Peptic ulcer and gastro-oesophageal reflux disease

Question 1

Classify Drugs used in peptic ulcers

Answer 1

1. Drugs that inhibit gastric acid secretion
   a) proton pump inhibitor
   b)H2 receptor antagonist
   c) anti muscuranic agents
   d) prostaglandin analogues
2. ulcer protectives
3. drugs that neutralize gastric acid
   a) non-systemic antiacids
   b) systemic antacids
4. anti-H. pylori agents

Question 2

Name proton pump inhibitors

Answer 2

1. Omeprazole
2. esomeprazole
3. lansoprazole
4. pantoprazole
5. rabeprazole

Question 3

Name H2 receptor antagonist

Answer 3

1. ranitidine
2. famotidine
3. cimetidine 
4. Roxatidine
5. Nizatidine

Question 4

Name Anti muscurenic agents related to peptic ulcer

Answer 4

1. Pirenepine
2. Telenzepine

Question 5

Name prostaglandin analogues

Answer 5

1. Misoprostol
2. Enprostil 

Question 6

Name ulcer protective drugs

Answer 6

1. Sucralfate
2. colloidal bismuth substrate 

Question 7

Name non systemic antiacids

Answer 7

1. Magnesium hydroxide
2. magnesium trisilicate
3. aluminum hydroxide
4. calcium carbonate

Question 8

Name systemic antacids

Answer 8

1. Sodium bicarbonate
2. sodium citrate

Question 9

Name anti H. pylori agents

Answer 9

1. amoxycillin
2. tetracycline
3. clarithromycin
4. Metronidazole
5. bismuth subsalicylate
6. H2 antagonist
7. proton pump inhibitors

Question 10

What is the mechanism of action of proton pump inhibitor

Answer 10

1. It is absorbed into the small intestine and into the blood.
2. Then it diffuses into the parietal cells and into the Caniculi of the cell.
3. It is converted to sulfenamide . Sulfenamide binds covalenyb with SH group of the proton pump and irreversibly inactivates it

Question 11

What are the therapeutic uses of proton pump inhibitors

Answer 11

1. Peptic ulcer
   a) H. pylori associated ulcers
   b) acute bleeding ulcers
   c) NSAID induced ulcers
   d)stress ulcers
2. Used preoperatively to reduce the risk of aspiration pneumonia
3. Zollinger-Ellison syndrome
4. Gastro-oesophageal reflux disease (GERD)

Question 12

What are the adverse effects of proton pump inhibitors

Answer 12

1. Headache, diarrhoea and abdominal pain
2. skin rashes and arthralgia
3. decrease vitamin B 12 absorption
4. increase the risk of infections
5. osteoporosis
6. hypergastremia with me predisposed to gastric tumours
7. gynaecomastia
8. erectile disfunction

Question 13

 What are the drug interactions of proton pump inhibitor

Answer 13

1. Omeprazole inhibits the metabolism of drugs like phenytoin, warfarin, diazepam, etc.
2. Decrease the bioavailability of itraconazole, iron salts, etc.

Question 14

What is the mechanism of action of H2 blockers

Answer 14

Competitively block H2 receptor on parietal cells and inhibit gastric acid production. They also reduce secretion stimulated by acetylcholine, gastrin, food, etc.

Question 15

Which H2 blocker has almost 100% bioavailability

Answer 15

Nizatidine

Question 16

Which H2 blocker also has an anti-adrenergic effect

Answer 16

Famotidine
Cemetidine

Question 17

What are the drug interactions of cemetidine

Answer 17

It is an enzyme inhibitor and increases the plasma concentration of many drugs such as phenytoin, digoxin, Theophylline, warfarin, propranolol etc.

Question 18

What are the adverse effects of cemetidine 

Answer 18

1. Increases plasma prolactin levels
2. menstrual irregularities
3. galactorrhoea
4. gynaecomastia
5. oligospermia
6. impotence in men

Question 19

What are the uses of H2 antagonist

Answer 19

1. Peptic ulcer disease
   a)H pylori associated ulcers
   b)stress ulcers
   c)NSAID induced ulcers
2. Zollinger Ellison syndrome
3. gastro-oesophageal reflux disease GERD
4. preoperatively to reduce risk of aspiration pneumonia

Question 20

Name the mechanism of action of prostaglandin Analogues

Answer 20

Inhibit gastric acid secretion and increased mucus and bicarbonates secretion. They also increase mucosal blood flow. 

Question 21

What are the uses of prostaglandin analogues 

Answer 21

Prevention and treatment of NSAIDs induced gastric duodenal ulcers

Question 22

What is the mechanism of action of ulcer protective sucralfate

Answer 22

It is a complex of aluminum hydroxide and sulphate sucrose.
1. In acidic pH sucralfate undergoes polymerization and forms of sticky polymer the adheres to the ulcer base and protects it.
2. Also precipitates proteins at the ulcer base ulcer base and forms a barrier against acid pepsin.
3. Stimulates release of PGs and epidermal growth factor thus producing cytoprotective effect.
4. Increases mucus and bicarbonate secretion

Question 23

Sucralfate decreases the absorption of which drugs

Answer 23

digoxin, tetracyclines, ketoconazole, fluoroquinolones, etc 

Question 24

What are the adverse effects sucralfate

Answer 24

1. Aluminum toxicity in patients with renal failure
2. constipation

Question 25

What are the uses of sucralfate

Answer 25

1. Peptic ulcer 2. prevention of bleeding from stress ulcers 3. reduce risk of aspiration pneumonia 4. GERD with oesophagitis 5. others such as mucositis, radiation proctitis, rectal ulcer, burns, bedsores, etc.

Question 26

What are the side effects of busmuth containing preparation

Answer 26

Blackening of the tongue and stool

Question 27

What is the mechanism of Antacids

Answer 27

Weak base is the neutralize gastric acid and raise a gastric pH. Do not affect acid production but neutralizes pH

Question 28

What are the properties of an ideal antacid

Answer 28

1. Insoluble and capableof neutralizing acid 2. Not liberate CO2 3. non-absorbable 4. should not disturb the acid base balance of the body

Question 29

What are the disadvantages of sodium bicarbonate

Answer 29

1. Releases CO2 that causes abdominal distension and belching 2. highly water soluble 3. causes metabolic acidosis 4. produces rebound acidity

Question 30

Sodium bicarbonate causes sodium attention and thus Should be avoided in which patients

Answer 30

Patients with 1. CCF 2. Hypertension

Question 31

Anti-acids increase pH in this form non-observable complexes with many drugs which are what

Answer 31

1. Tetracyclines 2. iron 3. fluoroquinolones 4. ketoconazole etc

Question 32

Which drug is a topical anaesthetic and anesthetizes gastric mucosa and relieve symptoms of gastritis in GERD

Answer 32

Oxethazaine

Question 33

Which drug forms frost on the contents of the stomach and prevents gastro-oesophageal reflux

Answer 33

Sodium alginate

Question 34

Which Antibiotic drugs can be used for H. pylori infection

Answer 34

1. Amoxycillin 2. tetracycline 3. clarithromycin 4. metronidazole 5. tinidazole

Question 35

Describe triple therapy of H. pylori for 14 days

Answer 35

1. Lansoprazole 13 mg BD + 2. clarithromycin 500 mg BD + 3. amoxycillin 1 g BD Proton pump inhibitor continued for six more weeks to enhance ulcer healing

Question 36

Name quadruple drug therapy for treating H. pylori for 14 days

Answer 36

1. Omeprazole 20 mg BD + 2. Colloidal bismuth citrate 120 mg QID + 3. tetracycline 500 mg QID + 4. Metronidazole 400 mg TID Proton pump inhibitor should be used for six more weeks to enhance ulcer healing

Question 37

Which drugs are useful for GERD

Answer 37

1. Proton pump inhibitors and H2 receptor blockers 2. antacids 3. prokinetic drugs (Metoclopramide, cisapride, mosapride)