GERD, PUD, IBD, H.Pylori Flashcards
What defenses does the stomach have against gastric acid
mucus
bicarb
prostaglandins (stim mucus prod)
What medications are acid blocking
PPIs
H2 blockers
What factors contribute to acid related mucosal injury
NSAIDs
H. Pylori
What is the MOA of antacids
Neutralize acids (raise pH)
What is the indicated use for antacids
mild, intermittent heartburn / reflux (<1 episode/week)
What agents are antacids
Calcium carbonate
aluminum hydroxide
magnesium hydroxide
What are examples of calcium hydroxide antacids
Tums
maalox
What are examples of aluminum hydroxide and magnesium hydroxide
Mylanta
Gaviscon
What are the side effects of aluminum based antacids
constipation
hypophosphatemia
What are the side effects of calcium based antacids
constipation
hypercalcemia
alkalosis
AKI/CKD
What is the MOA of surface agents used in GERD
coats the esophageal/gastric mucosa and creates a physical barrier from the acid
When should surface agents be used in GERD
swallow after meals and avoid drinking/eating after meals
What agents are surface agents for GERD
Sucralfate
Sodium alginate
Bismuth
What are the uses of H2 blockers
GERD
Dyspepsia
PUD
What is the MOA for H2 blockers
block stimulation of gastric parietal cells by competing with H2 receptors
Which agents are H2 blockers
Cimetidine
Ranitidine
Famotidine
What are the side effects of H2 blockers
H/A, Dizziness, Diarrhea, constipation
*cimetidine: gynecomastia
*prolonged use may lead to B12 deficiency
What is the MOA of PPIs
block gastric H/K ATPase, inhibiting gastric acid secretion
When are PPIs used with GI issues
GERD, PUD, H Pylori
dyspepsia
What is the most effective acid suppressing medication
PPI
When should PPIs be taken
30-60 min before first meal of the day
Why should PPIs be TAPERED off if taken for longer that 6 months
To avoid rebound gastric hyper secretion
What agents are PPIs
Omeprazole
pantoprazole
lansoprazole
esomeprazole
What drug interactions occur with PPIs
Decrease HIV protease inhibitors
increase digoxin concentration
increased methotrexate conc
decrease platelet effect of clopidogrel
decrease PO absorption of iron
What are some long term risks associated with PPIs
Increased risk for CDiff
bacterial pneumonia
acute intestinal nephritis
CKD
Gastric polyps
what complications are associated with PUD
bleeding
perf
obstruction
What is the mainstay treatment for PUD
omeprazole
What is the triple therapy for H. Pylori and how long is it given
Clarithromycin +Amox (metronidazole if PCN allergy) +PPI
2 week duration
What is a quadruple therapy for H. Pylori
Bismuth subsalicylate + tetracycline + Metronidazole + PPI
When should H. Pylori eradication be confirmed
at least 2 weeks off of PPI
What is the MOA of Bismuth
stimulates prostaglandin/ mucus /bicarb production in the stomach
reduces inflammation
mild antimicrobial activity against H. Pylori
When is Bismuth used with H.Pylori
component of the quadruple therapy
What is the combo Bismuth therapy
bismuth
metronidazole
tetracycline
What are the side effects of the bismuth combo therapy
Diarrhea/ abnormal stools/ nausea/ headache
photosensitivity
What are the side effects associated with Bismuth
Black stools & black tongue (reversible)
Bismuth neurotoxicity
What is Bismuth neurotoxicity
encephalopathy
aseptic meningitis
seizures
What is the BBW with the bismuth combo therapy
Metronidazole is carcinogenic in mice/rats… unknown in humans
What is the MOA for Misoprostol
Synthetic prostaglandin E1 analog that inhibits acid secretion by reducing the ability of the parietal cells to respond to histamine
What is misoprostol used for
prevention of NSAID induced gastric ulcers
What is the BBW with misoprostol
contraindicated in pregnancy / women of child bearing age. May cause birth defects, premature birth, abortion, uterine rupture
What are pro kinetic agents for the GI system
Metoclopramide
dompreidone
erythromycin
What is the MOA of metoclopramide
Dopamine antagonist. Enhances upper GI tract response to Ach to enhance motility, increase colon motility, and shorten transit time
When is metoclopramide indicated
gastroparesis
persistent GERD
N/V
What is the BBW associated with metoclopramide
irreversible tardive dyskenesia
What is the MOA of Domperidone
peripheral dopamine agonist (does not cross BBB)
increases esophageal peristalsis, gastric motility, and gastric emptying
decreases small bowel transit time
When is domperidone utilized
motility disorders
N/V
gastroparesis
When is domperidone contraindicated
Pt. on other QT prolonging agents
prolactinomas
What is the MOA of erythromycin
macrolide
motilin agents and increases gastric contraction
When is erythromycin used with GI issues
gastroparesis as an abx
*4 week max d/t tachyphylaxis
When is erythromycin contraindicated with GI disorders
Myasthenia gravis
CYP3A4 enhancers
What is the MOA of neostigmine
acetylcholinesterase inhibitor
When is neostigmine used with the GI system
acute colonic pseudo-obstruction
*primarily myasthenia gravis
urinary retention
post op bladder distention
How do you treat an IBD flare up
glucocorticoids
aminosalicylates
What glucocorticoids can be used for IBD exacerbation
prednisone
budesonide
hydrocortisone
How do you maintain mild IBD
aminosalicylates
-sulfasalazine
mesalamine
5-ASA
*specifically for UC)
Which IBD patients need biologics for IBD treatment
Severe IBD
(CD+UC)
What biologics are used for IBD
azathiopring
adalimumab
inflixumab
What immunomodulators can be used for IBD and who uses them
azathioprine
6-MP
methotrexate
*moderate maintenance therapy for crohns (+/- UC)
What is the MOA for aminosalicylates (5-ASA)
Work topically on affected/inflamed areas of mucosa
*anti-inflammatory and immunosuppressive activity
What is the precursor of 5-ASA
Sulfasalazine
*originally an RA treatment
When are 5-ASAs typically used
mild-moderate UC (flares and maintenance
mild colonic crohns disease (distal)
How do AZO work
azo bond prevents absorption of the drug
when it reaches lower GI, bacteria cleave the molecule and release the 5-ASA
How do mesalamine compounds work
Has special resins/coatings to release the active form once in the lower GI tract
What are some side effects of AZO compounds
oligospermia in men (reversible)
bone marrow suppression
impairs folate absorption
**need folate supp
What are the side effects of mesalamine
nephrotoxicity/ interstitial nephritis
What is the MOA for Thiopurines
immunosuppression
When are thiopurines used
to induce and maintain remission of both UC and Crohns
*good with patients ho cannot maintain remission
*can take 3-6 months to observe effect
What is the BBW for thiopurines
chronic immunosuppression increases the risk of malignancy
What can you not take azathioprine with and why
allopurinol because it can lead to leukopenia
What is the MOA of methotrexate
immunosuppressant and anti-inflammatory for IBD
*cytotoxic in high doses and immunosuppressive in low doses
When is methotrexate used with IBD
to induce and maintain remission in crohns
What is the BBW with methotrexate
Malignancy lymphomas, lung disease, PJP, hepatotoxicity, teratogenic, unexpected severe bone marrow suppression and aplastic anemia
What are side effects of methotrexate
alopecia
bone marrow suppression
mucositis
SJS/TEN
How do TNF inhibitors help with IBD
help mitigate overactive immune response in crohns and UC
What is the MOA of biologics for IBD
bind and sequester TNF to decrease inflammatory response
What BBW is associated with biologics
serious infections from immunosuppression
What biologics for IBD are administered SQ
certolixumab
adalimumab
What is the MOA of glucocorticoids for IBD
inhibits production of inflammatory cytokines and inhibits migration of inflammatory cells to affected area
