Pharm-Antacids/Anti-PUD Flashcards

1
Q

What 3 things do antacids do?

A
  1. neutralize HCl in stomach
  2. Decrease acid load to duodenum
  3. Diminish pepsin activity
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2
Q

What SE is associated with sodium bicarb?

A

metabolic alkalosis

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3
Q

What makes aluminum hydroxide different from other antacids?

A

Aluminum compounds, in contrast to other antacids, cause slowing of gastric emptying and marked constipation. Used with caution in the elderly.

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4
Q

What effect does magnesium hydroxide have that is different from aluminum hydroxide?

A

prominent laxative effect (osmotic diarrhea)

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5
Q

What is acid rebound? What antacid is associated with it?

A

Increased gastric acid secretion several hours after neutralization.
Calcium carbonate-containing antacids evoke hypersecretion of hydrogen ions (acid rebound).

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6
Q

What antacid can cause milk-alkali syndrome? what is it?

A

Calcium carbonate. Hypercalcemia.

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7
Q

What do H2 blockers do? What is the prototypical example?

A

inhibits basal acid secretion including nocturnal secretion.

Cimetidine (strong p450 inhibitor)

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8
Q

What do proton pump inhibitors do?

A

form covalent bond /w proton pump (H+/K+ ATPase) → irreversible inhibition of acid production (long acting b/c need to regenerate pumps)
blocks both basal and stimulated acid secretion.

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9
Q

What is the prototypical PPI?

A

Omeprazole: (-prazoles)
Pro-drug (needs low pH to activate)
Reduces gastric acid → elevates gastric pH

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10
Q

Why are PPIs better than H2 antagonists?

A
  1. No effect on pepsinogen
  2. no effect on p450
  3. no serious SE associated w/ high doses
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11
Q

What do Prostaglandins/Mucosal Protective Agents inhibit/stimulate?

A

Inhibits: Acid secretion, Gastrin release and Pepsin secretion
Stimulates: Mucus secretion, Bicarbonate secretion and Mucosal blood flow

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12
Q

What prostaglandin E1 analog can be used to prevent NSAID-induced gastric ulcers? Why is it not widely used?

A

Misoprostol
SE: D, GI upset (exacerbates IBD), abortion
b/c multiple daily dosing and SE

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13
Q

What mucosal protective agent forms a sticky polymer that adheres to ulcerative tissue and coats mucosal defects?

A

Sucralfate (sugar molecule)

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14
Q

What does chelated bismuth (bismuth subsalicylate) do? Why is it important in children?

A

Protects the ulcer crater and allows healing.
Some activity against H. pylori.
Should not be used repeatedly or for more than 2 months at a time.
Can cause black stools, constipation.
Can color mucosal tissue.
Subsalicylate is clinically important for children recovering from influenza or chicken pox because of the association between salicylates and Reye’s syndrome.

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15
Q

What do antispadmodics do? What do they inhibit? What other drug do they resemble?

A

A specific anticholinergic effect (antimuscarinic) at the acetylcholine (ACh)-receptor sites.
Competitive inhibitors of muscarinic receptors in the enteric plexus and on smooth muscle.
SE: tachycardia, constipation, hypersensitivity to light, dry mouth, urinary retention, cycloplegia (atropine-like, but don’t cross BBB and are less potent).

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16
Q

What is the treatment protocol for pts w/ H. Pylori associated PUD?

A

Triple therapy:

  1. Proton pump inhibitor
  2. 2 antibiotics (clarithromycin, amoxicillin or metronidazole)
  3. Bismuth salicylate (may be used instead of 2nd antibiotic)