Peptic Ulcer Disease

Question 1

Omeprazole, Esomeprazole, Pantoprazole

Answer 1

Peptic ulcer disease
-Proton pump Inhibitor (PPI)
MOA
-Inhibit the H+/K+ ATPase thus decreasing Acid in the Stomach Lumen
Physiological effects
-Decreases secretion of acid into the stomach lumen
-Raises gastric pH to 4 – 6
• IV vs PO –> Equally effective at increasing pH
• IV vs PO –> IV may work 1 hour faster
-PPIs are more superior for bleeding ulcers
ADE
o Acute Adverse Effects
• Headache, Nausea, Abdominal pain
o Chronic Adverse Effects
• Drug interactions, Disease correlations, Effects of increased gastric pH
o Inhibitors of CYP2C9, CYP2C19

Question 2

Ranitidine, famotidine, cimetidine

Answer 2

Peptic ulcer disease
-H2- Receptor Antagonist
MOA
-Blocks Histamine Receptor thus inhibiting an H+/K+ ATPase activator, therefore decreasing the amount of acid in the stomach lumen.
Physiological effectso
-Increases gastric pH but less than PPIso
-Cimetidine – inhibits several CYP isoenzymes (numerous drug interactions)
-Equal in efficacy to PPIs for non-bleeding ulcers, stress ulcer prophylaxis
ADE
o Acute Adverse Effects
• Headache, Dizziness
o Chronic Adverse Effects
• Thrombocytopenia?, Effects of increased gastric pH

Question 3

Sucralfate

Answer 3

Peptic ulcer disease
-NSAID Induced Treatment besides H2RA and PPI
MOA
-Forms a complex of albumin / fibrinogen at ulcer site creating a protective barrier
-May increase PGE2, gastric mucus
ADE
-constipation

Question 4

Misoprostol

Answer 4

Peptic ulcer disease
-NSAID Induced Treatment besides H2RA and PPI
MOA
-Synthetic analog of PGE1
-Promotes gastric mucus and mucosal bicarb secretion
-Inhibits basal and nocturnal gastric acid secretion from parietal cells
Clinical concepts
-Stimulates uterine contractions – CONTRAINDICATED in pregnancy, can cause abortion
ADE
-Diarrhea (dose dependent)
-Abdominal cramping, flatulence

Question 5

Calcium Carbonate, Aluminum Hydroxide, Magnesium Hydroxide, Bismuth Subsalicylate

Answer 5

Peptic ulcer disease
-antacids
MOA
-Directly neutralizes acidity in stomach
-Acts as a buffer to increase gastric pH
-Slight increases in pH inhibits pepsin proteolysis which may be beneficial in patients with ulcers
ADE
-Flatulence, gastric distention, nausea, vomiting, diarrhea, constipation, eructation, abdominal cramping, chalky taste, hypercalcemia

Question 6

Azithromycin (Erythromycins), Bethanechol, Metoclopramide, Cisapride (limited access

Answer 6

Peptic ulcer disease
-prokinetic agents
MOA
-Increase gastric emptying