GI drugs for Peptic Ulcers

Question 1

What are the Antacids

Answer 1

• Al(OH)₃
• Mg(OH)₂
• CaCO₃

Question 2

What are the H2 blockers used for peptic ulcers

Answer 2

• Cimetidine (only 1st gen)
• Famotidine
• Ranitidine
• Nizatidine

Question 3

What are the PPIs for peptic ulcers

Answer 3

• Omeprazole
• Esomeprazole
• Lansoprazole
• Rabeprazole
• Pantoprazole

Question 4

What antimicrobials can fight H. Pylori

Answer 4

• Clarithromycin
• Amoxicillin
• Metronidazole
• Tetracyclin

Question 5

What are the Mucosal protective agents

Answer 5

• Sucralfate
• Bismuth subsalicylate
• Misoprostol

Question 6

What is the main function of antacids

Answer 6

Pepsin inactivation by increasing stomach pH

Question 7

What can Al(OH)3 lower the f of

Answer 7

• Tetracyclines
• Digoxin
• Antimuscarinics

Question 8

What is the main AE of Al(OH)3

Answer 8

Constipation

Question 9

What is the main AE of Mg(OH)2

Answer 9

Diarrhea

Question 10

What are the CaCO3 AE

Answer 10

Nephrolithiasis and Constipation

Question 11

What do H2 blockers do

Answer 11

• 90% reduction in HCl secretion
• Ulcer healing

Question 12

What happens when H2 monotherapy is stopped

Answer 12

Recurrence

Question 13

How do H2 blockers work

Answer 13

• Block Gs
• Decrease cAMP
• Inactivation of H+/K+ pump

Question 14

Why are 2nd gen H2 preferred

Answer 14

• Don’t inhibit P450
• Longer acting

Question 15

What are the main side effects of Cimetidine

Answer 15

• Cross BBB
• Stimulates prolactin
• Anti-androgenic

Question 16

Which class are prodrugs

Answer 16

PPIs

Question 17

What can you give for hemorrhagic ulcers

Answer 17

PPIs

Question 18

What happens with prolongued use of PPI and H2

Answer 18

Decrease f of B12, digoxin, ketoconazole

Question 19

What is the H. Pylori triple therapy

Answer 19

2 ABX and PPI

Question 20

What requires acid for activation

Answer 20

Sucralfate

Question 21

How do Mucosal Protective Agents work

Answer 21

Form physical barrier by polymerizing and binding necrotic tissue

Question 22

What kind of ulcers is Misoprostol used for

Answer 22

• NSAID induced
• Replaced by H2 and PPIs

Question 23

When is Misoprostol contraindicated

Answer 23

Pregnancy

Question 24

How do antacids work

Answer 24

Form salt and water

Question 25

When do you give antacids

Answer 25

* GERD * Gastritis * PUD

Question 26

When do you give H2 blockers

Answer 26

* Acute stress ulcer * Prevent PNA aspiration pre-op

Question 27

How are H2 blockers administered

Answer 27

PO, IV

Question 28

What are the H2 blocker AEs

Answer 28

* Nausea * HA * Dizziness

Question 29

What do PPIs do

Answer 29

* 100% reduction in HCl * Support platelet aggregation

Question 30

How do PPIs work

Answer 30

* Covalently bind H+/K+ pump in parietal cell * Irreversible inactivation

Question 31

When do you give PPIs

Answer 31

* GERD * Gastric ulcers * MEN I * ZE Syndrome * H. Pylori (w/ ABX) * NSAID ulcers

Question 32

How are PPIs administered

Answer 32

PO, IV

Question 33

What drugs does omeprazole inhibit

Answer 33

* Warfarin * Phenytoin * Diazepam * Cyclosporine * Clopidogrel

Question 34

What are the PPI AE

Answer 34

* Nausea, Diarrhea * GI, Resp infections * Pancreatitis * Hepatotoxicity * Interstitial nephritis

Question 35

How do you Dx H. Pylori

Answer 35

* Endoscopy * Serology * Urea breath test

Question 36

What is the other H. Pylori Tx combo

Answer 36

Bismuth, 2ABX, PPI/Ranitidine

Question 37

What do you not give Sucralfate with

Answer 37

PPIs, H2

Question 38

What does Misoprostol do

Answer 38

* Decrease HCl * Increase mucin and bicarb

Question 39

How does Misoprostol work

Answer 39

* Gi * Increase PG synthesis

Question 40

What are the AE for Misoprostol

Answer 40

* Diarrhea * Abortion * Exacerbation of IBD