Peptic Ulcer Disease (PUD)

Question 1

Pepsinogen

Answer 1

Secreted by chief cells, breaks down proteins

Inactive form of pepsin

Question 2

HCL

Answer 2

Secreted by parietal cells, breaks down food

Activates pepsinogen

Question 3

Intrinsic factor

Answer 3

Secreted by parietal cells

Vitamin B absorption

Question 4

Protective factors

Answer 4

Mucus and bicarbonate (basic)

Question 5

Dyspepsia

Answer 5

Imbalance between aggressive and protective factors in the stomach

Question 6

GERD

Answer 6

Gastroesophagel Reflux Disease “Heartburn”

Acidic contents of stomach move upward into esophagus when stomach contracts due to decreased lower esophagel sphincter tone

Question 7

GERD Stages Treatment

Answer 7

1-H2 antagonist and antacids as needed
2-H2 antagonist
3-proton pump inhibitors (ppi)

Question 8

PUD

Answer 8

Peptic Ulcer Disease

Erosion of the mucosal layer of the GI tract along with acute inflammation

Question 9

Location/Cause of PUD

Answer 9

Duodenum (most common)

Usually correlated with H pylori infection

Question 10

H pylori Antibiotics

Answer 10

Clarithromycin
Amoxicillin
metronidazole
tetracycline

Question 11

Triple therapy (H pylori)

Answer 11

PPI +clarithromycin +amoxicillin/metronidazole/or tetracycline

Question 12

Quadruple Therapy (H pyloro)

Answer 12

PPI + metronidazole + pepto + tetracycline

Question 13

H2 Receptor antagonist (-tidine) MOA

Answer 13

Decrease stomach acid through suppressing volume and acidity of parietal cell secretions

*H2 only found in stomach

Available otc for gerd short term

Question 14

H2 receptor antagonists drugs

Answer 14

Cimetidine(tagamet)
Famotidine(pepcid)
Ranitidine(Zantac)

Question 15

Cimetidine (tagamet)

Answer 15

*Inhibits p450 enzymes

First drug

Females dec alcohol metabolism
Males inc estradiol, gynecomastia

Question 16

Famotidine(Pepcid)

Answer 16

Best bc of bioavailability

Longer half life and no p450 inhibit

Question 17

Ranitidine(zantac)

Answer 17

Prototype drug

Higher potency than cimetidine

Question 18

PPI MOA *-prazole

Answer 18

Dec acid secretion by irreversibly blocking H+, K+, -ATPase

Can have gastrin rebound/interfere with Ca absorption

Question 19

Omeprazole(prilosec) PPI

Answer 19

Enters as prodrug, converted into sulfenic acid, and then inhibits proton pump by binding to it covalent and irreversible

Question 20

Esomeprazloe(nexium)

Answer 20

Other PPI

Question 21

Sucralfate(carafate) MOA

Answer 21

Neutralize acid and coat the empty stomach with yellow viscous goo

Question 22

Misoprostol(cytotec) MOA

Answer 22

Inhibits acid secretion and stimulates mucus secretion

Stimulates oxytocin receptor and useful for NSAID users

Question 23

Is Misoprostol(cytotec) category X

T/F

Answer 23

True

Question 24

Simethicone (gas-X, Mylanta gas)

Answer 24

Reduce gas bubbles/bloating

Question 25

Antacids (Ca++, Al3+, Mg 2+) MOA

Answer 25

Alkaline substances that neutralize stomach acid

Otc and usually used in combination

Question 26

Mg is ______

Answer 26

Cathartic

Question 27

Al is ____

Answer 27

Constipating

Question 28

Calcium carbonate (A)

Answer 28

Tums

Question 29

Calcium carbonate with magnesium hydroxide (A)

Answer 29

Mylanta Supreme, Rolaids

Question 30

Magnesium hydroxide (A)

Answer 30

Milk of magnesia

Question 31

Sodium bicarbonate (A)

Answer 31

Alka-seltzer

Question 32

Aluminum hydroxide (A)

Answer 32

Alterna Gel

Question 33

Mg OH with Al OH and simethicone (A)

Answer 33

Mylanta

Question 34

Pepto-Bismol (bismuth salts) MOA

Answer 34

Bismuth inhibits bacterial growth, may prevent bacteria from adhering to stomach wall