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Pharm II N306 > Pharm II week 1 > Flashcards

Pharm II week 1 Flashcards

1
Q

What are the Aggressive factors in the pathogenesis of ulcers?

A 
H. Pylori
NSAIDs
Acid
Pepsin
Smoking
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2
Q

What are the defensive factors in the pathogenesis of ulcers?

A

Mucus
Bicarb
Blood flow
Prostaglandins

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3
Q

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

A
  1. Antibiotics
  2. Antisecretory agents
  3. Mucosal protectants
  4. Antisecretory agens that enchance mucosal defenses
  5. Antacids
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4
Q

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

A

Diet

Lifestyle

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5
Q

What is H. Pylori?

A
  • Gram Negative bacillus
  • colonizes stomach and duodenum
  • not always symptomatic when infected
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6
Q

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

A

minimize the risk of resistance

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7
Q

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

A
  • amoxicillin
  • Clarithromycin
  • Bismuth (Petpto Bismal)
  • Metronidazole (Flagyl)
  • Tetracycline
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8
Q

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

A

diarrhea

take acidopholus

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9
Q

How does Clarithromycin impact H. Pylori?

A

inhibits protein synthesis

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10
Q

What are the S/e of Clarithromycin use?

A

N/D and distortion of taste

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11
Q

How does Bismuth in act on H. Pylori?

What is a S/e of use?

A

acts topically to disrupt the cell wall

Turns the tongue and stool black

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12
Q

What S/e are caused by use of Flagyl?

A

N, H/A

Don’t use with pregnancy

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13
Q

How does tetracycline act on H. Pylori?

What are S/e of use?

A

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

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14
Q

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

A

multiple doses (12 per day)
S/e
cost

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15
Q

Cimetidine (Tagamet) is what kind of agent?

What are the therapeutic uses for Tagament?

A 
Anti-secretory agent (H2RA)
Gastric ulcers
GERD, Zollinger-Ellison
Prevent aspiration pneumonitis
Dyspepsia
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16
Q

What is a risk of IV bolus use with Tagament?

A

hypotension and arrhythmias

17
Q

What are the pharmacodynamics of Cimetidine?

A
  1. Reduces gastric acid production by blocking histamine at H2 receptor site of parietal cells
  2. Reduction of H+ concentration & volume of gastric acid
18
Q

What are the A/e of Tagament?

A

Antiandrogenic effects
CNS effects
- crosses BBB

19
Q

What pt population should use caution with Tagament?

A

Elderly- Tagamet can cause confusion

20
Q

What drugs interact with Cimetidine?

A

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

  • Warfarin
  • Phenytoin (Dilantin)
  • theophylline
  • lidocaine
  • *Administer at least 1 hour apart
21
Q

Which 3 drugs are Antisecretory H2RAs?

A

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

22
Q

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

A

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
23
Q

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

A

Gastric AND duodenal ulcers
GERD,
Zollinger-Ellison
Dyspepsia

24
Q

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

A

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.

25
Q

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

A

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

26
Q

What are the Adverse effects of Prilosec?

A

GI and H/a

27
Q

What are the therapeutic uses of Omeprazole?

What Patient ed and nursing considerations for Prilosec?

A 
Gastric and duodenal ulcers
GERD, Zollinger-Ellison
Prevent aspiration pneumonitis
Dyspepsia
Take before meals and do not crush pills (no feeding tube use!)
28
Q

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

A

Can increase digoxin levels due to metabolism via CYP450 pathway.

29
Q

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

A

Mucosal
No
No
Acute ulcers and maintenance therapy

30
Q

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

A

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

31
Q

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

A

antisecretory
mucosal
prostaglandin E
NSAIDs

32
Q

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

A

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

33
Q

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

A

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

34
Q

What are the T/u of Antacids?

A

Primary: PUD

Symptom mgmt of GERD and dyspepsia

35
Q

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

A

Antacid

renal, abdominal

36
Q

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?

A

phosphate
renal
HTN, HF due to high Na+ content

Pharm II N306 (2 decks)

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