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Pharmacology > Peptic ulcer and reflux disease > Flashcards

Peptic ulcer and reflux disease Flashcards

1
Q

List the causative factors of peptic ulcer disease.

A

Increase gastric acid and/or pepsin
Reduced mucosal blood flow, duodenal bicarbonates, thickness of mucosal layer
NSAIDs, smoking

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2
Q

List the different types of anti-secretory drugs for PUD.

A

H2-receptor antagonists
Proton pump inhibitors
Anti-muscarinic drugs

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3
Q

List the different types of cytoprotective agents and mucosal strengtheners.

A

Sucralafate
Prostoglandins
Bismuth
Antacids

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4
Q

Describe the mechanism of action of proton pump inhibitors.

A

Weak bases, accumulate and activated in the canaliculi by acidic environment. Bind covalently to extracellular domain of H+/K+ATPase, 90% inhibition. Lasts 2-3 days

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5
Q

Give examples of proton pump inhibitors.

A

Esomeprazole

Pantoprazol

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6
Q

What is class of drugs that esomeprazol belongs to?

A

Proton pump inhibitors

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7
Q

Describe the kinetics of proton pump inhibitors.

A

Administered in capsules, 1 hours before meals, not coadministed with other acid suppressing agents

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8
Q

List the ADRs of proton pump inhibitors.

A

Gynaecomastia, renal impairment, headache, skin rashes, dizziness.
Old formulations inhibit CYP450

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9
Q

Describe histamine receptor antagonists for the use of PUD.

A

Reversible competitive inhibitors of H2 receptors.

Better for inhibiting nocturnal acid secretion, promotes healing of duodenal ulcers, relapse with withdrawal.

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10
Q

Give an example of histamine receptor antagonist used for PUD.

A

Ranitidine

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11
Q

What class of drugs does ranitidine belong to?

A

Histmine receptor antagonist.

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12
Q

List the side effects of histamine receptor antagonists.

A

Impotence, gynaecomastia.

Cimetidiene interferes with CYP450

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13
Q

Describe the pharmacokinetics of histamine receptor antagonists

A

Absorbed orally, high renal excretion.

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14
Q

Why are antimuscarinics rarely used for PUD?

A

Significant side effects - skin rashes, gastric stasis.

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15
Q

Why are gastrin antagonists rarely used for PUD?

A

Experimental, poor effectiveness, not used in Australia

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16
Q

Why are somatostatin analogues rarely used for PUD?

A

Require i.v. administration

17
Q

Describe the mechanism of action of sucralfate.

A

Complex of aluminium hydroxide and sulfated sucrose.
Viscous at acid pH, adheres to ulcers as a barrier
Stimulates mucosal protecting mechanisms (mucus, bicarbonate, PGs)

18
Q

List the ADRs of sucralfate.

A

Constipation, inhibit absorption of some drugs - theophylline, tetracycline, digoxin, amitriptyline.

19
Q

How is sucralfate used?

A

On an empty stomach 1h before meals

Not to be taken with antacids and meals to not alter pH

20
Q

What class of drugs does misoprostol belong to?

A

PGE1 analogue

21
Q

What is the therapeutic effect of prostaglandin analogues?

A

Inhibit acid secretion, increase mucosal blood flow and mucous, cytoprotective on gastric mucosa.

22
Q

List the ADRs of prostaglandin analogues.

A

Pain sensitisation initially, uterine contractions, diarrhoea, nausea, headache, dizziness.

23
Q

What are the clinical considerations for misoprostol (PGE1 analogue)?

A

Only for NSAID users

Ulcer healing

24
Q

What is the mechanism of action of bismuth chelate?

A

Coats ulcer base
Enhances PG synthesis, stimulates mucus and bicarbonate secretion
Moderate direct antimicrobial activity

25
Q

List the ADRs of bismuch chelate.

A

Blackening of stools and tongue, kidney and CNS cytotoxicity

26
Q

List the mechanism of action of antacids.

A

Weak acids

Inhibit pepsin formation (forms from pepsinogen at acidic pH)

27
Q

Which ulcers are antacids better for?

A

Duodenal ulcers

28
Q

What are the side effects of antacids?

A

Al3+ - constipation
Mg2+ - diarrhoea
Drug interaction to form insoluble complexes, avoided with a 2 hour gap

29
Q

What are common adjuncts to antacids?

A

Alginates: layer of foam on acid contents
Simethicone: decrease surface tension and bubble formation
Oxethazaine: local anaesthetic

30
Q

What is the best therapy for H. pylori?

A

PPI + amoxycillin + clarithromycin or

PPI + metronidazole + clarithromycin

31
Q

List the drugs that promote reflux.

A

Anti-muscarinics
PDE inhibitors
Ca2+ channel blockers
DA receptor antagonists

32
Q

List the drugs used for GORD.

A

PPIs, antacids, H2 receptor antagonists, sucralfate

Pharmacology (14 decks)

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