Stomach Drugs Flashcards
what are the causes of peptic ulcer disease?
- H. pylori
- NSAID
- Zollinger-Ellison syndrome
- stress ulcers
- smoking - increases pepsin production
- increased age
what is the stomach’s natural defense against peptic ulcer disease?
mucus, bicarbonate, blood flow, and prostaglandins
what are the causes of GERD?
- smoking
- increased age
- FOODS (chocolate and fat)
- medications (B-blockers, calcium channel blockers, nitrates)
- pregnancy
how should h. pylori be treated?
use a combination of antibiotics (2-3) with an acid reduction agent
- bismuth (Pepto-Bismol)
- clarithromycin - resistance
- amoxicillin
- tetracycline
- metronidazole (Flagyl) - resistance
does a bland food and avoidance of caffeine best treat for PUD?
no, it doesn’t work for everyone since everyone is different
- eat smaller meals
what is the action of H2 blockers (-tidine)?
inhibition of gastric acid secretion by blocking H2 receptors
what are the benefits of H2 blockers (-tidine)?
- easy to swallow
- often a better choice than antacids
- little-no effect from food
when does the dose of H2 blockers (-tidine) need to reduced?
in patients with renal impairment
what are the approved uses for H2 blockers (-tidine)?
- PUD
- esophagitis
- acute stress ulcer - GI bleeding
- Zollinger-Ellison syndrome
- GERD
what are the side effects of cimetidine (H2 Blocker)?
headache, drowsiness, confusion (ESPECIALLY IV DOSE IN ELDERLY)
- seems to be dose-related
- fewer CNS problems with other H2 blockers
antiandrogenic effects
- gynecomastia and decrease libido in males
many drug interaction r/t CP450 inhibition
what other examples of other H2 blockers besides cimetidine?
ranitidine (Zantac) and famotidine (Pepcid)
how do ranitidine (Zantac) and famotidine (Pepcid) work?
generally act the same as cimetidine but more potent, fewer side-effects, fewer drug interactions
what are the actions of proton-pump inhibitors (PPIs) (-prazole)?
binds to and inhibits enzymes on the parietal cell membrane and moderates acid secretion
what are the benefits of proton-pump inhibitors (PPIs) (-prazole)?
- more effective because they last longer
- last 2 weeks after the last dose - taper off to rebound hypersecretion
what are examples of proton-pump inhibitors (PPIs)?
- omeprazole (Prilosec)
- lansoprazole (Prevacid)
- Pantoprazole - most common because it can be given PO and IV
what is omeprazole (Prilosec) used for?
PPI - PUD - GERD - erosive esophagitis - Zollinger-Ellison syndrome NOT STRESS
what are the side effects of omeprazole (Prilosec)?
- N/V
- diarrhea
- headache
what are the consequences of long-term use of omeprazole (Prilosec)?
- association with C.diff
- maybe stomach ulcers and STOMACH CANCER
what are drug interactions with omeprazole (Prilosec)?
- clopidogrel - antiplatelet
- phenytoin - anti seizure
- warfarin
- benzodiazepines
do critically ill patients need to be treated prophylactically to prevent stomach ulcers?
probably not
what is the action of sucralfate (Carafate)?
ulcer coating drug - NO MORE THAN 8 WEEKS
- combines with chemicals from damaged cells in ulcer craters and forms a coating over the ulcer
- when there is a pH less than 4 it results in a product that is viscous and sticky and adheres to an ulcer crater
- doesn’t decrease acid production but creates a protective barrier
what is the negative about administration with sucralfate (Carafate)?
- taken 1 hour before meals without other drugs
- 2-4 times per day before meals and bed
what form does sucralfate (Carafate) come in?
pill or liquid
what is the main side effect of sucralfate (Carafate)?
constipation
