GERD, pancreatitis, PUD drugs

Question 1

H2 Receptor antagonists

Answer 1

famotidine, cimetidine, ranitidine, etc
treat GERD or PUD for 8 weeks or more
60% improvement and 50% healing for GERD
90% healing for DU
takes 1 1/2 hours to work
high doses more successful

Question 2

Proton Pump Inhibitors

Answer 2

omeprazole, lansoprazole, esompeprazole, pantoprazole, etc.
block K+/H+ exchange in parietal cells
more efficacious in GERD treatment than H2#
takes a couple days to work
treat for 8 weeks or more in GERD
4 weeks in PUD- 90% healing

Question 3

antacids

Answer 3

not the best GERD treatment
raise pH and increase gastric volume
PUD tx: dosed 1 and 3 hours after food and hs
- used prn for dyspepsia while on H2 or PPI

Question 4

bethanechol

Answer 4

cholinergic agent- prokinetic
increases LES tone
not the best choice because SE include NV, diarrhea, watery eyes, wheezing, irregular heartbeat
drug/disease interactions

Question 5

metoclopramide (Reglan)

Answer 5

prokinetic agent used to tx GERD
not effective for healing
SE: drowsiness, EPS, tardive dyskinesia

Question 6

Cisapride

Answer 6

prokinetic agent used to tx GERD
limited access
increase gastric emptying and LES tone
SE: diarrhea, increased QT
Drug interactions: fluconzazole, erthromcin, procainamide, antipsychotics, antidepressants

Question 7

octreotide (sandostatin)

Answer 7

may be useful in severe pancreatitis
somatostatin analog- inhibits hormones (GH) and decreases pancreatic output
SE: NV, malabsorption, liver dysfunction

Question 8

antibiotics in pancreatitis

Answer 8

imipenem/cilastin

Question 9

h2 receptor antagonist SE and interactions

Answer 9

SE: NV, drowsiness, HA, confusion (cimet), thrombocyto/neutropenia, bradycardia, gynecomastia, impotence (cimet)

interactions: increase pH, so decrease ketoconazole and iron
- cimetidine inhibits P450

Question 10

PPI SE and interactions

Answer 10

SE: NV, HA, diarrhea at high doses, osteoporosis

interactions: increase gastric pH so decrease ketoconazole and iron
- clopidogrel decreased
- all PPI are mild CYP450 #, but pantoprazole is the least

Question 11

antacid SE

Answer 11

magnesium: potent- can cause diarrhea- accumulates if renal dysfunction
calcium (tums): constipating
aluminum (mylanta): constipating and decreases phosphorus levels- can be toxic in renal patients
interactions: FQ and tetracyclines

Question 12

sucralfate

Answer 12

forms complex and binds ulcer in PUD
works best in acid environment, so dont use with PPI or H2#
1 gm QID or 2 gm BID
SE: constipation
interactions: FQ, tetras- best to separate all drugs

Question 13

bismuth subsalicylate (pepto)

Answer 13

used in combo to treat PUD caused by H. pylori

SE: black stool

Question 14

PGE1 analogue

Answer 14

prevention of NSAID induced ulcer
effective in tx, but not used much
50-200 mcg 2-4x day
SE: diarrhea, cramping, uterine contractions

Question 15

H. pylori ulcer treatment regimen

Answer 15

1st line: PPI + clarithromycin + amoxicillin or metronidazole
alternative: PPI+ bismuth+ metronidazole+ tetracycline x 10-14 days