Peptic Ulcers Agents

Question 1

What is used to eradicate H. pylori? (they lead to stomach ulcers)

Answer 1

Antibacterials are used to eradicate H. pylori

Question 2

Proton Pump Inhibitors: Adverse Effects? how long is its therapy? What does it ireversibly bind? to?

Answer 2

-Safe for short-term therapy
4-8 weeks

-Incidence low and uncommon:
headaches, GI (nausea/vomiting/diarrhea)

-Use with caution in patients with liver disease

Binds to H/K ATPase enzyme (proton pump)

Question 3

What is Misoprostol used to reduce?

Answer 3

To reduce gastic effects of NSAIDs e.g. ASA, diclofenac

Question 4

What kind of agent is misoprostol? (antacid)

Answer 4

-Synthetic prostaglandin (PGE1) analogue (helps replace prostaglandins)

Prostaglandins have cytoprotective activity  production of mucus and bicarbonate

Question 5

Inhibitors of Gastric Acid Secretion/Action, How do they work?

Answer 5

-H2 antagonists
-Proton pump inhibitors
-Antacids
-Other Agents – Protect mucosa

Question 6

What kind of therapy is used for H.pylor? how long is treatment?

Answer 6

Triple Therapy”
-Antibacterials eg amoxicillin + clarithromycin
-Proton pump inhibitor eg omeprazole
-7 – 14 days

(this reduces the chance of resistant developing)

Question 7

Misoprostol – Adverse Effects

Answer 7

*NOT USED IN PREGNANCY (can be used in medically mediated abortions)
Therapeutic doses for duodenal ulcers
often produce abdominal cramps, diarrhea

Question 8

H2 Antagonists: Adverse Effects?

Answer 8

-Low incidence of adverse effects

-Cimetidine may induce impotence and gynecomastia
antiandrogenic effect

-In elderly may see:
CNS depression (eg lethargy), confusion
renal/hepatic impairment

Question 9

What do Magnesium salts commonly cause? When are they dangerous for use?

Answer 9

Commonly cause diarrhea
(usually used with other agents to counteract diarrhea)
Dangerous when used with renal failure - Can lead to toxicitys

Hydroxide salt: magnesium hydroxide
Carbonate salt (also a combination product)
Combination products (aluminum and magnesium)

Question 10

Example of a Proton Pump Inhibitor (PPI)? How is it broken down?

Answer 10

Omeprazole (they all end with azole), they are all very similar

-Broken down by acid

Question 11

Example of an H2 Antagonist that reduces acid secretion is the most popular agent for treatment of acid related disorders?

Answer 11

Cimetidine (Tagamet)

Question 12

Client Implications/what must we teach out clients while taking H2 Antagonists (Cimetidine)

Answer 12

Care in patients with impaired renal or liver function

Use with caution in patients who are confused, disoriented, or elderly

Take 1 hour before or after antacids- important
affects absorption

Question 13

Antacids are used alone or in combination with what agents? How long are meds given after antacids are administered?

Answer 13

*Aluminum salts - Cause constipation

*Magnesium salts

*Calcium salts

*Sodium bicarbonate

1-2 hours

Question 14

Proton Pump Inhibitors (PPI): Mechanism of Action/how do they work?

Answer 14

-Irreversibly bind to H+/K+ ATPase enzyme (proton pump)

-normal acid secretion requires parietal cell to synthesize new H+/K+ ATPase

Question 15

Proton Pump Inhibitors: Indications/How is it used? what may they inhibit? What medication can be given along with it to help with this?

Answer 15

-Short-term treatment of active duodenal and benign gastric ulcers (4 to 8 weeks)

-GERD maintenance therapy

-Erosive esophagitis

May inhibit the absorption of drugs that require an acidic GI environment for absorption (ketoconazole given to try and offset this effect)

Question 16

Antacids: Drug Interactions/what must we bear in mind when combing these with other medications?

Answer 16

Absorption of other drugs
May reduce absorption of other drugs given at same time

*meds must be given 1 - 2 hours after antacid was given

Chelation
Chemical binding, or inactivation, of another drug
Produces insoluble complexes
reduced drug absorption
eg tetracycline

Question 17

Care Implications: Antacids?

Answer 17

Clients with HF or hypertension should use low-sodium antacids

Question 18

What does Cimetidine (Tagamet) inhibit? and how does it effect our metabolism?

Answer 18

Inhibits liver cytochrome P-450

Affect metabolism of other drugs causing increased drug levels eg warfarin

Question 19

Example of a Proton Pump Inhibitor (PPI)? How is it broken down?

Answer 19

Omeprazole (they all end with azole), they are all very similar.

-Broken down by acid (you must absorb it first so it can act on the cells)

YOU MUST TAKE THEM WHOLE WITHOUT BREAKING THEM BECAUSE IF THE DRUG HITS THE STOMACH ACID DEACTIVATES THE DRUG!!!I IT MUST BE ABSORBED

Question 20

Antacids: Mechanism of Action/How do they work?

Answer 20

-Antacids chemically neutralize acid

-Antacids DO NOT prevent acid production

Question 21

What kind of medications are sucralfates? What do they inhibit? What do they form? what can it cause?

Answer 21

• Cytoprotective agent
  -Forms gel with mucus in low pH
  -forming a protective barrier over top of the ulcer

-Inhibits pepsin

Question 22

Example of antacid aluminum slats? What may they cause?

Answer 22

-Aluminium hydroxide

Salts: carbonate, hydroxide

may cause constipation

Question 23

Sucralfate adverse effects? What may it cause?

Answer 23

• May cause constipation, nausea, and dry mouth

-May impair absorption of other drugs
-Little absorption from the gut

Question 24

What kind of drug is cimetidine? What is it used for? Adverse effects?

Answer 24

H2 antagonist

-Used for PUD and GERD

impotence
breast enlargement (gynomastia)
CNS depression in elderly
inhibits liver cytochrome P450