Week 7 - Peer support Flashcards
what is peptic ulcer disease?
a group of upper gastrointestinal (GI) disorders characterized by varying degrees of erosion of the esophagus, stomach, and small intestine.
What are two important agents that can weaken defenses of GI tract?
H. pyloriand NSAIDs.
What lifestyle choice can cause ulcers and increases the risk for recurrence?
Smoking and use of aspirin and other NSAIDs
What are the classes of Anti-Ulcer drugs?
*Antibiotics
*Antisecretory agents (proton pump inhibitors [PPIs] and histamine-2 [H2] receptor antagonists)
*Mucosal protectants
*Antisecretory agents that enhance mucosal defenses
*Antacids
What is first-line therapy for H pylori?
Standard-dose PPI (omeprazole)
Clarithromycin (500 mg twice daily)
Amoxicillin (1 g twice daily)
How do H2 blockers work to promote ulcer healing?
These agents promote ulcer healing by suppressing secretion of gastric acid.They block H2receptors, reducing both the volume of gastric juice and its hydrogen ion concentration. Cimetidine (Tagamet) suppresses basal acid secretion and secretion stimulated by gastrin and acetylcholine.
What are the names of some of the H2 blockers?
Cimetidine
ranitidine
famotidine (Pepcid)
nizatidine (axid).
What are the potential adverse effects of Cimetidine?
gynecomastia,
reduced libido, and impotence,
confusion,
hallucinations,
CNS depression, and
CNS excitation,
increased the risk for pneumonia because when gastric acidity is reduced, bacterial colonization of the stomach increases, resulting in a secondary increase in colonization of the respiratory tract.
What are some possible drug interactions we should be aware of?
warfarin,phenytoin,theophylline, andlidocaine. If these drugs are used with cimetidine, their dosages should be reduced. Antacids can decrease absorption of cimetidine.
What patients should we be cautious of when prescribing Cimetidine?
Use with caution in patients with renal or hepatic dysfunction.
What is the most effective drug for suppressing gastric acid secretion?
PPIs are the most effective drugs we have
Omeprazole is approved for short-term therapy of what conditions?
duodenal ulcers, gastric ulcers, erosive esophagitis, and GERD and for long-term therapy of hypersecretory conditions (e.g., Zollinger-Ellison syndrome).
Except for therapy of hypersecretory states, treatment should be limited to 4 to 8 weeks.
What are the potential adverse effects of PPIs?
Fractures, pneumonia, acid rebound, and intestinal infection withClostridium difficile
What are some drug that may interact with PPIs that we should be aware of?
PPIs can significantly reduce absorption ofatazanavir(Reyataz),delavirdine(Rescriptor), andnelfinavir(Viracept), all used to treat HIV/AIDS. These drugs should not be combined with a PPI. Reducing gastric pH can also decrease the absorption of two antifungal drugs:ketoconazoleanditraconazole. Ppis make Clopidogrel less effective increasing risk of stroke.
What are possible adverse effects of long-term PPI use?
Risk for osteoporosis and fractures increases. Encourage patients to maintain adequate intake of calcium and vitamin D. Inform patients about symptoms of hypomagnesemia, including muscle cramps, palpitations, and tremors.
What is the black box warning for Alosetron?
Alosetron can causeischemic colitis(intestinal damage secondary to reduced blood flow). Ischemic colitis and complications of constipation have led to hospitalization, blood transfusion, surgery, and death
What are the contraindications of Alosetron?
*Chronic constipation, severe constipation, or sequelae from constipation
*Intestinal obstruction or stricture, toxic megacolon, or GI perforation or adhesions
*Ischemic colitis, impaired intestinal circulation, thrombophlebitis, or hypercoagulable state
*Crohn disease or ulcerative colitis
*Diverticulitis
What are the two forms of inflammatory bowel disease?
Crohn disease or ulcerative colitis
Where does inflammation usually occur with Crohns?
Crohn disease is characterized by transmural inflammation and usually affects the terminal ileum but can also affect all other parts of the GI tract.
Where does inflammation usually occur with Colitis?
Ulcerative colitis is characterized by inflammation of the mucosa and submucosa of the colon and rectum
What are the five types of drugs used for IBD?
- 5-aminosalicylates(e.g., sulfasalazine)
- glucocorticoids(e.g., hydrocortisone)
- immunosuppressants(e.g., azathioprine),
- immunomodulators(e.g., infliximab), -
- antibiotics(e.g., metronidazole).
How does Sucralfate promote ulcer healing?
by creating a protective barrier against acid and pepsin.
What is the most common adverse effects of Sucralfate?
constipation
What is the only approved GI indication for Misoprostol?
prevention of gastric ulcers caused by long-term therapy with NSAIDs.
Misoprostol (Cytotec)
What are the most common adverse effects of Misoprostol?
Diarrhea and abdominal pain
What is the black box warning for Misoprostol?
When used in Pregnancy can cause birth defects/premature birth/uterine rupture.
What are the primary indications for Antacids?
PUD, GERD
What are the common adverse effects of Antacids?
Some (e.g., aluminum hydroxide) promote constipation, whereas others (e.g., magnesium hydroxide) promote diarrhea.
What are some potential drug interactions with Antacids and how might they be prevented?
cimetidine and ranitidine and sucralfate,
To minimize this interaction, administer these drugs at least 1 hour apart.
Peptic Ulcer Disease Step Therapy
Step 1
- lifestyle modifications
- OTC antacids
- H2 blocker
Step 2
- H. pylori testing
- PPIs
Step 3
- Treatment for H. pylori
- PPI
- antibiotics
Step 4
- Triple therapy
- Clarithromycin or Metronidazole 500mg
2xdaily
- Amoxicillin 1g 2xday
- treat for 10-14 days
Peptic Ulcer Disease Step Therapy
Step 1
- lifestyle modifications
- OTC antacids
- H2 blocker
Step 2
- H. pylori testing
- PPIs
Step 3
- Treatment for H. pylori
- PPI
- antibiotics
Step 4
- Triple therapy PPI plus
- Clarithromycin or Metronidazole 500mg
2xdaily
- Amoxicillin 1g 2xday
- treat for 10-14 days
- Quadruple therapy - PPI plus
- Flagyl 4xday
- tetracycline 4xday
- bismuth 4xday
-treat for 10-14 days
What is the name of a bulk-forming agent?
Psyllium, methylcellulose,andpolycarbophil
How should we advise our patients to take Bulk-Forming agents?
administered with a full glass of water or juice
What is the name of a stimulant laxative?
bisacodyl, senna, castrol oil
What are the two effects of stimulant laxatives on the bowels?
First, they stimulate intestinal motility, Second, they increase the amount of water and electrolytes within the intestinal lumen.
Which of the stimulant laxatives act on the small intestine?
Castor oil is the only stimulant laxative that acts on thesmall intestine.
What patients should we avoid prescribing laxative salts?
- renal impairment,magnesium can accumulate to toxic levels and are contraindicated in patients with kidney disease
Sodium absorption (from sodium phosphate) can causefluid retention,which, in turn, can exacerbate heart failure, hypertension, and edema.
What are the most common adverse effects of Polyethylene glycol?
nausea, abdominal bloating, cramping, and flatulence.
When are laxatives contraindicated?
- appendicitis
- enteritis
- diverticulitis
- ulcerative colitis
- acute surgical abdomen
- fecal impaction
- bowel obstruction.
Magnesium salts and sodium phosphate are contraindicated in patients with renal dysfunction.
What is the name of a serotonin receptor antagonist?
Ondansetron (Zofran and Zuplenz)
What baseline data is needed for serotonin receptor antagonist?
Obtain baseline QTcalevel and electrolytes.
What are the two glucocorticoids used for chemotherapy induced nausea and vomiting (CINV)?
methylprednisolone(Solu-Medrol)
dexamethasone(Decadron)
What medication has three principal benefits including sedation, suppression of anticipatory emesis, and production of anterograde amnesia and is used for CINV?
Ativan
What is the black box warning for promethazine?
respiratory depression from promethazine can be severe. Deaths have occurred. Because of this risk, promethazine is contraindicated in children below 2 years of age and should be used with caution in children above that age.
Droperidol is a butyrophenone (antipsychotic) that is used as an antiemetic, what evaluation is needed before starting a patient on this medication?
electrocardiographic evaluation before administration for QT prolongation
What medication suppresses emesis through the blockade of dopamine receptors in the CTZ.
Metoclopramide (Reglan)), also used to increases upper GI motility (by enhancing the actions of acetylcholine).
What is first-line therapy nausea and vomiting of pregnancy?
Doxylamine and vitamin B6in addition to diet changes
What antiemetics should be avoided with elderly patients?
Benzodiazepines, scopolamine, and metoclopramide should be avoided in older adults
Which antihistamines are used for motion sickness and suppression of N/V?
dimenhydrinate(Dramamine)
meclizine(Antivert, others)
cyclizine(Cyclivert).
What are the most effective antidiarrhea agents?
Opioids are the most effective antidiarrheal agents. ex: diphenoxylate, difenoxin, loperamide, paregoric, and opium tincture—are approved for diarrhea.
What is the most common causative organism of travelers diarrhea?
Escherichia coli
How should we treat travelers diarrhea that is not severe?
As a rule, treatment is unnecessary: infection withE. coliis self-limited and will run its course in a few days.
How do we treat travelers diarrhea that is severe?
severe, treatment with a fluoroquinolone antibiotic—ciprofloxacin(500 mg bid)—is indicated.
What should we advise our patient to do to reduce risk of travelers diarrhea infection?
Two measures—avoiding local drinking water and carefully washing foods—are highly effective
What are the four groups of drugs used for IBS?
antispasmodics(e.g., hyoscyamine and dicyclomine)
bulk-forming agents(e.g., psyllium and polycarbophil)
antidiarrheals(e.g., loperamide)
tricyclic antidepressants(TCAs
