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16 Cards in this Set

  • Front
  • Back
What are the key parts of the stomach?
Lower esophageal sphincter
Pyloric sphincter
What are the cells of the fundus and body?

mucus secreting epithelial cells
Mucus neck cells
Parietal cells (--> HCl)
Cheif cells (--> pepsinogen)
Enterochromaffin-like cell
D cells
Mucosal mast cells
What is the aetiology of peptic ulceration?
Excess acid & pepsin
- increased parietal cells, histamine, vagal activity, gastrin release. Imparied gastrin inactivation. Decreased somatostatin.

Decreased mucosal resistance
- atrophic mucosa, decreased mucosal blood flow (NO), decreased PGs, mucuos emusifiers

- Helicobacter pylori
Describe use of antimuscarinics for peptic ulcers.
Rarely used as significan SEs e.g. constipation, dry mouth, blurred vision, urinary retension, gastric stasis and skin rashes
Describe use of gastrin antagonists for peptic ulcers.
Rarely used as poor effectiveness
Describe use of somatostatin analogues for peptic ulcers.
Requires parenteral administration
Describe use of antacids for peptic ulcers.
Non systemic and Systemic

Al salts - constipation; P & F depletion; interfere iwht absorption of some drugs & excretion of others

Magnesium salts - diarrhoea; hypermagnesaemia in renal disease

Sodium salts - promote fluid retention and alkalosis; milk-alkali syndrome

Calcium salts - constipation/diarrhoea; milk-alkali syndrome; hypercalcaemia eventually leading to renal calculi

Even with non-systemic effect short lived
Describe use of CARBENOXELONE for peptic ulcers.
From liquorice root
- appears to accelerate the healing of gastric ulcers
- significant side effects. Carbenoxelone and related compounds have a "mineralcorticoid" effect causing sodium and water retention which can lead to alkalosis, hypertension and hypokalaemia. It can precipitate glaucoma and urinary retention.
Describe use of SUCRALFATE for peptic ulcers.
- Basic aluminium salt of sulphated sucrose
- Viscous at acid pH and adheres to surface of ulcers, to act as a barrier to the aggressive luminal factors (acid, pepsin, bile salts)
- Antacids & meals should not be taken within half and hour of sucralfate as they may raise the gastric pH and alter the physicochemcial properties of sulcralfate
- SEs include constipation, interference with absorption of some drugs or long term Al toxicity effecting CNS, bone and kidneys.
Describe use of BISMUTH COMPOUNDS for peptic ulcers.
- Forms precipitate which binds to proteins on surface of ulcers at acidic pH providing barrier to aggressive factors in gastric juice.
- Batericidal to Helicobacter pyloris
- SEs - Ammoniacal odour & taste and causes black discoloration of the tongue and faeces, long term could damage kidneys and CNS
- Not to be taken with meals, antacids or other medication.
Describe use of PROSTABLANDIN ANALOGUES for peptic ulcers.
- Inhibit acid secretion, increase mucosal blood flow & mucus, cytoprotective on gastric mucosa
- Misoprostol, Enprostil, arbaprostil, iloprostil, rioprostil and trimoprostil
- Comparable ulcer healing efficacy with H2 receptor antagonists
- Only in patients using NSAIDs with high risk of ulcer
- SEs - pain endings sensitised so pain often worsens initially; diarrhoea, nausea, headache and dizziness; because of their tropic effects on the uterus (menorrhagia & dysmenorrhoea), prostaglandins are contraindicated in females of childbearing age.
Describe use of antibiotics for peptic ulcers.
Helicobacter pylori unfortunately develops resistance very easily so need combination therapy e.g.
- Bismuth + Metronidazole + tetracycline or amoxycillin
- Omeprazole + amoxycillin
Describe use of H2 Histamine antagonists for peptic ulcers.
Cimetidine, Ranitidine, famotidine, nizatidine

Very low incidence of reversible SEs - headache, dizziness, skin rash, nausea, diarrhoea, confusion in elderly patients, impotence and gynaecomastia, Interferes with hepatic metabolism of certain drugs
- Absorbed orally (decreased absorption if taken with antacids)
- renally excreted - take care in renal failure
Describe use of proton pump inhibitors for peptic ulcers.
Omeprazole, lansoprazole, pantoprazole, rabiprazol
- Completely block acid secretion by inactivating the hydrogen-potassium ATPase proton pump at the parietal cell surface
- Extremely potent & rapidly effective (99.9%)
- poor & variable bioavailability (increased bioavailability as decreased acid in stomach)
- metabolized in liver
- SEs interstitial nephritis, (nausea & diarrhoea), ? hypergastrinaemia and gastric mucosal changes.
What are some drugs that promote reflux?
Phosphodiesterase inhibitors
Calcium channel blockers
Dopamine agonists

patient factors also important
What are some drugs to treat reflux oesophagitis?
Adjuncts with antacies - alginic acid, simethicone
H2 histamine blockers
proton pump inhibitors