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Pharmacology > Unit 6- Chapter 32 GERD and PUD > Flashcards

Unit 6- Chapter 32 GERD and PUD Flashcards

1
Q

What are the functions of the stomach? (3)

A
  1. Store food 2. Mix food 3. Emptying to upper part of GI tract
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2
Q

What are the 3 types of secretory cells?

A
  1. Chief 2. Parietal 3. Mucus
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3
Q

What do chief cells secrete?

A

Secrete pepsinogen inactive enzyme. HCl activates pepsinogen into pepsin

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4
Q

What do parietal cells secrete?

A

Hydrocholoric acid and intrinsic factor

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5
Q

What do mucus cells secrete?

A

Mucus

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6
Q

What is required to absorb vitamin B12?

A

Hydrochloric acid and intrinsic factor

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7
Q

What is the pH of the stomach?

A

1-5

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8
Q

Prostaglandins are secreted by what? What functions are the functions of prostaglandins in the stomach?

A

Cells lining the stomach; helps prevent damage to the lining by inhibiting acid productions, maintains blood flow and stimulates mucus and bicarbonate production

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9
Q

What causes GERD? (heartburn)

A

Dysfunction of lower esophageal sphincter allows reflux of gastric contents into esophagus (pepsin and HCl). Also could be caused by delayed gastric emptying, making stomach stay full for too long. Leads to feelings of bloating, results in stretching and regurgitation

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10
Q

What are the symptoms of GERD?

A

Burning, bloating, belching, regurgitation

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11
Q

What are the symptoms of PUD?

A

Burning gnawing, aching, bloating, N&V, anorexia, sensation of fullness

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12
Q

Where are the the ulcers commonly found in PUD?

A

gastric and duodenal ulcers

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13
Q

What is PUD caused by?

A

Oversecretion of HCl which causes injury to mucosal barrier in stomach; NSAIDs,which inhibit prostaglandins; infection by H. Pylori

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14
Q

What can GERD mimic?

A

Myocardial infarction or stomach cancer

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15
Q

What are the goals of treatment of GERD and PUD? (6)

A
  1. relieve symptoms 2. Decrease frequency and duration of reflux
  2. Heal tissue injury 4. Prevent recurrence 5. Manage any bleeding 6.Treat infection caused by H. Pylori
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16
Q

How can epigastric pain sometimes be relieved by?

A

Antacids and sometimes relief with eating

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17
Q

What is the pt education for GERD and PUD? (6)

A
  1. Weight reduction 2. Smoking cessation - increases gastric acid production 3. Avoid foods that. Increase acid production (i.e. alcohol) 4. Consume smaller meals 5. Avoid eating at bedtime- Remain upright after meals for 2 hours because full stomach increases pressure on lower esophageal sphincter which creates opening in lower esophageal sphincter that allows gastric contents to go into esophagus (regurgitation) 6. Avoid tight clothing over abdomen
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18
Q

What is the goal of drug therapy for GERD and PUD? (4)

A
  1. Used to relieve symptoms 2. Promote healing 3. Prevent recurrence 4. Antibiotics used for symptomatic H. Pylori
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19
Q

Why should NSAIDs be limited? What should be used instead (if feasible)

A

NSAIDs inhibit prostaglandins (which help prevent damage to the lining of the stomach by inhibiting acid production and stimulates mucus and bicarbonate production; acetaminophen

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20
Q

What antibiotics are used. For symptomatic H. Pylori? (5)

A
  1. Tetracycline 2. Amoxicillin 3. Metronidazole 4. Clarithromycin 5. Rifabutin
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21
Q

What percent of the US population suffers from GERD on a daily basis?

A

5-7%

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22
Q

What are the most effective antacid combinations? (3)

A
  1. Aluminum hydroxide 2. Magnesium oxide or hydroxide 3. Calcium carbonate
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23
Q

What type of antacids is not for pts with renal disease? Why?

A

Magnesium oxide or hydroxide- May cause hypermagnesemia

24
Q

When should other drugs be administered when a pt is prescribed an antacid?

A

Administer other drugs either 1 hour before or 2 hours after antacid

25
Q

What other ingredient is found in antacid combination products and why?

A

Simethicone- deforming agent that breaks up gas bubbles in the stomach, reducing stomach distention and heartburn. It is effective in pts who have overeaten or who have heartburn, but it is not effective in treating PUD

26
Q

What antacids may cause rebound hyperacidity?

A

Calcium carbonate and sodium bicarbonate

27
Q

Which antacid treats high phosphate levels in those with renal disease/ pt on hemodialysis?

A

Calcium carbonate

28
Q

What is the usual pH of the stomach?

A

1-2

29
Q

Antacids reduce the pH in the stomach to what?

A

3-4

30
Q

What is the action of antacids?

A

Buffer hydrochloric acid to a lower concentration (3-4 pH) from excessive eating and drrinking

31
Q

What are the uses of antacids?

A

Treats heartburn from excessive eating and drinking; acute ulcer treatment requires large volumes

32
Q

What is the common adverse effect of antacids?

A

Chalky taste

33
Q

What are the serious adverse effects of antacids?

A

Constipation (with calcium or aluminum); diarrhea with magnesium; electrolyte imbalance

34
Q

For whom are antacids contraindicated? What is recommended instead?

A

If pt is pregnant (safe if MD says it’s OK), has edema, heart failure, hypertension or salt restrictions. Low sodium antacid

35
Q

What is the action of histamine-2 receptor antagonist?

A

Blocks H2 receptors resulting in decreased volume of acid secreted

36
Q

What is the suffix of histamine-2 receptor antagonist?

A

-tidine

37
Q

What are the uses of Histamine-2 Receptor antagonists?

A

Treat GERD, duodenal ulcers, stress ulcers, Zollinger-Ellison syndrome (a hypersecretory condition), prevents gastric ulcers in critically ill patients

38
Q

What are the common adverse effects of histamine-2 receptor antagonists?

A

Dizziness, HA, somnolence, diarrhea, constipation

39
Q

What are the serious adverse effects of histamine-2 receptor antagonists?

A

Confusion, disorientation, hallucinations, gynecomastia, hepatotoxicity

40
Q

What histamine-2 receptor antagonist increases risk of cancer. How long is the recommended course of tx with this drug?

A

Ranitidine (Zantac) use no more than 8 weeks unless advised by doctor

41
Q

What is the name of the drug that’s a gastrointestinal prostaglandins?

A

Misoprostol (cytotoxic)

42
Q

What is the action of misoprostol (cytotec) (gastrointestinal prostaglandin)

A

Inhibits gastric acid and pepsin secretion; increases gastric mucus (helps put mucosal layer back into action and prevents new ulcers from forming)

43
Q

What is the use of gastrointestinal prostaglandins (misoprostol- Cytotec)

A

Prevents and treats gastric ulcers caused by NSAIDs (including aspirin) because it erodes mucosal barrier

44
Q

What is the common adverse effect of gastrointestinal prostaglandins?

A

Diarrhea

45
Q

What is the contraindication of misoprostol (cytotec) gastrointestinal prostaglandins?

A

Risk of miscarriage, causes uterine contractions; contraindicated for pt’s within child-bearing years. Ensure pt isn’t pregnant prior to administration. Ensure pt is using birth control and instruct pt to start drug on the 2nd or 3rd day of next menstrual cycle.

46
Q

What is the suffix of proton pump inhibitors?

A

-prazole

47
Q

What is the action of proton pump inhibitors?

A

Inhibits gastric secretion by inhibiting gastric acid pump of the parietal cells (H+/K+ ATP pump)

48
Q

What are the uses of proton pump inhibitors?

A

Treat severe esophagitis, GERD, gastric and duodenal ulcers caused by H. Pylori, hypersecretory disorders (Zollinger-Ellison syndrome)

49
Q

What are the common adverse effects?

A

Diarrhea, HA, fatigue, muscle pain

50
Q

What are the serious adverse effects of proton pump inhibitors?

A

Rash, risk of fractures (osteoporosis); hypomagnesemia; Since it changes the acid production of acid in the stomach- increases risk of C. Diff; B-12 deficiency in pts using longer than 2 years

51
Q

Why do proton pump inhibitors come in enteric forms. What is the eduction for these drugs?

A

They’re highly unstable in acid; want drug to pass through stomach and begin to dissolve in small intestine ; enteric to help decrease risk of reactivity; For short term use only (2 weeks). Should be taken 30 minutes prior to meds. take whole, do not crush or open capsule

52
Q

In what patients taking proton pump inhibitors at an increased risk of fractures and osteoporosis?

A

Pts taking a high dose of med or for long periods of time

53
Q

What type of drug is sucralfate (carafate)?

A

Coating agent

54
Q

What is the action of sucralfate (carafate) coating agent?

A

Adheres to craters of an ulcer, protecting it from acids, pepsin, and bile salts

55
Q

What is the use of coating agents? (Sucralfate- carafate))

A

Treatment of duodenal ulcers, for pts who cannot tolerate other therapies

56
Q

What are the common adverse effects of coating agents?

A

Constipation, dry mouth, dizziness; METALLIC TASTE

57
Q

How do coating agent s work? When should they be taken?

A

Acts locally in the stomach and reacts with HCl in a positive way to form a thick paste like substance that adheres to gastric mucosa. binds to the ulcer and promotes healing of the ulcer.

Pharmacology (1 decks)

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