(Gastrointestinal) Treatment Of Peptic Ulcer Disease

Front 1

6 classes of drugs for PUD

Back 1

Antibacterial combo
Proton pump inhibitors
H2 receptor antagonists
Sucralfate
Pisopostil / Octreotide
Antacids

Front 2

What class of drugs are these

-Omeprazoles

Back 2

Proton pump inhibitor

Front 3

Symptoms of PUD

Back 3

Gnawing pain, exacerbated when stomach is empty (between meals, 1-3 hrs after meals)

Front 4

Would you expect PUD to occur more in midday or throughout the night?

Back 4

During the sleeping hours of the night

Front 5

Sections of the stomach that contains both G cells and chief cells

Back 5

Antrum

Note that the fundus and body also have chief cells

Front 6

Section of the stomach that has parietal cells, ECL cells and chief cells:

Back 6

Fundus and body

Front 7

Which cells in stomach secrete gastrin?

Back 7

G-cells

Front 8

Situations of duodenal ulcers

Back 8

Incr in parietal cell mass in stomach, or if gastric emptying is more rapid

Front 9

Somatostatin is associated with which cell type in the stomach?

Back 9

ECL cells

Front 10

Three agonists that control gastric acid secretion:

Back 10

Histamine, Ach, Gastrin

Front 11

Does somatostatin have a positive or negative influence on the ECL cell?

Back 11

Negative

Front 12

Mechanism for how somatostatin blocks parietal cell release of acid:

Back 12

Binds to ECL cell causing a negative effect: Less histamine is released from ECL cells so less acid is produced.

Front 13

Which drug works to block M1 and M3 receptors?

Back 13

Muscarinic antagonists

Front 14

What is the mechanism of pirenzepine?

Back 14

Blocks M1 receptors on ECL cells, preventing histamine release

Front 15

Where are M1 receptors located?

Back 15

ECL cells

Front 16

Where are M3 receptors located?

Back 16

Parietal cell

Front 17

Two medications for PUD that work in the stomach lumen (after proton pumps have already released H+)

Back 17

Antacids
Sucralfate

Front 18

Five underlying etiologies for peptic ulcer disease:

Back 18

Failure of mucus secretion
Failure of mucosa or disease of tissue
Excess proteolytic enzyme (pepsin)
Excess HCl formation
H. Pylori

Front 19

Do patients often notice peptic erosions?

Back 19

No

Front 20

Risk factors for PUD:

Back 20

Coffee
Alcohol
Tobacco
Aspirin
Heredity
NSAIDS
Age

Front 21

Vagotomy blocks which phases of gastric acid secretion?

Back 21

Only cephalic phase

Front 22

What percentage of basal and nocturnal acid secretion s blocked by anticholinergics?

Back 22

40-50%

Front 23

This class of drugs is used to decrease gastric emptying and prolong the action o antacids

Back 23

Anticholinergics

Front 24

Which type of anticholinergics have less side effects? Give an example

Back 24

Selective antagonist to M1 receptors on ECL Cells
Pirenzepine is an example

Front 25

(T/F) Anticholinergics can cause a patient to believe that an ulcer has healed, when it hasn't.

Back 25

True - Anticholinergics provide relief for spasm and pain

Front 26

Contraindications for anticholinergics:

Back 26

Patients with gastric retention or reflux esophagitis (drug lowers LES tone)
GI stenosis or prostatic enlargement (Need parasymps to move past obstruction)
Narrow angle glaucoma

Front 27

"Two ""other"" treatments for stopping gastric acid secretion. These are ""old"" treatments"

Back 27

Sedatives and restful sleep

Front 28

Sucralfate, Bismuth, and prostaglandins have what in common:

Back 28

Provide mucosal protection

Front 29

Agent that decrease secretion of gastric acid:

Back 29

H2 receptor blockers,
Proton pump inhibitors
Prostaglandins
Anticholinergics

Front 30

Prokinetic agents (2)

Back 30

Metoclopramide
Bethanechol

Front 31

Recommended treatment for patient with recurrent ulcers with H. Pylori:

Back 31

Antimicrobial drugs in combo with anti-secretory drugs

Front 32

Two antibiotics that are currently used for treating H. Pylori

Back 32

Amoxicillin & Metronidazole

Tetracyclne used to be recommended

Front 33

Favored combination for PUD Rx with antibiotics:

Back 33

Amoxicillin + Metronidazole + Proton pump inhibitor (OMEPRAZOLE)

Front 34

(T/F) Pepto-bismol is not effective if the ulcer is caused by anti-inflammatory drugs or by hyper-scretory conditions

Back 34

True

Front 35

Five ways that Pepto-Bismol works:

Back 35

Selectively binds to proteins in ulcer base
Coating and protecting ulcer from acid and pepsin
Inhibits pepsin
Stimulates mucous production
Increases prostaglandin synthesis

Front 36

H.Pylori has more resistance to which one:

Metronidazole or tetracycline

Back 36

Metronidazole

Front 37

What do proton pump inhibitors do to the levels of these substances:

Intrinsic factor
Pepsin
Gastrin

Back 37

Does not mess with intrinsic factor or pepsin, but raises level of plasma gastrin

Front 38

pH needed to activate omeprazole:

Back 38

pH<2.0

Front 39

What enzyme is used to metabolize omeprazole?

Back 39

Good 'ol P450

Front 40

Why can proton pump inhibitors cause nosocomial infections?

Back 40

Because stomach acidity is neutralized, easier colonization.

Front 41

Proton pump inhibitor for patients unable to take oral meds:

Back 41

Pantoprazole

Front 42

Which are safer to use in pregnancy, H2 blockers or proton pump inhibitors?

Back 42

H2 blockers

Front 43

(T/F) When testing for efficacy of combo PPI + antibiotics, you must wait 3 weeks after stopping Rx to test for H. Pylori

Back 43

False - It's 1 week

Front 44

Which is better for healing NSAID induced ulcers - Proton pump inhibitors or H2 blockers?

Back 44

Proton Pump Inhibitors

Front 45

Three mechanisms how NSAIDS cause stomach problems:

Back 45

Direct injury of stomach
Decrease of prostaglandins causes increased gastric acid secretion
Increase expression of intercellular adhesion molecules in gastric endothelium (ICAM)

Front 46

H2 receptor antagonists all end in what suffix?

Back 46

-idine