Chapter 46: Antiulcer Drugs

Question 1

What is gastric ulcers? Like where?

Answer 1

Ulcers in the stomach

Question 2

Where is esophageal ulcers?

Answer 2

In the esophagus

Question 3

Where is duodenal ulcers?

Answer 3

In the early part of the small intestine

Question 4

What are reason why we get peptic ulceration? (3)

Answer 4

Mucosal lining erosion
Hyper secretions
( hycrocholirc acid or pepsin )
Gastric ph too low

Question 5

What are some factors that cause or predisposed a patient to peptic ulcers?

Main bacteria?

Answer 5

H.pylori
Mechanism disturbances
( how food flows their your gut, genetic influence )
Genetic influence
Environmental influence

Question 6

What 2 medication increases ulcers?

Answer 6

NSAIDs and steroids

Question 7

What are the 2 main symptoms of peptic ulcers?

Answer 7

Gnawing and aching pain

Question 8

What is the definition of peptic ulcer disease?

Answer 8

Gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin

Question 9

H. Pylori is the found in almost all ulcers, so what’s the first line therapy for these patients?

Answer 9

10-14 day course of PPI and antibiotics

Question 10

Why does esophageal ulcers occur?

Answer 10

Due to reflux of acid gastric secretions into the esophagus from an incompetence cardiac spichter

( GERD )

Question 11

Why does gastric ulcer occur?

Answer 11

Due to breakdown of gastric mucosal barrier

Question 12

Why does duodenal ulcers occur?

Answer 12

Due to hypersecretion of acid

Question 13

What is stress ulcers usually caused by?

Answer 13

It’s in the name itself
However mainly from trauma, burns and major surgery

Question 14

Usually what is the first finding of a stress ulcers after a patient in the ICU comes back from surgery 24 hours after?

Answer 14

GI lesions

Question 15

What are some symptoms we can see with stress ulcers ? (3)

Answer 15

Decreased blood flow
Mucosal ischemia
Hypo perfusion and repefusion of inury

Question 16

Does an NG tube and ventilator cause GI bleeding?

Answer 16

Yess it can

Question 17

Usually what do we want to do for these patients, for stress ulcers, like how do we prevent?

Answer 17

Usually using PPI
And or histamine receptor

Question 18

What is GERD?

Answer 18

Inflammation or erosion of the esophageal mucosa caused by reflux or gastric acid content into the esophagus

Question 19

What causes GERD?

Answer 19

Incompetent lower esophageal spincter

Question 20

Does GERD have ulcers?

Answer 20

No
They can lead to ulcers tho!

Question 21

What can aggravate GERD?

Answer 21

Smoking
Spicy foods
Citrus stuff

Question 22

What is the 3 treatment we use to help GERD?

Answer 22

Antiulcer drugs
H2 blockers
PPIs

Question 23

What are some Nonpharmacologic measure for ulcers?

Answer 23

Avoid tobacco and alcohol
Weight loss
Avoid hot spicy greasy foods
Take nsaids and steroids with food
Don’t eat before bedtime
Wear loose fitting clothing
Elevate HOB

Question 24

What are the 7 anti ulcer drug options we are going to talk about?

Answer 24

Tranquilizers
Anticholinergic
Antacids
H2 blockers
Proton pump inhibitors
Pepsin inhibitors
Prostaglandin analogue

Question 25

What are tranquilizers mix with?

Answer 25

Anxiety medication and anticholinergic

Question 26

What is the action of tranquilizers and how it places a role in helping with ulcers?

Answer 26

So it reduces the Vegas nerve which runs right by our stomach by reducing the amount of acid producing & the anti cholinergic helps dry up gastric secretions

Question 27

What are the side effects of tranquilizers? (3)

Answer 27

Edema Ataxia ( unsteady movement ) Confusion

Question 28

What does anticholinergic drugs do?

Answer 28

Pretty much help reduce the amount of acid in the body and helps dry it out

Question 29

What are anticholinergic drug side effects?

Answer 29

Same dry mouth Headache Dizziness Blurred vision Urinary rention and constipation ( no glaucoma !

Question 30

What is the first line of treatment for ulcers ? Usually OTC?

Answer 30

Antacids

Question 31

What are the 4 antacids?

Answer 31

Sodium bicarbonate Calcium carbonate Magnesium hydroxide Aluminum hydroxide

Question 32

What is our biggest concern of sodium bicarbonate? ( baking soda )

Answer 32

Hypernatremia !!( too much sodium ) Water rentetion Metabolic alkalosis

Question 33

What is the effect or action of sodium bicarbonate we tell patients about?

Answer 33

It’s quick onset but it doesn’t last long And you can have that rebound again

Question 34

In which patients should be careful with the administer of sodium bicarbonate?

Answer 34

Caution in patients with heart failure Hypertension Renal insufficiency

Question 35

Calcium carbonate ( tongs ) Help reduce the acid in the stomach What are the 4 side effects?

Answer 35

Acid rebound Constipation Hyper calcium Hypo phosphorus

Question 36

What’s important to remember is that whenever we see high calcium what do we think?

Answer 36

Low phosphors Or vise versa

Question 37

What is a complication of calcium carbonate ? (3)

Answer 37

Burnett syndrome alkalosis Hypercalcemia Crystalluria& renal failure

Question 38

What is the side effect of magnesium hydroxide?

Answer 38

Diarrhea - often mixed with alminium hydroxide

Question 39

Magnesium hydroxide is very dangerous against which type of patients?

Answer 39

Renal failure ( failing kidney cannot excrete extra magnesium )

Question 40

Aluminum hydroxide side effects? (4)

Answer 40

Constipation Anoriexa Weakness Impaired cognition

Question 41

What are your aluminum hydroxide complication?

Answer 41

Hypo phoso Hyper calcium Osteroposories Neprhotlithaid GI constipation

Question 42

Usually again that magnesium causing diarrhea and aluminum causing constipation what do we do?

Answer 42

Mix them together so it levels out

Question 43

What is the function behind antacids?

Answer 43

Neutralize HCI and reduced pepsin activity Increasing PH in the stomach and bladder

Question 44

If the ph is not where it needs to be in the stomach, usually because antacids increase it, what happens with other drugs?

Answer 44

Usually will not be absorbed

Question 45

What drug binds with calcium and should be avoided with antacids?

Answer 45

Tetracyclines

Question 46

Most medication should be administered _ to _ hours after an antacids?

Answer 46

1-2

Question 47

Educate patients that long term use of antacids can what?

Answer 47

Hide underlying causes or bleeding

Question 48

Now onto histamine blockers 2

Question 49

What is the action of histamine blockers 2?

Answer 49

These block h2 receptors that is released

Question 50

What are the 3 histamine blockers 2?

Answer 50

Cimetidine ( Tagamet ) Nizatidine ( axid ) Famotidine ( Pepcid (

Question 51

What are some side effects of h2 blockers? (3)

Answer 51

Erectile dysfunction Vitamin b12 deficiency Theombocytopenia

Question 52

Remmeber H1 is for allergies H2 is for ulcers

Question 53

Proton pump inhibitors!!

Question 54

What is the action of PPI?

Answer 54

So in our body, we have this enzyme hydrogen/potassium ATPase enzyme in the parietal cells that release this protons causing that heavy secretions of acid But the PPI literally shuts that down! And restarts it to a better level of acid

Question 55

What is PPI side effects? (3)

Answer 55

Vitamin B12 deficiency Hypomagenseima Blood dyscrasias

Question 56

PPI are highly protein bound So if you give this to another protein bound medication, like digoxin, it’ll have a more effect on which one?

Answer 56

Digoxin!

Question 57

Pepsin inhibitors!!

Question 58

What is pepsin inhibitors action?

Answer 58

Combined with protein to form thick paste covering ulcer protecting ulcer from acid and pepsin Covers stomach lining and protecting its from the acid

Question 59

What is the pepsin side effect?

Answer 59

Constipation !

Question 60

Pepsin Given 1 hour before meals and bedtime Do not give other medication at the same time Drug interactions Decrease the absorption of tetracycline, phenytoin, fat double vitamins, cipro, norfloxacin Hour of antacids separation

Question 61

Prostaglandins analogue

Question 62

What are the two medication of prostaglandin analogue?

Answer 62

Cytotec Misoprostol

Question 63

What is the action of prostaglandin analogue?

Answer 63

Decrease acid secretions Protects gastric mucosa Usually given for NSAIDS

Question 64

Prostaglandin analogue contraindication??????

Answer 64

Abortion pill !!!!!!!!! ( either for abortion or cervix dilation )