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29 Cards in this Set

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Peptic Ulcer Disease
1. Helicobacter pylori
2. Stress
3. Chronic use of NSAIDS
H. PYLORI
- gram negative bacteria.
- mucus layer of stomach - protected from acid where the bacteria produces urease whih neutralizes acid.
Treatment of H.pylori infections:
1. Amoxicillin
2. Tetracycline
3. Metronidazole
4. Clarithromycin
Amoxicilline
inhibits bacterial cell wall synthesis
Tetracycline
inhibits bacterial protein synthesis
Clarithromycin
Macrolide antibiotic that inhibits bacterial protein synthesis.
GERD can lead into:

ADENOCARINOMA.
1. Severe esophagitis
2. Stricture formation
3. Barrett's metaplasia
4. Barrett's esophagus
GOAL of GERD
complete resolution of symptoms healing of esophagitis
Agents of GERD
1. ANTACIDS
2. PPIs
3. H2 BLOCKERS.
Prokinetic Drugs:

enchance molitily, facilitate transit of contents, useful in hypomolility where ther is delay in gastric emptying
Acety: facilitatory
Serotonin: facilitates cholinergic neurons
Dopamine: inhibitory
Serotonin Receptor Modulators
Cisapride (PROPULSID)
Metoclopramide (Reglan)
Cisapride (Propulsid)
- agonist 5-HT4
- release of acetyl
Adverse Effect of Cisapride
1. serious cardiac a.e.
2. lenghtening of action potential adn prolong QT interval.
3. Cardiac arrythmias and death.
Drug interaction - cisapride
metabolized by CYP3A4:
1. ANTIBIOTICS
2. ANTIDEPRESSANT
3. ANTIFUNGAL
4. HIV protease inhibitor
Metoclopramide (Reglan)
Activation of 5HT4 receptor (facilitates Ach release)
Metoclopramide (central and peripheral anti-dopaminergic)
Central:
- antinauseant and antiemetic effect
Peripheral:
- prokinetic effect
Irritable Bowel Syndrome
(altered bowel movement)
Alosetron (LOTRONEX)
Tegaserod (ZELNORM)
ALOSETRON (LOTRONEX)
- 5HT-3 ANTAGONIST
- Relaxes the colon & slows transition of food residue through the colon.
ALOSETRON - S/E ON TEST

tx: IBS with diarrhea
ISCHEMIC COLITIS
SEVERLY OBSTRUCTED OR RUPTURED BOWEL.
TEGASEROD (ZELNORM):

tx: IBS with constipation
5HT - 4 RECEPTOR PARTIAL AGONIST.
TEGASEROD (ZELNORM) SE
1. diarrhea, hypovolemia, hypotension, syncope.
2. HA
3. Bile duct stone
4. Ischemic Colitis
5. Mesentric ischemia
6. Gangrenous Bowel
7. Spincter of Oddi spasm
Tegaserod
Discontinue if ischemic colitis
Tegaserod (contraindications)
1. severe renal impairement
2. mild to moderate hepatic impairment
3. Gall bladder disease
4. History of bowel obstruction
5. Spincter of Oddi dysfunction.
Antidiarrheal Agents
Loperamide (Imodium)ORALLY ACTIVE
Diphenoxylate (Lomotil)
Difenoxin (Motofen)
Overdose of loperamide
- constipation and paralytic ilues
Diphenoxylate (lomotil) active metabolite of Difenoxin (motofen)
combine with atropine to discourage abuse....high abuse for addiction
Kaolin and Pectin
ABSORB --- BACTERIA, TOXIN, AND FLUID
KAOLIN
- naturally occuring hydrated mag al silicate
PECTIN
Ingestible carbohydrate derived from applice

should not be taken w/in hours of other medication.