H2's and PPI's

Question 1

What do H2’s and PPI’s do?

Answer 1

• reduce gastric acid
• protect GI tract
• reduce incidence of ulcers
• increase risk of diarrhea and gastric cancers

Question 2

What bacteria associated with ulcers and Peptic Ulcer Disease (PUD)?

Answer 2

Helicobacter pylori
- colonizes stomach and duodenal linings
- 1/2 of all humans infected with H. pylori
- 2/3 of all with PUD cases H. pylori present

Question 3

What causes ulcers and peptic ulcer disease (PUD)?

Answer 3

• NSAIDs
  decrease protective mechanisms
  promote gastric acid secretions
• tobacco
• drugs
• dietary habits
• stress

Question 4

GI defenses

Answer 4

• mucus: protects GI linings from acid
• bicarbonate: neutralizes acid in mucosal layer
• prostaglandins: stimulate secretion of mucus and bicarbonate and promotes adequate blood flow
• blood flow itself: provides adequate nutrients and oxygen to cells

Question 4

diet and ulcers/ peptic ulcer disease

Answer 4

• small role
• bland diets do not help (diet probz not the cause)
• caffiene okay
• 5 to 6 small meals/day – not most ppl’s routine

Question 5

Histamine-2 Receptor Blockers

Answer 5

• H2 Receptor Blockers
• (-dines)
• Famotidine (Pepcid), rantidine (Zantac), cimetidine, nizatidine
• 50-75% reduction of gastric acid
• indicated for short term tx of ulcers, GERD, heartburn
• generally well tolerated

Question 6

Famotidine

Answer 6

• Pepcid
• H2 Receptor Blocker
• OTC anti-ulcer
• few indications to hold this drug
• PO, IV
• may cause thrombocytopenia (low platelets)

Question 7

Cimetidine

Answer 7

• OG anit-ulcer drug
• Tagamet
• reduces gastric acid secretion
• many drug-drug interactions – not commonly used anymore
• interactions include warfarin, beta blockers, anti-seizure meds
• headaches

Question 8

Proton Pump Inhibitors

Answer 8

• PPI’s
• (-azoles)
• Omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole, esomeprazole
• reduce acid production, 90% – more so than H2 blockers
• Is it enteric coated?? - Protonix
• not fast acting, relief next day (H2’s few hours)
• inc risk gastric cancers w/ longterm use
• may cause diarrhea
• few indications to hold

Question 9

Antacids

Answer 9

• directly neutralize stomach acids
• inorganic chemicals
• Calcium carbonate (Tums)
• Aluminum salts (Amphojel) – used w/ renal failure