Chapter 46: Peptic Ulcer Disease

Question 1

How do H2 receptor antagonists work?

Answer 1

Reversible and competitive inhibition of H2 receptors on parietal cells…prevents histamine from binding

Question 2

What do H2 receptor antagonists end in?

Answer 2

TIDINES

Question 3

Cimetidine inhibits cytochrome P450 mediated metabolism and thus interferes with __ metabolism

Answer 3

Hepatic

Question 4

Which H2 receptor antagonist would you avoid in pregnant or breast feeding patients?

Answer 4

Cimetidine

Question 5

What is the drug of choice for pregnant patient with peptic ulcer disease?

Answer 5

Ranitidine, famotidine, nizatidine

any TIDINE except cimetidine) (NOT PPIs

Question 6

Which H2 receptor antagonist would you give via IV to treat hypersecretory conditions? Or to treat patients who cannot tolerate oral med?

Answer 6

Ranitidine

“after you RAN, you needed an IV”

Question 7

What is the therapy of choice for H. pylori or NSAID derived ulcers?

Answer 7

PPIs “PRAZOLES”

Question 8

What is the MOA of PPIs?

Answer 8

Irreversibly inhibits H/K ATPase on parietal cells…stops production of HCl (~18 hours)

Question 9

What is a compensatory physiologic secretory effect that PPIs may have on the stomach?

Answer 9

May cause compensatory large increase in gastrin

Question 10

What are some serious/common adverse effects of PPIs? Don’t use with what drug?

Answer 10

Can interfere with the antiplatelet effects of Clopidogrel

Increased risk of bone fracture
remember our case patient with two broken hips?

Question 11

What are some weirdo effects associated with H2 antagonists?

Answer 11

Gynecomastia, galactorrhea, loss of libido

Question 12

Which are more expensive, H2 antagonists or PPIs?

Answer 12

PPIs are way more $$$$$$

Question 13

Do you use IV or oral PPIs?

Answer 13

Oral always unless serious/severe case…then pantoprazole can be given IV form

Question 14

Antacids neutralize gastric acid. List 4 antacids

Answer 14

Aluminum hydroxide
Magnesium hydroxide
Sodium bicarbonate
Calcium carbonate

Question 15

Which antacid can also be used in the treatment of osteoporosis?

Answer 15

Calcium carbonate

Question 16

Which antacid can also be used in the treatment of uric acid renal stones or diarrhea?

Answer 16

Sodium bicarbonate

Question 17

The multidrug regimen used to treat H. pylori includes which coating agent?

Answer 17

colloidal bismuth

bismuth impedes the growth of the organism

Question 18

Sucralfate MOA?

Answer 18

coat gastric mucosa with protective layer

Question 19

Misoprostol MOA and clinical application?

Answer 19

Prostaglandin - used to tx of NSAID induced ulcers –> replaces the mucosalprotective effects of PGE2

Question 20

Misoprostol used with what drug has abortifactant effects?

Answer 20

mifepristine

Question 21

What side effect of misoprostol interferes with patient adherence?

Answer 21

stomach cramps

Question 22

Dicylomine MOA and clinical application?

Answer 22

Inhibits Ach binding to parietal cells
Used in irritable bowel disease and peptic ulcer disease
Rarely used because not as effective as H2 blockers or PPIs

Question 23

H. pylori triple therapy =?

Answer 23

PPI, amoxicillin, clarithromycin