Upper GI Disorders (Exam 2) Flashcards
Histamine (H2) Receptor Antagonists MOA
competitively and reversibly inhibit histamine at parietal cell receptor sites
reduce volume and H+ of gastric secretions
H2 Antagonists are suppressors of ______ and _____ stimulated by food, vagus nerve, and gastrin
basal gastric acid output
acid output
Histamine (H2) Receptor Antagonists
Cimetidine (Tagamet)
Famotidine (Pepcid, Zantac)
Nizatidine (Axid)
these are all OTC + prescription
Cimetidine (Tagamet)
first H2 receptor antagonist used for peptic acid disorders
Cimetidine (Tagamet) side effects
reversible gynecomastia
hepatotoxicity
hematological disorders
CYP450 inhibitor drug interactions
Proton Pump Inhibitors MOA
Suppress gastric acid secretion by inhibiting H+/K+ ATPase enzyme system
PPI are most efficient when taken
30-60 minutes before breakfast
Best agents to treat peptic ulcer disease
PPIs
Proton Pump Inhibitors
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Dexlansoprazole (Dexilant)
____ is indicated only for GERD and H. pylori
Dexlansoprazole (Dexilant)
Which PPIs are available OTC?
Omeprazole
Esomeprozole
Lansoprazole
Which PPIs are available IV?
Pantoprazole
Esomeprazole
Which PPIs can you NOT crush?
Rabeprazole (Aciphex)
Pantoprazole (Protonix) tablets
Which PPIs can you open the capsules?
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Dexlansoprazole (Dexilant)
Most potent inhibitors CYP450
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Mucosal Protectants
Sucralfate (Carafate)
-aluminum salt of sulfated sucrose
Mucosal Protectants MOA
in acidic medium, aluminum splits off, remaining complex attaches to lesion and forms protective barrier
Mucosal Protectants Adverse Effects
constipation, hypophosphatemia, osteomalacia
Avoid Mucosal Protectants in patients with
chronic renal insufficiency –> prevent AI-induced neurotoxicity
Drug interactions in Mucosal Protectants
Antacids: decrease mucosal binding, take 30-60 mins apart
Interferes w/ absorption of digoxin, tetracycline, phenytoin, fluroquinolones
Prostaglandin Analogues
Misoprostol (Cytotec)
-prostaglandin E1 derivative
Prostaglandin Analogues MOA
replenish mucosal PG which may be depleted by NSAIDs
increases mucus bicarb secretion, stimulates blood flow, enhances mucosal defense
Prostaglandin Analogues have both _____ and _____ effects
anti-secretory
mucosal protective
Prostaglandin Analogues are used in patients at high risk for
NSAID induced ulcers
Prostaglandin Analogues adverse effects
diarrhea, abdominal pain/cramping
Can you use Prostaglandin Analogues in pregnant women?
NO
Category X
Antacids MOA
Neutralize gastric acid and treat ulcer pain
Antacids maintain intragastric pH ____.
> 4
Antacids mainly used for
dyspepsia
When should you take antacids?
1-3 hrs after each meal and at bedtime
Which form of antacids have better buffering capacity?
Liquids»_space; tablets
Antacid mixtures
more sustained action than single agents
allow for lower dosage
negate side effects
Antacids cause
acid-base disturbances
Calcium carbonate adverse effects
constipation
over production of gastric acid
hypercalcemia
hypophosphatemia
milk-alkali syndrome
Aluminium salts adverse effects
constipation
hypophosphatemia
osteomalacia
avoid in renal insufficiency
Magnesium salts adverse effects
diarrhea
renal toxicity
avoid in renal insufficiency
Sodium bicarb adverse effects
fluid retention
Antacids drug interactions
Bind w/ tetracyclines + fluroquinolones - decrease efficacy
Destroy enteric coated drugs - premature dissolution
Reduces absorption of sucralfate
Antacids
ALternaGel
Gaviscon
Maalox/Mylanta (Plus, Supreme, Ultra)
Rolaids
Pepcid Complete
Riopan
Milk of Magnesia
Brioschi
