GERD, PUD, IBD, and H. Pylori

Question 1

How much acid does the stomach make each day in response to meals?

Answer 1

3 cups

Question 2

What cells produce gastric acid?

Answer 2

Stomach parietal cells

Question 3

What stimulates parietal cells?

Answer 3

Histamine H2
ACh
Gastrin

Question 4

What are the stomachs defenses against gastric acid?

Answer 4

Mucous
Bicarbonate
Prostaglandins (stimulate mucous production)

Question 5

What medication classes are acid blocking?

Answer 5

Proton pump inhibitors (PPIs)
H2 Receptor Antagonists (H2RA or H2 Blockers)

Question 6

Which medication is the most effective suppressor of stomach acid?

Answer 6

PPI’s

Question 7

What are the two primary causes that contribute to acid-related mucosal injury?

Answer 7

NSAIDs
H. Pylori

Question 8

What are the effects of NSAIDs that contribute to acid-related mucosal injury (GERD or PUD)?

Answer 8

• Damage gastric epithelial cells
• Inhibit gastric mucosal COX activity

Question 9

What are the side effects of PPI’s?

Answer 9

Headache
Nausea
Abdominal pain
Diarrhea

Question 10

What are the symptoms of PUD?

Answer 10

Epigastric pain, n/v, fullness often associated with eating (or asymptomatic)

Question 11

What are some complications associated with ulcers?

Answer 11

Bleeding, perforation, obstruction

Question 12

What is the side effects of Bismuth subsalicylate (Pepto-Bismol)?

Answer 12

Black stools, black tongue (reversible)

Bismuth neurotoxicity: encephalopathy, aseptic meningitis, seizures

Question 13

What is the specific side effect of magnesium hydroxide?

Answer 13

Diarrhea

Question 14

What is the MOA of Bismuth?

Answer 14

Coats esophageal/gastric mucosa, creates physical barrier between mucosa and acid

• Stimulates prostoglandin, bicarbonate production
• Mild antibacterial activity

Question 15

What is the PK of Omeprazole?

Answer 15

• Oral admin, 30-60 minutes before first meal of day
• Onset 1 hour, duration 24 hours
• Taper to avoid rebound gastric hypersecretion

Question 16

What is the PK of Lansoprazole?

Answer 16

• Oral or IV admin
• Long duration of action due to covalent bonding with the H+/K+ ATPase enzyme

Question 17

What are the side effects of Lansoprazole?

Answer 17

HA, nausea, abd pain, diarrhea

*Increased risk of fractures, malabsorption of some minerals, C. Diff, PNA, AIN, CKD

Question 18

What are the side effects of Patoprazole?

Answer 18

HA, nausea, abd pain, diarrhea

*Increased risk of fractures, malabsorption of some minerals, C. Diff, PNA, AIN, CKD

Question 19

What PPI’s have increased duration due to the action of covalently bonding with ATPase?

Answer 19

Lansoprazole
Patoprazole

Question 20

What is the MOA of Misoprostol?

Answer 20

Analog of prostoglandin E1 –> inhibits acid secretion by reducing parietal cells ability to respond to histamine

Question 21

What are the uses of Misoprostol?

Answer 21

PUD
Prevention of NSAID-induced gastric ulcers

Question 22

What is included in Triple Therapy for H. Pylori treatment and how long is the duration of treatment?

Answer 22

• Amoxicillin (or metronidazole if PCN allergy), clarithromycin, and a PPI

Duration of treatment for 10 days, confirm eradication 4 weeks after stopping abx

Question 23

What is included in Quad Therapy for H. Pylori treatment and how long is the duration of treatment?

Answer 23

Bismuth, metronidazole, tetracycline, and PPI

Duration of treatment for 14-days, confirm eradication 4 weeks after stopping abx

Question 24

What are the side effects of Quad Therapy?

Answer 24

• Diarrhea, abnormal stools, nausea, HA, SJS, hepatic impairment
• Intracranial HTN, photosensitivity

Question 25

What substance directly inhibits the H+-K+-ATPase of the gastric parietal cell?

Acetazolamide

Atropine

Cimetidine

Famotidine

Omeprazole

Answer 25

Omeprazole