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PHARM EXAM 2 > Peptic Acid Disorders > Flashcards

Peptic Acid Disorders Flashcards

1
Q

GERD

A

Excess Gastric Motility

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2
Q

PUD

A

Gastric or Duodenal Ulcers

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3
Q

Gastritis

A

stress related mucosal injury

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4
Q

mucosal erosions and ulceration caused when…

A

that occur when caustic substances (acid, pepsin and bile) overwhelm the GI mucosa defensive mechanisms

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5
Q

Two groups of drugs that treat acid disorders

A

1) Decrease acidity

2) promote/increase mucosal defense

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6
Q

3 classes of drugs that decrease intragastric acidity

A

1) Antacids
2) Histamine- 2 Receptor Blockers H2
3) Proton Pump Inhibitors

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7
Q

3 classes of drugs that promote mucosal defense

A

1) Sucralfate
2) Prostaglandin analogs
3) Bismuth

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8
Q 
Antacids
Rx or over the counter?
Used for?
ADR?
Max frequency?
A
  • Nonprescriptions
  • good for heartburn and dyspepsia
  • neutralize stomach acid
  • Cause constipation/ diarrhea
  • max frequency: 1-2 times / week
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9
Q

MOA of Antacids

A

-weak bases + HCL => H2O + salt

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10
Q

Why are antiacids not very effective?

A

The body just gets more acidy (makes more acid)

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11
Q

How long does antiacid work?

A

2 hours

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12
Q

Pharmacokinetics of Antiacids

A

Liquid best
more water soluble= more effective
Gastric emptying high= less neutralization

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13
Q

What are the two types of antiacid drug interaction?

A

1) Bind to other drugs

2) some drugs need acidity

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14
Q

Antacids should not be given within 2 hours of what drugs?

A

tetracycline, fluorquinolones, itraconazole, iron

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15
Q

RX LISt Antacids

A

Sodium Bicarbonate
Calcium carbonate
Aluminum hydroxide gel
Aluminum hydroxide and MG hydroxide

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16
Q

Sodium Bicarbonate

A

-combine with HCL=>CO2

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17
Q

ADRs of Sodium Bicarbonate

A

-increase NA
increased Na => CHF, HTN, liver failure, renal insufficiency
-metabolic alkalosis

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18
Q

Calcium Carbonate

A
  • less soluble than sodium bicarb

- can also be used in osteperosis

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19
Q

ADRs of Calcium Carbonate

A

hypercalcemia, metabolic alkalosis

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20
Q

Magnesium Hydroxide & Aluminum Hydroxide

A
  • used togethor
  • dont form CO2
  • little metabolic alkolosis
  • neutralize HCL well
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21
Q

ADRs of Magnesium Hydroxide & Aluminum Hydroxide

A
  • Magnesium causes diarrhea & aluminum causes constipation
  • renal dz= al and mg toxicity
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22
Q

when were H2 Receptor Antagonists introduced

A

70s

OTC or RX

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23
Q

H2 Receptor Blocker RX List

A 
Cimetidine (Tagamet)- most complications
Famotidine (Pepcid)
Nizatidine (Axid)- only non IV
Ranitidine (Zantac)- most common- best one
-itidine
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24
Q

Which H2 blocker causes the most complications?

A

Cimetidine

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25
Q

Which H2 blocker is only non IV?

A

Nizatidine

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26
Q

Which H2 blocker is most commonly used and is the best one?

A

Ranitidine

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27
Q

Which cell are H2 receptors on?

A

Parietal cells

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28
Q

What do parietal cells release?

A

acid

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29
Q

Effect of H2 blocker of parietal cells…

A
  • go for H2 receptor but as dose increase become less selective and also go for H1 receptors
30
Q

A usual H2 blocker dose will inhibit 24 hr secretion of HCL by what percent?

A

60-70%

BID

31
Q

H2 blocker dose for GERD

A

BID

32
Q

H2 blocker dose for ulcer dz

A

twice a day or one large dose at bedtime

33
Q

What do you need to do to the H2 blocker dose in renal failure?

A

decrease dose in moderate to severe renal insufficiency

34
Q

ADRS of H2 blockers in ICU patients

A

hallucinations from IV formulation

35
Q

Which H2 Rx has the most drug interaction and what ADRs does it have?

A
  • Climetidine
  • gynecomastia and impotence in men
  • galactorrhea in women
36
Q

H2 Blockers in pregnancy

A

-safest

B class

37
Q

Antiacid classes ranked in pregancy safety

A

Antiacids > H2 blockers > PPI

38
Q

What are the four clinical uses of H2 blockers?

A

1) GERD
2) PUD
3) Nonucler dyspepsia
4) Prevention of bleeding from stress ulcers

39
Q

What is the most effective group of antiacid drugs?

A

Proton Pump Inhibitors

40
Q

Long term risks of PPIs…

A

3% chronic kidney dz

16% MI

41
Q

PPIs RX list

A
  • Esomeprazole (Nexium)-otc
  • Omeprazole (Prilosec)-otc
  • Lansoprazole (Prevacid)-otc
  • Pantoprazole (Protonix)-perscription only– cheapes generic available
  • Rabeprazole (Aciphex)-perscription only
  • Dexlansoprazole (Dexilant)- extended release?-perscription only
  • prazole
42
Q

PPI MOA…

A

prodrug, absorbed in small intestine, converted to active drug, work on piratetal cells by inhibiting HK-ATPase
non pumps= no acid

43
Q

What percent of acid secretion do PPIs block

A

90-98%

44
Q

Dosing of PPIs

A

Oral or IV, take on empty stomach 30-60 min before meals,

-take once/day

45
Q

ADRs of PPIs

A
  • c. diff
  • abdominal pain
  • bone fractures
  • decreased absorption of magnesium, calcium, and iron
46
Q

Risks of PPIs

A
  • B12 deficiency
  • respiratory and enteric infections
  • Gastrinoma
47
Q

PPIs and pregancy

A
  • Omeprazole & Esomeprazole = Class C = fetal toxicity

- other PPIs are class B

48
Q

Clopidogrel and PPIs

A

PPIs decrease the anti platelet effect of clopidogrel

  1. Avoid use of omeprazole while taking clopidogrel b/c get less antiplatelet effect, also called clopidogrel resistance
    2) also avoid esomeprazole, cimetidine, - azoles while taking clopidogrel
    3) If there is a risk of GI bleeding use Rabeprazole, pantoprazole
49
Q

Clinical uses of PPIs

A 
GERD
PUD
Nonulcer dyspepsia
Prevention of stress related bleeding
Gastrinoma
50
Q

Drugs that promote mucosal defense

A
  • Sucralfate
  • Prostaglandin analogue- mIsoprostol
  • Bismuth subsalicylate
51
Q

Sucralfate MOA

A

thick sticky paste, binds to ulcers, coats, little is absorbed

52
Q

ADR of Sucralfate

A

constipation

53
Q

Drug interactions of Sucralfate

A

1) binds and decreases absorbance of other drugs

2) it is an aluminum based drug= interacts with quinolones and TCN

54
Q

2 Clinical uses of Sucralfate

A

1) USE IN PREGNANCY

2) Prevent bleeding from stress gastritis

55
Q

Dosing of Sucralfate

A

4x daily

56
Q

MOA of Misoprostol- prostoglandin analogue

A

protect gastric mucosa

only given for NSAID induced ulcer

57
Q

ADRs Misoprostol- prostoglandin analogue

A

TERATOGEN STIMULATES UTERINE CONTRACTIONS

diarrhea, stomach pain, stimulate uterine contractions

58
Q

MOA Bismuth Subsalicylate

A

coats ulcers, protect from further damage

59
Q

ADRs of Bismuth Subsalicylate

A

blackens stools, salicylate toxicity

60
Q

Treatment for infrequent GERD or Dyspepsia

A

use antacids of H2 blockers

61
Q

Frequent GERD or Dyspepsia symptoms > 3 times/ weeks

A

H2 blockers- twice daily

controls symptoms 50-75 %

62
Q

Severe GERD

A

PPIs

Erosions-> barrets esophagus

63
Q

Therapy length for GERD

A

H2 blocker= 3 months
PPIs= 2 months
Complication of GERD= PPIs 4 months

64
Q

Non-ulcer dyspepsia= bloating

A

There is nothing

65
Q

Uncomplicated PUD

A

PPIs work faster than H2 blockers

PPIs heal 90% ulcers after 6-8 weeks

66
Q

H Pylori PUD

A

PrevPack, continue PPI for 6 weeks

67
Q

PrevPak

A

lansoprazole
amoxicillin
clarithromycin

68
Q

NSAID in PUD

A

NSAIDs inhibiti prostoglandins, stop NSAID and initiate therapy with either H2 or PPI, if pt. continues NSAIDs must take PPI

Give PPIs if pt. is on NSAID prophylaxis

69
Q

What stomach pH should ICU patients be kept at

A

above 4= less bleeding

70
Q

Prophylatic treatment for ICU pts.

A

H2 blockers IV

PPI= omeprazole- only one proved to work

sucraofate- helps

71
Q

Grastrinoma treatment

A

surgical and PPIs

PHARM EXAM 2 (3 decks)

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