Drugs affecting GI function: Part 1

Question 1

Peptic ulcer disease

Answer 1

Development of ulcers occurs when there is an imbalance between aggressive factors and defensive factors

Question 2

Defensive factors examples

Answer 2

Mucus
Bicarbonate
Blood flow
Prostaglandins

Question 3

Bicarbonate

Answer 3

Neutralizes any H+ ions that penetrate the mucus

Question 4

Prostaglandins

Answer 4

Stimulate secretion of mucus and bicarbonate

Question 5

Aggressive factors examples

Answer 5

H pylori 
NSAIDS (2nd most common) 
Gastric juice
Pepsin
Smoking

Question 6

H pylori

Answer 6

Most cases of PUD caused by this gram negative bacillus

Question 7

Gastric acid

Answer 7

Absolute requirement for ulcer formation

Question 8

NSAIDS block….

Answer 8

Prostaglandins

Question 9

Drug classifications used to treat PUD

Answer 9

Antibiotics
Antisecretory agents
Mucosal protectants
Antacids

Question 10

Types of anti secretory agents

Answer 10

Histamine 2 receptor antagonists
Proton pump inhibitors
Muscarinic antagonists

Question 11

Antibacterial drugs

Answer 11

Amoxicillin
Clarithromycin 
Bismuth 
Tetracycline
Metronidaxole

Question 12

What is the most common regimen for eradicating H pylori?

Answer 12

Omeprazole > Amoxicillin > Clarithromycin

Question 13

Histamine 2 receptor antagonists name

Answer 13

Cimetidine (Tagamet)

Question 14

Tagamet mechanism of action

Answer 14

Blocks H2 receptors, decreases volume of juices, decreases ion concentration (so increases pH)

Question 15

Uses for Tagamet

Answer 15

Gastric ulcers, GERD, aspiration pneumonia

Question 16

Adverse effects of Tagamet

Answer 16

Angioandrogenic effects (Gynecomastia - development of breast tissue)
CNS effects (confusion)
Pneumonia
IV bolus - can experience hypotension and dysrhythmias

Question 17

Tagamet drug interactions

Answer 17

Inhibits drug metabolism
-Coumadin
-Phenytoin
Antacids

Question 18

Other (newer) histamine 2 receptor antagonists

Answer 18

Ranitidine (Zantac)
Famotidine ( Pepcid)
Nizatidine (Axid)

Question 19

Newer histamine 2 receptor antagonists are….

Answer 19

More potent than Tagamet with less adverse effects (Do not cross blood brain barrier and do not bind to androgen receptors)

Question 20

Proton pump inhibitors main medication

Answer 20

Omeprazole (Prilosec)

Question 21

Proton pump inhibitors mechanism of action

Answer 21

Powerful suppression of acid secretion (in parietal cells)

Decreases gastric acid secretion by 97%

Question 22

Uses for proton pump inhibitors

Answer 22

Gastric ulcers

GERD

Question 23

What are the best drugs for anti-secretion?

Answer 23

Proton pump inhibitors

Question 24

With only 3% of gastric acid, you can…

Answer 24

Still eat food, digest, etc

Question 25

Adverse effects of PPIs

Answer 25

Short term: minimal | Long term: risk for cancer

Question 26

Other PPIs

Answer 26

Esomeprazole (Nexium) Lansoprazole (Prevacid) Pantoprazole (Protonix) Rabeprazole (Aciphex)

Question 27

Max time to take PPIs

Answer 27

6 weeks

Question 28

What is the PPI drug of choice in the hospital?

Answer 28

Protonix

Question 29

Sucralfate (Carafate) mechanism of action

Answer 29

Promotes ulcer healing by adhering to ulcer crater and forming a barrier over ulcer

Question 30

Adverse effects of other anti-ulcer drugs

Answer 30

``` Almost none (drug is not absorbed) Constipation ```

Question 31

Sucralfate keeps patients from having...

Answer 31

Pain while eating

Question 32

Antacids

Answer 32

Alkaline compounds that neutralize stomach acids

Question 33

Classes of antacids

Answer 33

Aluminum, magnesium, calcium, sodium

Question 34

Uses of antacids

Answer 34

PUD | GERD

Question 35

Adverse effects of antacids

Answer 35

Constipation Diarrhea Sodium loading

Question 36

Examples of antacids

Answer 36

TUMS, pep-bismol, aka-seltzer, etc