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GI pharm > Drugs Affecting Gastrointestinal Tract (GIT) Acid > Flashcards

Drugs Affecting Gastrointestinal Tract (GIT) Acid Flashcards

1
Q

what is GERD?

A

Passage of gastric contents into the esophagus becomes a disease when it causes macroscopic damage or symptoms that reduce QOL

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2
Q

what is Erosive esophagitis?

A

visible breaks with/without symptoms

  • Lining erodes away and can have visible breaks
  • Diagnosed via endoscopy (EGD)
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3
Q

what is Nonerosive reflux disease (NERD)?

A

symptoms of GERD without visible mucosal injury

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4
Q

When acid gets exposed to esophagus the tissue types can change (hyperplasia) and lead to ____ in esophagus.

A

cancers

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5
Q

Recommend endoscopy if patient has what?

A
  1. Heartburn with alarm symptoms (dysphagia, odynophagia, GI bleeding, anemia, weight loss, recurrent vomiting)
  2. Severe erosion on initial scope–>Repeat after 2 months of PPI
  3. Men >50 yo with chronic (>5 years) GERD and additional risk for Barrett’s esophagus and esophageal adenocarcinoma (nocturnal reflux, hiatal hernia, elevated BMI, tobacco use, intraabdominal fat)
  4. GERD symptoms that persist despite therapeutic trial of 4-8 weeks of BID PPI
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6
Q

what are the classes of drugs to treat GERD in order of lowest potency to highest potency?

A
  1. OTC antacids and histamine2-receptor antagonists (H2RA) at OTC doses
  2. H2RA at Rx doses
  3. Proton Pump Inhibitors (PPI)
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7
Q

The classes of drugs affecting the physiology of the production of acid are the ______

A

PPIs and the H2RAs

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8
Q

Antacids MOA

A

neutralize gastric acid so have a relatively fast onset

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9
Q

Antacid products

A

o Alka-Seltzer - NaHCO3 and/or KHCO3

o Maalox (liquid) - Al(OH)3 and Mg(OH)2

o Maalox (tablet) - CaCO3

o Milk of Magnesia - Mg(OH)2
o Pepto-Bismol - C7H5BiO4

o Pepto-Bismol Children’s - CaCO3

o Rolaids - CaCO3 and Mg(OH)2

o Tums - CaCO3

o Mylanta - Al(OH)3

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10
Q

Antacids are often used for what kind of GERD symptoms?

A

Often used for mild symptoms and for heartburn (i.e., symptoms less than once per week)

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11
Q

do antacids prevent GERD?

A

no

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12
Q

MC antacids that are used?

A

Rolaids and tums

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13
Q

what are the 4 Histamine2-receptor Antagonists (H2RAs)

A
  1. Cimetidine (Tagamet)
  2. Famotidine (Pepcid, et al.)
  3. Nizatidine (Axid)
  4. Ranitidine (Zantac)
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14
Q

Histamine2-receptor Antagonists MOA

A

inhibit histamine at H2-receptors of gastric parietal cells (and other tissues but not very clinically useful)

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15
Q

Histamine2-receptor Antagonists can sometime treat what other disease besides GERD?

A

chronic urticaria

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16
Q

what 2 Histamine2-receptor Antagonists can be used IV?

A

Ranitidine (Zantac)

Famotidine (Pepcid, et al.)

17
Q

what 2 Histamine2-receptor Antagonists are most used?

A

Ranitidine (Zantac)

Famotidine (Pepcid, et al.)

18
Q

what Histamine2-receptor Antagonists comes in a PO tablet only

A

Cimetidine (Tagamet)

19
Q

which Histamine2-receptor Antagonist Inhibits CYP450 metabolism and has several important DDIs

A

Cimetidine (Tagamet)

20
Q

what are some drugs that Cimetidine (Tagamet) has DDIs with because of the CYP450 metabolism

A

warfarin, phenytoin, diazepam, carbamazepine

21
Q

what is special about Ranitidine (Zantac)

A

Longer acting and more potent than cimetidine

No enzyme inhibition

22
Q

what is special about Famotidine

A

More potent than ranitidine

23
Q

what is special about Nizatidine (Axid)

A

No liver metabolism so would be good in patients with liver disease

24
Q

if your pt has liver disease and needs a Histamine2-receptor Antagonist, which one would you prescribe?

A

Nizatidine (Axid)

25
Q

Histamine2-receptor Antagonist reduce the absorption of__

A

FQs

26
Q

Histamine2-receptor Antagonist ADRs

A
  • Most are well-tolerated with some GI upset and HA
  • Cimetidine has more and different ADRs :antiandrogenic actions so men can get gynecomastia, and galactorrhea, Women can get breast tenderness and changes in menstruation from this
27
Q

DDIs of Histamine2-receptor Antagonist

A

Some drugs require acid (e.g., iron, digoxin, ampicillin) to be absorbed so coadministration can reduce effectiveness

28
Q

Most potent and MC used class of drugs for GERD

A

Proton Pump Inhibitors (PPIs)

29
Q

Proton Pump Inhibitors (PPIs) MOA

A

bind to active H+/K+-ATPase enzyme units (proton pump) of gastric parietal cells to suppress the secretion of H+ into the gastric lumen

30
Q

Proton Pump Inhibitors (PPIs) drugs end in what?

A

PRAZOLES

31
Q

what are the PPI drugs?

A 
Rx and OTC
o	Omeprazole (Prilosec)
o	Pantoprazole (Protonix) - IV and PO
o	Lansoprazole (Prevacid) - IV and PO
Rx ONLY
o	Rabeprazole (AcipHex)
o	Esomeprazole (Nexium) - IV and PO
o	Dexlansoprazole (Dexilant)
32
Q

PPIs are prodrugs that need what kind of environment to be activated?

A

acidic

33
Q

When should PPIs be taken?

A

in morning, 30-60 min before meal. if BID then second dose before a meal.

34
Q

Do PPIs work instantly?

A

no, it may take several days to achieve maximal efficacy

35
Q

What is an important DDI with omeprazaole?

A

clopidogrel

**Omeprazole (Prilosec) and clopidogrel (Plavix- antiplatelet): decreased action of clopidogrel due to 2C19 inhibition.
You need 2C19 to activate clopidogrel, so if you don’t have that you lower effectiveness of clopidogrel and this increases the chance for them to clot.

36
Q

A DDI for PPIs and Protease Inhibitors (used to treat HIV)?

A

reduced absorption of some Protease Inhibitors

GI pharm (11 decks)

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