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Peptic ulceration > Pharmacology of the upper GI tract > Flashcards

Pharmacology of the upper GI tract Flashcards

1
Q

What drugs may lead to peptic ulcers

A

NSAIDs

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2
Q

What bacteria is the main cause of peptic ulcers

A

H.Pylori

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3
Q

What is dyspepsia

A

Dysfunction of the upper GI tract

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4
Q

How do Calcium channel inhibitors affect GERD

A

Promote the opening of the lower oesophageal sphincter which makes the acid come up into the oesophagus

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5
Q

What conditions can cause GERD

A

Obesity
Pregnancy

Because they increase intra-abdominal pressure

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6
Q

Where is peptic ulceration more common

A

Duodenum

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7
Q

What is Zollinger-Ellison syndrome

A

Cells that secrete gastrin (D and/or G cells in pancreas) have a tumour. Gastrin promotes acid secretion

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8
Q

What Is gastritis

A

Inflammation of the stomach

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9
Q

What are signs and symptoms of peptic ulceration

A

Epigastric pain
-Pain is variable in relation to food

Hunger pain, which is relieved by eating

Night pain which is relieved by food, milk or antacids

Waterbrash (more salivating than normal because you have acid in your throat)

Nausea and less frequently vomiting

Vomiting blood- haematemesis

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10
Q

What can a H.Pylori infection lead to

A

Chronic inflammation and gastric damage leading to ulceration

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11
Q

What are the tests done to see if there is H.Pylori

A

Urea breath test (13C)
Biopsy for urease activity
H.Pylori antigens/antibodies in blood, saliva and stools

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12
Q

Warning signs of peptic ulceration which indicate complications

A
  • Over the age of 55 as it might be stomach cancer
  • Weight loss
  • Anaemia
  • Dysphagia (can be associated with oesophageal cancer)
  • Haematemesis (vomiting blood)
  • Malaena
  • Upper abdominal masses
  • Persistent symptoms with repeat requests for OTC remedies
  • Onset of new symptoms
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13
Q

What increases acid secretion

A

Histamine via H2 receptors

Gastrin

Acetylcholine via M-receptors - M3 on parietal cells

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14
Q

What decreases acid secretion

A

Prostaglandins (released by Cox) (E2 and I2)

Cytoprotective via bicarbonate and mucus release

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15
Q

Goals of treatment for GERD

A
  • Avoidance of causative drugs
  • Avoidance of causative foods
  • Propping up bed, removing belt
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16
Q

What do antacids do

A

Raise pH

17
Q

What are examples of antacids

A

Sodium bicarbonate and magnesium hydroxide

18
Q

What are alginates and examples of them

A

Gaviscon

  • Alginic acid when combines with saliva forms a viscous foam
  • This floats on the gastric contents forming a raft which protects the oesophagus during reflux
19
Q

What are Histamine H2 antagonists used for

A

Low dose OTC for short term relief

20
Q

What is the mechanism of action of histamine H2 receptors

A

Coupled via adenylyl cyclase to increase cAMP which actives the proton pump

21
Q

If histamine H2 antagonists don’t help, and if the patient is over 45 yo, what should the pharmacist do

A

Refer to doctor to rule out stomach cancer

22
Q

When are histamine H2 antagonists best given

A

at night

23
Q

What is a caution for cimetidine

A

INhibtis cp450 and therefore the metabolism of other drugs, resulting in important drug interactions e.g. oral anticoagulants

24
Q

Which histamine H2 antagonist does not inhibit the metabolism of other drugs

A

Ranitidine

25
Q

How do proton pump inhibitors work

A

Irreversible inhibition of the proton pump (H+/K+-ATPase)

26
Q

Why are PPIs very well tolerated

A

Because they are very selective to the stomach (activated by acidic pH)

27
Q

Which cells to PPIs act on

A

Parietal cells

28
Q

What are the side effects of PPIs

A

Inhibit H+ secretion by >90% so may lead to achlorhydia

Increases risk of campylobacter infection (particularly in older patients) which is food poisoning

29
Q

How is a helicobacter pylori infection eradicated

A

Triple therapy

2 antibiotics from:

  • clarithromycin
  • amoxicillin
  • metranidazole

plus

PPI and/or H2 antagonist

Triple therapy for 1 week then PPI alone

30
Q

Which antibiotics should you not have alcohol with

A

Metronidazole

31
Q

What is the second line therapy for helicobacter

A

Quadruple therapy

Combination of metronidazole and tetracycline and omeprazole

Bismuth subcitrate potassium may be useful

32
Q

IN the absence of H pylori dyspepsia, what is the treatment

A

PPI/H2RA

33
Q

What is the arachidonic acid pathway

A

Membrane gets chopped up by PLA2 and forms arachidonic acid. The arachidonic acid then forms leukotrienes and prostaglandins

34
Q

How do steroids affect the arachidonic acid pathway

A

They form lipocortin which inhibits PLA2 so stops the pathway

35
Q

How do NSAIDs affect the arachidonic acid pathway

A

They inhibit COX which is used to form prostaglandins. Prostaglandins are protective in the stomach so you lose that protection when having NSAIDs

36
Q

IF the patient is over the age of 65, and the patient is taking NSAIDs, what is a preventative measure to minimise GI damage

A

Prescribe PPIs

Give in combination with misoprostol (acts on prostanoid receptors to inhibit gastric H+ secretion)

37
Q

Who should misoprostol not be given to

A

Females of child bearing age because it can cause abortions

38
Q

Does taking NSAIDs with food prevent stomach ulcers

A

No. It only helps with reducing irritation

Peptic ulceration (8 decks)

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