PUD drugs

Question 1

aluminum -based antacids

Answer 1

aluminum hydroxide (Amphogel)

• rarely used alone
• SE: constipation
• binds to PO4

Question 2

magnesium-based antacid

Answer 2

magnesium hydroxide (Milk of Magnesia)

Contraindicated in renal failure pts.

SE: hypermagnesia, diarrhea (laxative)

Question 3

calcium-based antacids

Answer 3

calcium carbonate (Tums)
calcium acetate (PhosLo)
- rarely used alone
OK for renal/kidney disease pts. – binds to PO4

SE: hypercalemia –> renal calculi
Increased gastric acid production

Question 4

combination antacids

Answer 4

magnesium and aluminum (Maalox)
magnesium, aluminum and simethicone (Mylanta, Maalox Plus)

SE: bloating, constipation or diarrhea

Question 5

NI and Pt. education for antiulcer agents

Answer 5

antacids: don’t mix w/other drugs
PPIs: don’t crush
Carafate: before meal (1 hour)
H2B: CYP inhibitor

Pt. ed:  
decrease acidic foods
small, frequent meals
no NSAID
avoid fatty meals
raise head of bed for sleep

Question 6

H2 Blockers

Answer 6

Cimetidine (Tagamet)
Famotidine (Pepcid)
Ranitidine (Zantac)

MOA: decreases gastric acid secretion by blocking action of histamine @ H2 receptors

Caution: w/renal or hepatic pts, children, pregnant

Avoid use in elderly r/t CNS risk

Indications: used in conjunction w/antibiotics to treat ulcers

SE: bind to androgen receptors = gynecomastia, impotence

Question 7

How do NSAIDS contribute to peptic ulcers?

Answer 7

• inhibits synthesis of Cox 1 enzyme (protective)
• ↓ blood flow to GI
• ↓ secretion of mucus and bicarbonate
• ⇡ secretion of gastric acid⇡

Question 8

what defensive factors does the GI have?

Answer 8

1. MUCOUS CELLS - prevent auto-digestion
2. EPITHELIAL CELLS OF MUCOSA - secrete bicarbonate (alkaline)
3. PROSTAGLANDINS - produced by Cox 1 enzymes; ↓ gastric acid secretion; ⇡ mucus and bicarbonate secretion; regulate blood flow to mucosa
4. BLOOD FLOW - essential for maintaining mucosal integrity

Question 9

Antibiotics regimen to rid H. pylori bacteria

Answer 9

EXAMPLE OF A 2 WEEK REGIMEN
bismuth
clarithromycin (Biaxin)
amoxicillin
tetracycline
metronidazole (Flagyl)

Question 10

bismuth

Answer 10

• anti-inflammatory properties agains H. pylori (disrupts cell wall; inhibits urease activity)
• coats the stomach

SE: causes temporary black stools and tongue

Question 11

Cimetidine (Tagamet)

Answer 11

H2 Blocker
↓ gastric acid secretion
SE: binds to androgen receptors => gynecomastia / impotence
- smoking reduces effectiveness