Gastrointestinal Medications

Question 1

Describe the pathophysiology of gastroesophageal reflux disease (GERD)

Answer 1

acid regurgitation back into esophagus and oral cavity

Question 2

Describe the pathophysiology of hypersecretory conditions

Answer 2

excessive acid production

Question 3

Describe the pathophysiology of erosive esophagitis

Answer 3

ulceration of walls of esophagus

Question 4

Describe the pathophysiology of stomach ulcers.

Answer 4

infection with H. pylori

Question 5

What are some risk factors for peptic ulcer disease?

Answer 5

H. pylori infection, acid hypersecretion, stress, familial factors, smoking, heavy drinking, hyperparathyroidism, renal dialysis treatment, chronic use of NSAIDS

Question 6

Describe the pathophysiology of Barrett’s Esophagus.

Answer 6

lining of esophagus altered to resemble that in intestines

Question 7

Describe the symptoms of common gastrointestinal disorders.

Answer 7

acidic taste, pain/buring sensation, difficulties with digestion, GI ulceration and bleeding

Question 8

Describe the oral symptoms of common gastrointestinal disorders.

Answer 8

tooth erosion, irritation of the buccal mucosa, glossitis, burning mouth/tongue, inflammation of oropharynx, ulceration of pillars and pharyngeal walls

Question 9

Describe the mechanism of action of antacids used for the management of gastrointestinal disorders.

Answer 9

weak bases interact with stomach acid to form water and salt, they act locally to treat excess acidity and raise gastric pH

Question 10

What are some limitations and adverse effects of antacids?

Answer 10

frequent dosing is necessary, they need HCl for digestion, and they do not inhibit HCl production by parietal cells: adverse effects may include constipation and increased caries (due to high sugar content in some antacids)

Question 11

What are some examples of antacids?

Answer 11

Aluminum hydroxide, magnesium hydroxide or calcium carbonate (Tums), magnesium products including Milk of Magnesia and Maalox, Aluminum products including Amphojel and Aluminum glycinate, and others including milk and sucralfate (Carafate)

Question 12

How does Milk of Magnesia function as an antacid?

Answer 12

hydroxide ions bind with HCl in stomach neutralizing the acid

Question 13

What are some characteristics of Maalox (magnesium trisilicate) enabling it to serve as an antacid?

Answer 13

coats ulcerated area and protects ulcers from HCl, slow acting, neutralizes gastric pH, silica absorbs H+

Question 14

What are two features of aluminum products that help to treat GI disorders?

Answer 14

aluminum is an astringent that helps stop bleeding, and products like Amphojel coat and protect ulcers from H+

Question 15

Describe some effects of sucralfate (Carafate)

Answer 15

forms complexes with albumin, fibrinogen and globulin on ulcer surface, thus creating protective barrier to acid and pepsin (however it interferes with the absorption of many medications). It is not absorbed and also binds pepsin directly.

Question 16

Describe the mechanism of action of H2 receptor antagonists used for the management of gastrointestinal disorders.

Answer 16

Histamine H2 receptor antagonists address multiple symptoms by aiding in nocturnal acid control.

Question 17

Which H2 receptor antagonist is preferred by gastroenterologists?

Answer 17

Zantac. Others include Tagamet, Pepcid, and Axid (Tagamet is the one with the most adverse effects)

Question 18

Describe the mechanism of action of proton pump inhibitors used for the management of gastrointestinal disorders.

Answer 18

Bind to H+/K+ ATPase enzyme system in parietal cells helping to reduce gastric secretions, neutralize gastric acid after release, and protect gastric mucosa from damage.

Question 19

What are some examples of proton pump inhibitor medications?

Answer 19

Nexium, Prevacid, Prilosec, Protonix, Aciphex

Question 20

What is a second generation proton pump inhibitor indicated for use in the prevention and treatment of NSAID-induced gastrointestinal lesions?

Answer 20

Nexium

Question 21

State which antibiotics are used for the treatment of infection with H pylori.

Answer 21

amoxicillin, metronidazole, clarithromycin, tetracycline (these are used in combination with proton pump inhibitors and H2 receptor blockers to treat the ulcers)

Question 22

Describe important dental drug interactions with gastrointestinal medications.

Answer 22

antacids neutralize pH thereby interfering with absorption of many drugs (wait 2 hours). They also interfere with bioavailability and elimination of many drugs. Histamine antagonists decrease effects of antifungals and alter warfarin. Proton pump inhibitors decrease absorption of systemic antifungals.

Question 23

Tagamet (a histamine H2 receptor antagonist) increases serum concentration of which drugs commonly used in dentistry?

Answer 23

benzodiazepines, Lidocaine, Quinolone antibiotics (Cipro)

Question 24

Discuss dental practice management considerations for treating patients with peptic ulcer disease.

Answer 24

Avoid aspirin/NSAIDS in patients with Hx of stomach ulcers

Question 25

Describe the etiology Chrohn’s disease.

Answer 25

While the exact etiology is unknown, aspects that may be associated include allergies, destructive enzymes, bacterial and viral infections, stress, and immunologic factors

Question 26

What are two distinct conditions of IBS?

Answer 26

ulcerative colitis and Crohn’s disease

Question 27

What is the pathophysiology of Chrohn’s disease?

Answer 27

Autoimmune disease affecting entire wall of bowel; focal ulcerations along any point of alimentary canal from the mouth to the anus; most commonly involves the terminal ileum.

Question 28

What is the pathophysiology of ulcerative colitis?

Answer 28

Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. It almost invariably involves the rectum and typically extends in a proximal and continuous fashion to involve other portions of the colon.

Question 29

Discuss dental practice management considerations for treating patients with inflammatory bowel disease

Answer 29

Macrolide antibiotics (erythromycin) cause GI distress and diarrhea so caution should be exercised in prescribing these medications to patients with inflammatory bowel disease.

Question 30

Discuss risk factors associated with constipation.

Answer 30

inactivity, inadequate water intake, motility problems, medication-induced constipation, dependency upon laxatives, insufficient fiber intake

Question 31

Identify common classes of laxatives.

Answer 31

Bulk (carboxymethyl cellulose with psyllium), Osmotic (magnesium salts such as OTC magnesium citrate), Contact (bisacodyl aka Dulcolax and castor oil), Lubricants (mineral oil and glycerin)

Question 32

What are some common oral complications to GI disorders and associated medications?

Answer 32

xerostomia, taste alteration (metallic aftertaste), apthous stomatitis, candidiasis (esophageal), excessive salivation (mediated by vagus nerve in response to excessive gastric acid coming into the oral cavity)

Question 33

What are some complications of peptic/duodenal ulcers with manifestations related to cancer?

Answer 33

H. pylori associated with cancer of gastric mucoas = lymphoma and atrophic gastritis caused by chronic use of proton pump inhibitors increases risk for stomach cancer

Question 34

What is the standard first-line therapy for treatment of H. pylori?

Answer 34

One week triple therapy includes: amoxicillin, clarithromycin (Biaxin), and a proton pump inhibitor (Nexium, Prevacid, Protonix, Aciphex, Prilosec)

Question 35

What are unique oral manifestations of Crohn’s?

Answer 35

atypical mucosal ulcerations, diffuse swelling of lips and cheeks, cobblestone mucosal lesions