PUD

Question 1

Indications of Antacid therapy

Answer 1

Mild GORD
Dyspepsia
Reflux oseophagitis

Question 2

MOA of Antacids

Answer 2

Neutralise gastric acidity

Question 3

Which are the Antacids

Answer 3

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

Question 4

AE of systemic antacids

Answer 4

NaHCO3:
Na and H2O retention=Hypertension

Question 5

AE of Non-systemic antacids

Answer 5

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

Question 6

In renal insufficiency, systemic antacids result in

Answer 6

Metabolic alkalosis

Question 7

In renal insufficiency, non-systemic antacids result in

Answer 7

Toxicity

Question 8

Caution in Mg(OH)3

Answer 8

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

Question 9

Caution in Al(OH)3

Answer 9

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

Question 10

DI in Antacids

Answer 10

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

Question 11

Dosing interval requirements in Antacids

Answer 11

4 hrs before or 2 hrs after other drugs

Question 12

Which are the PPIs

Answer 12

Omeprazole
Esomeprazole
Lansoprazole
Pantoprazole
Rabeprazole

Question 13

Indications of PPIs

Answer 13

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

Question 14

MOA of PPIs

Answer 14

-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

Question 15

DOA of PPIs

Answer 15

24-48 hrs

Question 16

Bioavailability of PPIs

Answer 16

Pantoprazole>lansoprazole>rabeprazole> omeprazole

Question 17

DI of PPIs

Answer 17

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

Question 18

CI of PPIs

Answer 18

Lactation
Pregnancy 1st trimester

Question 19

AE of PPIs

Answer 19

Diarhoea
NV
Flatulence
Headache
Vertigo
Abd. pain or colic

Question 20

Which of the PPIs is partial reversible

Answer 20

Rabeprazole

Question 21

Which are the H2 R antagonists

Answer 21

Cimetidine
Ranitidine

Question 22

Indications of H2 R antagonists

Answer 22

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

Question 23

MOA of H2 R antagonists

Answer 23

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

Question 24

What is Cimetidine

Answer 24

Is a potent CYP450 inhibitor

Question 25

DI of Cimetidine

Answer 25

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

Question 26

AE of H2 R antagonist

Answer 26

diarhoea NV Myalgia Pruritus Skin rash Gynecomastia

Question 27

Name the prostaglandin

Answer 27

Misoprostol

Question 28

What is Misoprostol

Answer 28

PGE1 analogue (a gastric cytoprotective agent)

Question 29

Indications of MIsoprostol

Answer 29

prevent NSAID induced gastric and duodenal ulceration

Question 30

MOA of Misoprostol in Cytoprotection

Answer 30

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

Question 31

MOA of Misoprostol as in Acid-inhibition

Answer 31

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

Question 32

Caution in Misoprostol

Answer 32

Renal impairement

Question 33

CI of Misoprostol

Answer 33

Pregnancy (tetrogenic) Lactation Paediatrics

Question 34

AE of Misoprostol

Answer 34

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

Question 35

Which other drugs are used in PUD and GORD?

Answer 35

Sucralfate Bismuth Subcitrate

Question 36

What is Sucralfate

Answer 36

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

Question 37

MOA of Sucralfate

Answer 37

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

Question 38

Indications of Sucralfate

Answer 38

PUD Refluc Oesophagitis Chronic Gastritis COMT??

Question 39

DI of Sucralfate

Answer 39

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

Question 40

AE of Sucralfate

Answer 40

Constipation

Question 41

MOA of Bismuth Subcitrate

Answer 41

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

Question 42

Indications of Bismuth Subcitrate

Answer 42

PUD Adjuct H.pylori assoc. gastritis therapy

Question 43

AE of Bismuth Subcitrate

Answer 43

Teeth and stool darkening Abd. pain Metallic taste