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G.I. pharmacology > Peptic ulcer and gastro-oesophageal reflux disease > Flashcards

Peptic ulcer and gastro-oesophageal reflux disease Flashcards

1
Q

Classify Drugs used in peptic ulcers

A
  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
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2
Q

Name proton pump inhibitors

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

Name H2 receptor antagonist

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

Name Anti muscurenic agents related to peptic ulcer

A
  1. Pirenepine
  2. Telenzepine
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5
Q

Name prostaglandin analogues

A
  1. Misoprostol
  2. Enprostil 
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6
Q

Name ulcer protective drugs

A
  1. Sucralfate
  2. colloidal bismuth substrate 
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7
Q

Name non systemic antiacids

A
  1. Magnesium hydroxide
  2. magnesium trisilicate
  3. aluminum hydroxide
  4. calcium carbonate
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8
Q

Name systemic antacids

A
  1. Sodium bicarbonate
  2. sodium citrate
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9
Q

Name anti H. pylori agents

A
  1. amoxycillin
  2. tetracycline
  3. clarithromycin
  4. Metronidazole
  5. bismuth subsalicylate
  6. H2 antagonist
  7. proton pump inhibitors
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10
Q

What is the mechanism of action of proton pump inhibitor

A
  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
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11
Q

What are the therapeutic uses of proton pump inhibitors

A
  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)
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12
Q

What are the adverse effects of proton pump inhibitors

A
  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
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13
Q

 What are the drug interactions of proton pump inhibitor

A
  1. Omeprazole inhibits the metabolism of drugs like phenytoin, warfarin, diazepam, etc.
  2. Decrease the bioavailability of itraconazole, iron salts, etc.
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14
Q

What is the mechanism of action of H2 blockers

A

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

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15
Q

Which H2 blocker has almost 100% bioavailability

A

Nizatidine

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16
Q

Which H2 blocker also has an anti-adrenergic effect

A

Famotidine
Cemetidine

17
Q

What are the drug interactions of cemetidine

A

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

18
Q

What are the adverse effects of cemetidine 

A
  1. Increases plasma prolactin levels
  2. menstrual irregularities
  3. galactorrhoea
  4. gynaecomastia
  5. oligospermia
  6. impotence in men
19
Q

What are the uses of H2 antagonist

A
  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
20
Q

Name the mechanism of action of prostaglandin Analogues

A

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

21
Q

What are the uses of prostaglandin analogues 

A

Prevention and treatment of NSAIDs induced gastric duodenal ulcers

22
Q

What is the mechanism of action of ulcer protective sucralfate

A

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

23
Q

Sucralfate decreases the absorption of which drugs

A

digoxin, tetracyclines, ketoconazole, fluoroquinolones, etc 

24
Q

What are the adverse effects sucralfate

A
  1. Aluminum toxicity in patients with renal failure
  2. constipation
25
Q

What are the uses of sucralfate

A
  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.
26
Q

What are the side effects of busmuth containing preparation

A

Blackening of the tongue and stool

27
Q

What is the mechanism of Antacids

A

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

28
Q

What are the properties of an ideal antacid

A
  1. Insoluble and capableof neutralizing acid
  2. Not liberate CO2
  3. non-absorbable
  4. should not disturb the acid base balance of the body
29
Q

What are the disadvantages of sodium bicarbonate

A
  1. Releases CO2 that causes abdominal distension and belching
  2. highly water soluble
  3. causes metabolic acidosis
  4. produces rebound acidity
30
Q

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

A

Patients with
1. CCF
2. Hypertension

31
Q

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

A
  1. Tetracyclines
  2. iron
  3. fluoroquinolones
  4. ketoconazole etc
32
Q

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

A

Oxethazaine

33
Q

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

A

Sodium alginate

34
Q

Which Antibiotic drugs can be used for H. pylori infection

A
  1. Amoxycillin
  2. tetracycline
  3. clarithromycin
  4. metronidazole
    5. tinidazole
35
Q

Describe triple therapy of H. pylori for 14 days

A
  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
36
Q

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

A
  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
37
Q

Which drugs are useful for GERD

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

G.I. pharmacology (5 decks)

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