PUD and GORD

Question 1

Name 4 H pylori eradication regimens

Answer 1

1. Triple therapy
2. Quadruple therapy
3. Sequential therapy
4. Salvage therapy

Question 2

What does the classic triple therapy for H pylori eradication contain?

Answer 2

Omeprazole (ppi)
Amoxicillin (allergy- use metronidazole )
Clarithromycin
10-14 days
(First line)

Question 3

What does the quadruple therapy to eradicate H pylori contain?

Answer 3

Omeprazole (PPI) or H 2 R antag
Tetracycline
Metronidazole
Bismuth subsalicylate
10-14 days
(Can be used as salvage therapy)

Question 4

What does the sequential therapy for H pylori eradication contain?

Answer 4

PPI 10 days
Amoxicillin day 1-5
Then Clarithromycin and tinidazole or metronidazole days 6-10

Question 5

Name 2 gastric hyposecretory drug classes with examples

Answer 5

• Ppi: omeprazole

* h2 r antag: cimetidine, ranitidine

Question 6

Name a neutralising drug class with examples

Answer 6

Antacids: aliminium hydroxide, magnesium carbonate

Question 7

Role of histamine on gastric acid secretion? (3)

Answer 7

• Stored in enterochromaffin like (ecl) cells.
• released by gastric, ach and others to stimulate gastric acid release
• h2 receptors expressed on parietal cells

Question 8

Describe the mechanism of gastric acid secretion (4)

Answer 8

• Histamine binding shifts h2 receptors to active conformation
• g-protein activate adenylate cyclase to increase cAMP production
• this activates h/k antiporter pumps to exchange H in cell for k in stomach
• increased H increase acidity

Question 9

Name 3 h2 receptor antagonists

Answer 9

• Cimetidine (severe AE)
. Ranitidine
• nizatidine

Question 10

Name 5 adverse effects h2 R antagonists

Answer 10

• Dizzy, confusion
• fatigue
• Gynaecomastia,galactorrhoea,decreased sperm count (especially cimetidine)
• tolerance
• rebound acid hypersecretion afterwithdrawal

Question 11

Name 5 drug interactions with h2 R antagonists, especially cimetidine

Answer 11

• Azole antifungals: require acidic environment to be absorbed
• warfarin (inhibit CYP450 so reduced metabolism)
• phenytoin
• theophylline
• MDMA ecstasy
• diazepam

Question 12

Name 5 adverse effects PPI

Answer 12

more with omeprazole.
• git upset
• myalgia and joint pain
. C diff infection
• cardiotoxic
• improper digestion food