GERD/PUD Pharm

Question 1

prazole

Answer 1

PPIs

Question 2

idines

Answer 2

H2RAs

Question 3

antacids

Answer 3

sodium bicarb
calcium carbonate
magnesium hydroxide

Question 4

mucosal protective agents

Answer 4

bismuth
misoprostol
sucralfate

Question 5

antibiotics for h. pylori

Answer 5

amoxicillin
clarithromycin
metronidazole
tetracycline

Question 6

gastrin

Answer 6

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

Question 7

ACh

Answer 7

vagal stimualation

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

Question 8

final common pathway acid secretion

Answer 8

H/K ATPase

Question 9

somatostatin

Answer 9

inhibits gastrin secretion

Question 10

H2 receptor

Answer 10

histamine receptor

activation leads to increase in acid secretion

Question 11

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

Answer 11

GERD

Question 12

reduce gastric acidity

Answer 12

PPI
H2RAs
antacids

Question 13

mucosal defense

Answer 13

bismuth compounds
misoprostol
sucralfate

Question 14

lifestyle modifications

Answer 14

unlikely to control sx by themselves
-usually require meds

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

Question 15

proton pump inhibitors MOA

Answer 15

-prazole

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

Question 16

delayed release PPI

Answer 16

because broken down easily

Question 17

PPI admin

Answer 17

empty stomach
-30 min before meal

short half life and long duration of action**

Question 18

synthesis of H/K ATPase pumps

Answer 18

takes 18 hours

Question 19

adverse effects PPIs

Answer 19

increased risk of C. dif - 2-3x

decreased B12 absorption
increased nosocomial pneumonia
increased hip rxns

Question 20

drug interactions PPIs

Answer 20

rare

CYP P450 metabolism

may inhibit metabolism of warfarin

Question 21

clopidogrel

Answer 21

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**

Question 22

pantoprazole

Answer 22

use with clopidogrel

Question 23

H2RA MOA

Answer 23

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

Question 24

nocturnal acid secretion

Answer 24

with histamine majority

-so tx is H2RA

Question 25

H2RA

Answer 25

cimetidine famotidine nizatidine ranitidine

Question 26

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)

Answer 26

taking H2RA messed up his warfarin

Question 27

H2RA drug interactions

Answer 27

cimetidine is majority of DDIs -theophylline, warfarin, phenytoin, lidocaine interactions**

Question 28

PPI vs. H2RAs

Answer 28

H2RA - major effect is inhibition at night - daytime - only slight decrease in acid PPI - inhibit 90% of all daytime acid

Question 29

antacids

Answer 29

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

Question 30

AL salts

Answer 30

constipation

Question 31

Mg salts

Answer 31

diarrhea

Question 32

GERD tx

Answer 32

PPIs best H2RAs - used intermittently

Question 33

PPIs

Answer 33

need to be given daily

Question 34

erosive esophagitis

Answer 34

PPI for 8 weeks

Question 35

PUD tx

Answer 35

PPIs - greater sx relief and faster ulcer healing

Question 36

duodenal ulcer

Answer 36

H2RA or PPI 4 weeks

Question 37

gastric ulcer

Answer 37

PPI 8 weeks

Question 38

NSAID ulcer tx

Answer 38

discontinue ASA or NSAID PPI - if cannot continue H2RA if discontinue

Question 39

stress ulcer tx

Answer 39

prophylaxis - crticical ICU patients PPIs - omeprazole sodium bicarb - only drug FDA approved H2RAs - if no nasoenteric tube

Question 40

bismuth MOA

Answer 40

coat ulcer and protect further erosion also may stiluate mucus and bicarb secretion salicylate inhibits intestinal prostagladin

Question 41

blackening of tongue and stool

Answer 41

adverse effect of bismuth

Question 42

misoprostel

Answer 42

methyl analog of PGE1 stimulate mucus and bicarb secretion bind receptor on parietal cell - reducing histamine stimulated cAMP production - modest acid inhibition

Question 43

uterine contractions

Answer 43

misprostel

Question 44

sucralafate

Answer 44

mucosal protective not absorbed impairs absorption of other drugs

Question 45

h pylori

Answer 45

spiral gram neg rod with PUD tx goal - heal ulcer and eradicate organism

Question 46

combo tx for h pylori

Answer 46

first course tx - best chance for eradication pt compliance is important

Question 47

Case 46yo F burning epigastric pain relieved by eating, duodenal ulcer, gram negative spiral rod on culture alcoholic

Answer 47

ddx - h pylori

Question 48

tx of h pylori

Answer 48

amoxicillin clarithromycin metronidazole tetracycline 2 or 3 antibiotics and PPI**

Question 49

14 day triple therapy

Answer 49

for h pylori - PPI - clarithromycin - amox or metronidazole

Question 50

14 day quad therapy

Answer 50

for h pylori PPI or H2RA tetracycline metronodazole bismuth subsalicylate

Question 51

intolerance to alcohol

Answer 51

metronidazole