Peptic ulcer

Question 1

action of PGs

Answer 1

inc CAMP, inc blood flow, dec HCl (AP3 inhibit camp in parietal)

Question 2

antibiotics to address primary problem

Answer 2

amoxicillin, tetracycline, clarithromycin, metronidazole

Question 3

controllers of acid secretion

Answer 3

inc by histamine, gastrin, ach

Question 4

cimetidine, ranatidine

Answer 4

H2 antagonists
reduce basal and food stimulated acid secretion
reduce vol and conc of H+ secretion
heal ulcers

side effects: cyctochrome p450 inhib (potentiate tcas and anticoags)
dec male sexual function

Question 5

pirenzipine

Answer 5

M1 antagonist
reduce basal and food stimulated
heal ulcers

side effects: dry mouth

Question 6

omeprazole etc

Answer 6

PPI
for H2 antagonist non-responders
irreversible reaction with cysteine group
inactive in neutral ph, accumulates in low ph

side effect: diarrhoea (rare)

Question 7

antacids

Answer 7

NaHCO3 - but CO2 production

MgCl2 + H2O/ AlCl2 (diarrhoea/constipation)

Question 8

sucralfate

Answer 8

complex gel coating to protect mucosa (sucrose sulphate and AlOH)

side effect: constipation.

Question 9

bismuth chelate

Answer 9

coat ulcer, PG synthesis agonist (inc bicarb secretion), absorb pepsin

toxic to h pylori

side effects: n&v

Question 10

misoprostol

Answer 10

pge1 analog
acts on parietal cell to dec. secretion
inc blood flow, mucus and bicarb

good for nsaid induced

side effects: diarrhoea, nausea, abortion