upper GI

Question 1

Proton Pump Inhibitors (PRAZOLES):

Answer 1

INDICATIONS:PUD, GERD, with H.pylori, zollinger ellison
AA: nausea, flatulence, pain, diarrhea. REbound hypersecretion may occur, so drug tapering is preferred. Bone fractures can also occur, CKD, dementia, cdiff. Decreased b12 absorption. INTERACTIONS: warfarin, diazepam, MTX. CYP INHIBITOR.

Question 2

H2 Antagonists: ITIDINEs

Answer 2

bind to H2R to increase cAMP normLLY, BUT THIS SHIT BLOCKED.works also at night, but less potent than ppis.tolerance may occur.mostly kidney secretion. INDICATIONS: gastric and duodenal ulcers, GERD, stress ulcers. AA: neuro issues to elderly if IV. increases alc levels.
Cimetidine, famotidine: competitive antagonists. reversible. Cimetidine impacts CYP

Question 3

Cytoprotective: prostaglandin and somatostatin promoters

Answer 3

Misoprostol
Sucralfate:
octreotide/somatostatin analog:

Question 4

Misoprostol:

Answer 4

PGE1 analog: NSAID induced injury. Stimulates G pathway, mucin production increases. Not good for pregnant individuals

Question 5

Sucralfate:

Answer 5

cross links with HCL to make an acid buffer, a protective layer. AA: steatorrhea by binding to bile acids. Can also induce aluminum overload for CKD pts.can promote bezoars and constipation. UP THE BUSSY

Question 6

octreotide/somatostatin analog:

Answer 6

nhibits secretions, induces bicarb. BUT can inhibit other hormones and feeding behaviors. Not first line tx bc of this. Treats severe dirrhea for metastatic neuroendocrine tumors ina adults. Acromegaly, acute bleeding, fistula, pancreatitis. AA: steatorrhea, gall stones.

Question 7

TCA drugs:
Amitriptyline
Desipramine

Answer 7

blocks serotonin and NE reuptake, can also block muscarinics and adrenergics. INDICATIONS: IBS, cyclic vomiting syndrome, dyspepsia without ulcers.AA: dry mouth, dizziness, weight gain, consti[ation. Liver toxicities, glaucoma, arrhythmias.

Question 8

Antacids:

Answer 8

gastric acid neutralizers, inhibits pepsin. Alkalizes urine. ALUMINUM ONLY ANTACIDS: constipation, MAGNESIUM ONLY ANTACIDS: diarrhea. Not teh most effective tho. AA: belching, nausea, flatulence, tummy ache, metabolic alkalosis. Chelation of drugs. Simethicone: surfactant that reduces surface tension of gas bubbles

Question 9

H.Pylori: 14 day tx protocol with 4 combo drugs due to clarithromycin resistance. Discontinue 2 weeks before a urease test, also note macrolides AAs.

Answer 9

Amoxicillin: beta lactam
Clarithromycin: 50s inhibitor
Tetracycline: 30s inhibitor
Metronidazole: nucleic acid synthesis inhibition
PPI
Bismuth salicylate

Question 10

Prokinetic drugs

Answer 10

Erythromycin:
Bethanechol
Neostigmine:
Domperidone, metoclopramide:

Question 11

Erythromycin:

Answer 11

motilin mimetic for gastroparesis. CAN BECOME TOXIC. Prolong QT interval, tolerance builds.

Question 12

Bethanechol:

Answer 12

increases smooth muscle tone via M3 receptors after abdominal surgery. Tx of urinary retention as well. NOT GOOD FOR BOWEL OBSTRUCTIVE PTS OR IBD

Question 13

Neostigmine:

Answer 13

reversible AchE inhibitor, paralytic ileus and urinary bladder atony. Not goof for bowel obstruction or IBD pts.

Question 14

Domperidone, metoclopramide:

Answer 14

dopamine antagonist to stimulate gut motility n upper g bc dopamine inhibits it. AA: amenorrhea, prolactin levels elevated, gynecomastia, impotence anxiety, dystonia, dyskinesia. Good for CINV.