Week 6 GI- Upper GI

Question 1

MOA

Calcium carbonate

Class

Use

Answer 1

weak bases, react with protons in the lumon of the stomach to nuetralize stomach acid

antacids

heartburn

Question 2

Adverse Effects

Calcium Carbonate

Answer 2

Minimal with typical doses - constipation, belching, acid rebound, hypercalcemia, hypophosphatemia

**Milk-alkali syndrome **
-Historically occurred when antacids were administered with large amounts of milk Calcium carbonate
-Now not usually caused by milk, but by excessive calcium supplementation -Causes hypercalcemia, metabolic acidosis, and acute kidney injury

Question 3

moa

Famotidine

use

Answer 3

competitive inhibition of gastric parietal cell H2 receptors.
blocks vagal to gcell **gastrin **release to histamine release to h2 parietal cell H+ pathway… but does not inhibit vagal/gastrin to parietal cell H+ release.

18. 2 bee swatters: H2 histamine receptor antagonists (e.g. cimetidine, famotidine, nizatidine) inhibit acid secretion by parietal cells 19. Tie-dye: "-tidine" suffix of the H2 receptor antagonists (e.g. ranitidine, cimetidine, famotidine, nizatidine) 20. Gargling: H2 blockers (e.g. cimetidine) treat GERD (PPIs are first line) 21. Ulcerated sidewalk: H2 blockers (e.g. cimetidine) treat gastric and duodenal ulcers (PPIs are first line)

infrequent heart burn, night time acid reflux with a ppi

Question 4

adverse effects

Famotidine

Answer 4

diarrhea, constipation
tolerance may develope with prolonged usage

minimal adverse effects all in all

Question 5

moa

omeprazole

class

use

Answer 5

irreversibly inactivate parietal cell Na/K/ATPase proton pumps

inhibitis final step of all acid producing pathways (vagal/gastrin/h2)

PPI

27. Girl scout blocking puree pump: proton pump inhibitors (PPIs) irreversibly inhibit the H+/K+ ATPase (the final common pathway for H+ secretion) 28. PRIZE: "-prazole" suffix of PPIs (e.g. omeprazole, lansoprazole, rabeprazole) 29. Jumbo gas tank: gastrinoma causing hypersecretion of gastric acid (Zollinger-Ellison syndrome - treat with PPIs) 30. Helicopter hat: PPIs treat Helicobacter pylori infection

GERD, errosive esophagitis, PUD, prevtion of NSAID induced PUD, part of regimen of H. Pylori treatment

Question 6

Adverse Effects

Omeprazole

(PPI inhibitors)

Answer 6

• headache, diarrhea, abdominal pain
  More rare:
• increased risk of Cdiff infection
• respiratory infections
• decrease uptake of Fe, Ca, Mg

31. Chocolate fondue fountain: PPIs increase the risk of Clostridium difficile infection 32. Dirty lung spots: PPIs increase the risk of respiratory infections (e.g. pneumonia) 33. Medals bound to wagon: PPIs decrease the absorption of Ca2+, Mg2+, and Fe2+ (requires acidic environment) 34. Fractured axel: PPIs may increase the risk of osteoporotic hip fractures (due to decreased Ca2+ absorption) 35. Porous wood: PPIs may worsen osteoporosis (due to decreased Ca2+ absorption) 36. Falling magnets: PPIs can cause hypomagnesemia

Question 7

MOA

sucralfate

class

use

Answer 7

forms a viscous paste in acidic solutions that binds selectively to ulcers or erosions, stimulates mucosal prostaglandin and bicarbonate secretion.

mucosal protective agents

duodenal ulcer, less effective than ppi

Question 8

adverse effects

sucralfate

Answer 8

constipation

Question 9

MOA

Bismuth compounds

class

use

Answer 9

coat ulcers and erosions, may stimulate prostaglandin, mucus, and hco3 secretion

mucosal protective agent

diarhea, dyspepsia, part of H pylori quadruple therapy

Question 10

adverse effects

bismuth compounds

Answer 10

black stoll and toungue, constipation

Question 11

MOA

Vonoprazan

class

use

Answer 11

competes for potassium on the luminal side of the parietal cell and cuases rapid and reversible inhibition parietal cell proton pumps

potassium competitive acid inhibitors (PCABs)

erossive esophagitis, part of the rigimen for H. Pylori treament

Question 12

adverse effects

Vonoprazan

Answer 12

Diarrhea, abdomnial pain

Question 13

What are the drug combos used for H pylori treatment?

Answer 13

ppi + antibiotics (amoxicillin or clarithromycin)
ppi + bismuth subsalicylate + antibiotics
Potassium competitive acid inhibitors (PCABs)

Dual, triple, and quadruple
therapies exist for H pylori treatment.

• Dual therapy consists of a PPI
  with an antimicrobial (eg, amoxicillin).
• Triple therapy consists of com-
  bining a PPI with 2 antimicrobials (eg, clarithromycin and amoxicil-
  lin).
• Quadruple therapy refers to treatment with a PPI and 3 antimi-
  crobials (eg, tetracycline, metronidazole, and bismuth).