Peptic ulcer management

Question 1

peptic ulcers can occur where?

Answer 1

gastric and duodenal mucosa

Question 2

what are the peptic ulcer manegment drugs that function by decreasing gastric secretions ?

Answer 2

Proton pump inhibitors and H2 antagonists

Question 3

all h2 antagonist drugs end in suffix :

Answer 3

-idine

Question 4

all PPI drugs end in suffix:

Answer 4

-prazole

Question 5

what class of drug works by neutralizing gastric acid?

Answer 5

antacids

Question 6

what are some examples of mucosal/ulcer protective agents and how do they function ?

Answer 6

Sucralfate and CBS

mechanism: in acidic ph (<4) it polymerizes by cross linking of molecules and forms sticky gel which acts as acid resistant physical Barrier

-also secrets PGE2 AND HCO3-

-promotes healing of ulcer by binding to epithelial growth factors

Question 7

what is the mechanism of PPI and what do they bind to ?

Answer 7

activated form (activated when in acidic environment ) binds irreversibly to H+/K+ ATPase enzyme system (proton pump )and inhibits it

Question 8

PPI is a pro drug that is activated when ____

Answer 8

in acidic environment

Question 9

how long does it take for enzyme to resynthesizes after taking PPI?

Answer 9

18 hours

Question 10

what is the preferred drug for treatment of strep ulcer / GERD prophylaxis ?

Answer 10

PPI

Question 11

prolonged use of PPI can result in ___

Answer 11

gastritis

Question 12

what type of ulcer is H2 antagonist used to treat?

Answer 12

gastric ulcer caused by histamine induced gastric acid secretion

also NSAID induced ulcers ( if NSAIDs need to be continued then PPI is preferred)

Question 13

describe the mechanism of H2-antagonists.

Answer 13

competitively inhibits H2 receptors on parietal cells and suppress basal and food stimulated acid secretions

Question 14

what are the adverse effects of antacids?

Answer 14

AL. salts cause constipation
Mg. salts cause diarrhea
decrease bioavailability of other drugs

Question 15

what are the adverse effects of CBS ?

Answer 15

blackening of stool and darkening of tongue

Question 16

what’s the anti-microbial action of CBS ?

Answer 16

it dislodges H.pylori from surface of gastric mucosa

Question 17

how does H. pylori affect the stomach ?

Answer 17

disturbs normal negative feedback mechanisms of gastric secretion /acid release

produce other protylitic enzymes that decrease defense

Question 18

is single therapy effective in treating H. pylori infection ? if not , why , and what is an alternative effective treatment ?

Answer 18

no single therapy is not effective because resistance happens very quickly . instead , triple or quadruple therapy is employed .

triple therapy : omeprazole + clarithromycin + amoxicillin / metronidazole

quadruple therapy : omeprazole + CBS + tetrocyclien + metronidazole