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Exam 3 > Drugs used to treat GERD PUD and Gastric Motility Disorders > Flashcards

Drugs used to treat GERD PUD and Gastric Motility Disorders Flashcards

1
Q

Cimetidine, Ranitidine (Zantac), Famotidine (Pepcid), and Nizatidine are what class of drug?

A

H2 receptor antagonists

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2
Q

how do H2 receptor antagonists do their job?

A

they block histamine from binding to H2 receptor on parietal cells, resulting in reduced gastric acid secretion

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3
Q

Side effects of cimetidine

A

confusion, gynecomastia, infertility

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4
Q

Are H2 blockers safe in pregnancy?

A

Usually safe only if benefits outweigh the risks

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5
Q

What drugs do we have to renally adjust for?

A

H2 receptor antagonists

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6
Q

This drug class crosses the BBB, placenta, and is in breast milk

A

H2 receptor antagonists

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7
Q

How long does it take H2 receptor antagonist to peak?

A

1-3 hours

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8
Q

Which drugs may decrease the effects of ketoconazole, itraconazole, or alter serum levels of ferrous sulfate, diazepam?

A

H2: Ranitidine, Famotidine, Axid

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9
Q 
Name the drug class:
Omeprazole
Esomeprazole
Lansoprazole
Rabeprazole
Pantoprazole
A

Proton Pump Inhibitors

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10
Q

How to PPIs work?

A

they irreversibly bind the H+/K+ (ATPase) pump of the parietal cell, resulting in decreased acid secretion

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11
Q

Which drug results in the most potent gastric acid reduction?

A

PPIs

they heal ulcers more quickly than H2s

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12
Q

I usually take PPI 1POQD, but someone with what issues would take it BID?

A

ulcer

erosive espohagitis

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13
Q

PPIs work poorly in whom?

A

fasting patients
those taking other acid reducing agents

*they require an acididc environment for activity

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14
Q

When should I take my PPI?

A

30 minutes before a meal

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15
Q

Side effects from PPIs are rare, but what may I get?

A

diarrhea, Headache

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16
Q

Why shouldnt I stop taking my PPI abruptly?

A

it will increase gastrin levels by 400%, you gotta taper off to prevent dat acid spike

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17
Q

Who disrupts the mucosal defense layer?

A 
acid
pepsin
h pylori
aspirin
NSAIDS
corticosteroids
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18
Q

How do antacids work?

A

they neutralize gastric acid for a brief amount of time.
they enhance delivery of growth factors to injured muscosa AND
promote angiogenesis in injured mucosa.
Inhibit pepsin activity by binding bile acids
They also suppress H pyloi, but dont eradicate it

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19
Q

Name this drug class:
Calcium carbonate
magnesium hydroxide
aluminum hydroxide

A

Antacids

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20
Q

Adverse effects of calcium carbonate (antacid)

A

Milk-Alkali syndrome:
hypercalcemis
alkalosis
renal impariement

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21
Q

Adverse effects of magnesium Hydroxide (antacid)

A

Diarrhea

hypermagnesemia (in setting of renal failure)

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22
Q

Adverse effects of Aluminum Hydroxide

A

constipation
NEVER GIVE TO RENAL FAILURE PTS:
(due to neurotoxicity, anemia, hypophosphatemia)

23
Q

What is sulcrafate (carafate) made out of?

A

sulfate + aluminum

24
Q

Sulcrafate (Carafate) MOA

A

forms ulcer-adherent complex that covers the ulcer and protects it

enhances growth factor and angiogenesis on injured tissue
suppresses H pylori

25
Q

Sulcrafate (Carafate) Adverse effects

A

Constipation
ALUMINUM TOXICITY in renal failure patients
inhibits absoprtion of many other drugs

26
Q

Since sulcrafate inhibits absoprtion of many other drugs, what should we do?

A

administer other drugs at least two hours before sulcrafate

27
Q

Bismuth (pepto-bismol) MOA

A

suppresses H pylori
increases secretions
recruits macrophages to promote ulcer healing

28
Q

ADE of pepto bismol

A

black/gray stools

monitor in renal failure

29
Q

What is the result of giving bismuth with tetracyclines of uricosurics?

A

decreased effect

30
Q

what is the result of giving bismuth with aspirin, warfarin, or in hypoglycemics?

A

increased toxicity

31
Q

What do prostaglandin analogs do?

A

they improve muscoal blood flow, bicarb secretion, and dec acid secretion

protect us from NSAID induced ulcers

32
Q

What drug class is misoprostol (cytotec)?

A

synthetic prostaglandin analog

33
Q

Why is misoprostol contraindicated in pregnancy?

A

produces uterine contrations that may endanger prgnancy

34
Q

Misoprostol uses

A

NSAID induced gastric ulcers

but now PPIs are cheap and better

35
Q

Antacids but you at a 6x increased risk of what?

A

c diff

infectious diarrhea

36
Q

What is standard treatment for H. pylori?

A

PPI
clarithromycin
amoxicillin

BID 2 wks

37
Q

I have H. pylori but im allergic to penicillin and cant tolerate quadruple therapy

A

PPI
clarithromycin
metronidazole

BID 2 wks

38
Q

I have h pylori, im allergic to penicillin and ive failed a course of treatment

A

bismuth
metronidazole
tetracycline
PPI

39
Q

Who are NSAIDs?

A

aspirin, ibuprofen, naproxen, indomethacin

40
Q

I need to take an NSAID. Use of what other drugs will put me at an increased risk for developing an ulcer?

A

glucocorticoids
anticoagulants
biphosphonates
other NSAID/ASA

41
Q

What is the rate of stomach contractions?

A

3 per minute

42
Q

What is a gastroparesis diet?

A

small, frequent, low fat meals

43
Q

What antiemetics are given for gastroparesis?

A

compazine, phenergan, tigan, zofram

44
Q

How are prokinetic agents used for gastroparesis? (When and how do they help?)

A

Given 20-40 minutes before a meal to allow it to get into bloodstream
they cause the stomach to contract more often and should help empty the stomach and reduce symptoms

45
Q

Drug class:
Erythromycin
Metocloperamide
Domperidone

A

prokinetic agents

46
Q

Erythromycin MOA

A

antibiotic binds MOTILIN RECEPTORS in the stomach and small intestine, which stimulates contaction and improves emptying

IV dose is better than PO

47
Q

Erythromycin ADE

A

diarrhea
N/V
abdominal cramps

48
Q

Issue with Eyrthromycin for gastroparesis

A

not FDA approved for it and tolerance over time

49
Q

Domperidone MOA

A

blocks dopamine receptors to increase duration of antral and duodenal contractions and inhibit fundal relaxation

anti-emetic also

50
Q

Issue with domperidone

A

NOT IN US

CANADA ONLY

51
Q

Side effects of Domperidone

A

allergic rash

abdominal cramps

52
Q

Metocloperamide (Reglan) MOA

A

accelerates gastric emptying and intestinal transit

Peripherally: cholinergic enhancement thru cholinesterase inhibition, anti-dopaminergic (d2) and directly on GI smooth muscle

Centrally: anti-D2 and 5-HT3, so gives it some antiemetic propery

53
Q

Metocloperamide ADE

A

restless, drowsy, tired, insomnia

tardive dyskinesia at high doses

Exam 3 (18 decks)

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