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20 Cards in this Set
- Front
- Back
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name the drugs used for acid peptic disease
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antacid
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what are the clinical uses of antacids
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reflux esophagitis
peptic ulcer dz (DU, GU) prevention of acute GI bleeding chronic pancreatitis |
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mechanism of antacid; what are possible problems for taking baking soda?
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- neutralizes gastric acid by raising gastric pH (gives instant relief)
ie. using baking soda problem = it has a sodium load to it --> HTN, heart dz; it's also a systemic antacid and so you get alkalosis in your blood; kidney stones (bicarb makes calcium deposits in the urine) |
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what type of antacid do most people take ppl today? do you take them before or after you eat? do you take them liquid or in tablet?
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calcium carbonate
take them after you eat take them liquid historically, this was a real compliance issue... |
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what is the pH at which almost all your gastric acid is gone and pepsin activity is inhibited?
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pH = 4.0
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do antacids coat ulcers?
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no!! sucralfate is the coater
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mechanism and use of cimetidine (Tagamet), rimetidine (Xantax), etc
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mechanism = reversible block of histamine H2 receptors ---> decrease H+ secretion by parietal cells
uses = peptic ulcer, gastritis, mild esophageal reflux "Take H2 blockers before you DINE" |
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toxicities of cimetidine
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CNS:
confusion RENAL: intersitial nephritis DRUG-DRUG (bc cimetidine changes the metabolism of these drugs via P450 system in the liver): - oral anticoagulants (eg coumadin) - phenazone/amidoprine - diazepam Chlordiazepoxide Pentabarbitol Theophylline Propanolol Phenytoin |
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T or F. cimetidine is a better drug for longterm use.
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F. after 5 days, tolerance to cimetidine develops.
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"-dine"
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H2 blocker
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mechanism and uses of sucralfate
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adhesive and sticks to the ulcer (like you're putting a band-aid on the ulcer); so when you take it when you're stomach is empty, sucralfate will selectively go to the ulcerated site and keeps the acid/bile from getting to the ulcer (keeping pepsin off the ulcer); allows HCO3 secretion to reestablish pH gradient in the mucous layer
uses = increases ulcer healing |
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how do NSAIDs affect the stomach?
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deplete prostaglandins in the gastric mucosa, encouraging ulceration (via back-diffusion of acid)
chronic use of NSAIDs may be assoc with gastric side effects (when ulcer bleeds) resulting in hospitalization or death in some pts |
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what is misoprostol? mechanism?
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oral synthetic prostaglandin to bring up prostaglandin, to prevent NSAID-induced ulcerations
mechanism = Inhibition of acid secretion Mucus secretion and gel formation Bicarbonate ion secretion Mucosal blood flow |
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Do PPIs interact with plavix (platelet aggregation inhibitor)?
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Probably. PPI in some pts based on their genetic metabolism interferes with plavix antiplatelet effects of their stents. So if you see a pt with CAD complaining of ulcers, should not use PPI necessarily. You should check for plavix use. Let them talk to their cardiologist and figure out if he should take other meds, like H2 blockers. It might be omeprazole that will be the culprit. The newer generation of PPIs may not cause this drug drug interaction.
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toxicities of misoprostol
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induces abortion!!! (be careful with these for young women)
diarrhea, cramps/abd pain |
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mechanism and uses of omeprazole
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mech = irreversibly inhibits H/K ATPase in stomach parietal cells (so you want to catch as many pumps are working; take it 30-40 minutes before you eat so that when your pumps come on, PPI is already there to "gum it up"; it only gums up the active ones and so as each day goes by, it should lower secretions)
uses = peptic ulcer, gastritis, esophageal reflux |
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toxicities of omeprazole (prilosec)
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when your pumps come back into action (you'll get a lot of proton action) and sx's are worse; and you'll always have to stay on it.
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what are the drug-drug interactions of omeprazole? what about later generations?
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omeprazole = dec clearance of phenytoin, warfarin
lansoprazole = increases clearance of theophylline KNOW THAT OMEPRAZOLE INTERFERES WITH CLEARANE OF WARFARIN AND PHENYTOIN BC IT INTERFERES WITH THE P450 SYSTEM IN THE LIVER. but the other drugs seem to have little or no drug interactions |
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"-prazole"
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proton pump inhibitor
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is there chronic toxicity of PPIs?
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yes, if you chronically take PPIs and you fall when you're elderly, you're likely to break your hip. so it diminishes calcium reabsorption (possibly leading to osteoporosis).
you're also more prone to pneumonia and c. difficile. |
