GI: Anti-ulcer Agents

Question 1

Suffix of all H2 blockers

Answer 1

Tidine

Cimetidine
Famotidine
Nizatidine
Ranitidine

Question 2

Suffix for all the PPIs

Answer 2

Prazole

Question 3

What is the surface acting agent for ulcers?

Answer 3

Sucralfate

Question 4

What is the MOA of Misoprostol?

Answer 4

PGE1 analog

-increases mucus, bicarb, and blood flow to surface of cells

Question 5

Do the H2 blockers completely shut down acid production?

Answer 5

nope; only 20-50%

-should help ulcers in 4-8 weeks

Question 6

Cimitidine has the side effects of?

Answer 6

decreases testosterone-adrogen interaction

• gynecomastia in men
• galactorrhea in women

Question 7

Man comes in because he is developing breasts. He recently started a new medication but cannot remember the name. what is it?

Answer 7

Cimetidine

Question 8

Which H2 blocker interacts with CYP450 and can cause neutropenia/thrombocytopenia?

Answer 8

Cimetidine!

Question 9

What should you give a pregnant patient if they have to be on an H2 blocker?

Answer 9

ranitidine or famotidine

Question 10

MOA of PPIs?

Answer 10

Bind to sulfahydryl group of K/H+ ATPases to block H+

Take several days for new steady state

Question 11

A patient comes in with profuse watery diarrhea and dehydration. They say they are taking a medication, what are they taking?

Answer 11

PPI

-omeprazole is stereotypical for causing C. Diff

Question 12

What other issues, besides C. Diff, are associated with PPIs?

Answer 12

• Kidney Disease
• Osteoporosis/bone fractures (throws away calcium)
• CVD (MI)

Question 13

Does omeprazole interact with CYP450?

Answer 13

You betcha

Question 14

What are the two PPIs safe to take while pregnant?

Answer 14

Lansoprazole and pantoprazole

Question 15

MOA of sucralfate?

Answer 15

forms a sticky substance when interacting with acid to coat ulcers and protect them

Can protect all ulcers (aphthous, mucositis, radiation induced)

Question 16

Side effect of sucralfate?

Answer 16

Constipation.
-contains Aluminum

Just think that the sticky stuff is clogging you up

Question 17

What is a relative contraindiation to taking sucralfate?

Answer 17

Renal Failure

A patient with renal failure should avoid meds that contain aluminum

Question 18

Does sulcralfate interact with other drugs?

Answer 18

Yeah, so wait two hours between each

Question 19

Which drug is given for prophylaxis of NSAID induced gastric ulcers?

Answer 19

Misoprostol

Question 20

What are the off label uses for misoprostol?

Answer 20

1. cervical ripening,
2. Pregnancy termination
3. Post partum hemorrhage in high doses!`

Question 21

Bismuth is known for its anti-diarrheal effects, but what else does it inhibit?

Answer 21

It is also an antimicrobial agent!

Question 22

A patient comes in with black stool that is not tarry.. what did they likely take?

Answer 22

bismuth compound

Question 23

Does bismuth interact with any drugs?

Answer 23

Yes, so take 2 hours after other meds

Question 24

What are the relative contraindications for bismuth?

Answer 24

Patient on Antiplatelets or anticoags
-contains salicylate

Severe renal failure

Question 25

What are the absolute contraindicatios for Bismuth?

Answer 25

GI Bleed (salicylate)
Salicylate hypersensitivity

Question 26

What is triple therapy for H. Pylori

Answer 26

10-14 days of: BID

1. Clarithromycin
2. Amoxacillin/Metronidazole
3. PPI

Question 27

What is quadruple threapy for H. Pylori?

Answer 27

1. Metronidazole (BID)
2. Tetracycline (BID)
3. PPI (QID)
4. Bismuth (BID)

Question 28

If metronidazole containing triple therapy fails to eradicate H. Pylori what should be done?

Answer 28

Try non-metranidazole containing Quadruple threapy

Question 29

If a pregnant patient comes in with PUD not due to H. Pylori how should you treat?

Answer 29

Short term ant-acids or sucralfate

• if moderate: ranitidine (H2)
• if severe: lansoprazole (PPI)