Upper GI Drugs Flashcards
Name four strategies to treat Peptic Ulcer Disease
Decrease gastric acid production
Neutralize gastric acid
Increase Mucosal Defenses
Eradicate H pylori
What is an ECL cell and what does it produce?
EnteroChromaffin- Like cell
Produces Histamine (H2)
What three chemicals
cause parietal cells to produce gastric acid?
Gastrin (made in the G cell)
Histamine (made in the ECL cell)
Acetyl Choline (from nerve cells)
How does negative feedback work in the stomach as pertains to gastric acid?
Gastric Acid in the antrum enters the D cell causing it to release Somatostatin (which “stops everything”) which enters the receptor on the G cell to stop Gastrin production.
What are the three types of medications that reduce gastric acid secretion and which one is irreversible?
H2 Receptor Antagonists are reversible
Proton Pump Inhibitors are irreversible
PGE1 analog (misopristol)
Which PUD treatment is “the perfect drug” and why?
PPIs because they only work where they are needed so there are no side effects and are 90-98% effective
Which GI drugs should be taken before a meal and which should be taken after a meal? Why?
Antacids after a meal so they wil have some acid to neutralize.
Before a meal: PPIs (before breakfast) and Sucralfate (in order to pre-coat the stomach)
What is the treatment coctail to eradicate H pylori?
PPI
Clarithromycin
Metronidazole or Amoxicillin
+/- bismuth subsalicylate
Why do some antacids combine Mg(OH)2 and CaCO3?
To balance the side effects:
Mg(OH)2 –> diarrhea
CaCO3 –> constipation
Your patient is a 65 year old female with HTN, adrenal insufficiency, kidney disease and heartburn. She asks if its okay to take Pepsid (Famotidine). What is your concern?
H2 antagonists have renal elimination so you need to change the dose accordingly.
Your patient has occaisional severe heartburn at night. Which medication do you recommend and why?
H2 blockers/antagonists work best at night because that is when H2 is the primary inducer of acid (less ACh and Gastin)
Your patient has early cirrhosis and GERD. What can you recommend to control the acid?
H2 blockers would be better than PPIs because PPIs have hepatic metabolism
True or False: Long term use of PPIs increase the risk of pneumonia, infections and carcinoma.
False.
This is a concern, but has not been proven by evidence.
PPIs have four proven adverse effects: two are common and two are rare. What are they?
Common:
Increased fracture risk & decreassed B12 absorption
(Due to changes in absorption of Ca++ and B12
in a less acidic environment)
Rare: Decreased Mg++ & increased risk of CKD
Which medication is the first choice
to treat Zollinger Ellison Disease?
PPIs