23
Q

What is the MOA of misoprostol?

A

Provides protective prostaglandin to gastric mucosa and reduces gastric acid release from parietal cell

24
Q

How does misoprostol provide cytoprotection?

A

1) Stimulates bicarbonate and mucous production

2) Increases mucosal blood flow

25
Q

Standard doses of misoprostol reduce which acid output?

A

Basal and nocturnal

26
Q

What is misoprostol indicated for?

A

Prevention of NSAID induced gastric ulceration

27
Q

What are the contraindications for misoprostol?

A

Pregnancy and IBD

28
Q

What is the MOA for the bismuth compounds such as bismuth subsalicylate?

A

Antibacterial actions

29
Q

While the OTC use for Bismuth compounds is for heartburn, what is its prescription use for?

A

Used in combo with antibiotics and acid suppressant for H. pylori treatment

30
Q

What adverse effect is seen with bismuth compounds?

A

Black/dark regularly formed stool

31
Q

Because bismuth compounds have many drug interactions when should it be taken?

A

Two hours after other meds

32
Q

What is a relative contraindications for taking bismuth subsalicylate due to bleeding issues?

A

Patients on antiplatelets and anticoagulants

33
Q

In general what is the regimen for treatment of H. pylori?

A

Combination therapy with at least two antibiotics and an acid reducer of either PPI or H2 blocker for about 10-14 days

34
Q

Why might a patient with H. pylori have a false negative result on their gastric urease or urea breath test?

How can we prevent this?

A

1) Because within 4 weeks prior to the test the treatment regimen they were on suppressed the H. pylori
2) Avoid the use of tx agents 4 weeks prior to test

35
Q

Describe the triple therapy regimen for treatment of H. pylori including duration, dosing, and which agents

A

1) 14 days
2) BID dosing for all agents
3) PPI
4) Clarithromycin
5) Amoxicillin or Metronidazole

36
Q

Describe the quadruple therapy regimen for treatment of H. pylori including duration, dosing, and which agents

A

1) 10-14 days
2) PPI at BID, all others QID dosing
3) PPI
4) Metronidazole
5) Tetracycline
6) Bismuth subsalicylate

37
Q

When choosing the antibiotics for treatment of H. pylori what would make you choose metronidazole over amoxicillin?

A

Patient has a penicillin allergy

38
Q

Which H pylori treatment therapy should be used first?

What should be considered when this one fails?

A

1) Triple therapy

2) Move to quadruple therapy and switch antibiotics

39
Q

While there are drug pacs that include most of the drugs needed for H pylori treatment, which one is missing in the regimen?

A

PPI

40
Q

What should you consider doing after completion of the 10-14 day H. pylori combination therapy?

A

PPI therapy for a few/several weeks after

41
Q

Which antibiotic can fail to treat H pylori due to community acquired resistance?

A

Metronidazole

42
Q

If there is failure of eradication with metronidazole containing triple-therapy what should you do?

A

1) Stay on triple therapy but substitute it out with tetracycline
2) Switch to quadruple therapy with clarithromycin and amoxicillin as the antibiotics

43
Q

What should you do when treating H pylori with clarithromycin resistance?

A

1) Substitute either amoxicillin or tetracycline

2) Consider Bismuth quadruple therapy

44
Q

Which drug would you consider using on a pregnant patient without H pylori to treat PUD for a short course?

Which would you use in this scenario if the symptoms are moderate?

Which would you use in this scenario if the symptoms are severe?

A

1) Sucralfate
2) Ranitidine
3) Lansoprazole

45
Q

In the treatment of PUD for a patient that is NSAID-at risk, what are some options you have if NSAID are not required or if they are required?

A

1) If NSAID is not required, consider acetaminophen

2) If it is required consider COX-2 NSAID and/or consider PPI or Misoprostol

46
Q

What are the H2 Receptor Antagonists?

A

1) Cimetidine
2) Famotidine
3) Nizatidine
4) Ranitidine

47
Q

What are the Proton Pump Inhibitors?

A

1) Lansoprazole
2) Dexlansoprazole
3) Omeprazole
4) Esomeprazole
5) Pantoprazole
6) Rabeprazole

48
Q

What is the Surface Acting Agents?

A

Sucralfate

49
Q

What is the PGE1 Analog?

A

Misoprostol

GI Week 1 (6 decks)

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