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Pharm Exam 4 - Class Review > ch 64 > Flashcards

ch 64 Flashcards

1
Q

most cases of PUD are caused by

A

H.Pylori

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2
Q

a group of upper GI disorders characterized by varying degrees of erosion of the esophagus, stomach and sm intestines

A

Peptic ulcer disease

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3
Q

major aggressive factors of PUD

A

H pylori
NSAiDS
gastric acid
pepsin

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4
Q

what are the defensive factors of the stomach against PUD

A

mucus
Bicarbonate
Blood flow
prostaglandins

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5
Q

H pylori is a gram

A

gram negative bacillus

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6
Q

what other things can H. Pylori lead to

A 
PUD
gastric cancer (gastric mucosa-associated lymphoid tissue (MALT) lymphomas)
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7
Q

primary disorder in which hypersecretion of acid alone causes ulcers

A

Zollinger-Ellison syndrome

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8
Q

Smoking and PUD

A

delays ulcer healing and increases r/o occurance

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9
Q

Goals of drug therapy in PUD

A

alleviate symptoms
promote healing
prevent complications such as hemorrhage, perforation and obstruction
prevent recurrence

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10
Q

prophylaxis for NSAID induced ulcers

A

PPIs are preferred

Misoprostol is effective but can cause diarrhea

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11
Q

Treatment for NSAID treatment for ulcers

A

H2 receptor blockers and PPIS are preferred

d/c NSAIDS if possible

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12
Q

Treatment for H Pylori

A

Amoxicillin plus PPI plus Clarithromycin

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13
Q

if allergic to PCN how do you treat H pylori

A

Flagyl plus PPI plus clarithromycin

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14
Q

methods to determine eradication of H pylori

A

Breath tests
serologic tests
stool tests
microscopic of of a stained biopsy sample

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15
Q

what is the ulcer diet

A

a change in eating pattern may be beneficial - 5-6 small meals a day instead of 3 large - reduces fluctuations in gastric pH and facilitate recovery

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16
Q

what should be avoided with PUD

A

smoking
aspirin - unless for heart disease
NSAIDS

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17
Q

when do you use ABX for pt that test positive for H pylori

A

only if symptomatic

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18
Q

abx that can be used for H pylori

A 
amoxicillin
clarithromycin
flagyl
metronidazole
tetracycline
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19
Q

harmless adverse effect of Bismuth for H pylori

A

black coloration to tongue and stool

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20
Q

metronidazole or Tinidazole and alcohol

A

disulfiram like reaction

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21
Q

treat h pylori in places where resistance to clarithromycin is high

A 
quad therapy
Bismuth subsalicylate
metronidazole
tetracycline
PPI or an H2RA
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22
Q

what is the sequential therapy for H pylori for those who cant take all at once?

A

PPI plus amox for 5 days
then
PPI plus clarithromycin plus tinidazole for 5 days

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23
Q

H2 receptor antagonists work by

A

suppressing secretion of gastric acid

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24
Q

How do you take Cimetidine (Tagamet)

A

when taken with food it decreases rate of absorption and beneficial effects prolonged

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25
Q

Cimetidine promotes healing of

A

gastric and duodenal ulcers treatment

lower dose for prophylaxis against recurrence

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26
Q

to heal gastric ulcers how long is needed with cimetidine

A

8-12 weeks

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27
Q

Cimetidine is also used in

A 
GERD
Zollinger ellison syndrome
Heartburn
Acid indigestion
sour stomach
28
Q

antiandrogenic effects of Cimetidine

A

gynecomastia
reduced libido
impotence

29
Q

CNS effects of cimetidine

A

most likely in older adults who have renal or hepatic impairment

confusion
hallucinations
CNS depression or excitation

30
Q

cimetidine and resp effects

A

increased r/o pneumonia due to elevation of pH with antisecretory agent - bacterial colonization of stomach increases results in secondary increase in colonization of resp tract

31
Q

Cimetidine is a CYP

A

inhibitor

32
Q

drugs of concern with cemetidine

A

warfarin
phenytoin
theophylline
lidocaine

these drugs dosage should be reduced

33
Q

Antacids can _____ the absorption of cimetidine so they should be administered how

A

decrease

at least one hour apart

34
Q

what should pt report when taking H2 receptor antagonists

A 
lethargy
somnolence
restlessness
confusion
hallucinations
35
Q

PPIs can increase risk for

A

fractures (decreased absorption of Calcium)
pneumonia
acid rebound
intestinal infection with C. Diff

36
Q

Omeprazole is approved for

A 
short term therapy of 
duodenal ulcers
gastric ulcers
erosive esophagitis
GERD
long term therapy for 
hypersecretory conditions (Zollinger-Ellison syndrome)

prevent
stress ulcers in pt who are in ICU and have an additional risk factor such as multiple trauma, spinal cord injury, prolonged mechanical ventilation longer than 48 hours

37
Q

GERD is characterized by

A

heartburn

acid regurgitation

38
Q

characterized by breaks in them esophageal mucosa

A

erosive esophagitis

39
Q

characterized by mucosal breaks are absent

A

NERD (nonerosive reflux disease)

40
Q

Adverse effects of Omeprazole

A 
Pneumonia 
Fractures (decrease absorption of Ca)
rebound acid hypersecretion
hypomag
diarrhea -  increase r/o c diff
41
Q

erosive GERD can lead to

A

esophageal adenocarcinoma

Barrett esophagus

42
Q

Pt with NERD, PPIS are taken

A

PRN

43
Q

Pt with erosive GERD, PPIS are taken

A

continuously until symptoms resolve

44
Q

by elevating pH, omeprazole and other PPIs can significantly reduce absorption of

A

HIV
atazanavir
delavirdine
nelfinavir

antifungal
ketoconazole
itraconazole

45
Q

omeprazole and other PPIs can reduce the adverse effects of

A

Plavix but it may also reduce beneficial effects

46
Q

what is the dilemma with clopidogrel (plavix)

A

if used alone, there is a significant risk for GI bleeding

if combined with a PPI - risk of GI bleeding is decreased but antiplatelet effects are decreased as well.

if pt has risk factors for GI bleeding (advanced age, use of NSAIDS or anticoagulants) - benefits outweigh risk

if lack risk factors for GI bleeding - avoid combining PPI with clopidogrel

47
Q

symptoms of hypomag

A

muscle cramps
palpitations
tremors

48
Q

sucralfate is approved for

A

acute therapy and maintenance therapy of duodenal ulcers

49
Q

adverse effects of sulcralfate

A

constipation

50
Q

by raising gastric acid above pH above 4, _____ may interfere with sucralfate effects

A

antacids space 30 min apart

51
Q

sucralfate may impede the absorption of what drugs

A 
phenytoin
theophylline
digoxin
warfarin
fluoroquinolone abx (Ciprofloxacin)

administer at least 2 hours apart

52
Q

Misoprostol is approved for

A

prevention of gastric ulcers caused by long term therapy of NSAIDS

53
Q

what PUD med must be avoided in pregnancy

A

Misoprostol

54
Q

what PPI is safe in pregnany

A

esomeprazole

55
Q

what H2 receptor antagonist is safe in pregnancy

A

rantidine

56
Q

what drugs are safe for breastfeeding

A

omeprazole
esomeprazole
ranitidine

57
Q

PUD med consideration for older adults

A

PPIS
increased risk for fractures from osteoporosis
med interactions
vitamin/mineral deficiencies

58
Q

adverse effects misoprostol

A

diarrhea
abd pain
spotting
dysmenorrhea

59
Q

women of childbearing age that needs to use misoprostol must be able to

A

1) comply with birth control measures
2) be given oral and written warnings about the med
3) have a neg serum pregnancy test within 2 weeks before beginning therapy
4) begin therapy only on second or third day of next menstrual cycle

60
Q

principal indications for antacids

A

PUD

GERD

61
Q

adverse effects of antacids

A

constipation and diarrhea

sodium loading - some have substantial amounts of Na, can exacerbate hypertension and heart failure

62
Q

by raising gastric pH, antacids can influence dissolution and absorption of drugs such as

A

cimetidine and ranitidine

give one hour gap

63
Q

2 most common antacids

A

magnesium hydroxide

aluminum hydroxide

64
Q

2 less common antacids

A

calcium carbonate

sodium bicarbonate

65
Q

PPI and H2 receptor antagonists can be used as young as

A

1 month old

66
Q

which antacid promotes constipation

A

aluminum hydroxide

67
Q

which antacid promotes diarrhea

A

mag hydroxide

Pharm Exam 4 - Class Review (14 decks)

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