Exam 4 - GERD/PUD Flashcards
What does Parietal Secrete?
Acid in stomach
3 receptors on Parietal Call? What do they do?
Histamine H2
Gastrin
Achetylcholine
Activated cAMP by secreting H+ via Proton Pump
What do Prostaglandins stimulate secretion of?
Mucous and Bicarb
What are the gastric defenses?
Muscous and bicarb
What causes mucosal damage? What contributes?
Increased acid levels which overcome protective barrier. H Pylori and NSAIDs contribute.
Results in PUD, GERD, and stress-related mucosal injury.
Define PUD and cause?
Ulcers in lining of duodenum or gastric areas.
D/T NSAIDs, H Pylori, increased HCl, steroids, iron, bisphosphonates, smkoing
Define Stress Ulcers and cause?
Acute gastric or duodenal ulcers. Often in trauma patients.
Define GERD and causes
Retrograde passage of gastric contents from stomach to esophagus.
Inflammation of mucosa from increases gastric acid. D/T relaxes LES, increased gastric pressure, decreased gastric emptying time.
Signs and symptoms of GERD? Tx?
Heart burn, belching, chronic cough, hoarseness, dental erosions, angina
Tx= Antacids, OTC H2-antagonists, or PPI
Antacid MOA, use, and onset/duration?
Neutralizes acid and increases pH using Al, Ca, Mg. Primary use for intermittent symptoms.
10min onset, 1-2 hour duration
Antacid DDI, warnings, and ADR
DDI=Floroquinolones cause chelation; Itraconazole and iron cause increased pH and decreased absorption.
Al and Ca=Constipation
Mg=Diarrhea. Renal impairment warning!
Al and Ca cause what? Mg causes what? Renal issues?
Al and Ca=Constipation
Mg=Diarrhea. Renal impairment issues with Mg.
H2-blocker MOA and use?
Competes with histamine at H2 receptors on parietal call to decrease acid secretion.
Use: GERD, PUD, stress gastritis. Best for nocturnal acid.
H2-blockers end in what?
“-tidine”
H2-blockers warn/ADR with Cimetidine? Renal? Other?
Cimetidine=Increases prolactin, gynecomastic and galactorrhea
Increases Warfarin, phenytoin, diazepam, propanolol levels.
Renal dosing! Elderly dosing!
Can H2-blockers develop a tolerance?
Yes
Who does not get H2-blockers?
No preggers
Don’t use H2-blocker in which condition? Acid and drug issues?
Don’t use in H Pylori.
Reduced acid needed for some drugs.
H2-blocker more or less potent than PPI?
Less
When to take H2-blockers?
Before bed
PPI MOA and use?
Stops proton pump from secreting H+ to make HCl.
Use: GERD, PUD, dyspepsia without ulcers, stress gastritis, mucosal bleeding, hypersecretory issues, ICU patients
When to take PPI?
30-60 min before breakfast
Long term issues on PPIs?
Increased fractures, increased infection from acid barrier (pneumonia, C. Diff).
Decreased Mg and B12 absorption.
Do PPIs develop tolerance?
No
PPI more or less effective than H2-blocker?
More effective!
Patients find it hard to do what with PPIs?
Hard to discontinue. Must taper down.
PPI DDI?
Clopidogrel=decreases effect
Sucralfate MOA and use?
Aluminum salt binds with protein and forms barrier around ulcer. Increases prostaglandin secretion which increases mucous and bicarb.
Forms barrier around ulcer and allows healing.
Sucralfate ADR?
Constipation
Prostaglandin Analog MOA and use?
Synthetic Prostaglandin which increases mucous and bicarb secretion. Increases mucosal blood flow.
For NSAID-related ulcers.
Don’t use Prostaglandin Analogs in who?
Preggers!!!
Prostaglandin Analog ADRs?
Diarrhea, abdominal cramping in 30%.
Uterine contractions.
Prostaglandin Analog examples?
Misoprostal, Cytotec
Bismuth Salts MOA and use?
Unknown MOA. Doesn’t effect acid. Binds to and protects mucosal lesions. Coats stomach.
Use: H. Pylori, antimicrobial
Bismuth Salts warn/ADRs?
Black stool and tongue.
Caution in renal impairments and those already salicylates
Motility Agent MOA and use?
Metocloproamide. Increases motility of upper GI tract. Does not increase gastric acid secretion. Acts centrally on CTZ.
Use: Anti-nausea, anti-emetic, w/PPI for GERD, gasteroperesis, enteric feeding tubes
Motility Agent warn/ADRs?
Parkinson movements, drowsy, anxiety, restlessness
H Pylori tx?
2 weeks of triple or quadruple cocktail.
Triple=Metronidazole/Amoxicillin + Clarithromycin + PPI (CAP)
Quadruple=Metronidazole + TCN +Bismuth + PPI (MTBP)