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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Gastrointestinal Drugs: Peptic Ulcer Disease - Ch. 82 > Flashcards

Gastrointestinal Drugs: Peptic Ulcer Disease - Ch. 82 Flashcards

1
Q

Which cells secrete hydrochloric acid and pepsinogen?

A

HCl = Perietal cells
Pepsinogen = Chief cells

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2
Q

What is the purpose of parietal cells?

A

Produce and secrete HCl to keep stomach at pH of 1 to 2

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3
Q

What cells are the primary site of action for many acid-controller drugs?

A

Parietal cells

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4
Q

What do ECL stomach cells secrete?

A

Secrete histamine which stimulate parietal cells

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5
Q

What are stomach acid-related diseases?

A

Action of acidity on digestive tract integrity?

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6
Q

What is the purpose of drug therapies for stomach acid related diseases?

A

Eradicate H. pylori if present in the stomach
Reduce gastric acidity
Enhance mucosal defenses

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7
Q

90% of clients with what are found to have H. pylori?

A

Duodenal ulcers

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8
Q

70% of clients with what are found to have H. pylori?

A

gastric ulcers

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9
Q

What is used to eradicate H. pylori?

A

Antibacterials

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10
Q

Rates of what is much less when H. pylori is eradicated?

A

Recurrence rates are much lower

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11
Q

What are the inhibitors of Gastric acid secretion/action?

A

H2 antagonists
proton pump inhibitors
Antacids
other agents - protect mucosa

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12
Q

What are kinds of antacids?

A

Magnesium salts
Calcium salts
Sodium bicarbonate
Aluminum salts

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13
Q

What are H2 antagonists?

A

Reduce acid secretion
All available in OTC in lower dosage forms
Most popular drugs for treatment of acid-related disorders

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14
Q

Examples of H2 antagonists?

A

Cimetidine (Tagamet)
Famotidine (Pepcid)
Ranitidine (Zantac)
Nizatidine (Axid)

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15
Q

What is the mechanism of action of H2 antagonists?

A

Block histamine H2 receptors of acid-producing parietal cells
(receptor antagonist)
-Decreases HCl production

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16
Q

What are H2 antagonists used for?

A

GERD (gastro-esophogeal reflux disease) -erosive esophagitis

PUD (peptic ulcer disease)
Adjunct therapy in control of upper GI bleeding
Pathological gastric hypersecretory
conditions

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17
Q

What adverse effects are associated with h2 antagonists?

A

Low incidence of AEs
Cimetidine may induce impotence and gynecomastia (antiandrogenic effect)

In elderly; CNS depression, lethargy, confusion, renal/hepatic impairment

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18
Q

What interactions does H2 antagonist: Cimetidine have?

A

Inhibits liver cytochrome P-450
Affects metabolism of ofter drugs causing increased drug levels e.g, warfarin

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19
Q

extra care should be taken for patients with what who are taking Cimetidine?

A

Impaired renal or liver function

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20
Q

Cimetidine should be used with caution in what group of patients?

A

Confused, disorientated or elderly patients

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21
Q

Cimetidine should be taken 1 hour before what?

A

Antacids
-Affects absorption

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22
Q

What are Proton pump inhibitors (PPI)?

A

Inhbits the pump that moves H+ into the stomach lumen
more effective than H2 antagonists

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23
Q

What is the mechanism of action of PPIs?

A

Irreverisbly bind to H+/K+ ATPase enzyme (proton pump)

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24
Q

What does normal acid secretion require?

A

Normal acid secretion needs parietal cell to synthesise new H+/K+ ATPase

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25
Q

Examples of PPI?

A

Omeprazole
lansoprazole
rabeprazole
pantoprazole (Pantoloc) -IV option
esomeprazole
(all very similar)

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26
Q

Describe Omeprazole?

A

Enteric coated
Broken down by acid

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27
Q

What are proton pump inhibitors used for?

A

GERD maintenance therapy
Erosive esophagitis
Short-term treatment of active duodenal and benign gastric ulcers
Zollinger-Ellison syndrome (gastrin-producing tumour)

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28
Q

What are PPI safe for?

A

Short-term therapy
- 4-8 weeks

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29
Q

What adverse effects are associated with PPI?

A

Incidence of AE low and uncommon
-Headaches, Nausea, vomiting, diarrhea

30
Q

When should you use PPI with caution?

A

Liver disease pt

31
Q

What drug interactions do PPI have?

A

May inhibit the absorption of drugs that require an acidic GI environment for absorption
e.g, Ketoconazole (anti fungal)

32
Q

What is the typical therapy for H. pylori infection?

A

“triple therapy”
-Antibiotics e.g, amoxicillin + clarithromycin
-Proton pump inhibitor e.g, omeprazole
7-14 days

33
Q

proton pump inhibitors may cause increase serum levels of what?

A

Diazepam
phenytoin
increased chance for bleeding with warfarin (P450 inhibition)

34
Q

What should you teach a client if they are taking omeprazole?

A

Swallow it whole
-Not crushed, opened or chewed because of the enteric coating

It may be given with antacids
Short term treatment only

35
Q

What is the mechanism of action of Antacids?

A

Chemically neutralise acid
-Do not prevent acid production

36
Q

What OTC formulations of Antacids are available?

A

Capsules, tablets
Powders
Chewable tablets
Suspensions
Effervescent granules and tablets

37
Q

What are the salts in aluminium salts?

A

Carbonate, hydroxide salts

38
Q

What can aluminium salts may cause?

A

constipation
Often with magnesium salts to counteract constipation (can cause diarrhea)

39
Q

Examples of aluminium salts?

A

aluminum hydroxide (amphogel)
Aluminum carbonate
Combination products (aluminium and magnesium)

40
Q

What are the salts in magnesium salts?

A

Carbonate, hydroxide and oxide trisilicate

41
Q

What do magnesium salts commonly cause?

A

Diarrhea
(usually used with other agents to contract diarrhea)

42
Q

When is magnesium slat use dangerous?

A

If you have renal failure
-accumulation

43
Q

Examples of magnesium salts?

A

Hydroxide salt; Magnesium hydroxide
Carbonate salt
combination products (Al + Mg)

44
Q

What salts are Calcium salts?

A

many but carbonate is most common

45
Q

What may be caused by calcium salts?

A

Constipation
Kidney stones

46
Q

How is calcium salts often advertised?

A

Extra source of dietary calcium

47
Q

Example of calcium salts?

A

Calcium carbonate (TUMS)

48
Q

Describe sodium bicarbonate?

A

Highly soluble
Quick onset, short duration

49
Q

What may be caused by sodium bicarbonate?

A

May cause metabolic alkalosis

50
Q

The sodium content in sodium bicarbonate may cause problems in clients with what conditions ?

A

heart failure
hypertension
renal insufficiency

51
Q

What adverse effects are associated with antacids?

A

Minimal and depend on compound used

Aluminum and calcium salts = constipation
Magnesium salts = diarrhea
Calcium carbonate = constipation, gas and belching

52
Q

What drug interactions do antacids have?

A

May reduce absorption of other drugs if given at the same time
Can cause chelation

53
Q

What is chelation?

A

Chemical binding, or inactivation, of another drug
- Produces insoluble complexes
- reduced drug absorption
eg tetracycline

54
Q

What should be assessed for before antacid administration?

A

Allergies
preexisting conditions such as:
Fluid imbalances
Renal disease
HF
Pregnancy
GI obstruction

55
Q

Clients with heart failure and hypertension should use which antacids?

A

Low sodium antacids

56
Q

Most medications should be given how many hours after an antacid?

A

1-2 hours after giving an antacid

57
Q

Antacids may cause ____________ _______________ of enteric coating meds

A

Premature dissolving

58
Q

Antacids should be administered with what to enhance dispersion?

A

At least 240 mL of water
-Not needed for rapid dissolving forms

59
Q

What may aggregate underlying GI conditions when using antacids?

A

Caffeine
alcohol
harsh spices
black pepper

60
Q

What are the other agents that protect the mucosa?

A

Sucralfate
Misoprostol (Cytotec)

61
Q

What is sucralfate?

A

Cytoprotective agent
Forms gel with mucus in low pH
Attracted to and binds to the base of ulcers and erosions (forms a protective barrier)
Inhibits pepsin

62
Q

What is sucralfate used for?

A

Intestinal erosions

63
Q

What may be caused by sucralfate?

A

Constipation
Nausea
Dry mouth

64
Q

There is little absorption of sucralfate in what area?

A

gut

65
Q

Sucralfate may impair the absorption of what the drugs?

A

Tetracycline
Digoxin

66
Q

Why might sucralfate be used in chronic renal failure?

A

Reduce phosphate levels because it binds with phosphate

67
Q

What is Misoprostol?

A

Synthetic prostaglandin (PGE1) analogue
-Does the job of endogenous PGs (PHI2 and PGE2)
Prostaglandins have cytoprotective activity

68
Q

What does cytoprotective activity do?

A

Production of mucous and bicarbonate
Reduce acid secretion
Promote local cell regeneration
help maintain mucosal blood flow

69
Q

What is misoprostol used for?

A

Reduce gastric effects of NSAIDs

70
Q

When is misoprostol not used?

A

Pregnancy
-Terminates pregnancy

71
Q

Example of misoprostol combination tablets?

A

Arthrotec
= Diclofenac + misoprostol

72
Q

What adverse effects are associated with misoprostol?

A

Therapeutic doses for duodenal ulcers often produce:
abdominal cramps
diarrhea
PGE may cause contraction of smooth muscle-containing tissues

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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