Pharmaco ulcer/ antiemetic Flashcards by Katya Angoua

What is peptic ulcer disease

Inflamed lesions of the mucosa of the upper GIT

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Peptic ulcer disease causes

Increased acid secretion
Decreased PG secretion
H pylori infection
Increased pepsin production

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Would eradication of h pylori reduce recurrence of ulcers

Yes

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What is dyspepsia

Heartburn or indigestion

Epigastric discomfort after meals

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Is dyspepsia associated with GERD

Yes

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What is GERD

Gastro esophageal reflux disease is backflow of acid chyme from stomach into the esophagus

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Symptoms of GERD

Dyspepsia
Dysphasia ( severe case)
Chest pain ( severe case)
Sore throat if gets there

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GERD complications

Esophageal ulcers
Esophageal erosions
Narrowing of esophagus

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What is zollinger Ellison syndrome

Formation of tumors in the pancreas or the duodenum

Cause increase in gastrin and therefore increase in acid secretion

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Acute gastroparesis

Delay in gastric emptying seen after surgery or trauma or infection

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Irritable bowel syndrome

Non inflammatory disease with altered bowel movement causing either diarrhea or constipation

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Comstipation

Difficult passage of hard and dry stool into the anus

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Constipation treatment

Increased fibres in diet ( fruits , vegetables, whole grains )

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Vomiting

Physiological Reflex due to presence of irritating substance in GIT or blood
Generally preceded by nausea

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Diarrhea

Increased frequency of elimination of stool as well as altered consistency of stools

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What is a cause of severe diarrhea

Bacterial infection

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What hormones stimulate acid secretion

Gastrin
Acetylcholine
Histamine

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What receptors do histamine bind to in GIT

H2 receptors

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What are the drugs that inhibit acid secretion

H2 antagonists
Anticholinergic
Proton pump inhibitors
PG analogs

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How can you treat acid hypersécrétion

Inhibit acid secretion from parietal cells
Neutralize acidity
Cytoprotective agents
Eradicate h pylori

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Antacids action

Neutralize acidity of stomach

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Types of antacids

Aluminum hydroxide
Magnesium hydroxide
Carbonates

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Aluminum hydroxide reacting with acid in stomach produce …

Water

Insoluble aluminum chloride salt which will be excreted ( increased risk of constipation)

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Aluminium hydroxide reduces absorption of …

Tetracyclines

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What is the effect of mgcl2 formed by magnesium hydroxide in stomach on the intestine ?

Laxative effect

Products you can combine antacids with

Maalox Mucogel Gaviscon Gastrocote

Types of carbonate antacids

``` Calcium carbonate ( effective) Sodium bicarbonate ( fast) ```

Are antacids used as primary treatment for peptic ulcer ?

NO | Just dyspepsia

Action of histamine antagonists

They inhibit cAMP and protein kinases activation Inhibit proton pump Reduce pepsin

Examples of H2 receptor antagonists

Cimetidine Ranitidine Nizatidine Famotidine

Where are H2 antagonists absorbed

Gut

Diseases that you can treat with H2 antagonists

Dyspepsia Peptic ulcers GERD

Cimetidine adverse effect

Gynecomastia

Cimetidine inhibits ...

CYP450 CYP2C9 CYP2D6 CYP3A4

Proton pump inhibitors inhibit reversible or irreversibly the proton pump?

Irreversibly

Which drug is the most longer acting one ? H2 antagonists or proton pump inhibitors

Proton pump inhibitors

Types of proton pump inhibitors

``` Omeprazole Lansoprazole Pantoprazole Rabeprazole Esomeprazole ```

Disease treated by proton pump inhibitors

Peptic ulcer ( 4 weeks) Zollinger-Ellison syndrome GERD (omeprazole, lansoprazole)

Side effects of using atropine for peptic ulcer

Blurred vision | Urinary retention

M1 selective antagonist drug name

Pirenzepine

Role of cytoprotective agents in peptic ulcer management

Physical barrier over surface of ulcer

Cytoprotective agents in peptic ulcers drugs name

Sucralfate Bismuth chelate Misoprostol

Sucralfate action

Protect ulcer Inhibit pepsin Stimulates PG synthesis Stimulates mucus and bicarbonate

When do you use sucralfate

If patient can’t handle h2 antagonists or proton pump inhibitors drugs

Bismuth chelate Action

``` Protect ulcer Adsorbs Pepsin Stimulates PG synthesis Stimulates bicarbonate secretion Used for eradication of h pylori in combination ```

Can bismuth chelate cause encephalopathy ?

Yes in case of renal excretion impairment

Misoprostol nature

PG E1 analogue

How do you use misoprostol

As prophylaxis against peptic ulcer for patients taking NSAIDs

Can you take misoprostol in pregnancy ?

No can induce labor

What drugs are used in h pylori eradication ?

Proton pump inhibitors OR H2 receptor antagonists + (2 or more) Amoxicillin , clarithromycin, bismuth chelate, metronidazole, tetracycline

Most common h pylori treatment

Omeprazole Amoxicillin Metronidazole

What initiates vomiting

Nucleus of cells in medulla forming vomiting center

How do you activate the vomiting center

By activating afférent fibers from chemoreceptors trigger zone, the inner ear, or the cortex

How do you activate the chemoreceptors trigger zone ?

Stimulation of serotonin, dopamine, histamine, muscarinic receptors

What are the types of antiemetics

``` Serotonin receptors antagonist Dopamine receptor antagonists Cannabinoids Histamine ( H1)receptor antagonist Antimuscarinic receptors Steroids ```

Serotonin receptors antagonists name

Ondansetron | Granisetron

Serotonin receptor antagonist action

Block 5-HT3 receptors in CTZ and GIT | reduce stimulation of vomiting center peripherally and centrally

When do you use ganisetron and ondansetron?

In chemotherapy induced Emesis Postoperative emesis Not for non severe emesis

What can you add to ondansetron therapy failure to make it work

Dexamethasone

Types of dopamine receptor antagonists

Prochlorperazine Domperidone Metoclopramide

Which one is more effective in chemotherapy induced emesis , ondansetron or prochlorperazine?

Ondansetron

Metrocloprqmide action

Act on D2 receptor and 5-HT3 ( so used in GERD)

Types of synthetics cannabinoids

Nabilone | Dronabinol

Adverse effects of cannabinoids

``` Drowsiness Dry mouth Mood change Postural hypotension Hallucinations ```

Antiemetics Antihistamines

Dimenhydrinate Meclizine Promethazine

What antihistamines do you use for motion sickness

Dimenhydrinate | Meclizine

Antimuscarinic used for motion sickness

Scopolamine

Antispasmodic agents goal

Relieve cramps or spams of stomach and intestines

2 groups of antispasmodics

Anticholinergics ( autonomie innervation) Relaxants ( affect smooth muscle directly)

Antispasmodic anticholinergic

Hyoscine Propantheline Dicycloxerine

Muscles relaxants antispasmodic

Mebeverine Drotaverine Alverine