GERD + PUD Flashcards
H2 Receptor Antagonists (Cimetidine, Ranitidine, Famotidine, Nizatidine)
Inhibit histamine at H2 receptor on parietal cell –> decreases HCl secretion
AE (Cimetidine): confusion, gynecomastia, infertilty, drug interactions (P450)
Crosses BBB + placenta
Proton Pump Inhibitors (omeprazole, esomeprazole, lansoprazole, rabeprazole, pantoprazole)
Irreversibly bind H/K pump (ATPase) of parietal cells –> decrease HCl secretion
Proton Pump Inhibitors (omeprazole, esomeprazole, lansoprazole, rabeprazole, pantoprazole)
Irreversibly bind H/K pump (ATPase) of parietal cells –> decrease HCl secretion
Most potent gastric acid reduction, best in acidic environment and taken shortly before meal
AE: diarrhea, headache (usually well tolerated), drug interactions (clopidogrel, antifungals)
Antacids (Ca Carbonate, Mg Hydroxide, Al hydroxide)
Neutralize gastric acid (increase delivery of growth factors, increase angiogenesis, bind bile acids + inhibit pepsin, suppress H. pylori)
AE Ca Carb: Milk-alkali syndrome - hypercalcemia, alkalosis, renal impairment
AE Mg Hydrox: diarrhea
AE Al Hydrox: constipation (don’t give pts with renal failure - neurotoxicity, anemia, hypophosphatemia)
Sulcrafate
Ulcer-adherent complex (adheres + protects) –> helps DU, increases delivery of growth factors, increases angiogenesis + formation of tissue, suppresses H.pylori
AE: constipation, Al toxicity in renal failure, drug interactions
*Administer other drugs at least 2 hrs before sulcrafate
Bismuth (pepto-bismol)
Recruits macrophages –> helps ulcer healing (increases prostaglandins + mucus, bicarbonate secretion, suppresses H. pylori)
AE: black/gray stool, rare toxicity (tinnitus, confusion, muscle spasm) - increases tox: aspirin, warfarin, hypoglycemics; monitor in renal failure
Misoprostol (cytotec)
Prostaglandin E1 analog (increases bicarbonate & mucus, increases mucosal blood flow, protective against NSAID-induced GU (no DU effects)
AE: abdominal pain, diarrhea!!!
**DON’T USE WHEN PREGNANT - induces uterine contractions
