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Pharmacology II > Exam 2: GI disorders > Flashcards

Exam 2: GI disorders Flashcards

1
Q

What are Antacids and what is their action?

A
  • Weak bases that interact with stomach acid to form water and salt
  • They act locally to treat excess acidity and raise gastric pH.
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2
Q

At what pH is pepsin maximally active?

A
  • pH = 2

- When pH > 4, pepsin activity decreases

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3
Q

At what pH do best antacids buffer to?

A

pH of 3-4

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4
Q

Do Antacids inhibit HCl production by parietal cells?

A
  • No

- Need HCl for digestion

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5
Q

Side effect of Antacids?

A

Constipation

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6
Q

Name the 3 primary compounds used alone or in combination in antacid products

A
  1. Aluminum salts
  2. Magnesium salts
  3. Calcium carbonate
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7
Q

Which of the primary compounds used in antacids are poorly absorbed?

A

Calcium and Magnesium

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8
Q

Which of the primary compounds used in antacids are not absorbed at all?

A

Aluminum

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9
Q

Which of the primary compounds in antacids form compounds in the small intestines that may lead to constipation?

A

Calcium carbonate

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10
Q

How does Milk of Magnesia work?

A

Hydroxide ions bind with HCl in stomach = neutralizes

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11
Q

How does Maalox work and what is its onset of action time?

A
  • Coats ulcerated area and protects ulcers from HCl
  • Reacts with gastric acid to form silicon dioxide in stomach (silica absorbs H+)
  • Neutralizes gastric pH
  • Slow acting
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12
Q

Explain the action of Amphojel

A
  • Aluminum is astringent to stop bleeding
  • Coats and protects ulcers from H+
  • Interferes with absorption of tetracyclines
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13
Q

How much milk can neutralize one volume of acid?

A

One volume of milk

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14
Q

Describe the action of sucralfate (Carafate)

A
  • Forms complexes with albumin, fibrinogen and globulin on ulcer surface, thus creating protective barrier to acid and pepsin
  • Interfers with the absorption of many medications
  • *Not absorbed
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15
Q

When is Sucralfate indicated?

A

First choice therapy in the management of acid-related diseases during pregnancy

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16
Q

Name the Histamine H2 Receptor Antagonists used for acid control?

A
  • Tagamet
  • Pepcid
  • Axid
  • Zantac
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17
Q

Which of the Histamine H2 Receptor Antagonists are preferred by gastroenterologists?

A

Zantac

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18
Q

What is Tritec and when is it indicated?

A
  • It is a prescription with antibiotics (clarithromycin) that is used to treat ulcers
    Histamine H2 Receptor Antagonist
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19
Q

How do Proton Pump Inhibitors work?

A
  • Bind to H+/K+-ATPase (Proton pump) enzyme system in parietal cells
  • This is the final common pathway for acid secretion.
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20
Q

What are the effects of Proton Pump Inhibitors on acid secretion?

A
  1. Reduces gastric secretions
  2. Neutralize gastric acid after release
  3. Protect gastric mucosa from damage
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21
Q

Which have better nocturnal acid control, Proton Pump Inhibitors or Histamine H2 Receptor Antagonists?

A
  • Histamine H2 Receptor Antagonists have nocturnal acid control
  • PPI’s have poor nocturnal acid control
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22
Q

Name the 5 available Proton Pump Inhibitors

A
  1. Nexium
  2. Prevacid
  3. Prilosec
  4. Protonix
  5. Aciphex
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23
Q

Which of the Proton Pump Inhibitors are sold over the counter?

A

Prilosec

24
Q

What are the indications for Nexium?

A
  • Indicated for use for prevention and treatment of NSAID-induced gastrointestinal lesions
  • Better at healing erosive lesions than Prilosec
25
Q

5 Dental Treatment Planning Considerations

A
  1. Drug interactions with antacids
  2. Histamine antagonists decrease antifungals
  3. Histamine antagonists alter warfarin
  4. Tagamet = increases serum concentration
  5. PPI’s decrease absorption of systemic antifungals
26
Q

Define in more detail what occurs with drug interactions and antacids

A
  1. Binding of drugs in stomach = metals
  2. Antacids neutralize pH = interferes with absorption of many drugs = wait 2 hours
  3. Interferes with bioavailability and elimination of many drugs
27
Q

Oral complications of GI medications

A
  • Xerostomia
  • Taste alteration (metallic)
  • Aphthous stomatitis
  • Candidiasis (esophageal)
  • Excessive salivation
28
Q

Peak prevalence of peptic ulcer disease (age)

A
  • Young adulthood (30 years to 50 years of age)

- First degree relatives threefold higher risk

29
Q

There is a higher prevalence of peptic ulcer disease in what patients?

A
  1. Smokers
  2. Heavy Drinkers
  3. Hyperparathyroidism
  4. Renal dialysis patients
  5. Use of NSAIDS (chronic use)
30
Q

Death from peptic ulcer disease is more likely in what age group?

A

Elderly

31
Q

What is the etiology of peptic ulcer disease?

A
  • Helicobacter pylori infection
  • *Humans are only known hosts of H. pylori
  • *Organism resides in oral cavity
    Present in 90% of cases
32
Q

Name the contributing factors to peptic ulcer disease

A
  1. Acid hypersecretion
  2. Smoking
  3. Stress = increases acid secretion
  4. Use of NSAIDS for > 1 month
33
Q

Name 3 complications of peptic ulcer disease

A
  1. H Pylori associated with cancer of gastric mucosa = lymphoma
  2. Peptic ulcers rarely undergo transformation to carcinoma
  3. Atrophic gastritis caused by chronic use of proton pump inhibitors increases risk for stomach cancer
34
Q

Treatment of peptic ulcer disease if it is an uncomplicated ulcer:

A

Antisecretory drugs

35
Q

Treatment of peptic ulcer disease if H. pylori is present

A

Antisecretory drugs + antibiotics

36
Q

What combination therapy can be used to treat peptic ulcer disease with H. pylori present?

A

Antibiotics + proton-pump inhibitor or Pepto Bismol

37
Q

Antibiotics are used in combination with what other two acid drugs to treat ulcers caused by H. pylori

A
  1. Proton pump inhibitors

2. H2 receptor blockers

38
Q

What antiboitics are used to treat H. pylori?

A
  1. Amoxicillin
  2. Metronidazole
  3. Clarithromycin
  4. tetracycline
39
Q

What is the normal procedure once H. pylori is detected in patients with a peptic ulcer?

A
  • Eradicate it and allow the ulcer to heal
    • Standard first-line therapy is a one week triple therapy consisting of the antibiotics:
      ○ Amoxicillin
      ○ Clarithromycin
      ○ A PPI
40
Q

What is used to treat clarithromycin-resistant strains of H. pylori?

A

Levofloxacin (Levaquin) is added as part of the therapy

41
Q

What drugs should be avoided when a patient has peptic ulcer disease?

A
  • Avoid aspirin, NSAIDS

* *Use acetaminophen or COX-2 inhibitor

42
Q

Name the oral manifestations of peptic ulcer disease

A
  • Vascular malformations of lip

- Enamel erosion

43
Q

Name the 2 dental treatment planning considerations for a patient with Peptic Ulcer disease

A
  1. Macrolide antibiotics (erythromycin) cause GI distres and diarrhea
    a. Caution in patients with IBS
    b. Antibiotics: macrolides, cephalosporins, clindamycin = pseudomembraneous colitis
  2. Avoid aspirin/NSAIDS in patients with Hx of stomach ulcers
44
Q

Name the two distinct conditions of IBS

A
  1. Ulcerative Colitis

2. Crohn’s disease

45
Q

Etiology of IBS:

A 
- Unknown
		○ Allergy
		○ Destructive enzymes
		○ Bacterial and viral infections
		○ Stress
		○ Immunologic factors
- Atypical mycobacteria in minority of Crohn's patients
46
Q

Name the 3 lines of treatment of IBS

A
  1. Anti-inflammatories; corticosteroids
    1. Immunosuppressive agents; Antibiotics
    2. Monoclonal antibody; Surgical resection
      • *Supportive Therapy = rest, dietary changes, nutritional supplementation
47
Q

3 drugs to have caution with in a patient with IBS

A
  1. Use of Corticosteroids
    a. Risk for adrenal suppression
  2. Immunosuppressive drugs
    a. Blood dyscrasias = order blood tests
    b. Damage liver = order liver function test
  3. Caution with analgesics
    a. Avoid aspirin and NSAIDS
48
Q

T or F, in patients with acute episodes of IBS, it is ok to perform elective dental procedures as well as urgent, emergency dental procedures

A
  • False, only urgent, emgerceny dental care during acute episodes
    Elective procedures done during remission
49
Q

Name the oral manifestations of Crohn’s

A
  • Atypical mucosal ulcerations, diffuse swelling of lips and cheeks, cobblestone mucosal lesions
  • Aphthous ulcerations
50
Q

Name the 3 Antidiarrheal agents

A
  1. Absorbents
  2. Opioids - paregoric
  3. Ioperamide (Imodium)
51
Q

Describe the absorbent antidiarrheal agents

A
  • Bismuth subsalicylate (pepto-bismol)

- Caution with salicylate allergy

52
Q

Describe the opioids - paregoric antidiarrheal agents

A
  • Codeine and diphenoxylate (in Lomotil) = prescription drug

- Remember that codeine causes constipation as a side effect.

53
Q

What is Imodium?

A
  • OTC
  • Muscle relaxant
  • Relieves spasm and decreases gut motility
54
Q

Patient considerations with laxatives

A
  • Inactivity
  • Inadequte water intake
  • Motility problems
  • Medication-induced constipation
  • Dependency upon these products
  • Eat more fiber-containing foods
55
Q

Name the 4 types of laxatives

A
  1. Bulk - Carboxymethyl cellulose with psyllium
    a. Absorb water to form softened stools by increasing bulk of intestinal contents
  2. Osmotic - magnesium salts (OTC)
    a. Used as prep for colonoscopy
  3. Contact - bisacodyl
    a. Bisacodyl also used in high doses as colonoscopy prep
  4. Lubricants - mineral oil, glycerin
    a. Act as emollients

Pharmacology II (24 decks)

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