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Gi > Treatment of Peptic Ulcer > Flashcards

Treatment of Peptic Ulcer Flashcards

1
Q

Eradication of H. pylori

Triple therapy

A

Triple Therapy:

  1. ​PPI (omeprazole), metronidazole/amoxicillin and clarythromycin
  2. Clarythromycin, tetracycline, ompeprazole
  3. H2 receptor antagonist (rantidine), bisthmus sunsalicyclate, clarythromycin
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2
Q

Eradication of H. pylori

Quadruple therapy

A

Quadruple therapy:

  1. ​Bisthmus subsalicyclate for mucosal protection, metronidazole tetracyline PPI
  2. Reistant case: PPI, Amoxicillin, clarythromycin metronidazole
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3
Q

What happens if a single therapy is used to eradicate H pylori

A
  • less effective
  • antimicrobial resistance

therefore: use a combination given twice daily for 2 weeks

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4
Q

PPI

overview

A
  • inhibit acid secretion by > 90%
  • More effective at healing ulcers than H2 receptor anatagonists
  • Longer duration of action than H2 receptor anatagonists
    • ​This is becuase they inhibit the H/K-ATPase pump
  • Once daily 30 min before breakfast or largest meal
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5
Q

PPI

Uses

A
  • Treat peptic ulcer
  • Reflux esophagitis
  • Part of treating H. pylori
  • Zollinger Ellison syndrome
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6
Q

PPI

Drug interactions

A

Ompeprazole inhibits CYP450 therefore reduces metabolism of warfarin and phenytoin

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7
Q

H2 Receptor Antagonists

Include

A
  1. Famotidine
  2. Cimetidine
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8
Q

H2 Receptor Antagonists

MOA

A

Competitivily and reversibly block histamine induced acid secretion by parietal cells

  • less than PPI
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9
Q

H2 Receptor Antagonists

PHARMACOKINETICS

A

Well absorbed orally

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10
Q

H2 Receptor Antagonists

Adverse effects

A

Cimitidine:

Acts as nonsteroidal antiandrogen →gynecomastia and galactorrhea

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11
Q

Cimitidine drug interactions

A
  • inhibits CYP450 and reduce meabolism of warfarin and phenytoin
  • Reduce efficacy of drugs that require an acidic enviornment for absorption like ketoconazole
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12
Q

Antimuscarinic Agents

A

Dicyclomine:

  • Adjucnt in Zollinger Ellison syndrome
  • Those who are refractory to other treatments
    • Adverse effect
      • carduac arrythmia
      • dry mouth
      • constipation
      • urinary retention
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13
Q

Antacids

A
  • weak bases
  • react with gastric acid to form water and a salt→decreasing acidity
  • Reduce pepsin activity
    • Pepsin in inactive at pH>4
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14
Q

Commonly used antacids

A
  • MgOH
  • Milk of magnesia
  • Aluminum OH

relieve pain and provide symptomatic relief

avoid other drugs

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15
Q

Cytoprotective Compounds

A
  1. Bismuth subsalicylate
  2. Sucralfate
  3. Misoprostol
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16
Q

Bismuth subsalicylate

A
  • combination regimen to treat h pylori infection of peptic ucler
    • antimicrobial
  • Coat ulcer base→protective barrier and increase bicarb and mucous secretion
  • Inhibit pepsin
  • BLACK TONGUE AND STOOL
17
Q

Sucralfate

A
  • forms complex gels with mucus
    • decrease degradation of mucous by acid and pepsin
  • Stimulate PG release and bicarb from mucous
  • Forms viscous paste in acidic enviornment
    • ​Efficacy reduced by antacids and H2 antagonists
  • Orally to heal duodenal ulcers and prevent their recurrence
18
Q

Misoprostol

A
  • Inhibits gastric acid secretion
  • Increase secretion of mucous and bicarb
  • ONLY used to prevent gastric damage that occurs with chronic use of NSAIDs
  • Uterine contractions therefore contraindicated in pregnancy
  • Causes diarrhea and abdominal cramps

Gi (5 decks)

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