PUD Flashcards
Classes of drugs to treat PUD (5)
- Antibiotics for H.Pylori
- Anti Secretory:
- Mucosal Protectant:
- Prostaglandin Agent
- Antacid
3 ways drugs work to treat ulcers
- erradicate H pylori
- reduce gastric acidity
- enhance mucosal defenses
Anti ulcer drugs only treat ulcers: true or false
FALSE- also treat gastritis and GERD
What is the regiment for treating H pylori w/ ABX ? how long?
At least 2 antibiotics, preferably 3 abx + PPI or H2 blocker
->14 days
do we give ABX to someone who is asxs but has h pylori ?
nope!
issues w/ treating h pylori?
patient complianc: cost, pill count, SE
3 types of anti secretory agents:
- H2Blockers
- Proton Pump Inhibitors
- Muscarinic antagonist ???
prototype of H2 blockers
- Prototype: cimetidine (Tagamet) –> in the drug book, original H2 blocker
- Also Know: famotidine (Pepcid) –> more commonly used
how fo H2 blockers work?
- Act on H2 receptors on parietal cells
- ->Suppress acid secretion
indication for using H2 blockers
ulcers, GERD, heartburn, aspiration pneumonitis, Zollinger-Ellison syndrome (acid hypersecretion)
Duration of treatment on H2 blockers
4-6 weeks, up to 12
side effects of cimetidine
LOW
◦ Androgen blockade :Gynecomastia, reduced libido, impotence
◦ CNS Effects b/c crosses BB : Elderly (somnolence, seizure)
◦ Pneumonia (all H2 blockers)
‣ Bacterial colonization in the stomach increases with less acid present
• increase risk of aspiration pneumonia
drug drug interactions w/ cimetidine
◦ Warfarin, phenytoin, metformin, glipizide
◦ separate antacids by 1 hr.
route for cimetidine
IV, oral 2x day
side effects of famotidine?
pneumonia risk
prototype for anti secretory: proton pump inhibitor
omeprazole (Prilosec)
how does omeprazole (Prilosec) fxn
Irreversible inhibition of H+,K+ ATPase
most effective drug for acid suppresiion?
omeprazole (Prilosec)
how long does omeprazole (Prilosec) work and when do see effects?
-life of enzyme (1 day) and results w/in 2 hours
indication for using omeprazole (Prilosec)
ulcers, erosive esophagitis, GERD Zollinger-Ellison, stress ulcer prevention–> ICU/Trauma
how long to be on omeprazole (Prilosec)
4-8 weeks
short term vs long term side efffects of omeprazole (Prilosec)
Side Effects: headache, diarrhea, N/V (<1%)
long term side effects: osteoporosis and hip fractures, Cdiff, pneumonia, acid rebound (difficult to come off drug), kidney disease, Mg deficiency
◦ Possible: B12 deficiency, dementia
patient education for omeprazole (Prilosec)
• only want patients on these short term!
–> wean off and put on H2 blocker
ending for ppi’s
prazole
prototype for mucosal protectant
Sucralfate
how does Sucralfate fxn
Creates a protective coating on the gastric and esophageal surface
–>protects the ulcer from acid and pepsin
*Not absorbed -> does not reduce acid secretion
side effects of Sucralfate
constipation
admin for Sucralfate
Take 1 hr before meals and at HS
>Interfere with absorption of other meds
• Separate by 2 hrs.
admin considerations giving sucralfate for gi vs esophagus ulcer
- Ulcers in esophagus: make a slurry w/ the pill
- Ulcers in stomach: take pill as regular
Prostaglandin Agent prototype
misoprostol (Cytotec)
how does misoprostol (Cytotec) fxn?
Synthetic prostaglandins (stimulate secretion of mucous/bicarbonate, cause vasodilation
how do NSAID cause ulceration?
NSAID inhibits prostaglandin –> suppresses mucous/bicarb, promote gastric acid
indication for using misoprostol (Cytotec)
Used only for NSAID gastric ulcers
misoprostol (Cytotec) safe for preggos?
Pregnancy Category X –> prostaglandins stimulate uterine contractions
side effects of misoprostol (Cytotec)
diarrhea, abdominal pain, spotting, dysmenorrhea
fxn of antacids
Alkaline compounds that neutralize stomach acid
indication for using antacids
PUD, GERD symptom control
admin of antacids
Separate 1 hour from other drugs –> drug needing acidic enviro for absorb will be diminished
different kinds of antacid compounds
aluminum
magnesium
calcium
sodium
antacid compounds that cause constipation?
aluminum
calcium
anatacid compound not safe for renal disease?
magnesium
magnesium + kidney disease = hypo or hyper magnesium?
hyper
antacid of choice? why?
milk of magnesia is antacid of choice: high acid neutralizing effects, rapid acting, long lasting effects
antacid compound that causes diarrhea
magnesium
antacid compound that causes gas
sodium and calcium
anatacid compound that causes fluid retention
sodium
avoid sodium antacids in which patient popilation
HTN, heart failure
antacid compound that causes acid rebound and need repeat dosing
calcium (tums)
what is simethicone
decreases gas (not a PUD or laxative)
