Upper GI

Question 1

Upper GI

Rx

Answer 1

• H2 RECEPTOR BLOCKER: cimetidine, famotidine
• PROTON PUMP BLOCKER: Omeprazole
• ANTACIDS: Mg(OH)2, Al(OH)3, CaCO3
• MUCOSAL PROTECTIVE: Sucralfate
• ANTI-EMETIC = Metoclopramide, ondansetron

Question 2

PUD

Risk factors

Answer 2

• H. Pylori
• NSAIDs
• Salicylates (aspirin)
• Tobacco
• Heredity/Age

Question 3

Peptic Acid dz

Answer 3

• PUD

* Gastro Reflux

Question 4

Peptic acid disease

Tx Themes

Answer 4

• DOWN gastric secretion
• STOP gastric acid
• UP Mucosal defense
• KILL H. Pylori

Question 5

Peptic Acid Dz

H2 blocker (OTC)

Answer 5

• CIMETIDINE, FAMOTIDINE
• PUD, GERD,
• block histamine-related gastic acid secretion from parietal cell
• reversible
• rapidly absorbed, minimal protein bind
• renal elimination
• SE: tolerance possible, cross placenta, Rx-Rx intxn w/ CIMETIDINE (prolactin —> gynedomastia, impotence, galactorrhea)

Question 6

Reduce long-term ulcers from NSAIDs?

Answer 6

Famotidine

Question 7

PPI (OTC)

Answer 7

OMEPRAZOLE
PUD, GERD, ZOSTER-ELLISON
*Irreversible inhibition - active H/Katpase proton pump
*give as inactive prodrug, weak base to parietal cell canaliculus, then activated
*new enzyme needed to regenerate pump from scratch
*1 dose= DOWN acid 3 days
S.E.: well tolerated, cross placenta, long term safety (infxns)? Long term UP risk CKD

Question 8

PPI vs H2

Answer 8

PPI good all day and night

H2 only good at night

LESS Ach + GASTRIN

Question 9

Zoster-ellison syndrome

Tx

Answer 9

Omeprazole (PPI)

Gastrin-producing tumor, NO H2 BLOCKER

Question 10

Antacids

Answer 10

OCCASIONAL HEARTBURN, NOT LONG-TERM
*COMBINE 2: Mg(OH)2 (makes diarrhea) + Al(OH)3/CaCO3 (makes constipation)
*weak bases
*Kidney excretion
S.E.: DECREASE OTHER RX ABSORPTION

Question 11

Mucosal Protective Agents

Sucralfate

Answer 11

*at low pH, pastes against (+)-charged epithelium/ucler, protects from acid/pepsin
*take BEFORE meal
S.E.: other Rx absorb in paste (take Rx 2 hrs b/f), NO W/ ANTACIDS

Question 12

Mucosal Protective Agents

Bismuth subsalicylate

Answer 12

PEPTO-BISMOL
*Bind to ulcers, protect from pepsin/acid (+HCl —>bismuth oxycholride+salicylic acid)
*Antimicrobial
*Black stool/tongue
S.E: NO KIDS - REYE’S SYNDROME

Question 13

Mucosal protective agents
PG analogs

Misoprostol

Answer 13

*STOP Acid secretion (ECL, maybe parietal), UP mucus/bicarb secretion
*PGE1 analog
S.E: NO PREGNANCY (contractions)

Question 14

Gastric acid secretion

Hormones+receptors

Answer 14

• Ach (ATROPINE) —> M3 —> H/Katpase acid
• Secretin —> G cells —>Gastrin —> CCKb —> H/Katpase acid
• ECL cells —> Histamine (CIMETIDINE) —> H2 receptor —> H/Katpase acid

Somatosatin STOP acid
PGE2/I2 = STOP acid, UP mucus/bicarb

Question 15

H. Pylori

Tx

Answer 15

PPI + ABX (clarithromycin w/ metronidazole/amoxicillin

+/- Bismuth

Question 16

Targets for anti-emetic tx

Answer 16

• NEURO: labrinth/vestibular nuclei
• NEURO: CTZ
• NEURO/HORMONE: Pharynx/stomach 5-HT3 receptors

Also noxious chems in GI cause N/V

Question 17

Anti-emetic

CNS dopamine receptor blocker

Answer 17

METOCLOPRAMIDE
*CHEMO-INDUCED NAUSEA
*CTZ/CNS D2/5-HT3 blocker; PERIPH GUT 5-HT4 blocker
*Prokinetic (Ach release in myenteric plexus)
S.E: Extrapyramidal/TARDIVE DYSKINESIA

Question 18

Anti-emetic

Selective 5-HT3 receptor blocker

Answer 18

ONDANSETRON
*NO muscarinic/dopamine effects
S.E.: constipation

Question 19

Anti-emetics

Lesser used

Answer 19

Meclizine (H1)
Scopolamine (Ach)
Dronabinol (THC!!!)