L5 GORD, Peptic Ulcer Disease, Dyspepsia

Question 1

Ulcer in which pain is worse when fasting and relieved with food?

Answer 1

Duodenal Ulcers

Question 2

Ulcer associated with pain with eating => weight loss/anorexia, nausea?

Answer 2

Gastric Ulcers

Question 3

Main Causes of Ulcerative Dyspepsia?

Answer 3

• NSAIDS
• H Pylori
• Smoking, Alcohol
• Malignancy

Question 4

Most common cause of Peptic Ulceration in western world?

Answer 4

NSAIDS - inhibits prostaglandin production (increased acid secretion, decreased mucous secretion)

Question 5

OTC treatments of Non-Ulcerative Dyspepsia?

____________: Calcium Carbonate + Magnesium Carbonate

____________: Sodium Alginate + Calcium Carbonate- Forms raft to protect from reflux

___________: Bismuth inhibits peptic activty (Increases mucus, prostaglandin and bicarbonate secretion)

Answer 5

Rennies: Calcium Carbonate + Magnesium Carbonate

Gaviscon: Sodium Alginate + Calcium Carbonate- Forms raft to protect from reflux

Pepto Bismol: Bismuth inhibits peptic activty (Increases mucus, prostaglandin and bicarbonate secretion)

Question 6

Side Effects of Aluminium vs. Magnesium as a Dyspepsia Medication?

Answer 6

Aluminum => Constipation. also binds NSAIDS and Tetracycline decreasing bioavailability

Magnesium => Diarrhea

Question 7

MOA of Alginates against dyspepsia?

Answer 7

Usually combined in with antacids

Forms a raft to protect from reflux

Question 8

First Line Therapy for treatment of Dyspepsia (Ulcerative and Non-Ulcerative)

Answer 8

Proton Pump Inhibitors (PPIs) (-prazoles)

OR

Histamine-2 (H2) Receptor Antagonists (-tidine)

Question 9

Drugs/MOA/Absorption/Elimination/SEs of PPIs?

Answer 9

Drugs: -azole Esomeprazole, Pantoprazole, Lansoprazole

MOA: Prodrugs activated by acidic environment in the stomach and bind irreversibly to H+/K+ ATPase at the gastric parietal cell

Absorption: Rapidly absorbed in the small intestine into circulation - Taken Pre Meal

Hepatic Elimination:

• CYP 450 complications
• Decreased Ion absorption (Ca, Mg, Phosphate, Aluminum)
  => Increased risk of electrolyte deficiency
  => Increased risk of osteoporosis

Question 10

Drugs/MOA/Side Effects of Histamine-2 Receptor Antagonists?

Answer 10

Drugs: -tidine

MOA: Competitive antagonist to H2 receptor on gastric parietal cells => reduced acid/pepsin secretion

Side Effects:

• GI (Constipation, Diarrhea, Nausea, Abdominal pain)- Caused by Bacterial overgrowth due to changes in acidic environment
• Cimetidine: CYP 450 Inhibitor + Weak Anti-androgenic via inhibition of androgen receptor and increasing estrogen levels => Gynecomastia, Reduced Libido

Question 11

Second Line Treatment of Dyspepsia?

Answer 11

PPI or H2 receptor antagonist (whichever was not used as a first line)

Question 12

MOA of H. Pylori => Duodenal and Gastric Ulceration?

Diagnosis?

Answer 12

Releases Urease => Ammonia => gastric mucosa breakdown + local inflammatory response

Diagnosis:

• Urea Breath Test
• Stool Antigen Test
• Endoscopic Biopsy

Question 13

Treatment of H. Pylori Infection?

Failure?

Answer 13

Triple Therapy (2 antibiotics +PPI):

• Amoxicillin
• Metronidazole/Macrolide (Clarithromycin)
• Full Dose PPI (2x daily for 7 days)

FAILURE=> Quadruple Therapy (Culture sensitivity check prior)

• Tetracycline
• Metronidazole
• PPI
• Bismuth (14 Days)

Question 14

MOA of NSAIDs => Peptic Ulcer Disease

Answer 14

• Decreased Prostaglandin synthesis
• Inhibits gastric microcirculatory response to injury: (Prostaglandins are Vasodilators, inhibited with NSAIDs)
• COX-1 and COX-2 Inhibition
• Local irritant to stomach lining