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Gastroenterology > GERD/PUD Therapy Lecture PDF > Flashcards

GERD/PUD Therapy Lecture PDF Flashcards

1
Q

Factors that impact gastric acid secretion (4)

A
  • gastrin binding to receptors on parietal cell
  • H2 binding to receptors on parietal cell
  • Ach binding to parietal cell
  • proton pump
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2
Q

Defensive factors that prevent peptic ulcers

A
  • mucus
  • bicarb
  • blood flow
  • prostaglandins
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3
Q

Aggressive factors that cause peptic ulcers

A
  • gastric acid
  • pepsin
  • pathogen such as helicobacter pylori
  • NSAID use
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4
Q

Nondrug therapy to prevent ulceration of GI (2)

A
  • diet plays no role

- alcohol and cigarettes

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5
Q

Histamine 2 receptor antagonist mech of action

A

-Because parietal cells have receptors for histamine to promote gastric secretions when released from mast cells thruout gastric mucosa, these antagonists prevent secretion

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6
Q

H2 receptor antagonists indications (4)

A
  • gastric or duodenal ulcers (not curative of H pylori infection)
  • GERD mild relief
  • zolinger ellison syndrome
  • heartburn
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7
Q

Cimetidine (tagamet) drug class, ADR’s (2)

A
  • prototype H2 blocker

- antiandrogenic effects causing gynecomastia, reduced libido, impotence, CNS effects

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8
Q

Ranitidine (zantac) differs from cimetidine in 3 ways

A
  • more potent
  • fewer ADR’s (no antiandrogen effects)
  • fewer interaactions
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9
Q

Sucralfatte (carafate) drug class and mech of action

A
  • aluminum hydroxide complex of sucrose
  • Promotes ulcer healing by creating protective barrier against acid and pepsin, forms a viscous and sticky substance that covers ulcer crater for 6 hours
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10
Q

Proton pump inhibitor mech of action

A

-binds to proton pump of parietal cell causing irreversible inhibition of enzyme that generates gastric acid at the final step, inhibiting up to 90% of 24 hr acid secretion without tolerance in only one a day dosing

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11
Q

Proton pump inhibitor therapeutic uses (4) and ADR’s (6)

A
  • GERD
  • peptic ulcer disease
  • long term therapy of hypersecretory conditions
  • no impact on warfarin
  • headache, NVD
  • pneumonia
  • fractures increased risk of osteoperosis (use lowest dose and maintain Ca2+ and vit D)
  • rebound acid hypersecretion when discontinued
  • hypomagnesemia
  • C diff infection in long term
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12
Q

Omeprazole (prilosec) drug class, administration

A

PPI, oral in sustained release capsule containing protective enteric coated granules

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13
Q

Omeprazole (prilosec) therapuetic uses (4)

A
  • gastric and duodenal ulcers
  • GERD
  • erosive esophagitis
  • 4-8 week treatment except in hypersecretory states
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14
Q

Omeprazole (prilosec) alternatives (4)

A
  • lansoprazole (prevacid)
  • rabeprazole (aciphex)
  • pantoprazole (protonix)
  • esomeprazole (nexium)
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15
Q

Misoprostol drug class and therapeutic use

A

Synthetic analogue of prostaglandin E1 used for prevention of gastric ulcers caused by long term NSAID therapy

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16
Q

Misoprostol ADR’s (2)

A
  • NVD

- Pregnancy category X

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17
Q

Antacids mech of action

A

-Alkaline compounds that neutralize gastric acid reducing descrution of gut wall

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18
Q

Antacids indications (3)

A
  • peptic ulcer disease
  • prophylaxis against stress ulcers
  • heart burn
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19
Q

Antacids ADR’s (3)

A
  • constipation and diarrhea depending on aluminum or magnesium (many preps balance these out)
  • Na+ loading increasing hypertension
  • acid rebound
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20
Q

Antacids drug interactions (3)

A

-can influence dissolution of many drugs (cimetidine and ranitidine) and chelate drugs in stomach preventing absorption (fluorquinolones)

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21
Q

Antacid families (4)

A
  • magnesium hydroxide
  • aluminum hydroxide
  • calcium carbonate (tums)
  • sodium bicarb (unfit for ulcers but treats acidosis)
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22
Q

Milk alkali syndrome

A

Characterized by hypercalcemia, metabolic acidosis, soft tissue calcification, and impaired renal function

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23
Q

Bismuth subsalicylate (pepto) function

A

Promote ulcer healing by forming protective coating over ulcer, promotes secretion of bicarb and prostaglandins, suppresses growth of H pylori, as well as assist in diarrhea treatment, and can be prophylaxis against travelers diarrhea

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24
Q

Bisthmus subsalicylate (pepto bismol) ADR’s (2)

A
  • harmless stool color change

- long term risk of neurologic injury

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25
Q

Clarithromycin triple therapy

A

Less effective due to resistance treatment for H pylori includes standard dose of PPI + 2 antibiotics (clarithromycin + amoxicillin OR metronidazole)

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26
Q

Bisthmuth based quadruple therapy

A

First line treatment for H pylori including pepto, metronidazole, tetracycline, and standard dose PPI

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27
Q

Clarithromycin based quadruple therapy

A

First line treatment for h pylori including amoxicilin, clarithromycin, metronidazole, and PPI for 14 days

28
Q

Helidac, pylera, and prevpac

A

Combo therapies that implement the triple and quadruple regimens into one pack of pills multiple times a day

29
Q

Treatment for NSAID related ulcers (2)

A

8 week course of H2RA or full dose sucralfate OR 4 week course of PPI

30
Q

At least __% of adults experiencereflux symptoms of heartburn occasionally

A

50%

31
Q

Gastric reflux mech of action

A

Because organs are crowded together we see the increase in abdominal pressure above thoracic causing contents to be pushed upward when the lower esophageal sphincter is weakned or incompetent

32
Q

Causes of GERD (4)

A
  • Structural/mechanical due to pregnancy or large meal
  • hiatal hernia
  • posture (lying down after meal)
  • delayed gastric emptying due to diabetes, parkinsons, myasthenia gravis, etc
33
Q

Dietary elements and drugs that decrease lower esophageal pressure (3)

A
  • acidic, fat, or spicy food
  • anticholinergics
  • Ca2+ channel blockers
34
Q

Atypical symptoms of GERD (3)

A
  • heartburn which may radiate to shoulders, neck, and back
  • hoarseness
  • asthma
35
Q

Alginic acid and example

A

Acts as a barrier to reflux and coats the esophagus when reflux occurs (gavison – sodium bicarb + alginic acid)

36
Q

Baclofen (lioresal) drug class and function

A

GABA receptor agonist that deceases postprandial acid reflux in patients with GERD

37
Q

Metoclopramide (reglan) mech of action

A

Inhibition of inhibitory D2 receptors in gut with subsequent release of Ach into myenteric plexus causing peristalsis, increases lower esophageal sphincter tone

38
Q

Metoclopramide indications (2) and ADR’s (3)

A
  • GERD
  • diabetic gastroparesis

-diarrhea, gynecomastia, tardive dyskinesia

39
Q

Bethanechol (Urecholine) drug class

A

Muscarinic agonist

40
Q

Erosive esophagitis treatment (1)

A

PPI 8-12 weeks followed by tapeing off

41
Q

PPI dose reduction

A

After 8-12 weeks should attempt alternate day therapy and eventually try stopping if don’t have relapse of symptoms, if stricture present, chronic maintenance therapy recommended without reduction in dose

42
Q

Antiemetics offer 3 benefits

A
  • reductjion of anticipatory nausea and vomiting
  • prevention of malnutrition and dehydration secondary to vomit
  • prevent motion sickness
43
Q

Standard guidelines for treatment of chemo induced nausea and vomiting

A

-3 drug regimen consisting of aprepitant, a 5 HT3 receptor antagonist and dexamethasone

44
Q

Dopamine antagonists used to suppress emesis (3)

A

Phenothiazines including chlorpromazine, prochloperazine, and triethylperazine

45
Q

Butyrophenone (1) used to suppress emesis

A

-haldol

46
Q

Dexamethasone/methylprednisolone drug class, function, ADR’s (1)

A
  • Corticosteroids
  • 2 commonly used to treat emesis associated with cancer chemo
  • very few because only used on intermittent basis
47
Q

Ondansetron (zofran) mech of action

A

Blocks serotonin (5 HT3) receptors in the upper GI tract

48
Q

Ondansetron (Zofran) drug class and function, ADR’s (2)

A

Serotonin receptor antagonist, most effective drug for suppression of nausea and vomiting caused by chemo drugs or anesthesia as well as IBS

-constipation and headache

49
Q

Granisetron (kytril) function

A

Similar action to odansetron

50
Q

copolamine (hyoscine, transderm-scop) drug class, mech of action, ADR’s (3)

A
  • anticholinergic muscarinic antagonist
  • most effective drug for prophylaxis and treatment of motion sickness by depressing the neuronal activity in the pathwaybetween vestibular system and vomiting system
  • Dry mouth, blurred vision, urinary retention
51
Q

Antihistamine use for motion sickness and examples (3)

A
  • Less effective than scopolamine for motion sickness but the sedation makes them less desirable
  • dimehydrinate (Dramamine), meclizine (Antivert), diphenhydramine (Benadryl)
52
Q

Diphenoxylate drug class, function, administration

A
  • opioid
  • indicated for diarrhea only
  • PO only dispensed with combo with atropine (Lomotil) – prevents abuse
53
Q

Loperamide (immodium) drug class, function

A
  • opioid
  • OTC used to treat diarrhea by suppressing bowel motility (including IBS), does not cross BBB leaving CNS effects not noticeable
54
Q

Paregoric (camphorated tincture of opium) and opium tincture

A
  • dilute solution of powdered opium that has antidiarrheal doses that cause neither euphoria or analgesia
  • 25x more potent version indicated for diarrhea but with high abuse potential
55
Q

Irritable bowel syndrome signs and symptoms

A
  • Cramping, abdominal pain in association with diarrhea, constipation, or both due to an unknown pathophysiologic cause but can have symptoms triggered by stress, depression, or dietary choices
  • second only to common cold for missed work days :(
56
Q

Alosetron (lotronex) drug class and function

A
  • serotonin antagonist
  • stringent risk management program due to toxicity but approved for diarrhea predominant IBS in women by slowing transit
57
Q

2 examples of bulk forming agents for diarrhea

A
  • methylcellulose (citrucel)

- polycarbophil (fibercon)

58
Q

Antidiarrheals do not help with travelers diarrhea because they…

A

…prolong the course of the infection

59
Q

Eluxadone (viberzi) drug class and function and contraindication (1)

A

Mu opioid receptor agonist and delta receptor antagonist for PO treatment of adults with IBS-D, contraindicated in patients with any biliary duct problems

60
Q

Polyethylene glycol (Miralax) function

A

Can increase frequency of bowel movements in patients with IBS-C, well tolerated and safe for long term use

61
Q

Lubiprostone (amitzia) drug class and function

A

Selective chloride channel activator, can modestly improve IBS-C

62
Q

Chronic idiopathic constipaion (CIC) presenting complaint vs IBS-C

A

Presents with constipation as primary complaint while IBS-C presents with discomfort primarily

63
Q

Ulcerative colitis mild moderate and severe management

A

Mild - aminosalicylate
Moderate - budosenide (corticosteroid)
Severe - azathioprine (immunosuppressant)

64
Q

Crohn’s disease mild moderate and severe management

A

Mild - budoesonide (corticosteroid)

Moderate to severe - azathioprine or methotrexate

65
Q

Sulfasalazine (azulfidine) drug class, function, indication (1), ADR (1)

A

5-ASA (metabolized into this)
suppresses prostoglandin synthesis decreasing inflammatory response
-acute treatment of mild to moderate ulcerative colitis
-Hematologic disorders

66
Q

Budesonide drug class and function

A

Synthetic corticosteroid used for induction of remission in mild to moderate ulcerative colitis and crohns disease

67
Q

Azathioprine (imuran) drug class and function

A

Thiopurine immunosuppressant, take 3-6 months to reach use effective for long term treatment and not for acute suppression of inflammation associated with ulcerative colitis and crohns

Gastroenterology (25 decks)

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