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MBBS 2: GIT Pharmacology > PUD, H. Pylori and Antiflatulants > Flashcards

PUD, H. Pylori and Antiflatulants Flashcards

1
Q

What are the causes of PUD?

A
  1. heliCobacter pylori bacteria - 95% 2. benign pancreatic tumour secretions - less than 5%
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2
Q

Describe what helicobacter pylori bacteria do in the stomach?

A

attach to the epithelial cellsof the stomac and duodenum which stops them from bein washed out of the stomach and once attached cause damage to the cells by secreting degradative enzymes, toxins and initiating a self destructive immune response

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3
Q

State treatments for PUD?

A
  1. antacids 2. H2 receptor blockers 3. mucosal protective agents 4. proton pump inhibitors 5. anti-cholinergics 6. prostaglandin analogs 7. anti-microbial agents
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4
Q

State examples of antacids?

A

weak bases - 1. aluminium hydroxide - Al(OH)3 2. magnesium hydroxide - Mg(OH)2 3. calcium carbonate - CaCO3 4. sodium carbonic acid - NaHCO3

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5
Q

What are the actions of antacids?

A
  1. prevent injury from H+ 2. neutralize gastric acid → reduce gastric acidity→ reduce peptic activity 3. protect face of ulcer
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6
Q

Side effects?

A
  1. contraindicated in patients with impaired renal function 2. Mg salts → diarrhea 3. aluminium salts → constipation 4. calcium carbonate → tastes chalky + frequent use causes constipation
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7
Q

What is the function of histamine H2 receptor blockers?

A

Inhibit secretion of gastric acid through competitive inhibition of Histamine H2 receptors - Suppresses 24 hour gastric secretion by 70%

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8
Q

What is the down side of H2 receptor blockers?

A

may alter the effects of other drugs through interactions with CYP450 - especially cimetidine

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9
Q

State examples of H2 receptor blockers?

A
  1. cimitidine 2. famotidine 3. ranitidine 4. nizatidine
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10
Q

What are the general side effects?

A
  1. diarrhoea 2. dizziness 3. muscle pain 4. alopecia 5. hypergastrinaemia
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11
Q

What are the specific side effects of cimetidine?

A
  1. inhibits metabolism of estrogen 2. crosses placental barrier and appears in breast milk 3. long term use in females may cause galactorrhea 4. long term use in males may cause gynecomastia and impotence
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12
Q

Which drugs undergo first pass hepatic metabolism?

A
  1. cimetidine 2. ranitidine 3. famotidine
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13
Q

Which drug has little first pass metabolism?

A

nizatidine

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14
Q

What is the duration of action?

A

6–10 hours : given twice daily

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15
Q

How do they work?

A

Inhibit 90% of nocturnal acid (which depends largely on histamine).

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16
Q

Give examples of proton pump inhibitors?

A
  1. omeprazole 2. iansoprazole 3. pantoprazole
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17
Q

What are the actions of proton pumps?

A

Strong inhibitors of gastric acid secretion through irreversible inhibition of proton pump, preventing “pumping” or release of gastric acid - Decreases acid secretion by up to 95% for up to 48 hours

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18
Q

What is the duration of action?

A

48-72 hours

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19
Q

What is the duration of the course of treatment?

A

4-8 weeks

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20
Q

Compare proton pump inhibitors and H2 receptor blockers?

A

proton pump inhibitors have faster relief and healing than H2 receptor blockers

21
Q

What are the gastrointestinal side effects?

A

nausea, vomiting, diarrhea, abdominal pain

22
Q

What are the nervous system side effects?

A

headache, somnolence, peripheral neuritis, confusion

23
Q

Describe other general side effects?

A
  1. overgrowth of bacteria - increases in gastric bacterial concentrations 2. impotence, gynaecomastia, pain in muscles and joints
24
Q

Describe the drug interactions of PPIs?

A
  1. May affect absorption of drugs due to decreased gastric acidity like digoxin and ketoconazole 2. Omeprazole can inhibit metabolism of coumadin (Warfarin ), diazepam and phenytoin
25
Q

Which drugs have no significant interactions?

A

Rabeprazole and pantoprazole

26
Q

What do prostaglandins exist as?

A

PGE2 + PG12 analogues

27
Q

When are they used?

A

For treatment of NSAID induced injury

28
Q

How do they work?

A
  1. Stimulates Gi pathway, leading to decrease in gastric acid release 2. Stimulate secretion of mucus and bicarbonate (cytoprotective effect)
29
Q

What are the side effects?

A
  1. diarrhea 2. cramping 3. abdominal pain (30%) 4. birth defects 5. premature birth
30
Q

State an example of a prostaglandin?

A

misoprostol

31
Q

What are anticholinergics?

A

muscarinic M1 acetylcholine receptor antagonist

32
Q

How do they work?

A

block gastric secretions - about as effective as H2 blockers

33
Q

What are the side effects?

A

anorexia, blurry vision, constipation, dry mouth, sedation

34
Q

Give examples?

A
  1. pirenzipine 2. atropine
35
Q

Give an example of a gastrin-receptor antagonists?

A

proglumide

36
Q

Name mucosal protective agents?

A

sucralfate (carafate)

37
Q

Describe the mode of action of sucralfate?

A
  1. Breaks down into sucrose sulfate and an aluminum salt in the stomach 2. Negatively charged sucrose sulfate binds to positively charged proteins in the base of ulcers or erosion, forming a physical barrier 3. Physical barrier restricts further caustic damage and stimulates mucosal prostaglandin and bicarbonate
38
Q

Describe the drug interactions?

A

May bind with other drugs and interfere with absorption

39
Q

Describe the treatment?

A
  1. taken on an empty stomach before meals 2. Given approximately 2 hours before or after other drugs
40
Q

Name colloidal bismuth compounds?

A
  1. bismuth subsalicylate 2. bismuth subcitrate - Bismuth is minimally absorbed from GIT (< 1%).
41
Q

Describe the action of bismuth?

A
  1. Coats ulcers and erosions, creating a protective layer against acid and pepsin 2. It may stimulate prostaglandin, mucus, and bicarbonate secretion
42
Q

Describe the benefit of bismuth?

A

has direct antimicrobial effects and binds enterotoxins, accounting for its benefit in preventing and treating traveler’s diarrhea

43
Q

What is bismuth used as?

A

Used as second-line therapy for the eradication of H pylori infection - a PPI with bismuth subsalicylate , tetracycline and metronidazole for 10–14 days

44
Q

What are the side effects?

A

blackening of stool and tongue

45
Q

What are antimicrobial agents used for?

A

> 85% PUD caused by H. pylori

46
Q

Describe the antibiotic ulcer therapy?

A
  1. Bismuth - Disrupts bacterial cell wall 2. Clarithromycin - Inhibits protein synthesis 3. Amoxicillin - Disrupts cell wall 4. Tetracycline - Inhibits protein synthesis 5. Metronidazole - Used often due to bacterial resistance to amoxicillin and tetracycline, or due to intolerance
47
Q

What is the use of antiflatulants?

A

used to relieve panful symptoms associated with gas

48
Q

Give an example of an antiflatulant?

A

simethicone - a detergent

49
Q

Describe the action of simethicone?

A
  1. Alters elasticity of mucus-coated bubbles, causing them to break 2. Large bubbles -> smaller bubbles, and less pain - Used often, but limited data regarding effectiveness

MBBS 2: GIT Pharmacology (2 decks)

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