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Pharmacology > PUD > Flashcards

PUD Flashcards

1
Q

Indications of Antacid therapy

A

Mild GORD
Dyspepsia
Reflux oseophagitis

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2
Q

MOA of Antacids

A

Neutralise gastric acidity

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3
Q

Which are the Antacids

A

NaHCO3
CaCO3
Al(OH)3
Mg(OH)3

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4
Q

AE of systemic antacids

A

NaHCO3:
Na and H2O retention=Hypertension

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5
Q

AE of Non-systemic antacids

A

CaCO3:
Hypercalcaemia, rebound acidosis, belching
Al(OH)3: Constipation
Mg(OH)3: diarhoea

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6
Q

In renal insufficiency, systemic antacids result in

A

Metabolic alkalosis

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7
Q

In renal insufficiency, non-systemic antacids result in

A

Toxicity

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8
Q

Caution in Mg(OH)3

A

renal insufficiency: incr. plasma Mg–>
hypermagnesaemia= mental depression, coma and NV

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9
Q

Caution in Al(OH)3

A

renal insufficiency: incr. Al–> CNS accumulation=incr. neurotoxicity, encephalopathy

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10
Q

DI in Antacids

A

Absorb other drugs: digoxin, phenytoin
Chelates other drugs: iron, tetracyclines
Incr. gastric emptying: decr. absorption of digoxin, levadopa
Incr. gastric pH: decr. absorp. of acidic drugs indomethacin, sulphonamides, ketoconazole, itraconazole
Urine alkalinisation: incr. clearance ot tetracyclines, sulphonylureas

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11
Q

Dosing interval requirements in Antacids

A

4 hrs before or 2 hrs after other drugs

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12
Q

Which are the PPIs

A

Omeprazole
Esomeprazole
Lansoprazole
Pantoprazole
Rabeprazole

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13
Q

Indications of PPIs

A

Duodenal & gastric ulcer (stress/NSAID)
GORD
H. Pylori irradication (+ antibiotics)
ZOllinger-Ellison Syndrome

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14
Q

MOA of PPIs

A

-Irreversibly bind to and inhibit H/K ATPAse pump enzyme of gastric parietal cell
-weak bases=incr. pH=stabilise ulcer clot= decr. bleeding
-inhibit H.pylore urease= prevent ammonia production and expose H.Pylori to acidic conditions
-inhibit gastric mucosal carbonic anhydrase

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15
Q

DOA of PPIs

A

24-48 hrs

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16
Q

Bioavailability of PPIs

A

Pantoprazole>lansoprazole>rabeprazole> omeprazole

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17
Q

DI of PPIs

A

inhibit CYP450:
decr. elimination of diazepam, warfarin, phenytoin
decr. gastric acidity:
decr. absorp. of ketoconazole, itraconazole

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18
Q

CI of PPIs

A

Lactation
Pregnancy 1st trimester

19
Q

AE of PPIs

A

Diarhoea
NV
Flatulence
Headache
Vertigo
Abd. pain or colic

20
Q

Which of the PPIs is partial reversible

A

Rabeprazole

21
Q

Which are the H2 R antagonists

A

Cimetidine
Ranitidine

22
Q

Indications of H2 R antagonists

A

PUD
Prevention of stress ulcer in critically ill patients
GORD
Zollinger Ellison syndrome

23
Q

MOA of H2 R antagonists

A

Block histamine actions on H2 R in parietal cells
decr. ACh and gastrin-induced gastric acid secretion

24
Q

What is Cimetidine

A

Is a potent CYP450 inhibitor

25
Q

DI of Cimetidine

A

agents metabolised by CYP450:
midazolam
diazepam
Propranolol
Nifedipine
Phenytoin
=decr. gastric acidity: decr. absorp. of ketoconazole, itraconazole

26
Q

AE of H2 R antagonist

A

diarhoea
NV
Myalgia
Pruritus
Skin rash
Gynecomastia

27
Q

Name the prostaglandin

A

Misoprostol

28
Q

What is Misoprostol

A

PGE1 analogue (a gastric cytoprotective agent)

29
Q

Indications of MIsoprostol

A

prevent NSAID induced gastric and duodenal ulceration

30
Q

MOA of Misoprostol in Cytoprotection

A

Cytoprotection:
Incr. bicarbonate secretion,mucus production, mucosal blood flow
= incr. O2 and nutrient supply to healing mucosa
=incr. epithelialisation

31
Q

MOA of Misoprostol as in Acid-inhibition

A

decr. gastric cAMP levels
=decr. H/K ATPase pump activity
=decr. acid production

32
Q

Caution in Misoprostol

A

Renal impairement

33
Q

CI of Misoprostol

A

Pregnancy (tetrogenic)
Lactation
Paediatrics

34
Q

AE of Misoprostol

A

Abd. pain
Diarrhoea
Menstrual disorders
Cramps
Uterine contractions
Vaginal Haemorrhage
Menorrhagia
Dysmenorrhoea

35
Q

Which other drugs are used in PUD and GORD?

A

Sucralfate
Bismuth Subcitrate

36
Q

What is Sucralfate

A

Its a sucrose-hydrogen sulphate aluminum complex
Its a mucosal protective agent

37
Q

MOA of Sucralfate

A

In acidic pH<4: dissociates to ALOH and scurose octasulfate
Sucrose Octasulfate undergoes polymerisation= forms a viscous paste like complex with a strong -ive charge= binds +ively charged proteins in base of ulcers or erosions
Formed insoluble complex creates a barrier that protects ulcer from further damage for up to 6 hrs

38
Q

Indications of Sucralfate

A

PUD
Refluc Oesophagitis
Chronic Gastritis
COMT??

39
Q

DI of Sucralfate

A

Sulfate= decr. abs. of digoxin, phenytoin, cimetidine, ranitidine, warfarin, theophylline

40
Q

AE of Sucralfate

A

Constipation

41
Q

MOA of Bismuth Subcitrate

A
  • absorbs toxins and coats ulcers and erosions–> creates a protective layer against acid
    -stimulates PG, mucus, and bicarbonate secretion
42
Q

Indications of Bismuth Subcitrate

A

PUD
Adjuct H.pylori assoc. gastritis therapy

43
Q

AE of Bismuth Subcitrate

A

Teeth and stool darkening
Abd. pain
Metallic taste

Pharmacology (50 decks)

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