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Maddy - GI II Exam I - some pharm > Pharm - Anti-ulcers > Flashcards

Pharm - Anti-ulcers Flashcards

1
Q

list the H2- receptor antagonists

A

1) cimetidine
2) famotidine
3) nizatidine
4) ranitidine

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2
Q

list the proton-pump inhibitors

A

1) lansoprazole
2) dexlansoprazole
3) omeprazole
4) esomeprazole
5) pantoprazole
6) rabeprazole

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3
Q

list the surface acting agents

A

sucralfate

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4
Q

list the PGE1 analogs

A

misoprostol

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5
Q

list the bismuth compounds

A

bismuth subsalicylate

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6
Q
  • tidine ending indicates a ______
A

H2 receptor antagonist

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7
Q

-prazole ending indicates a ______

A

proton pump inhibitor

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8
Q

MOA of histamine type 2 (H2) blockers

A

reversibly inhibit H2 receptors on basolateral membrane of parietal cells
- inhibits 20%-50% of acid production depending on dose

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9
Q

onset of action for H2 receptor blockers

A

rapid (0.5-2 hours)

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10
Q

compare onset of H2 receptor blockers, antacids, and PPIs

A

most rapid onset: antacids
middle: H2 receptor blocker
slowest onset: PPIs

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11
Q

how long does ulcer healing take w/ H2 receptor blockers

A

4-8+ weeks

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12
Q

normal adverse effects H2 receptor blockers

A

(all relatively mild, transient, and infrequent)

  • nausea/diarrhea/constipation
  • headaches
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13
Q

rare adverse effects of H2 receptor blockers, particularly cimetidine

A
  • decreases testosterone binding to androgen receptors –> gynecomastia in men and galactorrhea in women
  • neutropenia, thrombocytopenia
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14
Q

drug interactions of cimetidine (H2 receptor blocker)

A

cimetidine is the prototypical inhibitor of several CYP450 isoenzymes –> LOTS of drug-drug interactions

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15
Q

drug interactions of ranitidine (H2 receptor blocker)

A

inhibits CYP450 (but only 10% compared to cimetidine)

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16
Q

relative contraindications of H2 receptor blockers

A

pregnancy

  • famotidine can be used
  • only use ranitidine if necessary
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17
Q

MOA of proton pump inhibitors

A

covalently bind to sulfhydryl groups of H+/K+ ATPase at parietal cell secretory sites –> inhibits gastric acid secretion by irreversibly inhibiting functioning “-ase” pumps
- inhibits 50%-90% acid secretion

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18
Q

how long does ulcer healing take w/ PPIs

A

4-8+ weeks

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19
Q

how long does it take to see full symptom effects of PPIs and how long do their effects last

A

several days

- effects last 24 hours

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20
Q

adverse effects of PPIs

A
  • diarrhea/dyspepsia/nausea
  • CDAD** (c. diff associated diarrhea)
  • headaches/dizziness
  • myalgia/fatigue/myopathy
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21
Q

drug interactions of PPIs

A

omeprazole is the prototypical PPI that inhibits CYP450 –> lots of drug interactions

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22
Q

relative contraindications of PPIs

A

pregnancy

  • pantoprazole can be used
  • lansoprazole only if necessary
  • try to avoid omeprazole
23
Q

MOA of sucralfate

A

undergoes cross-linking from interaction w/ stomach acid –> creates a viscous, sticky polymer which adheres to epithelial cells around the ulcer’s crater –> prevents acid access to ulcer sites

may also:
stimulate local prostaglandin and mucous production and EGF (cytoprotection)

24
Q

does sucralfate affect pH

A

nope

25
Q

indications for sucralfate

A

duodenal ulcers, but also:

  • aphthous ulcers
  • mucositis/stomatitis
  • radiation proctitis/ulcers (enema)
  • bile reflux gastropathy
26
Q

adverse effects sucralfate

A

constipation

27
Q

relative contraindications sucralfate

A

severe renal failure

28
Q

when should patients take sucralfate to avoid drug interactions

A

take 2 hours after other medications

29
Q

normal frequency for taking sucralfate for active ulcers

A

QID

30
Q

MOA misoprostol

A

it’s a prostaglandin E1 analog
- provides protective prostaglandin to the gastric mucosa and reduces gastric acid release from the parietal cells

  • also provides cytoprotection
31
Q

how does misoprostol provide cytoprotection

A

increases mucosal defenses

  • stimulates bicarbonate and mucous production
  • increases mucosa blood flow
32
Q

normal indications for misoprostol

A

prevention of NSAID-induced gastric ulceration in patients at high risk of ulcerations and complications

33
Q

off-label uses for misoprostol

A
  • w/ or w/o mifepristone for pregnancy termination
  • alone for cervical ripening
  • post-partum hemorrhaging
34
Q

adverse effects misoprostol

A
  • diarrhea

- headaches/dizziness

35
Q

contraindications for misoprostol

A
  • pregnancy (unless specifically for common, off label issues)
  • IBD
36
Q

MOA bismuth compounds

A

believed to prevent microbial attachment to mucosa, possible inactivation of enterotoxins, and disruption of bacterial cell wall

37
Q

compare uses of OTC and Rx bismuth compounds

A

OTC: used alone for reflux, indigestion, and diarrhea

Rx: used in combination w/ antibiotics and acid suppressants for H. pylori

38
Q

adverse effects bismuth compounds

A
  • constipation

- black/dark stools

39
Q

when should patients take bismuth compounds to avoid drug interactions

A

2 hours after other meds

40
Q

relative contraindications for bismuth compounds

absolute contraindications for bismuth compounds

A

relative:

  • antiplatelets and anticoags
  • severe renal failure

absolute:

  • GI bleeding
  • salicylate hypersensitivity
41
Q

what is important when treating for H. pylori

A

COMBINATION THERAPY :)
- at least 2 antibiotics and an acid reducer (PPI or H2 blocker)

  • ACG recommendations
  • double therapy
  • triple therapy
42
Q

describe triple therapy for treatment of H. pylori

A

duration: 14 days
- all at BID dosing

  • PPI
  • clarithromycin
  • amoxicillin OR metronidazole
43
Q

describe quadruple therapy for treatment of H. pylori

A

duration: 10-14 days
- PPI at BID, all others at QID

  • PPI
  • metronidazole
  • tetracycline
  • bismuth subsalicylate
44
Q

official ACG recommendations for treating H. pylori

A

10-14 days of triple drug regimen

  • PPI
  • clarithromycin
  • amoxicillin OR metronidazole
45
Q

describe the Helidac (QID) treatment for peptic ulcer disease

A
  • bismuth subsalicylate
  • metronidazole
  • tetracyline

PLUS a PPI

46
Q

describe the Pylera (3 capsules QID) treatment for peptic ulcer disease

A
  • bismuth subcitrate potassium
  • metronidazole
  • tetracycline

PLUS a PPI (omeprazole)

47
Q

for complete healing of ulcers, what should you prescribe after 10-14 day H. pylori combo therapy

A

PPI therapy for several weeks

48
Q

if there is failure of eradication w/ metronidazole containing triple therapy, what should be prescribed

A

a non-metronidazole containing quadruple therapy

49
Q

how to alter treatment in H. pylori with penicillin allergy

A

substitute metronidazole with bismuth quadruple therapy

50
Q

how to alter treatment in H. pylori with metronidazole resistance

A

substitute tetracycline and consider quadruple therapy w/ clarithromycin and amoxicillin

51
Q

how to alter treatment in H. pylori with clarithromycin resistance

A

substitute either amoxicillin or tetracycline and consider bismuth quadruple therapy

52
Q

treatment for pregnant patients with PUD without H. pylori

A

consider short course of antacids or sucralfate

  • moderate sx: consider ranitidine
  • severe sx: consider lansoprazole
53
Q

compare treatment in patients with PUD if NSAID is required or not required

A

NSAID not required: acetaminophen and discontinue NSAID

NSAID required: COX-2 NSAID and/or PPI or misoprostol

Maddy - GI II Exam I - some pharm (23 decks)

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