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Pharm Exam 3 > Drug Therapy for Peptic Ulcer Disease > Flashcards

Drug Therapy for Peptic Ulcer Disease Flashcards

1
Q

Peptic Ulcer Disease (PUD) (Patho)

A

Group of gastrointestinal disorders

Differentiated by degree of erosion of gut wall

Caused by:
Imbalance between aggressive and defensive factors

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2
Q

Pepsin

A

Proteolytic enzyme the promotes protein breakdown

Pepsin activity is pH dependent

As pH increases so does pepsin activation

pH of > 5 is needed to prevent pepsin activation
Goal of drug therapy should be to raise gastric pH above 5

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3
Q

Most Common Causes of PUD

A 
Helicobater pylori (H. pylori)
#1 cause
Additional aggressive factors must also be present
 Non-steroidal anti-inflammatory drugs (NSAIDs)
#2 cause
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4
Q

H. pylori

A

Gram (-) bacillus

Colonizes stomach and duodenum

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5
Q

NSAIDs

A

Prevent synthesis of prostaglandins (group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness)

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6
Q

Pepsin

A

Proteolytic enzyme (enzymes that break protein)

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7
Q

Smoking

A

Delays ulcer healing

↑ risk of recurrence

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8
Q

Mucus

A

Protective barrier over the underlying epithelial cells

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9
Q

Bicarbonate

A

Base secreted by epithelial cells; neutralize acid

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10
Q

Blood flow

A

Maintains healthy cells and prevents ischemia

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11
Q

Prostaglandins

A

Molecules that promote mucus and bicarbonate production

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12
Q

GERD

A

Occurs when stomach acid or bile reflux back into the esophagus

Primary cause:
Incompetent lower esophageal sphincter (LES)

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13
Q

Factors contributing to impaired LES function

A 
Foods
Alcohol
Caffeine
Medications
Smoking
Recumbent position
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14
Q

Histamine2 Receptor Antagonists (H2RA)

A 
Drugs
Cimetidine
Ranitidine
Famotidine
Nizatidine
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15
Q

Histamine2 Receptor Antagonists (H2RA)

Cimetidine
Ranitidine
Famotidine
Nizatidine

A

A first-line treatment for PUD and GERD

Promote gastric healing by preventing acid secretion

All 4 agents equally effective

Serious adverse reactions uncommon

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16
Q

Cimetidine (difference)

A

Adverse effects:
CNS
Increased risk of Pneumonia

DDI:Inhibitoy of CYP450
Antacids

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17
Q

Proton Pump Inhibitors (PPI)

A

Omeprazole

Esmoeprazole

Lansoprazole

Dexlansoprazole

Rabeprazole

Pantoprazole

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18
Q

Proton Pump Inhibitors (PPI)

A

Most effective drugs for inhibiting acid secretion
All agents equally efficacious
Well tolerated
Selection based on cost, preference, DDIs

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19
Q

Mechanism of Action PPI

A

Irreversible inhibition of proton pump

  • -Short half-life
  • -Long PD effects
  • -New proton pumps must be created to overcome affects of drugs
  • -EXCEPTION rabeprazole
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20
Q

Sucralfate MOA AND PHARMACOKINETICS

A

Mechanism of action
Undergoes polymerization and cross-linking in the stomach → sticky gel
Binds to ulcer
Blocks acid and pepsin from reaching tissue

Pharmacokinetics
Minimal systemic absorption
Duration of action ~6 hour

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21
Q

Sucralfate (Indications, AE, DDI’s, Implications)

A

Indication
Treatment and maintenance of PUD

Adverse effects
Constipation

DDIs
Minimal
May ↓ absorption of some medications

Nursing implications:
Give 1 hour before meals
Separate from other medications by ~2 hours

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22
Q

Misoprostol (MOA and Indications)

A

Mechanism of action
Analog of prostaglandin E1 (PGE)
Promotes PGE synthesis

Indication
Prevent ulcers in patients on chronic NSAID therapy

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23
Q

Misoprostol (AE, Contraindications)

A 
Adverse effects:
Diarrhea
Abdominal pain
 Contraindications
Pregnancy – category X drug
Precautions MUST be taken in women of child-bearing age
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24
Q

Antacids

A

Alkaline products that neutralize stomach acid

  • -If pH raised > 5, may also inhibit action of pepsin
  • -May increase production of PGE

Poorly absorbed systemically
Exception sodium bicarbonate

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25
Q

Antacids (Indications and Dosage)

A

Indication
-PUD
-Symptomatic relief in GERD
Potency based on acid neutralizing capacity (ANC)

Dosage

  • Lower for gastric ulcers
  • Higher for duodenal ulcers
26
Q

H. Pylori Associated Ulcers

A 
Treatment regimen
-Antibiotics
Minimum of 2 different agents
Up to 3 different agents	
Do NOT use 1 antibiotic alone

-Antisecretory agents
PPI or H2RA
Hasten healing and relieve symptoms
Ideal duration of therapy is 14 days

27
Q

Clarithromycin Antibiotics for H. Pylori

A

Mechanism of action:
Inhibits bacterial protein synthesis

Adverse Effects:
Nausea
Diarrhea
Change in taste

28
Q

Amoxicillin

Antibiotics for H. Pylori

A

Mechanism:
Inhibits bacterial cell-wall synthesis

Adverse effects: Diarrhea

Other considerations:
Low resistance rates
Works best at higher pH

29
Q

Bismuth

Antibiotics for H. Pylori

A

Mechanism:
Disrupts bacterial cell walls

Adverse Effects
Black discoloration of tongue and stool

30
Q

Tetracycline

Antibiotics for H. Pylori

A

Mechanism:
Inhibits bacterial protein synthesis

Adverse Effects:
Stains developing teeth and skin

Other considerations:
Contraindicated in pregnancy and young children

31
Q

Metronidazole

Antibiotics for H. Pylori

A

Mechanism:
Inhibits bacterial cellular metabolic processes

Adverse Effects:
Nausea
Headache

Other Considerations
Avoid use with alcohol
Avoid in pregnancy

32
Q

Tinidazole

Antibiotics for H. Pylori

A

Mechanism:Inhibits bacterial cellular metabolic processes

Adverse Effects:
Nausea
Headache

Other considerations:
Avoid use with alcohol
Avoid in pregnancy

33
Q

NSAID-induced Ulcers

A

Risk factors
Age > 60
History of ulcers
High-dose NSAID therapy

Prophylaxis
PPIs preferred
Consider misoprostol therapy

34
Q

NSAID-induced Ulcers

A

Treatment
PPI or H2RA
Antacids and sucralfate NOT recommended
Consider discontinuing NSAIDs

Evaluation of treatment
Pain relief
NOTE: pain may subside before ulcer is fully healed

35
Q

Non-drug Therapy

A

Diet
‘Ulcer Diet’ does not accelerate healing
Eat 5 to 6 small meals per day

Discontinue NSAIDs if possible

Avoid smoking, aspirin, NSAIDs and alcohol

Stress reduction

36
Q

Drug Therapy for Constipation- Pathogenesis

A 
Primary Function
-Absorb water and electrolytes
-90% of water in colon is reabsorbed
Soft, formed stool
-How do you define normal bowel function?
37
Q

Drug Therapy for Constipation- Pathogenesis

A

Role of Fiber
Absorbs water, ↑ fecal mass
Digested by bacteria, ↑ fecal mass
20 – 60 grams of daily fiber recommended

38
Q

Drugs for Constipation

A

Laxatives

  • Bulk-forming
  • Surfactant (Stool softeners)
  • Lubricant

Cathartics

  • Stimulant
  • Saline

Other

  • Lactulose
  • Lubiprostone
39
Q

Drugs for Constipation

Indications

A

Indications:

  • Relieve constipation
  • Obtain stool sample
  • Evacuate bowel before procedure
  • Modify effluent from ileostomy or colostomy
  • Prevent fecal impaction in bedridden patients
  • Remove poisons
40
Q

Drugs for Constipation (Contraindications)

A

Contraindications:

  • Symptoms of intraabdominal infection
  • Acute surgical abdomen
  • Fecal impaction or bowel obstruction
  • Habitual use

CAUTION: pregnancy and lactation!!!!

41
Q

Bulk-forming Laxatives

Drugs

A

Methylcellulose (Citrucel)

Psyllium (Metamucil)

Polycarbophil (FiberCon)

42
Q

Bulk-forming Laxatives (Mechanism and indication)

A

Mechanism of action:

  • Act like dietary fiber
  • Swell with exposure to water → form a gel → softens and ↑ fecal mass
  • Stimulates peristalsis

Indication:

  • Constipation
  • Modify effluent for ileostomy and colostomy
43
Q

Bulk-forming Laxatives

Adverse effects and Counseling Points

A

Adverse Effects:

  • Flatulence and bloating
  • Esophageal obstruction

Counseling Points:

  • Take with a full glass of water or juice
  • Contraindicated in patients with narrowing of the intestinal lumen or obstruction
  • May take 1 to 3 days to see effects
44
Q 
Surfactant Laxatives
(Drugs and mechanism of Action)
A

Drugs
Docusate sodium
Docusate calcium

Mechanism of action:

  • Alter stool consistency
  • Lower surface tension, allow more water penetration in feces
  • Interact with intestinal wall:
    - -Inhibit fluid reabsorption
    - -Stimulate secretion of water and electrolytes into intestines
45
Q

Surfactant Laxatives (Adverse Effects and Couseling Points)

A

Adverse Effects:
Minimal

Counseling Points:

  • Take with a full glass of water
  • May take 1 to 3 days to see effect
46
Q

Lubricant Laxatives

A

Drug:
Mineral oil

Mechanism of action:

  • Indigestible and poorly absorbed hydrocarbon
  • Lubrication

Indication:
Fecal impaction

47
Q

Lubricant Laxatives (Adverse Effects and Counseling Points)

A

Adverse effects:

  • Lipid pneumonia (aspiration)
  • Anal leakage

Counseling points:

  • Taken PO or rectally
  • Most effective when administered rectally
  • Onset of effect is approximately 6 to 8 hours
48
Q

Stimulant Cathartics

A

Drugs:
Bisacodyl
Senna
Castor oil

Mechanism of action:

  • Irritate the GI mucosa
  • ↑ secretion of water and electrolytes into the intestine
  • Stimulates intestinal peristalsis

Indication:

  • Opioid-induced constipation
  • Constipation due to slow colonic transit time
  • Bowel prep for procedure
49
Q

Bisacodyl (Tablets & Suppositories)

Stimulant Cathartics

A

Onset:
6 to 12 hours
15 to 60 minutes

Adverse Effects:
Abdominal pain/ cramping
Nausea
Diarrhea

Counseling Points:

  • Tablets are enteric coated, do NOT crush or chew
  • Separate from milk and antacids by 1 hour
  • Suppositories may cause burning
50
Q

Senna (Stimulant Cathartics)

A

Onset:
6 to 12 hours

Adverse Effects:
Abdominal pain/ cramping
Nausea
Diarrhea

Counseling Points:
Plant-based
May cause yellow-brown coloring of urine

51
Q

Castor Oil (Stimulant Cathartics)

A

Onset:
2 to 6 hours
(QUICKEST)

Counseling Points:

  • Do NOT administer at bedtime
  • Powerful laxative, not for routine use
  • Bad taste, chill or mix with juice
52
Q

Saline Cathartics

A

Drugs:
Magnesium salts
Sodium phosphate

Mechanism of action:

  • Salts that are poorly absorbed in the intestines
  • Draw water into intestinal lumen
  • Stimulates peristalsis
53
Q

Magnesium salts
Magnesium citrate
Milk of magnesia

Saline Cathartics

A

Indication:
Constipation
Bowel prep

Onset:
30 minutes to 6 hours

Adverse Effects:

  • Dehydration
  • Accumulation of Mg in renal impairment
  • Abdominal pain/ cramping

Counseling Points:

  • Increase fluid intake during treatment
  • Use cautiously in renal impairment
54
Q

Sodium phosphate

Saline Cathartics

A

Indication:
Constipation
Bowel prep

Onset:
30 minutes to 6 hours

Adverse Effects:
Fluid retention
Abdominal pain/ cramping

Counseling Points:

  • Increase fluid intake during treatment
  • Use cautiously in heart failure
55
Q

Osmotic Cathartics: Pothylene glycol

A

Mechanism of action:
Non-absorbable compound, retains water in intestinal lumen
↑ fecal mass, softens feces
↑ peristalsis

56
Q

Polyehtylene Glycol (Miralax)

Osmotic Cathartics

A

Indication:
Constipation

Onset:
1 to 3 days

Adverse Effects:

  • Nausea
  • Abdominal bloating
  • Cramping
  • Flatulence

Counseling Points:

  • Dissolve powder in water, juice, coffee, tea
  • May take 1 to 3 days for effects
57
Q

Lactulose

A

Semisynthetic disaccharide (galactose and fructose)

Mechanism of action:

  • Poorly absorbed
  • Metabolized by bacteria into compounds that cannot leave colon
  • Exerts osmotic effect, drawing water
58
Q

Lactulose (Indication and Adverse Effects)

A

Indication:

  • Constipation
  • Hepatic encephalopathy

Onset of action:
1 to 3 days

Adverse effects:

  • Flatulence
  • Abdominal cramping
59
Q

Lubiprostone (Amitiza)

Mechamism of action and Indications

A

Mechanism of action:

  • Selective chloride channel activator in intestines
  • ↑ chloride-rich fluid in intestines
  • Enhances peristalsis in small and large intestines

Indications:

  • Chronic idiopathic constipation
  • Irritable bowel syndrome with constipation
  • Opioid-induced constipation
60
Q

Lubiprostone (Amitiza)

Adverse effects and Counseling points

A

Adverse effects:

  • Diarrhea
  • Abdominal distention and pain
  • Flatulence
  • Vomiting
  • Chest tightness 30-60 minutes after the first dose

Counseling points:
-Administered orally
Take with a full glass of water
-Monitor for signs of chest tightness and dyspnea

61
Q

Laxative Abuse

A

Causes:
-Misconception of normal
Self-perpetuating cycle

Consequences:

  • Diminishes defecatory reflexes
  • Electrolyte imbalances, dehydration and colitis

Treatment:

  • Stop laxatives
  • Patient education
  • Dietary changed

Pharm Exam 3 (1 decks)

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