Anti-Ulcer Pharm

Question 1

What is the general definition of an ulcer?

Answer 1

Defect that exposes thru all the layers of the mucosa (epithelium, lamina propria, muscularis mucosa) and exposes the submucosa

Question 2

What 3 things stimulate parietal cells to secrete acid?

Answer 2

1. histamine
2. gastrin
3. ACh

Question 3

Source and primary stimulus of histamine in the GI tract.

Answer 3

Comes from Enterchromaffin-like cells

Gastrin stimulates secretion from ECL cells

Question 4

Source and primary function of somatostatin in the GI system.

Answer 4

Secreted from D cells in the presence of acid. Inhibits Gastrin and Histamine release

Question 5

Main source of protective mucin in the duodenum.

Answer 5

Brunner’s Glands

Question 6

What is the MOA of PPIs?

Answer 6

Irreversibly block ACTIVE hydrogen/potassium ATPase.

Question 7

When and how should PPIs be administered.

Answer 7

The best time of the day is in the morning 20-30min before breakfast. PPIs can also be administered post-prandially (right after a meal) b/c acid pumps will be most active.

Should be taken once a day to be effective. It shows little effect when it is taken on an “as needed” basis.

Question 8

What is a major complication of taken PPIs for an extended period of time.

Answer 8

Very high gastrin levels that lead to intense rebound acid production.

PPI’s decrease acid which prevents somatostatin from being released to inhibit G cells from releasing gastrin.

Question 9

Which PPI is approved for use with the anti-platelet agent Clopidogrel?

Answer 9

Dexlansoprazole

Question 10

Which PPI should be the last choice for use in pregnant patients?

Answer 10

Omeprazole

Question 11

Which two Histamine-2 Receptor Antagonists (H2RAs) are used most often?

Answer 11

Ranitidine
Famotidine
(cimetidine was the first but has too many side effects with the CNS and liver CYP enzymes)

Question 12

What type of acid secretion are H2RAs most effective in suppressing?

Answer 12

Basal acid secretion. Like the kind at night.

Less effective with stimulated acid secretion during meals.

Question 13

Misoprostol

Answer 13

MOA: PGE1 analog, prevents acid secretion and improves mucous secretion.

Used to prevent NSAID ulcers but not to heal existing ulcers.

Causes diarrhea and abortion in pregnant females due to increased smooth muscle movement

Question 14

Sulcralfate

Answer 14

MOA: sticky gel that coats and protects existing ulcers from stomach acid.

Lasts 6 hrs. and should be taken 1hr before meals.

Can inhibit absorption of other meds

Question 15

Antacids

Answer 15

MOA: directly combine with stomach acid acting as a base for neutralization.

Question 16

Bismuth subsalicylate

Answer 16

MOA: not fully understood

Used mainly as an antidiarrheal. Reacts with hydrogen sulfide in the colon to create black stools

Question 17

How is GERD stage 1 managed?

Answer 17

Diet changes, weight loss, antacids, H2RAs

Question 18

How is GERD stage 2 managed?

Answer 18

Move on to PPIs which are more effective than H2RAs.

Question 19

How is GERD stage 3 managed?

Answer 19

Stage 3 means ALARM SYMPTOMS

Endogastroduodenoscopy (EGD) checking for Barrett esophagus, ulcer, or stricture.

PPI before breakfast and H2RA before bed.

Question 20

What is the general treatment for Peptic Ulcers?

Answer 20

PPI w/ antimicrobial to eradicate H. pylori if present

Question 21

What is the main treatment for acute GI bleeds secondary to a peptic ulcer?

Answer 21

Endoscopic thermal bandage followed by:

Pantoprazole (prevents re-bleed)
-goal is to raise the pH above 4 to inactivate pepsin

Question 22

What is the biggest risk factor towards the development of stress ulcers?

Answer 22

Mechanical ventiliation for more than 48 hrs and coagulopathy