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

Drug Therapy for Peptic Ulcer Disease Flashcards

(61 cards)

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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
Antacids (Indications and Dosage)
Indication -PUD -Symptomatic relief in GERD Potency based on acid neutralizing capacity (ANC) Dosage - Lower for gastric ulcers - Higher for duodenal ulcers
26
H. Pylori Associated Ulcers
``` 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
Clarithromycin Antibiotics for H. Pylori
Mechanism of action: Inhibits bacterial protein synthesis Adverse Effects: Nausea Diarrhea Change in taste
28
Amoxicillin | Antibiotics for H. Pylori
Mechanism: Inhibits bacterial cell-wall synthesis Adverse effects: Diarrhea Other considerations: Low resistance rates Works best at higher pH
29
Bismuth | Antibiotics for H. Pylori
Mechanism: Disrupts bacterial cell walls Adverse Effects Black discoloration of tongue and stool
30
Tetracycline | Antibiotics for H. Pylori
Mechanism: Inhibits bacterial protein synthesis Adverse Effects: Stains developing teeth and skin Other considerations: Contraindicated in pregnancy and young children
31
Metronidazole | Antibiotics for H. Pylori
Mechanism: Inhibits bacterial cellular metabolic processes Adverse Effects: Nausea Headache Other Considerations Avoid use with alcohol Avoid in pregnancy
32
Tinidazole | Antibiotics for H. Pylori
Mechanism:Inhibits bacterial cellular metabolic processes Adverse Effects: Nausea Headache Other considerations: Avoid use with alcohol Avoid in pregnancy
33
NSAID-induced Ulcers
Risk factors Age > 60 History of ulcers High-dose NSAID therapy Prophylaxis PPIs preferred Consider misoprostol therapy
34
NSAID-induced Ulcers
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
Non-drug Therapy
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
Drug Therapy for Constipation- Pathogenesis
``` Primary Function -Absorb water and electrolytes -90% of water in colon is reabsorbed Soft, formed stool -How do you define normal bowel function? ```
37
Drug Therapy for Constipation- Pathogenesis
Role of Fiber Absorbs water, ↑ fecal mass Digested by bacteria, ↑ fecal mass 20 – 60 grams of daily fiber recommended
38
Drugs for Constipation
Laxatives - Bulk-forming - Surfactant (Stool softeners) - Lubricant Cathartics - Stimulant - Saline Other - Lactulose - Lubiprostone
39
Drugs for Constipation | Indications
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
Drugs for Constipation (Contraindications)
Contraindications: - Symptoms of intraabdominal infection - Acute surgical abdomen - Fecal impaction or bowel obstruction - Habitual use CAUTION: pregnancy and lactation!!!!
41
Bulk-forming Laxatives | Drugs
Methylcellulose (Citrucel) Psyllium (Metamucil) Polycarbophil (FiberCon)
42
Bulk-forming Laxatives (Mechanism and indication)
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
Bulk-forming Laxatives | Adverse effects and Counseling Points
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
``` Surfactant Laxatives (Drugs and mechanism of Action) ```
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
Surfactant Laxatives (Adverse Effects and Couseling Points)
Adverse Effects: Minimal Counseling Points: - Take with a full glass of water - May take 1 to 3 days to see effect
46
Lubricant Laxatives
Drug: Mineral oil Mechanism of action: - Indigestible and poorly absorbed hydrocarbon - Lubrication Indication: Fecal impaction
47
Lubricant Laxatives (Adverse Effects and Counseling Points)
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
Stimulant Cathartics
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
Bisacodyl (Tablets & Suppositories) Stimulant Cathartics
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
Senna (Stimulant Cathartics)
Onset: 6 to 12 hours Adverse Effects: Abdominal pain/ cramping Nausea Diarrhea Counseling Points: Plant-based May cause yellow-brown coloring of urine
51
Castor Oil (Stimulant Cathartics)
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
Saline Cathartics
Drugs: Magnesium salts Sodium phosphate Mechanism of action: - Salts that are poorly absorbed in the intestines - Draw water into intestinal lumen - Stimulates peristalsis
53
Magnesium salts Magnesium citrate Milk of magnesia Saline Cathartics
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
Sodium phosphate Saline Cathartics
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
Osmotic Cathartics: Pothylene glycol
Mechanism of action: Non-absorbable compound, retains water in intestinal lumen ↑ fecal mass, softens feces ↑ peristalsis
56
Polyehtylene Glycol (Miralax) Osmotic Cathartics
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
Lactulose
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
Lactulose (Indication and Adverse Effects)
Indication: - Constipation - Hepatic encephalopathy Onset of action: 1 to 3 days Adverse effects: - Flatulence - Abdominal cramping
59
Lubiprostone (Amitiza) | Mechamism of action and Indications
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
Lubiprostone (Amitiza) | Adverse effects and Counseling points
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
Laxative Abuse
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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