Dyspepsia

Question 1

Ways in which acid secretion are controlled

Answer 1

Increase:

• Histamine via H2r
• Gastrin
• ACh via M3r on parietal cells

Decrease:

• Prostaglandins E2 and I2

Question 2

Treatment of peptic ulceration

Answer 2

Antacids

Alginates

H2 antagonists

Question 3

Antacids MOA and examples

Answer 3

Sodiunm Bicarb: simplest

Magnesium hydroxide and aluminium hydroxide

Calcium salts may icnrease gastrin release

Question 4

H2 receptor antagonists MOA

Answer 4

H2 is coupled cia cAMP to activate PP

Cimetidine, Rainitidine, Famotidine

Low dose OTC for short term relief. High dose POM

Best given at night

Question 5

Considerations with Cimetidine

Answer 5

P450 inhibitors, so may interact with OCs, Phenytoin, Carbamazepine, TCAs

Raitidine does not, so is favoured

Question 6

PPI MOA and examples

Answer 6

Oemprazolem lasoprazole

• Widely usedm act via irreversible inhibition of PP(H/K-ATPase)

Activated by acid pH, may lead to achlorhydria

Increased risk oof campyolobacter infection

Is OTC

Question 7

Prokinetic drugs MOA and exampels

Answer 7

Move conotent from stomach to duodenum, useful in GORD

Domperidone: Closure of oesopohageal sphincter, opens lower

Metocloperamide: Acts locally to increase gastyric motility and emptying

Question 8

HP eradication

Answer 8

Triple therapy foor 1 week then PPI alone

2 from:

• Metronidazole
• Amoxicilin
• Clarithromycin

+

PPI and/oro H2 antagonist

Ocasionally bismuth chelate

Question 9

Approach to non-HP peptic ulceration management

Answer 9

1. Antacid or alginate and antacid
2. H2 Antagonist
3. PPI

Step up or down as appropriate

Question 10

Ulcerogenic effects of NSAIDs an oral steroids

Answer 10

COX1 protective

COX2 Pathologiucal

Most NSAIDs non-selectively inhibit both.

COX-2 Selective: celecoxib