- less soluble than sodium bicarb - can also be used in osteperosis

Peptic Acid Disorders Flashcards by Jonas Slackman

GERD

Excess Gastric Motility

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PUD

Gastric or Duodenal Ulcers

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Gastritis

stress related mucosal injury

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mucosal erosions and ulceration caused when…

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

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Two groups of drugs that treat acid disorders

1) Decrease acidity

2) promote/increase mucosal defense

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3 classes of drugs that decrease intragastric acidity

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

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3 classes of drugs that promote mucosal defense

1) Sucralfate
2) Prostaglandin analogs
3) Bismuth

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Antacids
Rx or over the counter?
Used for?
ADR?
Max frequency?

Nonprescriptions
good for heartburn and dyspepsia
neutralize stomach acid
Cause constipation/ diarrhea
max frequency: 1-2 times / week

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MOA of Antacids

-weak bases + HCL => H2O + salt

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Why are antiacids not very effective?

The body just gets more acidy (makes more acid)

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How long does antiacid work?

2 hours

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Pharmacokinetics of Antiacids

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

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What are the two types of antiacid drug interaction?

1) Bind to other drugs

2) some drugs need acidity

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

tetracycline, fluorquinolones, itraconazole, iron

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RX LISt Antacids

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

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Sodium Bicarbonate

-combine with HCL=>CO2

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ADRs of Sodium Bicarbonate

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

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Calcium Carbonate

less soluble than sodium bicarb

- can also be used in osteperosis

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ADRs of Calcium Carbonate

hypercalcemia, metabolic alkalosis

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Magnesium Hydroxide & Aluminum Hydroxide

used togethor
dont form CO2
little metabolic alkolosis
neutralize HCL well

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ADRs of Magnesium Hydroxide & Aluminum Hydroxide

Magnesium causes diarrhea & aluminum causes constipation
renal dz= al and mg toxicity

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when were H2 Receptor Antagonists introduced

70s

OTC or RX

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H2 Receptor Blocker RX List

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

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Which H2 blocker causes the most complications?

Cimetidine

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Which H2 blocker is only non IV?

Nizatidine

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

Ranitidine

Which cell are H2 receptors on?

Parietal cells

What do parietal cells release?

acid

Effect of H2 blocker of parietal cells...

- go for H2 receptor but as dose increase become less selective and also go for H1 receptors

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

60-70% | BID

H2 blocker dose for GERD

BID

H2 blocker dose for ulcer dz

twice a day or one large dose at bedtime

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

decrease dose in moderate to severe renal insufficiency

ADRS of H2 blockers in ICU patients

hallucinations from IV formulation

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

- Climetidine - gynecomastia and impotence in men - galactorrhea in women

H2 Blockers in pregnancy

-safest | B class

Antiacid classes ranked in pregancy safety

Antiacids > H2 blockers > PPI

What are the four clinical uses of H2 blockers?

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

What is the most effective group of antiacid drugs?

Proton Pump Inhibitors

Long term risks of PPIs...

3% chronic kidney dz | 16% MI

PPIs RX list

- 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

PPI MOA...

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

What percent of acid secretion do PPIs block

90-98%

Dosing of PPIs

Oral or IV, take on empty stomach 30-60 min before meals, | -take once/day

ADRs of PPIs

- c. diff - abdominal pain - bone fractures - decreased absorption of magnesium, calcium, and iron

Risks of PPIs

- B12 deficiency - respiratory and enteric infections - Gastrinoma

PPIs and pregancy

- Omeprazole & Esomeprazole = Class C = fetal toxicity | - other PPIs are class B

Clopidogrel and PPIs

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

Clinical uses of PPIs

``` GERD PUD Nonulcer dyspepsia Prevention of stress related bleeding Gastrinoma ```

Drugs that promote mucosal defense

- Sucralfate - Prostaglandin analogue- mIsoprostol - Bismuth subsalicylate

Sucralfate MOA

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

ADR of Sucralfate

constipation

Drug interactions of Sucralfate

1) binds and decreases absorbance of other drugs | 2) it is an aluminum based drug= interacts with quinolones and TCN

2 Clinical uses of Sucralfate

1) USE IN PREGNANCY | 2) Prevent bleeding from stress gastritis

Dosing of Sucralfate

4x daily

MOA of Misoprostol- prostoglandin analogue

protect gastric mucosa | only given for NSAID induced ulcer

ADRs Misoprostol- prostoglandin analogue

TERATOGEN STIMULATES UTERINE CONTRACTIONS diarrhea, stomach pain, stimulate uterine contractions

MOA Bismuth Subsalicylate

coats ulcers, protect from further damage

ADRs of Bismuth Subsalicylate

blackens stools, salicylate toxicity

Treatment for infrequent GERD or Dyspepsia

use antacids of H2 blockers

Frequent GERD or Dyspepsia symptoms > 3 times/ weeks

H2 blockers- twice daily | controls symptoms 50-75 %

Severe GERD

PPIs | Erosions-> barrets esophagus

Therapy length for GERD

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

Non-ulcer dyspepsia= bloating

There is nothing

Uncomplicated PUD

PPIs work faster than H2 blockers PPIs heal 90% ulcers after 6-8 weeks

H Pylori PUD

PrevPack, continue PPI for 6 weeks

PrevPak

lansoprazole amoxicillin clarithromycin

NSAID in PUD

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

What stomach pH should ICU patients be kept at

above 4= less bleeding

Prophylatic treatment for ICU pts.

H2 blockers IV PPI= omeprazole- only one proved to work sucraofate- helps

Grastrinoma treatment

surgical and PPIs