GERD treatment Flashcards

1
Q

Pathways with gastric acid secretion

A

Sight of food- vagus nerve signal Ach release

Ach binds to receptors in parietal cells, stimulates H/K ATPase

H+ react with Cl in blood to form HCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prostaglandins

A

Cytoprotective effect on yhr GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acid Neutralization w antacids

Ca Carbonate

MgOH

Efficacy
SE

A

OTC antacids

Effective, but can cause belching

combined with AlOH and CaCarbonate to mediate gastric emptying

Similar
Diarrhea, constipation, renal, altered absorption (daizepam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Histadine synthesis

A

from AA Histidine by histidine decarboxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diphenhydramine

Works best when

Duration

SE

A

1st gen H1 inhibitor
Inverse agonist of H1 receptor (does not inhibit release)

Admin prior to histamine release, effective orally/topically

4-6 hrs

Crosses BBB, so sedation, antimuscarinic
Minimal GI SE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cetirizine

SE

1/2 life

Duration

A

2nd gen H1 blocker

Cant penetrate BBB (no sedation)

Drowsiness (dose related)

8 hrs

12-24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

H1 receptor location
mechanism
effect

A

Nonvascular SM, Vasc SM, brain
inc DAG/IP3
inc vasc permeability and VD, constrict Vasc SM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

H2 receptor location

Mech

Effect

A

Gastric mucosa, cardiac, mast cells brain, Vasc SM

Inc cAMP

Inc gastric acid and VD, cardiac stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

H3/H4 location

mech

Effect

A

H3- CNS, inc cAMP, dec histamine release, inc NT release

H3- immune cells, inc cAMP, mediate immune cell recruitment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Selective H2 receptor antagonists

Use

Mech

A

Cimetidine/ranitidine- dec GA sec

Effective against basal acid sec, esp nocturnal (primary factor for duodenal ulcer healing), also stimulated acid production

Competitive, reversible inhibitors of H2 receptor (similar in structure to histamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nocturnal acid breakthrough

Give _____ to suppress NAB

A

> 60 min of intragastric pH <4 between 10/6 for pts taking PPI twice daily

H2 antihistamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

H2 antihistamine pharmacokinetics

SE

A

Oral/IV (rapid absorption)

Rare
Cimetidine inhibits p450 metab in liver (interferes with warfarin, phenytoin, cafeinne)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gastric pump inhibitors

Mech

Ex

A

most effective acid suppressing agents

Selective, irreversible H/K ATPase inhibitors (gastric parietal cells)

Bind to H/K APTase, inhibit reease of acid into GI tract

Omeprazole/pantoprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Omep/Panto use

Structure

A

Primary tx for GERD, PUD, NSAID/stress ulcers, combo to treat H pylori

Omep= mix of R/S isomers
Esomeprazole (S isomer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Omep/panto mech

A

PPI travel to parietal cells and acumulte in acidic secretory canaliculi

Form covalent bonds with cysteine residues of H/K pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Omep/panto uptake

activation

Do not give with

Duration

A

unstable at low pH- omep given in alkali soluble capulse to prevent degradation in stoamch

require acid environment to be active- given with food to stimulate acid secretion

acid suppressors (H2 antag)

90 min in blood

17
Q

Omep/panto pharm

Effective

A

PPI metabolized in liver by p450

24-48 hrs (due to irreversible nature)

18
Q

Typical course of treatment

Omep SE

potential cause of

A

PPI for 8 weeks, disc/maintained at low dose

hypochlorhydria (dec HCl) hypergastremia (inc gastrin prod)

Gastric bacterial overgrowth ( C diff) can occur

CKD

19
Q

PPI and azoles

Omep inhibits

Inc risk of

A

inc pH can alter uptake of azoles

hepatic metabolizing drug enzymes (infl metab of benzos, warfarin, phenytoin)

gastric cancer

20
Q

Esomeprazole

A

extremely similar to Omep

21
Q

Bismuth

Sucralfate

A

promotes mucosal healing, no GA neutralization (soothe, coat)

AlOH and sulfated sucrose

Binds/protects mucosa- promotes PG synthesis

22
Q

H pylori tx

Ab include

Beware

A

double/triple regimen with PPI and 2/3 ab for 2 weeks

metronidazole/clarithromycin\

resistance