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Pharmacology Exam 2 > PUD and GERD > Flashcards

PUD and GERD Flashcards

1
Q

Why do NSAIDs increase risk of PUD?

A
  1. Direct or topical irritation

2. inhibition of GI prostaglandin synthesis which is needed to maintain blood flow, stim bicarb and mucous production

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2
Q

Which two bisphosphonates can induce ulcerations?

A

Alendronate (Fosamax)
Risedronate (Actonel)

*take with a full glass of water and sit up

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3
Q

Which infection is strongly associated with PUD?

A

H.pylori

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4
Q

H.pylori - how does it damage the gut?

A

produces a large amount of urease –> catalyzes the breakdown of urea to alkaline ammonia and CO2

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5
Q

What is the only cancer you can cure by treating the causative organism?

A

gastric carcinoma or B-cell lymphoma r/t h.pylori

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6
Q

PUD - general approach to treatmen

A
  1. stop smoking
  2. take NSAIDs with food
  3. stop or decrease NSAID dose
  4. Meds: misoprostol, H2RA, PPI or PPI with hs H2RA
  5. consider h.pylori
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7
Q

How long does treatment of PUD take?

A

6-8 weeks

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8
Q

Oral antacids - drugs

A

Amphojel, Maalox, Maalox HRF, Mylanta DS

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9
Q

What are oral antacids use for?

A

symptom relief

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10
Q

Oral antacids - ADE

A

diarrhea or constipation

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11
Q

Oral antacids - DDI and Why?

A

binds and prevents absorption or: levothyroxine, tetracyclines, iron, isoniazid, FQs

Why? binds with di valent and tri valent cations like Mg, Ca and Al

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12
Q

Which formula of oral antacids may be more effective?

A

chewable

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13
Q

What may be of concern in CHF patients regarding oral antacids?

A

Na+ content - depends on dose

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14
Q

*What medication provides a protective barrier in the esophagus against gastric contents…floats on surface of gastric contents but does not neutralize acid?

A

Gaviscon (antacid containing alginic acid)

used mostly for GERD

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15
Q

*What class are Ranitidine (Zantac), Famotidine (Pepcid) and Cimetidine (Tagamet) in?

A

Histamine Receptor Antagonist (H2RA)

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16
Q

*H2RA - MOA

A

reversibly inhibit H2 receptors on parietal cells (except famotidine which has some noncompetitive inhibition)

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17
Q

Of the H2RAs, which is probably “a little” better and why?

A

Famotidine (Pepcid) because longer t1/2 (12 hours)

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18
Q

Most H2RAs are BID dosing. Why do you give the 2nd dose at bedtime?

A

because nocturnal acid suppression is important for healing

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19
Q

H2RAs - ADE

A

thrombocytopenia (small risk), increased serum Cr and BMS

20
Q

Which H2RA should be avoided in BMT patients?

A

Ranitidine (Zantac)

most likely to cause BMS

21
Q

Which H2RA is used for prophylaxis of NSAID induced duodenal ulcers?

A

Famotidine (Pepcid)

22
Q

How are most H2RAs cleared?

A

renal (adjust per CrCl)

23
Q

*What class are Esomeprazole (Nexium), Lansoprazole (Prevacid), Panteprazole (Protonix) and Omeprazole (Prilosec)?

A

“prazoles” = PPI

24
Q

*PPI - MOA

A

Prodrug that requires activation by acid. Irreversibly bind to H+/K+ ATPase pump on parietal cell and inhibits acid generation.

25
Q

How long does it take to restore proton pumps after DC of PPI?

A

3-5 days

26
Q

General dosing for PPI

A

qd

27
Q

*How are most PPIs cleared?

A

hepatically

watch DDI…esp. CYP450

28
Q

What are the long term safety concerns of PPI?

A
  1. increased risk of fractures (b/c decreased Ca absorption)
  2. possible hypomagnesemia
  3. gastric carcinoid tumors from hypergastrinemia
  4. pneumonia and enteric infections
29
Q

Why is there an increased risk of pneumonia for the elderly on PPI?

A

Lower acid in the gut allows bacteria to grow and if aspirated, can cause pneumonia.

30
Q

Why is there an increased risk of enteric infections on PPI?

A

Lower acid in the gut allows bacteria to grow (Salmonella, Shigella, Cholora)

31
Q

*When is misoprostol (cytotec) used?

A

prophylaxis for PUD if on long term NSAID

32
Q

Misoprostol (cytotec) - ADE

A

diarrhea and cramping

33
Q

Misoprostol (cytotec) - pregnancy warning

A

avoid - can cause contractions

can be used to stimulate labor

34
Q

*h.pylori triple therapy - PPI

A

PPI bid + clarithromycin 500 mg bid + AMX 1000 mg bid

80-90% eradication

35
Q

at what pH does the gut heal?

A

> 4

36
Q

ACG guidelines for maintenance of GERD

A

PPIs

37
Q

Which drug can be given to pregnant women with N/V or HA?

A

Reglan

38
Q

In what condition is Reglan contraindicated in?

A

small bowel obstruction

39
Q

How is Reglan eliminated?

A

renal (adjust per CrCl)

40
Q

“functional GERD” - peak/onset

A

peaks at 4 months

usually gone by 12 months

41
Q

GERD - non-pharmacological treatment (infants)

A 
hypoallergenic formula trial
positioning (head up)
avoid caffeine, chocolate and spicy foods (breastfeeding)
weight control
avoid passive smoking
42
Q

GERD - non-pharmacological treatments (adult)

A 
IBW
modify diet
avoid ETOH and smoking
HOB up
avoid tight garments
43
Q

Pharmacological options - GERD

A
  1. oral antacids
  2. H2RA
  3. PPI
  4. Prokinetic agents
44
Q

Reglan - ADEs

A

drowsiness, diarrhea, dystonia, EPS

45
Q

What pro kinetic drug can be used to treat GERD?

A

Reglan

46
Q

*Risk factors -PUD

A

NSAIDS
h.pylori
steroids
anti-coagulants

47
Q

Which pathway is DDI most likely with Prilosec (PPI)?

A

2C19

Pharmacology Exam 2 (9 decks)

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