peptic ulcers Flashcards

1
Q

definition

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

classification of antacids

A

absorbable antacids

non absorbable

antacids (most common)
combined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

⦁ Non-absorbable antacids

A

Magnesium hydroxide –pulv.

° Aluminum hydroxide–pulv.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

⦁ Combined preparations

A

Almagel (Muthesa) –susp. 170ml

° Maalox –tab; susp.

° Talcid –tab.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

affect of antacids on pepsin

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

indication for aluminium and magnesium (non abs)

A

symptomatic relief of peptic ulcer disease and GERD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why are absorbable antacids rarely used

A

increased ADR e.g.

kidney stones

altered bone mineralization

alkaline milk syndrome ( nausea vom diarrheoa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

benefits of combined antacids

A

al- prolonged effect

mg- fast onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

adr’s

A

⦁ Magnesium hydroxide: Diarrhea.

⦁ Aluminum hydroxide: constipation,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

effects of cimetidine CYP450

A

cimetidine inhibits CYP450
increases serum lvl of

  • theophyline
  • diazepam
  • warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
ADR
⦁ 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
drug interactions of omeprazole d/2 CYP450 inhibition
inhibits metabolism of - cyclosporine - diazepam - phenytoin - warfarin potentiating their adrs risk
27
mucosal protective agents
enhance mucosal protection mechanisms, preventing mucosal injury, healing existing ulcers.
28
classification
Sucralfate (aluminium salt of sulfated sucrose) –tab. 500 mg: Colloidal Bismuth Subcitrate(tab. 120 mg):
29
sucralfate MOA
polymerizes in acidic conditions forms a protecting gel over ulcer stimulates - PGE2 - bicarbonate
30
sucralfate adr
constipation
31
sucralfate drug interxn
inhibits absoprtion of other drugs
32
Colloidal Bismuth MOA
binds glycoproteins and amino acids at ulcer base forming a coating. stim PGE2 and bicarbonate
33
what effect does bismuth have that sucralfate doesn't
bismuth has anti H.pylori effect
34
colloidal bismuth ADR
METAL TASTE BLACK STOOLS encephalopathy
35
ANTIMICROBIAL AGENTS FOR ERADICATION OF H.PYLORI: Classification:M CAT 500
⦁ Metronidazole (Flagyl) –tab. 500mg. ⦁ Clarithromycin (Klacid) –tab. 500 mg. ⦁ Amoxicillin (Amopen) –caps. 1 g. ⦁ Tetracycline (Tetracycline) –caps. 500 mg.
36
describe the triple therapy for H.pylori eradication
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
how long should the rx last for
10 days/ 14 days
38
considerations in pregnancy
ppi cross placental barrier and are found in breast milk replace w/ H2 blocker bismuth salts are CI in pregnancy
39
ulcer rin liver failure
ppi has liver met half the daily dose cimetidine inhibits cyp450 so special care in liver failure as it worse
40
ulcer in kidney failure
h2 blockers excreted by kidneys at same rate as creatinine reduce dose