Gastrointestinal Pharmacotherapy Flashcards
Describe what peptic ulcer disease is.
A group of upper gastrointestinal disorders characterized by varying degrees of erosion of the gut wall
What are the two classifications of ulcers?
classified by location
gastric
duodenal
What is an ulcer?
a sore in the lining of the stomach or intestine
What substances in the body cause the damage?
HCL and pepsin
What are the main causes of ulcers and there percent ratio of cases?
95% helicobactor pylori bacteria, NSAIDS
5% benign pancreatic tumor secretions
Explain how ulcers are caused by helicobactor pylori.
in response to the infection:
- gastrin secreted by G-cells
- stimulates excess acid production to destroy it
- continued excess causes tissue dmg and ulceration
in some cases chronic inflammation develops, leading to atrophy of wall and occasionally malignant outgrowths (dmg to cell DNA)
What are the signs and symptoms of an ulcer?
- gnawing, burning pain in the upper abdomen
- freq occur several hrs after meal, when food leaves stomach, but acid production is still high
- can occur at night and wake pt
- instead of pain, can experience intense hunger or bloating. antacids and milk provide temp relief
- other pts have no pain but black stools indicating bleeding
How is peptic ulcer disease diagnosed?
by data from medical hx
should be confirmed by endoscopy (can get sample) or barium x-ray
can test for h. pylori by blood, breath, or stool test
Describe the types of cells found in the gastric/fundic glands and what are found in the pyloric glands.
gastric/fundic
parietal - hcl and intrinsic
mucoid - mucous
chief - pepsinogen
pyloric:
mucoid
List the 5 drugs used to treat peptic ulcer disease.
- Antacids (neutralize acid)
- H2 blockers (block histamine from mast cells which trigger gastrin secretion)
- proton pump inhibitors (inhibit secretion of H+)
- cytoprotective agents (boost mucous production)
- H. pylori treatment
List the 5 antacid drugs in the antacid family.
Na - BICARBONATE
(Alka-Seltzer)
Ca - CARBONATE
(turns)
Mg - HYDROXIDE
(milk of magnesia)
Al - HYDROXIDE
(amphojel)
COMBINATION
(Maalox, Mylanta, novaluzid)
How do antacids work to treat ulcers?
neutralize stomach acid
What are two the common AE of antacids?
HYPOKALEMIA
prevent absorption of tetracycline (an antibiotic)
When are antacids used?
- heartburn
- hyperacidity
- gastritis
- peptic ulcer
What is the AE of Na-bicarbonate based antacids?
metabolic alkalosis (becomes alkaline)
What are the adverse effects of Ca-carbonate antacids?
hypercalcemia
rebound acid increase
What is the AE of Mg-hydroxide antacids?
diarrhea
What ire the AE of aluminum hydroxides?
constipation
hypophosphatemia
List the four H2R blockers (H2RA)
cimetidine
famotidine
nizatidine
ranitidine
What do H2RAs do?
block H2 receptors (binding sites for histamines) which inhibits histamine stimulated acid secretion
What are H2RAs used to treat?
peptic ulcer, gastritis, GERD
What are the AE of cimetidine?
anti androgenic
confusion (esp in elderly)
List the 5 PPI drugs
Omeprazole
Lansoprazole
Esomeprazole
Rabeprazole
Pantoprazole
How do PPI drugs act?
inhibit the proton pump which is the parietal cells method for ejecting H+ into the stomach
What are PPI drugs used for?
peptic ulcer, gastritis, GERD
What are the 3 miscellaneous drugs used to treat ulcers?
Sucralfate
Bismuth subsalicylate (Pepto-Bismol)
Misoprostrol
describe sucralfate’s mechanism of action, what it treats, and its side effects.
M OF A: forms polymers (foams) in acidic env. to coat and protect ulcer
USED FOR:
peptic ulcer disease
ulcer prophylaxis (stress ulcer)
AE:
drowsiness, constipation
describe bismuth subsalicylate’s M of A, indications, and AE.
M of A:
coats esophagus and acts as barrier to acid
Indication:
PUD (peptic ulcer disease), GERD
AE:
nausea, diarrhea, black tongue
What are the AE of PPIs?
nausea
diarrhea
colic belching
describe misoprostol’s M of A, indications, and AE
M of A:
inc mucous production
Indications:
prevent NSAID-induced peptic ulcers
AE:
diarrhea, stimulates uterus contraction
What are the two antibiotics used to treat H pylori?
tetracycline and metronidazole
