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GK Pharm 2 Exam 2 > GI & Peptic 2 > Flashcards

GI & Peptic 2 Flashcards

1
Q

PPI

  • Bioavailability of all agents is decreased by what?
  • How is this fixed?****
A
  • Bioavailability of all agents is decreased by what?
  • How is this fixed?****
  • Food***
  • Administer approximately 30 - 60 mins BEFORE a meal (usually breakfast)***

(Know this)

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2
Q

PK of PPIs

  • Acid inhibition lasts up to __ hours.
  • How many hours are required for synthesis of new H+/K+-ATPase pump molecules
  • Undergo which rapid 1st pass systemic effect?
  • Which type of clearance neglible?
A

Acid inhibition lasts up to 24 hours.

hours required for synthesis of new H+/K+-ATPase pump molecules: 18 hours

1st pass hepatic

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3
Q

PK of PPIs

  • Dose reduction in pts w/ what condition?
A

​

  • Severe liver impairment
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4
Q

Which nerve stimulates postganglionic neurons of the enteric nervous system to release acetylcholine (ACh), which binds to M3 receptors on parietal cells and ECL cell?

A

Vagus

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5
Q

3 SE of PPIs

A
  • Diarrhea**
  • HA
  • Abdominal pain
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6
Q

PPI adverse effects

  • Acid is important in releasing what from food?
  • Acid also promotes absorption of what 3 food bound minerals?***
    • What should you monitor?
    • What could you supplement with?
A
  • Releasing B12 from food
  • 3 food-bound minerals: iron, Ca, Mg*** (know this)
  • Monitor: bone density
  • Ca supplements
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7
Q

Adverse effects of which agent?

  • Community-acquired respiratory infections and nosocomial pneumonia
  • 2- to 3-fold increased risk for hospital- and community-acquired Clostridium difficile infection
  • Salmonella, Shigella, E coli, Campylobacter
A

PPI

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8
Q

PPI Drug Interactions

  • Decreased gastric acidity may alter absorption of what 4 drugs? Which drug especially?**
A
  • Ketoconazole
  • Itraconazole
  • Digoxin***
  • Atazanavir

“A KID”

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9
Q

PPI Drug Interactions

Omeprazole may inhibit the metabolism of what 3 drugs?

A
  • Warfarin***
  • Diazepam
  • Phenytoin

“Omeprazole went to War w/ P. diddy”

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10
Q

PPI Drug Interactions

  • Which 2 PPIs have no significant drug interactions?
A
  • Rabeprazole
  • Pantoprazole

“A rabbi wearing pants is getting no action…”

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11
Q

PPI Drug Interactions

  • Metabolized by P450 cytochromes
  • What is the “prodrug” which requires activation by the hepatic P450 CYP2C19?
  • PPIs could reduce activation of what drug?
A
  • Clopidogrel
  • Clopidogrel
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12
Q

PPI Drug Interactions

  • Which 2 PPIs are preferred bc/ of minimal CYP2C10 inhibition?
A

Rabeprazole & Pantoprazole

“Rabbi wearing Pants”

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13
Q

Mucosal Protective Agents

  • Gastroduodenal mucosa evolved defense mechanisms to protect itself against the noxious effects of what 2 substance?
A
  • acid & pepsin
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14
Q

What substance appears to be important in stimulating mucus and bicarbonate secretion and mucosal blood flow?

A

Mucosal prostaglandins

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15
Q

What are the 3 Mucosal Protective Agents?

A
  • Sucralfate
  • Prostaglandin analogs
  • Bismuth
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16
Q

Which Mucosal Protective Agent?

  • Salt of sucrose complexed to sulfated aluminum hydroxide
  • forms a viscous, tenacious paste that binds selectively to ulcers or erosions for up to 6 hours
A

Sucralfate

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17
Q

Which Mucosal Protective Agent?

  • Negatively charged sucrose sulfate binds to positively charged proteins in the base of ulcers or erosion
  • Forms a physical barrier that restricts caustic damage
  • Stimulates mucosal prostaglandin and bicarbonate secretion
A

Sucralfate

18
Q

Which Mucosal Protective Agent?

  • Used to prevent stress-related bleeding
A

Sucralfate

19
Q

Adverse effects of which Mucosal Protective Agent?

  • Small amount of aluminum is absorbed
  • Do not be used for prolonged periods in patients with renal insufficiency
A

Sucralfate

20
Q

Prostaglandin Analogs

  • What are the 2 primary prostaglandins?
A

E & F

21
Q

What is the name of a prostaglandin analog? (Methyl Analog of PGE1)

A

Misoprostol

22
Q

Misoprostol (prostaglandin analog)

  • Metabolized to what?
  • Serum half life is how long?
  • Excreted how?
A
  • Metabolized to a metabolically active free acid
  • Half life: less than 30 mins
  • Excreted in the urine
23
Q

T/F

  • Dose reduction of Misoprostol is NOT needed in pts w/ renal insufficiency
A

True

24
Q

Prostaglandin Analogs: Misoprostol

Pharmacodynamics

  • Has what 2 properties?
  • Binds to prostaglandin receptor on parietal cells, reducing histamine stimulated _____ production and causing modest acid inhibition
  • Prostaglandins stimulate what 3 things?
A

Prostaglandin Analogs: Misoprostol

Has what 2 properties?

Acid inhibitory & Mucosal protective properties

Binds to prostaglandin receptor on parietal cells, reducing histamine stimulated cAMP production and causing modest acid inhibition

  • Prostaglandins stimulate what 3 things?*
    1. Intestinal electrolyte & fluid secretion
    2. Intestinal motility
    3. Uterine contractions
25
Q

Which medication?

Reduces the incidence of NSAID-induced ulcers

A

Misoprostal

(Prostaglandin Analog)

26
Q

Adverse reactions of which medication?

uterine contractions

do not use in pregnancy/childbearing women unless they have a neg. serum pregnancy test and on effective contraceptive measures

A

Misoprostol

(Prostaglandin Analog)

27
Q

What are the 2 bismuth compounds?

A
  • bismuth subsalicylate
  • bismuth subcitrate potassium
28
Q

Which bismuth compound?

  • combination prescription product that also contains metronidazole and tetracycline for the treatment of H pylori.
A

bismuth subcitrate potassium

29
Q

Bismuth

  • Over 99% of bismuth appears where?
  • What substance is (like ASA), readily absorbed and excreted in the urine
A
  • in the stool
  • Salicylate
30
Q

Bismuth Compounds

  • May stimulate what 3 things?
  • Which bismuth reduces stool frequency and liquidity in acute infectious diarrhea?
A
  • secretion of: prostaglandin, mucus, bicarbonate
  • Bismuth subsalicylate
31
Q

Bismuth has direct ____ effects against ______ and binds enterotoxins, accounting for its benefits in preventing and treating _______.

A

Bismuth has direct antimicrobial** against **H. pylori** and binds enterotoxins, accounting for its benefits in preventing and treating **traveler’s diarrhea.

32
Q

Which bismuth is for prevention of traveler’s diarrhea?

A

Bismuth subsalicylate

33
Q
  • Which bismuth therapy is first line due to “superior compliance?”
  • Which is 2nd line?
A

1st: “Triple Therapy”

  • Proton Pump Inhibitor
  • Clarithromycin
  • Amoxicillin or Metronidazole

(twice daily)

2nd: Bismuth based quadruples

34
Q

ADEs of Bismuth Compounds

  • What are 2 harmless effects?
  • Avoided in pts w/ _____ insufficiency
  • Bismuth toxicity results in what?
  • Bismuth toxicity is NOT reported in which 2 forms of bismuth?
  • High dosages of bismuth subsalicylate can lead to what?
A
  • 2 harmless: blackening of stool & darkening of tongue
  • Avoided in pt w/ renal insufficiency
  • Bismuth toxicity -> encephalopathy (ataxia, HAs, confusion, seizures)
  • 2 forms bismuth toxicities NOT reported in: bismuth subsalicylate & bismuth citrate
  • salicylate toxicity
35
Q

ADEs of what drug?

  • Nausea, Vomiting, Diarrhea
  • Flatulence
  • hypomagnesemia, hypocalcemia
A

PPI

36
Q

Which drug requires monitoring of:

  • Pregnancy test
  • Serum phosphate
  • Should avoid in pregnancy
A

Misoprostol

37
Q

H. pylori can lead to what 2 cancers?

A
  • Mucosa-associated lymphoid tissue (MALT) lymphoma
  • Gastric cancer
38
Q

What are the 4 “established indications” to treat an H. pylori infection?

A
  • Gastric or duodenal ulcer
  • MALT lymphoma
  • After endoscopic resection of gastric cancer
  • Uninvestigated dyspepsia
39
Q

What is the triple therapy to eradicate H. pylori?

A
  • # 1: PPI
  • # 2: Clarithroymycin
  • # 3: Amoxicillin or Metronidazole

(all twice daily)

40
Q

What is the quadruple therapy to tx H. pylori?

A
  • bismuth
  • metronidazole
  • tetracycline
  • PPI
41
Q

Eradication of H. pylori after abx tx may be confirmed how?

A
  • urea breath test
  • Stool antigen test
  • upper endoscopy

(+ result = persistent infection)

42
Q
A

GK Pharm 2 Exam 2 (19 decks)

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