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clinical pharm y5 > peptic ulcers > Flashcards

peptic ulcers Flashcards

1
Q

definition

A

erosion of the gastric/ duodenal mucosa up to lamina muscularis mucosae

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2
Q

classification of anti ulcer drugs

A

⦁ Antacids.

drugs suppressing secretion

⦁ Proton pump inhibitors (PPI).
⦁ H2 –histamine receptor blockers.
⦁ Antimuscarinic agents.
Mucosal protective agents.

drugs for the eradication of H.pylori

⦁ Antimicrobial agents for eradication of Helicobacter pylori.

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3
Q

classification of antacids

A

absorbable antacids

non absorbable

antacids (most common)
combined

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4
Q

⦁ Absorbable antacids

A

Sodium bicarbonate –pulv (can produce transient metabolic alkalosis; therefore, not recommended for long-term use).

° Calcium carbonate –tab (reacts with HCl to form CO2 and CaCl2; commonly used).

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5
Q

⦁ Non-absorbable antacids

A

Magnesium hydroxide –pulv.

° Aluminum hydroxide–pulv.

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6
Q

⦁ Combined preparations

A

Almagel (Muthesa) –susp. 170ml

° Maalox –tab; susp.

° Talcid –tab.

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7
Q

what are antacids

A

weak bases that react with gastric acid to form water and a salt,
diminishing gastric acidity.

take 1-3 hrs b4 meal and before bed

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8
Q

affect of antacids on pepsin

A

reduces it’s effect by increasing ph above 4 rendering it inactive

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9
Q

indication for aluminium and magnesium (non abs)

A

symptomatic relief of peptic ulcer disease and GERD.

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10
Q

why are absorbable antacids rarely used

A

increased ADR e.g.

kidney stones

altered bone mineralization

alkaline milk syndrome ( nausea vom diarrheoa)

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11
Q

benefits of combined antacids

A

al- prolonged effect

mg- fast onset

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12
Q

adr’s

A

⦁ Magnesium hydroxide: Diarrhea.

⦁ Aluminum hydroxide: constipation,

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13
Q

H2 RECEPTOR ANTAGONISTS

A

act selectively on H2 receptors in the stomach, blood vessels, and other.

competitive antagonists of histamine

fully reversible.

completely inhibit gastric acid secretion induced by histamine or gastrin.

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14
Q

H2 antagonist classification

A

FIRST GEN
⦁ Cimetedine –tab. 200 mg.

SECOND GEN
⦁ Ranitidine (Zantac) –tab. 150mg; 300mg.

THIRD GEN
⦁ Famotidine (Qamatel) –tab. 20mg; 40mg.

⦁ Nizatidine –tab.

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15
Q

how are H2 antagonis

phk ADME

A

ADMIN h2 antag
oral
IV less common

DISTRO: h2 antag

  • breat milk
  • cross placenta

Met:
liver

EXC: h2 blockers
urine

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16
Q

effects of cimetidine CYP450

A

cimetidine inhibits CYP450
increases serum lvl of

  • theophyline
  • diazepam
  • warfarin
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17
Q

diff betw/ 1st gen cimetidine and 2nd gen ranitidine

A

ranitidine is longer acting

ranitidine is more potent

ranitidine doesn’t affect other drugs unlike cimetidine

18
Q

compare famotidine to ranitidine

A

3 to 20 times more potent than ranitidine.

19
Q

ADR of H2 antag

A

endocrine: gynecomastia reduced sperm count (CIMETIDINE, again)

CNS disturbed in elderly w/ iv admin

⦁ Inhibition of hematopoiesis.

20
Q

drug interxns of H2 antag

A

cimetidine and ranitidine increases metabolistm

cimetidine increases drug conc of

  • theophylline
  • diazepam
  • warfarin

ketoconizole rnneds acidity for absoprtion so has reduced absorption if taken w/ theses

21
Q

PROTON PUMP INHIBITORS (PPIs)

A

⦁ Omeprazole (Sopral) –caps. 20mg.
⦁ Esomeprazole (Nexium) –tab. 20mg.
⦁ Rabeprazole (Pariet) –tab. 20mg.

22
Q

PPI phD

A

prodrugs with an acid-resistant enteric coating

coating is removed in the alkaline duodenum

absorbed and transported to the parietal cell canaliculu

converted to the active form reacts with the H+/K+-ATPase, forming a stable covalent bond.

inhibit gastric acid secretion by more than 90 percent.

23
Q

indications for ppi

5

A

⦁ Treating erosive esophagitis, GERD

⦁ Active duodenal ulcer;

⦁ Long-term treatment of Zollinger-Ellison syndrome);
⦁ PPIs reduce the risk of bleeding by aspirin and other NSAIDs.
⦁ PPIs used with antimicrobial regimens to eradicate H. pylori.

24
Q

ppi phK

A

ADMIN: PPI
oral

DISTRO: ppi

MET: ppi
liver

EXC: ppi
urine
feces

25
Q

ADR

A

⦁ Decreased vitamin B12 and calcium absorption due to suppressed gastric acid secretion.

⦁ Hypochlorhydria and risk of enteric infections.

⦁ The incidence of gastric carcinoid tumors increased

26
Q

drug interactions of omeprazole d/2 CYP450 inhibition

A

inhibits metabolism of

  • cyclosporine
  • diazepam
  • phenytoin
  • warfarin

potentiating their adrs risk

27
Q

mucosal protective agents

A

enhance mucosal protection mechanisms, preventing mucosal injury,
healing existing ulcers.

28
Q

classification

A

Sucralfate (aluminium salt of sulfated sucrose) –tab. 500 mg:

Colloidal Bismuth Subcitrate(tab. 120 mg):

29
Q

sucralfate MOA

A

polymerizes in acidic conditions

forms a protecting gel over ulcer

stimulates

  • PGE2
  • bicarbonate
30
Q

sucralfate adr

A

constipation

31
Q

sucralfate drug interxn

A

inhibits absoprtion of other drugs

32
Q

Colloidal Bismuth MOA

A

binds glycoproteins and amino acids at ulcer base forming a coating.

stim PGE2 and bicarbonate

33
Q

what effect does bismuth have that sucralfate doesn’t

A

bismuth has anti H.pylori effect

34
Q

colloidal bismuth ADR

A

METAL TASTE

BLACK STOOLS

encephalopathy

35
Q

ANTIMICROBIAL AGENTS FOR ERADICATION OF H.PYLORI:

Classification:M CAT 500

A

⦁ Metronidazole (Flagyl) –tab. 500mg.

⦁ Clarithromycin (Klacid) –tab. 500 mg.

⦁ Amoxicillin (Amopen) –caps. 1 g.

⦁ Tetracycline (Tetracycline) –caps. 500 mg.

36
Q

describe the triple therapy for H.pylori eradication

A

1) PPI (omeprazole)2x/d

2) clarithromycin 500mg 2x/day
if resistant use
- metronidazole 500mg 2x/day

3) amoxicillin 1000mg2x/d or metronidazole if not used in step 2

37
Q

how long should the rx last for

A

10 days/ 14 days

38
Q

considerations in pregnancy

A

ppi cross placental barrier and are found in breast milk
replace w/ H2 blocker

bismuth salts are CI in pregnancy

39
Q

ulcer rin liver failure

A

ppi has liver met
half the daily dose

cimetidine inhibits cyp450 so special care in liver failure as it worse

40
Q

ulcer in kidney failure

A

h2 blockers excreted by kidneys at same rate as creatinine

reduce dose

clinical pharm y5 (22 decks)

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