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Therapeutics > Dyspepsia > Flashcards

Dyspepsia Flashcards

1
Q

What may GORD (gastro-oesophageal reflux disease) leading to oesophagitis be due to?

A

Obesity
Pregnancy
Drug-induced

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2
Q

What is peptic ulceration?

A

Gastric and duodenal

Can lead to anaemia

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3
Q

What’s Zollinger-Ellison syndrome/

A

Rare gastrin0secreting tumour of D-cells of the pancreas

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4
Q

What are the symptoms of peptic ulceration?

A

Precise epigastric pain
Hunger pain, relieved by eating
Night pain, relieved by food, milk or antacids
Waterbrush, appearance of water in the mouth
Nausea and sometimes vomiting
Haematemesis

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5
Q

What are the main causes of peptic ulceration?

A 
Helicobacter pylori (80-90% duodenal ulcer have gram-ve infection)
70% patients have gastric ulcer, remainder mostly NSAID induced
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6
Q

What are the tests for H. pylori?

A

Urea breath test- patient given 13C and bacterial ureases convert it to 13CO2 which is absorbed and exhaled from the lungs
H. pylori antigens/antibodies in blood, saliva, stools

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7
Q

What symptoms are suggestive of serious disease?

A 
Aged over 45 years
Weight loss
Anaemia
Dysphagia
Haematemesis
Melaena (tarry stools)
Upper abdominal masses
Persistent symptoms with repeat requests for OTC remedies
Onset of new symptoms
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8
Q

What increases acid secretions?

A

Histamine via H2 receptors
Gastrin
Acetylcholine via M-receptoras- M3 on parietal cells

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9
Q

What decreases acid secretions?

A

Prostaglandins (E2 and I2)

Also cytoprotective via bicarbonate and mucus release

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10
Q

What are the goals of treatment?

A

Symptomatic relief or cure
Suppression of acid release or activity, and mucosal protection
Allow natural healing and eradicate infection

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11
Q

What lifestyle changes can provide symptomatic relief?

A

Avoidance of causative drugs
Avoidance of causative foods
GORD- propping up bed, removing belts

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12
Q

What antacids are used?

A

Sodium bicarbonate
Magnesium hydroxide
Aluminium hydroxide

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13
Q

What are alginates?

A

Gaviscon
Alginic acid when combined with saliva, forms a viscous foam which floats on the gastric contents forming a raft which protects the oesophagus during reflex

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14
Q

What are H2 antagonists

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Receptors are coupled via adenylyl cyclase to increase cAMP which activates the proton pump

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15
Q

What do histamine H2 antagonists do?

A

Reduce gastric acid secretion
Provide symptomatic relief
Best given at night
Promote ulcer healing (relapse on discontinuation)
Reduce the need for surgery in ulceration

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16
Q

What does cimetidine do?

A

Inhibits cytochrome P450 and the metabolism of other drugs

17
Q

What drugs does cimetidine interact with?

A 
Oral anticoagulants
Phenytoin
Carbamazepine
Tricyclic antidepressants 
(ranitidine doesn't interact this way and is favoured)
18
Q

What are PPIs (proton pump inhibitors)

A

Omeprazole, pantoprazole, lansoprazole

Act via irreversible inhibition of the proton pump (H+/K+-ATPase)

19
Q

How do PPIs work?

A

Activated by acid pH
Inhibit H+ secretion by >90% may lead to achorhydia
Increased risk of campylobacter infection due to increased pH
Omeprazole is now OTC

20
Q

What are pro-kinetic drugs?

A

Cause gastric emptying

Movement of gastric contents from stomach to duodenum- of benefit in GORD

21
Q

What does domperidone do?

A

Increased closure of oesophageal sphincter (good for reflux disease) and opens lower sphincter

22
Q

What does metocloperamide do?

A

Acts locally to increase gastric motility and emptying (combined with analgesics to accelerate absorption

23
Q

What triple therapy is used for eradication of helicobacter pylori?

A 
2 from:
Metronidazole
Amoxicillin
Clarithromycin 
Plus PPI and/or H2 antagonist
Triple therapy for 1 week then PPI alone for ulcer healing
24
Q

What’s bismuth chelate?

A

Kills H. pylori, coats the ulcer, absorbs pepsin, increase prostaglandin production and increased HCO3- secretion

25
Q

How is non-H. pylori dyspepsia treated?

A

Step 1: antacid and/or alginate
Step 2: H2 antagonist
Step 3: PPI

26
Q

What drugs cause ulcerogenic effects?

A

Oral NSAIDs and corticosteroids

Ibuprofen has low incidence of GI side effects

27
Q

What do cyclooxygenases (COX) exist as?

A

COX-1: is the physiological form, involved in gastric protection
COX-2: selective inhibitors (celecoxib) have less GI-side effects

28
Q

What is celecoxib?

A

COX-2 selective inhibitors have less GI-side effects

29
Q

How can you minimise GI damage?

A

Prophylaxis with PPI
H2 antagonists less or ineffective
Give in combination with misoprostol- a stable PGE1 analogue, acts on prostanoid receptors to inhibit gastric H+ secretion

Therapeutics (17 decks)

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