study day 8

Question 1

treatment of P ulcers

+ goal

Answer 1

Drugs used in the treatment of peptic ulcers and hypersecretion of gastric acid→
- Antacids
- Mucosal defenses
- Histamine-2 receptor antagonists
- Proton pump inhibitors

The goal of drug therapy is to:
1) alleviate symptoms
2) promote healing
3) prevent complications (hemorrhage, perforation, obstruction),
4) prevent recurrence

Question 2

antacids

Answer 2

Alkaline compounds (bases) that simply neutralize gastric acid (HCI)
- reduce the activity of pepsin
- Short duration of action

Adverse effects:
1) constipation
2) diarrhea
3) reduce the absorption of certain drugs (eg.ciprofloxacin, tetracycline)

Question 3

sucralfate and bismuth

Answer 3

Sucralfate
- Forms a protective barrier on the ulcer
- Adverse effect: constipation

Bismuth subsalicylate (Pepto-Bismol)
- Forms a protective barrier over gastric mucosa
- Also has a bacteriostatic, antisecretory and anti-inflammatory activities
(acting against bacteria while coating the stomach)

Adverse effect:
1) Black tongue and black feces

Question 4

misoprostol

Answer 4

Enhancer of mucosal defenses
- Prostaglandin PGE1 analogue
- Stimulants submucosal blood flow as well as the production of HCO3- and mucus
- Tend to make smooth muscle contract therefore causing things to movequicker through the intestines

• Adverse effects:
  1) Diarrhea,cramps,contraction of the uterus
  2) induction of labor

Question 5

histamine antagonists

Answer 5

Cimetidine: adverse effects
1) Inhibits hepatic metabolism
2) Anti-androgenic effects (gynecomastia,erectile dysfunction, reduced libido)

Ranitidine, famotidine, nizatidine
- For all members of this class, possible rebound gastric acid secretion upon discontinuation after chronic therapy
- Proven to be cancer causing therefore are no longer used
- due to the chemistry of these meds that cause a build up of impurities

Question 6

proton pump inhibitor

Answer 6

Esomeprazole, pantoprazole, rabeprazole, dexlansoprazole
- Inhibits the gastric H+/ K+ ATPase pump (inhibit H+ from entering into the
stomach)
- Adverse effects:
2) Headache and diarrhea
3) increase risk of osteoporosis
4) Can decrease the absorption of vitaminB12 and iron

Question 7

antibiotic regimens

h pylori

Answer 7

triple therapy without bismuth:
Proton pump inhibitor (lanzoprazole) (PPI)
+ Antibiotic (amoxicillin) (Penicillin)
+ Antibiotic (clarithromycin) (macrolide)
+ Antibiotic (metronidazole) (giardia)

Quadruple therapy with bismuth: Proton pump inhibitor
+ Tetracycline (anti-depressant)
+ Bismuth salts (salicylate)
+ Metronidazole (DNA synthesis inhibitors)

Question 8

antidirrheal

Answer 8

Loperamide (Imodium)
1) Morphine derivative with few effects

Other drugs
- Anticholinergics, verapamil, AI salts, lomotil (combination diphenoxylate- atropine)
- Muscarinic antagonist- Anti SLUDGE