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Pharm N895 > GI: GERD > Flashcards

GI: GERD Flashcards

1
Q

Types of cells in the gastric gland

A

Mucosal, parietal, chief, endocrine (enterochromaffin like cells, G cells, D cells)

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2
Q

location & function of mucosal cells

A

Near the top/pit of gastric gland, mucosal cells secrete mucous and bicarb

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3
Q

Location & function of parietal cells

A
  • Isthmus of gastric gland
  • secrete gastric acid and IF
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4
Q

Parietal cells: resting vs stimulated state

A

Go between resting and stimulated state.

Resting state: tubovesicles in cytoplasm that contain proton pumps. Surface: receptors for gastrin, Ach, histamine

Stimulated state: TVs and PPs fuse to surface. Canaliculus surface area of cell expands to make room for more. HCl and KCl released. Hydrogen and chloride bind –> hydrochloric acid.

K+ is pumped back into cell and process continues

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5
Q

Location & function of chief cells

A

Base of gastric gland

Chief cells secrete gastric lipase and pepsin to break downlipids and proteins

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6
Q

Location and function of endocrine cells

A

Interspersed through gastric gland

  • Enterochromaffin like cells (ECLs) secrete histamine
  • G cells secrete gastrin
  • D cells secrete somatostatin (the brakes)
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7
Q

chemical messengers that increase gastric acid secretion

A

Ach, histamine, and gastrin all increase GA secretion.

(Ach released by vagus)

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8
Q

chemical messenger that inhibits gastric acid secretion

A

Somatostatin: binds to ECLs, G cells, and directly to parietal cells to inhibit GA secretion

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9
Q

Gastric Acid Defenses

A

Lower esophageal sphincter tone

  • Prevents acid reflux into esophagus

Gastric mucous coats the surface of the stomach

  • Traps secreted bicarb
  • Secreted by mucous cells
    • Stimulated by PGs (PGE­­­­1 and PGE2)

Mucous creates gel-like surface. Stimulated by PGs, NSAIDs, decrease PG synthesis – hence ulcer w/overuse

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10
Q

Causes of / risk factors for GERD

A
  • decreased lower esophageal sphincter tone (caffeine, chocolate, spicy foods, etc)
  • decreasedesophageal clearance of gastric fluids
  • decreased saliva production (iatrogenic – meds)
  • Delayed gastric emptying (gastroparesis from diabetes)
  • Obesity
  • Pregnancy
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11
Q

How to treat GERD in pregnancy: lifestyle

A

Lifestyle modification before pharm interventions:

  • Smaller meals
  • Avoid eating at bedtime
  • Elevate HOB
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12
Q

How to treat GERD in pregnancy: pharm

A

Pharm stepwise Tx:

  1. Antacids
  2. H2 antagonists –> Ranitidine (Zantac) has most safety data
  3. PPI (less safety data c/t H2Bs): Lansoprazole (Prevacid) and Pantoprazole (Protonix) have more safety data
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13
Q

Type of drugs used to treat GERD

A

PPIs, antacids, H2 blockers

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14
Q

Types of PPIs

A
  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Pantoprazole (Protonix)
  • Lansoprazole (Prevacid)
  • Dexlansoprazole (Dexilant)
  • Rabeprazole (Aciphex)
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15
Q

PPI: MOA

A

Prodrugs absorbed in sm intestines

Travel systematically to parietal cells

Activated by stimulated proton pumps

Irreversible disulfide bonds formed with the proton pump

Must create new proton pumps to secrete gastric acid. Why they are so effective.

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16
Q

PPI: dosing

A

Counseling: take 15-30min before bfast or biggest meal of day; Dose after dinner for nocturnal symptoms

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17
Q

PPIs: absorption

A

A: rapid, bioavailability & absorption rate decreased w/food

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18
Q

PPIs: half life & duration

A

½ life: 1.5h, 24h duration (irreversible bond)

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19
Q

PPIs: metabolism

A

M: liver via CYP2C19 and CYP3A4

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20
Q

PPIs: Excretion

A

E: inactive in urine and feces

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21
Q

PPIs: important drug interaction

A

Clopidogred (Plavix) Interaction – prodrug requiring CYP2C19 activation: potential reduce antiPLT activity; avoid PPI or RX protonix or aciphex if necessary

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22
Q

PPIs: ADRs

A

Prolonged use:

  • decreased vit B12 absorption
  • decreased mg (esp w/diuretics)
  • increased risk bone fractures (decreased Ca absorption) Ca needs acidic environment
  • increased risk C. diff & pneumonia (GA destroys c diff spores, bacteria)

Discontinuation causes rebound acid hypersecretion * -Temporary. some recommend H2B bridge.*

Short term well-tolerated

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23
Q

PPIs: crush or split tablets?

A

• Do not crush or split tablets

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24
Q

PPIs vs H2 blockers for esophageal GERD Sx

A

PPIs more efficacious

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25
Q

PPIs: which are most effective?

A

All PPIs equally effective

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26
Q

PPIs: what to do if partial response only?

A

adjust timing to fit Sx, consider BID

27
Q

PPI onset

A

Takes a few days, Use antacids as bridge

28
Q

PPIs vs H2Bs when maintenance Tx is needed

A
  • Continue PPI if Sx return after Tx, erosive esophagitis, Barrett’s esophagitis
  • Consider H2 if no erosive esophagitis
29
Q

Omeprazole (Prilosec): available formulations

A
  • Capsule, tablet, suspension
  • QD, OTC
  • Available for pedi, 5kg

(PPI)

30
Q

Omeprazole (Prilosec): drug interactions

A

Def not w/Plavix

(PPI)

31
Q

Esomeprazole (Nexium) : formulations

A
  • Capsule, packet, injection
  • QD, OTC
  • Available for pedi 1-11yo
32
Q

Pantoprazole (Protonix): formulations

A

Tablet, packet, injection

QD

(PPI)

33
Q

Lansoprazole (Prevacid): formulations

A
  • Capsule/ODT, suspension
  • OTC
  • Available for pedi 1-11yo

(PPI)

34
Q

Dexlansoprazole (Dexilant): formulations

A

Capsule

QD

(PPI)

35
Q

Rabeprazole (Aciphex): formulations

A
  • Tablet, sprinkle capsules
  • QD
  • Available for pedi 1-11yo
36
Q

Which PPI if must use w/plavix

A

Pantoprazole (Protonix) or Rabeprazole (Aciphex)

37
Q

PPI w/relatively more safety data in pregnancy

A

Pantoprazole (Protonix) and Lansoprazole (Prevacid)

38
Q

Most common PPI for pedi, even infants

A

Lansoprazole (Prevacid)

39
Q

Antacids: MOA

A

Neutralize GA by reacting w/hydrochloric acid

40
Q

Antacids: special considerations

A

Consider pt characteristics when Rxing, e.g, no alka seltzer for CHF, RF, low Na+ diet d/t fluid retention

41
Q

Types of antacids

A
  • Sodium Bicarbonate (Alka Seltzer)
  • Calcium Carbonate (Tums)
  • Magnesium hydroxide + Aluminum hydroxide (Mylanta)
42
Q

Sodium Bicarbonate (Alka Seltzer): dosing

A

325 mg 1-4x daily prn

43
Q

Calcium Carbonate (Tums): dosing

A

500-1000 mg Q2h prn

44
Q

Magnesium hydroxide + Aluminum hydroxide (Mylanta): dosing

A

10-20mL (400-800mg aluminum +mg) 4x daily prn

45
Q

Sodium Bicarbonate (Alka Seltzer): ADRs

A

Belching, metabolic alkalosis, fluid retention

46
Q

Sodium Bicarbonate (Alka Seltzer)​: forms

A

NaCl, CO2 and H20

47
Q

Calcium Carbonate (Tums): ADRs

A

Belching, hypercalcemia, metabolic alkalosis

48
Q

Calcium Carbonate (Tums)​: forms

A

Forms: CaCl2, CO2 and H20

49
Q

Magnesium hydroxide + Aluminum hydroxide (Mylanta): ADRs

A

Diarrhea (Mg), Constipation (Al), Aluminum accumulation in CKD

Combined to reduce AEs of both

50
Q

Magnesium hydroxide + Aluminum hydroxide (Mylanta): forms & C/Is

A
  • Forms: MgCL and Al2Cl3 and H20
  • Not in RF!
51
Q

H2 Blockers: agents

A
  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Ranitidine (Zantac)
  • Nizatidine (Axid)
52
Q

H2 Blockers: MOA

A

Acid inhibition via reversible H2 receptor blockade

53
Q

H2 Blockers: absorption

A

rapid, 1-3h

54
Q

H2 Blockers: 1/2 life & duration

A

1.1-4h (duration of effect: most 10-12h)

55
Q

H2 Blockers: metabolism

A

10-35% via liver

56
Q

H2Bs: excretion

A

parent drug & metabolites in kidneys

57
Q

H2Bs: ADRs

A

Diarrhea, HA, fatigue, constipation (minor)

CNS effects (confusion, hallucinations, delirium) more in elderly

58
Q

Cimetidine (Tagamet): formulation & dosing

A

Tablet or solution

Q12h, OTC

(H2B)

59
Q

Cimetidine (Tagamet)​: ADRs

A

H2B adrs + Gynecomastia/impotence (cimetidine)

(H2B)

60
Q

Cimetidine (Tagamet): drug interactions

A

Drug interactions: Cimetidine (CYP2C9, CYP2D6, CYP1A2) - inhibitor, may increase serum concentration

(H2B)

61
Q

Famotidine (Pepcid): formulations and dosing

A
  • Tablet, suspension, injection
  • Q12h, OTC
  • Pedi dosing available
62
Q

Ranitidine (Zantac): formulation and dosing

A
  • Tablet, capsule, syrup, injection
  • Q12h, OTC
  • Pedi dosing available
63
Q

Ranitidine (Zantac): pregnancy

A

Has most safety data in pregnancy of H2Bs

64
Q

Nizatidine (Axid): formulation and dosing

A

Tablet, capsule, solution

Q12h

Pharm N895 (13 decks)

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