- Gram Negative bacillus - colonizes stomach and duodenum - not always symptomatic when infected

Pharm II week 1 Flashcards by Ryan Liberty

What are the Aggressive factors in the pathogenesis of ulcers?

H. Pylori
NSAIDs
Acid
Pepsin
Smoking

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What are the defensive factors in the pathogenesis of ulcers?

Mucus
Bicarb
Blood flow
Prostaglandins

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What are the 5 drug classes for treatment of Peptic Ulcer Disease?

Antibiotics
Antisecretory agents
Mucosal protectants
Antisecretory agens that enchance mucosal defenses
Antacids

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What are the 2 non-drug therapeis for treatment of Peptic Ulcer Disease?

Diet

Lifestyle

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What is H. Pylori?

Gram Negative bacillus
colonizes stomach and duodenum
not always symptomatic when infected

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Why use 2-3 antibiotics plus an antisecretory agent in treatment of H. Pylori?

minimize the risk of resistance

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Which 5 antibacterial drugs are used to treat H. Pylori?

amoxicillin
Clarithromycin
Bismuth (Petpto Bismal)
Metronidazole (Flagyl)
Tetracycline

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What is a S/e of Amoxicillin and what can be done to limit it?

diarrhea

take acidopholus

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How does Clarithromycin impact H. Pylori?

inhibits protein synthesis

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What are the S/e of Clarithromycin use?

N/D and distortion of taste

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How does Bismuth in act on H. Pylori?

What is a S/e of use?

acts topically to disrupt the cell wall

Turns the tongue and stool black

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What S/e are caused by use of Flagyl?

N, H/A

Don’t use with pregnancy

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How does tetracycline act on H. Pylori?

What are S/e of use?

inhibits bacterial protein synthesis
stains teeth
Don’t use with pregnancy

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What are barriers to compliance with use of antibiotics to eradicate H. Pylori?

multiple doses (12 per day)
S/e
cost

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Cimetidine (Tagamet) is what kind of agent?

What are the therapeutic uses for Tagament?

Anti-secretory agent (H2RA)
Gastric ulcers
GERD, Zollinger-Ellison
Prevent aspiration pneumonitis
Dyspepsia

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What is a risk of IV bolus use with Tagament?

hypotension and arrhythmias

What are the pharmacodynamics of Cimetidine?

Reduces gastric acid production by blocking histamine at H2 receptor site of parietal cells
Reduction of H+ concentration & volume of gastric acid

What are the A/e of Tagament?

Antiandrogenic effects
CNS effects
- crosses BBB

What pt population should use caution with Tagament?

Elderly- Tagamet can cause confusion

What drugs interact with Cimetidine?

Inhibits Hepatic drug metabolism: reduce dose of Tagament with the following:

Warfarin
Phenytoin (Dilantin)
theophylline
lidocaine
*Administer at least 1 hour apart

Which 3 drugs are Antisecretory H2RAs?

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)

Ranitidine (Zantac) is more potent than Tagamet. What are the difference with A/e between the two drugs?

Ranitidine has fewer A/e:

no antiandrogenic effect
does not cross the BBB

Also fewer drug interactions:

weak inhibitor of hepatic drug metabolizing enzymes
***Antacids can decrease absorption of Zantac

What are the therapeutic uses for Ranitidine AND Famotidine (Pepcid)?

Gastric AND duodenal ulcers
GERD,
Zollinger-Ellison
Dyspepsia

What are the A/e of Ranitidine use compared to Tagament and Zantac?

Ranitidine does NOT cause antiandrogenic effects like Tagamet
Does NOT inhibit hepatic drug metabolizing enzymes
Difference: DOES increase risk for pneumonia due to increase in pH.

Omeprazole (Prilosec) is an antisecretory agent as a ___ ___ Inhibitor. What are the pharmacodynamics for this class? Is Prilosec used ST or LT?

Proton pump. Inhibit gastric secretion by blocking the final pathway of acid production Short Term use

What are the Adverse effects of Prilosec?

GI and H/a

What are the therapeutic uses of Omeprazole? | What Patient ed and nursing considerations for Prilosec?

``` Gastric and duodenal ulcers GERD, Zollinger-Ellison Prevent aspiration pneumonitis Dyspepsia Take before meals and do not crush pills (no feeding tube use!) ```

Rabeprazole (Aciphex) is a PPI, what D/i is seen with use?

Can increase digoxin levels due to metabolism via CYP450 pathway.

Sucralfate (Carafate) is what type of GI protectant? Does sucralfate have acid neutralizing capacity? decrease acid? What are the T/u of Sucralfate?

Mucosal No No Acute ulcers and maintenance therapy

What are the A/e and D/i of Carafate?

constipation Decreases absorption of phenytoin, digoxin, theophylline, warfarin and fluoroquinolones. so ***administer 2 hours apart

Misoprostol (Cytotec) is an ____ agent. It enhances ___ defenses. Cytotec is a synthetic form of ____ and is approved for gastric ulcers from LT use of ____.

antisecretory mucosal prostaglandin E NSAIDs

What are the A/e of Cytotec use and what patient education?

diarrhea abdominal pain NO PREGNANCY- CAT X Use contraception and take with food

What are the pharmacodynamics of antacids? (____ gastric __, ___ acidity, inactivate ___ when gastric pH is >5). Chemical compostion of antacids?

Decrease gastric acid, neutralizes acidity and inactivates pepsin when pH is >5. Inorganic salts: Mg, Na, Ca, Al

What are the T/u of Antacids?

Primary: PUD | Symptom mgmt of GERD and dyspepsia

Milk of Magnesia is an ____. Caution with use in ___ patients and undiagnosed ____ pain.

Antacid | renal, abdominal

Aluminum hydroxide (Amphogel and Alternagel) is an antacid. Since Al binds with ____, it is used in patients with ____ failure. AlOH should be avoided in what type of pts?

phosphate renal HTN, HF due to high Na+ content