Exam 4 - GERD/PUD

Question 1

What does Parietal Secrete?

Answer 1

Acid in stomach

Question 2

3 receptors on Parietal Call? What do they do?

Answer 2

Histamine H2
Gastrin
Achetylcholine

Activated cAMP by secreting H+ via Proton Pump

Question 3

What do Prostaglandins stimulate secretion of?

Answer 3

Mucous and Bicarb

Question 4

What are the gastric defenses?

Answer 4

Muscous and bicarb

Question 5

What causes mucosal damage? What contributes?

Answer 5

Increased acid levels which overcome protective barrier. H Pylori and NSAIDs contribute.

Results in PUD, GERD, and stress-related mucosal injury.

Question 6

Define PUD and cause?

Answer 6

Ulcers in lining of duodenum or gastric areas.

D/T NSAIDs, H Pylori, increased HCl, steroids, iron, bisphosphonates, smkoing

Question 7

Define Stress Ulcers and cause?

Answer 7

Acute gastric or duodenal ulcers. Often in trauma patients.

Question 8

Define GERD and causes

Answer 8

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.

Question 9

Signs and symptoms of GERD? Tx?

Answer 9

Heart burn, belching, chronic cough, hoarseness, dental erosions, angina

Tx= Antacids, OTC H2-antagonists, or PPI

Question 10

Antacid MOA, use, and onset/duration?

Answer 10

Neutralizes acid and increases pH using Al, Ca, Mg. Primary use for intermittent symptoms.

10min onset, 1-2 hour duration

Question 11

Antacid DDI, warnings, and ADR

Answer 11

DDI=Floroquinolones cause chelation; Itraconazole and iron cause increased pH and decreased absorption.

Al and Ca=Constipation
Mg=Diarrhea. Renal impairment warning!

Question 12

Al and Ca cause what? Mg causes what? Renal issues?

Answer 12

Al and Ca=Constipation

Mg=Diarrhea. Renal impairment issues with Mg.

Question 13

H2-blocker MOA and use?

Answer 13

Competes with histamine at H2 receptors on parietal call to decrease acid secretion.

Use: GERD, PUD, stress gastritis. Best for nocturnal acid.

Question 14

H2-blockers end in what?

Answer 14

“-tidine”

Question 15

H2-blockers warn/ADR with Cimetidine? Renal? Other?

Answer 15

Cimetidine=Increases prolactin, gynecomastic and galactorrhea

Increases Warfarin, phenytoin, diazepam, propanolol levels.

Renal dosing! Elderly dosing!

Question 16

Can H2-blockers develop a tolerance?

Answer 16

Yes

Question 17

Who does not get H2-blockers?

Answer 17

No preggers

Question 18

Don’t use H2-blocker in which condition? Acid and drug issues?

Answer 18

Don’t use in H Pylori.

Reduced acid needed for some drugs.

Question 19

H2-blocker more or less potent than PPI?

Answer 19

Less

Question 20

When to take H2-blockers?

Answer 20

Before bed

Question 21

PPI MOA and use?

Answer 21

Stops proton pump from secreting H+ to make HCl.

Use: GERD, PUD, dyspepsia without ulcers, stress gastritis, mucosal bleeding, hypersecretory issues, ICU patients

Question 22

When to take PPI?

Answer 22

30-60 min before breakfast

Question 23

Long term issues on PPIs?

Answer 23

Increased fractures, increased infection from acid barrier (pneumonia, C. Diff).

Decreased Mg and B12 absorption.

Question 24

Do PPIs develop tolerance?

Answer 24

No

Question 25

PPI more or less effective than H2-blocker?

Answer 25

More effective!

Question 26

Patients find it hard to do what with PPIs?

Answer 26

Hard to discontinue. Must taper down.

Question 27

PPI DDI?

Answer 27

Clopidogrel=decreases effect

Question 28

Sucralfate MOA and use?

Answer 28

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.

Question 29

Sucralfate ADR?

Answer 29

Constipation

Question 30

Prostaglandin Analog MOA and use?

Answer 30

Synthetic Prostaglandin which increases mucous and bicarb secretion. Increases mucosal blood flow. For NSAID-related ulcers.

Question 31

Don't use Prostaglandin Analogs in who?

Answer 31

Preggers!!!

Question 32

Prostaglandin Analog ADRs?

Answer 32

Diarrhea, abdominal cramping in 30%. Uterine contractions.

Question 33

Prostaglandin Analog examples?

Answer 33

Misoprostal, Cytotec

Question 34

Bismuth Salts MOA and use?

Answer 34

Unknown MOA. Doesn't effect acid. Binds to and protects mucosal lesions. Coats stomach. Use: H. Pylori, antimicrobial

Question 35

Bismuth Salts warn/ADRs?

Answer 35

Black stool and tongue. Caution in renal impairments and those already salicylates

Question 36

Motility Agent MOA and use?

Answer 36

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

Question 37

Motility Agent warn/ADRs?

Answer 37

Parkinson movements, drowsy, anxiety, restlessness

Question 38

H Pylori tx?

Answer 38

2 weeks of triple or quadruple cocktail. Triple=Metronidazole/Amoxicillin + Clarithromycin + PPI (CAP) Quadruple=Metronidazole + TCN +Bismuth + PPI (MTBP)