Gi drugs Flashcards
what is peptic ulcer disease
degrees of erosion to the gut wall can be caused by an imbalance betwwen the mucosal wall and the aggressive factors
defensive factors of the gi system
mucous, secreted from the Gi cells of the mucosa, protects from acid and pepsin
bicarbonate , secreted by epithelial cells , helps neutralize hydrogen ions
pathogenesis of peptic ulcer disease
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Inhibit the biosynthesis of prostaglandins
Reduce blood flow, mucus, and bicarbonate
Gastric acid
Causes ulcers directly by injuring cells of the GI mucosa and indirectly by activating pepsin
Increased acid alone does not increase ulcers but is a definite factor in PUD
most common cause of ulcer development
other causes
Infection with H. pylori is the most common cause of gastric and duodenal ulcers
Second most common cause
NSAIDs
goals of drug therapy
Alleviate symptoms
Promote healing
Prevent complications
Prevent recurrence
do not alter disease process but instead will help with healing
anti ulcer drugs include
Antibiotics
Antisecretory agents
Mucosal protectants
Antisecretory agents that enhance mucosal defenses
Antacids
true or false with h pylori associated infections all patients should be given antibiotics
true
nsaid incduced ulcers treatment
Histamine blockers and PPIs (eg, omeprazole) are preferred
Antacids, sucralfate are not recommended
stop nsaid use
non drug therapy for ulcers
ulcer diet does not speed up healing
changing eating patterns could help to eating 5- 6 smaller meals which will reduce pH flucuation
avoiding nsaid use, smoking and reducing stress
evaluation and therapy
relief of pain , H pylori tests
common histamine 2 receptor antagonists
Cimetidine [Tagamet]
Famotidine [Pepcid]
histamine 2 receptor antagonists are ?
first line of treatment for treating gastric and duodenal ulcers
Promote healing by suppressing secretion of gastric acid
All are equally effective
Serious side effects are uncommon
adverse effects of Cimetidine [Tagamet]
Antiandrogenic effects
CNS effects
Pneumonia
IV bolus: Can cause hypotension and dysrhythmias
drug interactions of Cimetidine [Tagamet
Warfarin, phenytoin, theophylline, lidocaine
Antacids can reduce absorption of cimetidine
Cimetidine and antacids should be administered at least 1 hour apart
Famotidine [Pepcid uses
Short-term treatment of gastric/duodenal ulcers
Prophylaxis of recurrent duodenal ulcers
Treatment of GERD
Over-the-counter (OTC): Treatment of heartburn, acid indigestion, sour stomach
adverse effects of pepsid ?
No antiandrogenic effects because it does not bind to androgen receptors
Possible increased risk for pneumonia caused by elevation of pH
proton pump inhibitors
Most effective drugs for suppressing secretion of gastric acid
uses of ppi
Therapeutic uses: Short term
Gastric/duodenal ulcers
GERD
risk of ppi ?
Can increase the risk of serious adverse events, including fracture, pneumonia, acid rebound
Omeprazole [Prilosec]
First available PPI
Inhibits gastric secretion
Short half-life
Used for short-term therapy
Ulcer prophylaxis is indicated only for patients in intensive care units, and then only if they have an additional risk factor, such as multiple trauma, spinal cord injury, or prolonged mechanical ventilation (longer then 48 hours)
prilosec adverse effects
Usually inconsequential with short-term use
Pneumonia
Fractures
Hypomagnesemia
Rebound acid hypersecretion
Esomeprazole [Nexium, Nexium IV]
Nearly identical to omeprazole [Prilosec]
used for Erosive esophagitis, GERD, duodenal ulcers associated with H. pylori infection, prophylaxis of NSAID-induced ulcers
Esomeprazole [Nexium, Nexium IV] adverse effects
Headache, diarrhea, nausea, flatulence, abdominal pain, dry mouth, pneumonia, hypomagnesemia, osteoporosis, fractures
Pantoprazole [Protonix]
Treatment of GERD and hypersecretory states
Similar to omeprazole and the other PPIs
adverse effects of Pantoprazole [Protonix]
Oral: Diarrhea, headache, dizziness
IV: Diarrhea, headache, nausea, dyspepsia, injection-site reactions, including thrombophlebitis and abscess
Long-term use: Hypomagnesemia, osteoporosis, fractures
Rabeprazole uses
H. pylori eradication, duodenal ulcers, GERD, hypersecretory states (eg, Zollinger-Ellison syndrome)
rabeeprazole action
Reduces gastric acidity by inhibiting gastric H+,K+-ATPase
therapeutic use of sucralfate
Acute ulcers and maintenance therapy
other anti ulcer drugs
Sucralfate [Carafate]
Misoprostol [Cytotec]
Antacids
Sucralfate [Carafate] adverse effects
Constipation (only 2% of patients
Antacids may interfere with effects of sucralfate
Misoprostol [Cytotec] therapeutic uses
Only approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy
Misoprostol [Cytotec] adverse effects
: Dose-related diarrhea and abdominal pain
Misoprostol [Cytotec] contraindications
pregnancy, seen as a category x
what does an antacid do ?
React with gastric acid to produce neutral salts or salts of low acidity
Reduce destruction of gut wall by neutralizing acid
May also enhance mucosal protection by stimulating production of prostaglandins
antacis should be used cautiously with patients that have
renal impairment
true or false Except for sodium bicarbonate, antacids do not alter systemic pH
true
common antacid family
Aluminum compounds
Magnesium compounds
Calcium compounds
common adverse effects seen with antacids
Constipation: Aluminum hydroxide
Diarrhea: Magnesium hydroxide
Sodium loading
true or false , cemeditdine and antacids can be taken together
false they should be taken 1 hour apart
how does sucralate help promote gastric ulcer healing ?
by creating a barrier against pepsin and acid
treatment of h pylori ulcer
combination of antibiotics
cimetidine action
supress secretion of gastric acid by blocking histamine receptors on parietal cells in stomach
Misoprostol mechanism of action ?
prevent ulcers from nsaid usage
