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GI II Exam 1 > GERD/PUD Pharm > Flashcards

GERD/PUD Pharm Flashcards

1
Q

prazole

A

PPIs

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2
Q

idines

A

H2RAs

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3
Q

antacids

A

sodium bicarb
calcium carbonate
magnesium hydroxide

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4
Q

mucosal protective agents

A

bismuth
misoprostol
sucralfate

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5
Q

antibiotics for h. pylori

A

amoxicillin
clarithromycin
metronidazole
tetracycline

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6
Q

gastrin

A

secreted with dietary peptide

to ECL - binds CCK receptor - release of histamine

histamine - to parietal cell - activation of H/K ATPase

gastrin also activates parietal cell

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7
Q

ACh

A

vagal stimualation

-to muscarinic receptor of ECL - increased histamine - increased acid from parietal

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8
Q

final common pathway acid secretion

A

H/K ATPase

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9
Q

somatostatin

A

inhibits gastrin secretion

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10
Q

H2 receptor

A

histamine receptor

activation leads to increase in acid secretion

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11
Q

case 43yo heartburn and acid taste, sx after eating, smokes pipe, PHM 2x MI

A

GERD

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12
Q

reduce gastric acidity

A

PPI
H2RAs
antacids

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13
Q

mucosal defense

A

bismuth compounds
misoprostol
sucralfate

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14
Q

lifestyle modifications

A

unlikely to control sx by themselves
-usually require meds

target populations - overweight, tobacco users, trigger avoidance, sleep quickly after eating

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15
Q

proton pump inhibitors MOA

A

-prazole

  • inactive prodrugs
  • targeted to parietal cell - protonated and activated
  • covalent bind with H/K ATPase
  • irreversible inactivation**
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16
Q

delayed release PPI

A

because broken down easily

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17
Q

PPI admin

A

empty stomach
-30 min before meal

short half life and long duration of action**

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18
Q

synthesis of H/K ATPase pumps

A

takes 18 hours

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19
Q

adverse effects PPIs

A

increased risk of C. dif - 2-3x

decreased B12 absorption
increased nosocomial pneumonia
increased hip rxns

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20
Q

drug interactions PPIs

A

rare

CYP P450 metabolism

may inhibit metabolism of warfarin

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21
Q

clopidogrel

A

pro-drug
requires CYP2C19 for anti-platelet activity

PPI can decrease activation and decrease anti-platelet activity

omeprazole adverse drug-drug interaction

give pantoprazole or rabeprazole instead**

22
Q

pantoprazole

A

use with clopidogrel

23
Q

H2RA MOA

A

H2 receptor specific

ECL histamine release to stimulate H/K ATPase on parietal cell
-block this

-but still have gastrin and ACh stimulate histamine release

24
Q

nocturnal acid secretion

A

with histamine majority

-so tx is H2RA

25
Q

H2RA

A

cimetidine
famotidine
nizatidine
ranitidine

26
Q

Case 40yo M frequent bloody noses and easy bruising, history of DVT, heartburn recent OTC taken, INR 4, drug inhibit factor II, VII, IX, X (warfarin)

A

taking H2RA

messed up his warfarin

27
Q

H2RA drug interactions

A

cimetidine is majority of DDIs

-theophylline, warfarin, phenytoin, lidocaine interactions**

28
Q

PPI vs. H2RAs

A

H2RA - major effect is inhibition at night - daytime - only slight decrease in acid

PPI - inhibit 90% of all daytime acid

29
Q

antacids

A

weak bases
-bind HCl

produces CO2
-gas and distension

with sodium bicarb and calcium carb

mg has no gas formation - but does have laxative effects

30
Q

AL salts

A

constipation

31
Q

Mg salts

A

diarrhea

32
Q

GERD tx

A

PPIs best

H2RAs - used intermittently

33
Q

PPIs

A

need to be given daily

34
Q

erosive esophagitis

A

PPI for 8 weeks

35
Q

PUD tx

A

PPIs - greater sx relief and faster ulcer healing

36
Q

duodenal ulcer

A

H2RA or PPI 4 weeks

37
Q

gastric ulcer

A

PPI 8 weeks

38
Q

NSAID ulcer tx

A

discontinue ASA or NSAID

PPI - if cannot continue
H2RA if discontinue

39
Q

stress ulcer tx

A

prophylaxis - crticical ICU patients

PPIs - omeprazole sodium bicarb - only drug FDA approved

H2RAs - if no nasoenteric tube

40
Q

bismuth MOA

A

coat ulcer and protect further erosion

also may stiluate mucus and bicarb secretion

salicylate inhibits intestinal prostagladin

41
Q

blackening of tongue and stool

A

adverse effect of bismuth

42
Q

misoprostel

A

methyl analog of PGE1

stimulate mucus and bicarb secretion

bind receptor on parietal cell - reducing histamine stimulated cAMP production - modest acid inhibition

43
Q

uterine contractions

A

misprostel

44
Q

sucralafate

A

mucosal protective

not absorbed

impairs absorption of other drugs

45
Q

h pylori

A

spiral gram neg rod

with PUD

tx goal - heal ulcer and eradicate organism

46
Q

combo tx for h pylori

A

first course tx - best chance for eradication

pt compliance is important

47
Q

Case 46yo F burning epigastric pain relieved by eating, duodenal ulcer,

gram negative spiral rod on culture

alcoholic

A

ddx - h pylori

48
Q

tx of h pylori

A

amoxicillin
clarithromycin
metronidazole
tetracycline

2 or 3 antibiotics and PPI**

49
Q

14 day triple therapy

A

for h pylori

  • PPI
  • clarithromycin
  • amox or metronidazole
50
Q

14 day quad therapy

A

for h pylori

PPI or H2RA
tetracycline
metronodazole
bismuth subsalicylate

51
Q

intolerance to alcohol

A

metronidazole

GI II Exam 1 (29 decks)

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