GI drugs for Peptic Ulcers Flashcards
What are the Antacids
- Al(OH)3
- Mg(OH)2
- CaCO3
What are the H2 blockers used for peptic ulcers
- Cimetidine (only 1st gen)
- Famotidine
- Ranitidine
- Nizatidine
What are the PPIs for peptic ulcers
- Omeprazole
- Esomeprazole
- Lansoprazole
- Rabeprazole
- Pantoprazole
What antimicrobials can fight H. Pylori
- Clarithromycin
- Amoxicillin
- Metronidazole
- Tetracyclin
What are the Mucosal protective agents
- Sucralfate
- Bismuth subsalicylate
- Misoprostol
What is the main function of antacids
Pepsin inactivation by increasing stomach pH
What can Al(OH)3 lower the f of
- Tetracyclines
- Digoxin
- Antimuscarinics
What is the main AE of Al(OH)3
Constipation
What is the main AE of Mg(OH)2
Diarrhea
What are the CaCO3 AE
Nephrolithiasis and Constipation
What do H2 blockers do
- 90% reduction in HCl secretion
- Ulcer healing
What happens when H2 monotherapy is stopped
Recurrence
How do H2 blockers work
- Block Gs
- Decrease cAMP
- Inactivation of H+/K+ pump
Why are 2nd gen H2 preferred
- Don’t inhibit P450
- Longer acting
What are the main side effects of Cimetidine
- Cross BBB
- Stimulates prolactin
- Anti-androgenic
Which class are prodrugs
PPIs
What can you give for hemorrhagic ulcers
PPIs
What happens with prolongued use of PPI and H2
Decrease f of B12, digoxin, ketoconazole
What is the H. Pylori triple therapy
2 ABX and PPI
What requires acid for activation
Sucralfate
How do Mucosal Protective Agents work
Form physical barrier by polymerizing and binding necrotic tissue
What kind of ulcers is Misoprostol used for
- NSAID induced
- Replaced by H2 and PPIs
When is Misoprostol contraindicated
Pregnancy
How do antacids work
Form salt and water
When do you give antacids
- GERD
- Gastritis
- PUD
When do you give H2 blockers
- Acute stress ulcer
- Prevent PNA aspiration pre-op
How are H2 blockers administered
PO, IV
What are the H2 blocker AEs
- Nausea
- HA
- Dizziness
What do PPIs do
- 100% reduction in HCl
- Support platelet aggregation
How do PPIs work
- Covalently bind H+/K+ pump in parietal cell
- Irreversible inactivation
When do you give PPIs
- GERD
- Gastric ulcers
- MEN I
- ZE Syndrome
- H. Pylori (w/ ABX)
- NSAID ulcers
How are PPIs administered
PO, IV
What drugs does omeprazole inhibit
- Warfarin
- Phenytoin
- Diazepam
- Cyclosporine
- Clopidogrel
What are the PPI AE
- Nausea, Diarrhea
- GI, Resp infections
- Pancreatitis
- Hepatotoxicity
- Interstitial nephritis
How do you Dx H. Pylori
- Endoscopy
- Serology
- Urea breath test
What is the other H. Pylori Tx combo
Bismuth, 2ABX, PPI/Ranitidine
What do you not give Sucralfate with
PPIs, H2
What does Misoprostol do
- Decrease HCl
- Increase mucin and bicarb
How does Misoprostol work
- Gi
- Increase PG synthesis
What are the AE for Misoprostol
- Diarrhea
- Abortion
- Exacerbation of IBD
