Upper GI drugs

Question 1

Simple explanation of GORD

Answer 1

imbalance between damaging and protective mechanisms

Question 2

How do antacids work?

Answer 2

brief neutralisation of gastric acid
rapid onset bu transient

Question 3

When are antacids used?

Answer 3

GORD
dyspepsia

Question 4

Dyspepsia lay mans term

Answer 4

indigestion

Question 5

Antacids adverse effects

Answer 5

milk alkali syndrome (in high doses)
aluminium containing = constipation
magnesium-containing = diarrhoea
carbonate compounds release CO2 –> belching

Question 6

How does alginic acid work and what is a common brand name for it?

Answer 6

inert raft on gastric contents
protects against reflux
combined with antacids
gaviscon

Question 7

Name some H2 receptor antagonists

Answer 7

cimetidine
nizatidine
famotidine

Question 8

How do H2 receptor antagonists work

Answer 8

reduce basal and stimulated acid secretion
reduce pepsin secretion

Question 9

H2 receptor antagonists indications

Answer 9

duodenal ulcer
gastric ulcer
GORD symptomatic relief

Question 10

Adverse effects of H2 receptor antagonists

Answer 10

diarrhoea
headache
confusion in elderly

Question 11

Cimetidine adverse effects

Answer 11

anti-androgen = gynaecomastia
inhibits P450 = enhances warfarin, theophylline, tolbutamide

Question 12

How do PPIs work?

Answer 12

irreversibly inhibit the final common pathway of H+ secretion

Question 13

Name some PPIs

Answer 13

omeprazole
lansoprazole
pantoprazole
esomeprazole

Question 14

Metabolism of PPIs

Answer 14

via P450 system

Question 15

PPI adverse effects

Answer 15

diarrhoea
headache
infectious gastroenteritis (reduce bacteria killing)
hypergastrinaemia and acid rebound
impaired calcium and magnesium absorption

Question 16

When should PPIs be stopped in hospital?

Answer 16

when on broad spectrum abx
PPIs should be stopped to prevent C.Diff infection

Question 17

Indications for parenteral acid suppression

Answer 17

prevention of aspiration during anaesthesia
stress ulcer prophylaxis in ITU
peptic disease and unable to take oral treatment for 5 days
post-endoscopic in selected GI haemorrhage patients
non-responsive zollinger ellison syndrome

Question 18

What is the best medical treatment for GORD?

Answer 18

PPI
(better than H2RA)

Question 19

Surgical management of GORD

Answer 19

laparoscopic fundoplication

Question 20

How should acid suppression be approached in peptic ulcer?

Answer 20

remove aetiological factors (NSAIDs, H pylori)
PPI

Question 21

How is misoprostol used for the upper GI tract?

Answer 21

prostaglandins make mucosa healthy
PGE1 analogue
inhibits acid secretion
increases gastric mucus production
increases mucosal blood flow
(can be used for pts on NSAIDs)

Question 22

Misoprostol adverse effects

Answer 22

diarrhoea
uterine contractions - avoid in pregnancy and young women
menorrhagia + post-menopausal bleeding

Question 23

How does sucralfate help in peptic ulcers?

Answer 23

coats ulcer base
forms cover on ulcers
?stimulates prostaglandin synthesis
prevents diffusion of acid

Question 24

Bismuth adverse effects

Answer 24

black stools
black tongue
minimal absorption

Question 25

Bismuth OTC name

Answer 25

Peptobismol