Tx for PUD I

Question 1

What is dyspepsia?

Answer 1

any symptoms referable to the upper GIT… including upper abdominal
pain or discomfort, heart burn, acid reflux, nausea & vomiting

Question 2

Symptoms arise from 5 main conditions. Name them.

Answer 2

• Non-ulcer / functional dyspepsia (indigestion)
• Gastro-oesophageal reflux disease (GORD)
• Gastritis
• Duodenal ulcers
• Gastric ulcers

Question 3

What are the clinical features of indigestion? (6)

Answer 3

Vague abdominal discomfort associated with belching
* Bloated
* Flatulence
* Feeling of fullness
* Nausea / vomiting
* Heartburn

Question 4

Explain the aetiology of GORD

Answer 4

Lower oesophageal sphincter
incompetence - ↓ muscle tone via
medicine / over treating

Question 5

Aetiology of gastritis

Answer 5

Increased acid produc on →
inflammation of stomach, attributed to
Helicobacter pylori infection, NSAIDs /
acute alcohol ingestion

Question 6

How does the H pylori affect the muosa?

Answer 6

• Duodenal & gastric ulceration
• H. pylori present in 95% and 70% of
  ulcers respec vely → thought to secrete
  chemical factors which cause gastric
  mucosal damage.

Question 7

When to refer a pt with dyspepsia

Answer 7

Anaemia
* Loss of weight / Anorexia
* Recent onset of progressive symptoms
* Severe pain (at night)
* Dysphagia (difficulty in swallowing) and haematemesis
* Persistent vomiting (with / without blood)
* Referred pain
* Treatment failure

Question 8

What is the non-pharmacological advice for dyspepsia

Answer 8

Lifestyle advise:
* Move to a lower fat diet (decrease spicy food and chocolate)
* Eat smaller frequent meals
* Reduce alcohol & caffeine intake
* Smoke cessation
* Lose weight

Question 9

Examples of H2 receptor antagonists

Answer 9

Cimetidine and Ranitidine

Question 10

Examples of Proton pump inhibitors

Answer 10

Lansoprazole
Omeprazole

Question 11

Examples of prostaglandins (1)

Answer 11

Misoprostol

Question 12

What is the MOA of antacids?

Answer 12

Neutralise stomach acid

Question 13

what are the active ingredients found in antacids?

Answer 13

• Sodium, potassium = quick acting, quick action
• Magnesium (diarrhoea), aluminium (constipation) = less soluble,
  prolonged action
• Calcium (constipation) = quick acting, prolonged action

Question 14

Directions of use of antacids

Answer 14

1 tablet 1 hour after meals and at bedtime

Question 15

Drug interactions of antacids

Answer 15

Affect absorption of drugs
tetracyclines, fluoroquinolones, iron,
digoxin, indomethacin - esp enteric coated tablets – leave gap of 2
hours between medications

Question 16

Contraindications of antacids

Answer 16

patients on salt-restricted diets / cardiovascular disorders
(hypertension), children under 12 years

Question 17

Why is it good to take antacids after a meal?

Answer 17

Take after food (pc), gastric emptying delayed, longer
duration of action

Question 18

What is the first line of tx of heartburn and reflux? What is its MOA?

Answer 18

Alginates (gaviscon)
MoA: contact with gastric acid = precipitation – sponge-like matrix that floats on top of stomach contents

Question 19

What is gelacid? how is it taken?

Answer 19

Comination of alginates and antacids

Take after each meal and
before bed-time
* Safe in pregnancy & lactation

Question 20

CI of Gelacid

Answer 20

Pts on salt-restricted diets

Question 21

What is the MOA of H2 antagonists?

Answer 21

Reduce gastric acid and
pepsin secretion by blocking
the action of histamine at the H2- receptors in the parietal cells of the stomach

Question 22

DIs of H2 antagonists

Answer 22

Inhibits hepatic microsomal enzymes (cytochrome P450) and has the potential for multiple drug interactions

Question 23

Adverse effects of H2 antagonists (6)

Answer 23

Headache, confusion, dizziness, diarrhoea, myalgia, skin rashes

Question 24

Indications of Cimetidine and Ranitidine

Answer 24

short-term relief of heartburn, dyspepsia and
hyperacidity

Question 25

Dosage of Cimetidine

Answer 25

max 200mg/dose & 800mg/day for max 14 days

Question 26

Dosage of Ranitidine

Answer 26

max 75mg/dose & 300mg/day for max 14 days