PUD+ GERD Dr. J

Question 1

True or false: PPIs are prodrugs

Answer 1

True

Question 2

What type of environment do PPIs need to be in to be activated?

Answer 2

Acidic

Question 3

What 3 components make up a PPI?

Answer 3

1. Benzimidazole
2. Methylsulfinyl
3. Pyridine

Question 4

When Omeprazole is activated by a proton catalyzed process, what does it generate?

Answer 4

A sulphenamide

Question 5

The sulphenamide interacts _____ with the sulphydryl groups of cysteine residues

Answer 5

Covalently

Question 6

To prevent premature degradation of proton pump inhibitors by acid in the gastric lumen, oral dosage forms are supplied in what kind of formulations?

Answer 6

Enteric coated

Question 7

How are PPIs absorbed and how does it reach its site of action?

Answer 7

Systemically; through the blood

Question 8

What CYP enzymes extensively metabolize PPIs?

Answer 8

1. 2C19
2. 3A4

Question 9

Protonix is is freely ____ in water

Answer 9

Soluble

Question 10

The stability of protonix in aqueous solution is dependent on what?

Answer 10

pH

Question 11

The delayed release and enteric coated tablets dissolve only at what pH for PPIs?

Answer 11

Alkaline

Question 12

What inhibits acid production by reversible competing with histamine for binding to H2 receptors on the basolateral membrane of parietal cells?

Answer 12

H2RAs

Question 13

True or false: H2RAs are less potent than PPIs

Answer 13

True

Question 14

The H2RAs predominantly inhibit what?

Answer 14

Basal acid secretion

Question 15

Because of what H2RAs inhibit, what are they efficacious for?

Answer 15

Suppressing nocturnal secretion

Question 16

True or false: H2RAs need to have enteric coating

Answer 16

False

Question 17

Why isn’t ranitidine on the market?

Answer 17

NDMA levels increase in ranitidine even under normal storage conditions

Question 18

H2RAs are rapidly absorbed after oral administration with peak serum concentrations within how many hours?

Answer 18

1-3

Question 19

Absorption of H2RAs may be enhanced by ____ or decreased by ______

Answer 19

Food; antacids

Question 20

What type of cells are the most prevalent in the acid secreting regions of the stomach?

Answer 20

Enterochromaffin like cells (ECL)

Question 21

What cytoprotective effects does PGE2 have? 3

Answer 21

1. Stimulation of mucin
2. Stimulation of bicarbonate secretion
3. Increase mucosal blood flow

Question 22

Misoprostol is an agonist at what receptor?

Answer 22

EP3

Question 23

True or false: mistoprostol is a prodrug

Answer 23

True

Question 24

What does misoprostol decrease?

Answer 24

Acid secretion

Question 25

What does sucralfate undergo in an acidic environment?

Answer 25

Extensive cross-linking

Question 26

What does sucralfate produce?

Answer 26

Viscous, sticky polymer that adheres to epithelial cells and ulcer craters

Question 27

What are the 4 mechanisms of sucralfate cytoprotection?

Answer 27

1. Protective effects in mucus 2. Antipeptic effect 3. Barrier effect 4. Enhanced tissue growth

Question 28

Antacids can prolong neutralizing effects on the pH in the presence of _____.

Answer 28

Food

Question 29

H. Pylori releases cytokines, toxins, and chemokines that result in

Answer 29

A massive inflammatory response

Question 30

Neutrophils are released from the capillaries to kill H. Pylori, but what else does it destroy?

Answer 30

Mucus secreting mucous membranes of the stomach