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81 Cards in this Set
- Front
- Back
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What has an anitemetic property
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Dexamathasone
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What are the three causes of PUD
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Hpylori
Increased Hcl inadequate mucosal defense against gastric acid |
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Antimicrobials are the optimal therapy for what
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duodenal and gastric ulcers infected with h pylori
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how can you document/diagnosis h pylori infx?
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1. endoscopic bx of gastric mucosa
2. serologic tests 3. breath tests for urea 4. eradication of H pylori rapid healing of peptic ulcers and low recurrence rates |
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what drugs do you treat h pyloir with for the triple therapy
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for 2 wks
1. PPI 2. metronidazole or amoxicillin 3. clarithromycin |
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what drugs do you treat h pyloir with for the quadruple therapy
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1. bismuth subsalicylate
2. metronidazole 3. tetracycline 4. H2 blocker or PPI |
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What do bismuth salts do?
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Bismuth salts do not neutralize acid but inhibit pepsin and increase secretion of mucous
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is Gerd assoc with h.pylori?
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GERD is not assoc. w/ H pylori and does not respond to abx
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What is gastric acid secreted from?
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Gastric acid secretion by parietal cells is stim by ACh, histamine, and gastrin
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What diminishes gastric acid production?
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Prostaglandin E2 and somatostatin
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H2 blockers work for what?
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Effective against nocturnal acid secretion, basal, and food-stim.
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H2 blocker drugs name them
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1. cimetidine
2. ranitidine 3. famotidine 4. nizatidine |
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name cimetidine phaophys
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1.slowly inactivated by liver’s microsomal mixed-function oxygenase system
2.interfere w/ metabolism of other drugs |
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Ranitdine work how long? don't inhibit what? and don't affect what?
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a. longer-acting than cimetidine
b. does not inhibit mixed-function oxygenase system c. does not affect conc. of other drugs |
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nizatidine elminated by what?
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Kidney
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Actions of H2 blockers?
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1. no effect on H1 receptors
2. completely inhibit gastric acid secretion induced by histamine or gastrin 3. only partially inhibit acid secretion induced by ACh |
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b.c. h2 blockers are awesome they have reduced what?
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the use of PPI's
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Peptic ulcer disease and h2 blockers what do they do/how do they help?
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1. effective in promoting healing of duodenal and gastric ulcers
2. recurrence is common after tx is stopped 3. can be prevented w/ eradication of H pylori |
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How do H2 blockers help GERD?
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1. effective for prevention and tx of GERD
2. 50% of pts do not benefit; PPIs are preferred 3. stop acid secretion- may not work for 45 min 4. antacids neutralize acid already in stomach but effects are shorter lasting |
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adverse side effects of cimetidine?
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a. can have endocrine effects b/c it acts as nonsteroidal antiandrogen
i.gynecomastia, galactorrhea, reduced sperm count b.inhibits cytochrome P450 and can slow metabolism and potentiate action of several drugs i.warfarin |
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all h2 blockers byt famotidine inhibt what?
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gastric first-pass metabolism of ethanol
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H2 side effect what deals with an acidic enviroment
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Other drugs that depend on acidic medium for absorption will not be efficiently absorbed example: Ketoconazole
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PPIs bind to what and do what
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Bind to proton pump of parietal cell and suppress secretion of H+ ions into gastric lumen
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name the 5 ppi's and which is first in class
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"the PRAZOLE"
1. omeprazole a.first in class 2. lansoprazole 3. rabeprazole 4. pantoprazole 5. esomeprazole |
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PPI action is to what? and how long does it take?
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1. inhibit basal and stim gastric acid secretion > 90%
2. acid suppression begins w/in 1-2 hrs |
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What is the therapeutic uses of PPIS
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1.preferred for tx erosive esophagitis, active duodenal ulcer, and hypersecretory conditions (Zollinger-Ellison syndrome- gastrin producing tumor)
2.approved for tx GERD 3.PPIs reduce risk of bleeding from an ulcer caused by asa and NSAIDs |
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adverse side Effects of PPI's in general and in particular Omeprazole ?
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1.Omeprazole interferes in oxidation of warfarin
2.drug interactions not a problem w/ other PPIs 3.prolonged therapy may low B12 |
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Prostaglandins: prostaglandin E2 how does it work?
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1. produced by gastric mucosa
2. inhibits secretion of HCl 3. stimulates secretion of mucous and bicarb (cytoprotective effect) 4. deficiency is thought to be involved in pathogenesis of peptic ulcers |
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name the prostaglandin
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Misoprostol
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Misoprostol whats the analong? and what kind of action does it have?
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a. analog of PTG E2
b. cytoprotective actions |
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Misoprostol when is it prophylaticly used?
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c. prophylactic use justified in pts taking NSAIDs and at high risk of NSAID-induced ulcers (elderly)
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Misoprostol what does it cause in pregnancy ?
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d. produces uterine contrx and contraindx during pregnancy
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Antacids : what reacts with gastric acid?
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weak bases
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antacids may reduce what colonization ?
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ii. May reduce H pylori colonization and stim. PTG synth
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What are the commonly used antacids
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Think: hydroxide and carbonate
1. aluminum hydroxide 2. magnesium hydroxide 3. calcium carbonate 4. sodium bicarbonate |
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Which antacid should u not use long term
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sodium bicarbonate B.C. systemic absorption can produce transient metabolic ALKalosis (not recommended for long-term use)
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What can one antacid also be used as? aka another therapeutic use
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calcium carbonate also used as Ca supplements for tx of osteoporosis
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What are the four adverse s/e of antacids?
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1.Al hydroxide may be constipating
2.Mg hydroxide may produce diarrhea 3.combined preps aid in normalizing bowel fxn 4.sodium content of antacids important consideration in pts w/ HTN or CHF |
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What is the compound in antacids which make them mucosal protective?
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cytoprotective compounds
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which are the mucosal protective agents ?
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i. Sucralfate
ii. Colloidal bismuth |
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how is sucralfate mucosal protective
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1. form complex gels w/ epithelial cells
2. create physical barrier that impairs diffusion of HCl and prevents degradation of mucous by pepsin and acid 3. stim PTG, mucous, and bicarb 4. heals duodenal ulcers |
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how is colloidal bismuth mucosal protective
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1. effectively heal peptic ulcers
2. antimicrobial 3. increase secretion of mucous to coat and protect ulcer crater |
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What is chemotherapy induced emesis?
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n/v produced by chemo needs effective management
10-40% experience anticipatory vomiting Uncontrolled vomiting results in dehydration, metabolic imbalance, nutrient depletion |
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how many % in chem get chem induced emesis ?
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70-80% on chemo experience n/v
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who is more susceptible to chem induced emisis
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Young pts and women more susceptible than older pts and men
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what is the mechanisms that triggers the vomiting in regards to chemo induced emesis
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2 brainstem sites involved in vomiting reflex
1.chemoreceptor trigger zone in area postrema (caudal end of 4th ventricle) a.outside BBB 2.vomiting center in lateral reticular formation of medulla a.coordinates motor mechanisms of vomiting b.responds to afferent input from vestibular system i.vestibular system involved in motion sickness |
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Emetic actions of chemo agents?
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Dopamine receptor type 2 and 5-HT3 play critical roles
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Antiemetic drugs that are anticholinergic drugs? what are they useful for? and what are they ineffective for?
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1.scopolamine
2.H1 blockers a.Dimenhydrinate b.Meclizine 3.Useful in motion sickness 4.Ineffective on substances that act directly on chemoreceptor trigger zone |
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antiemetic drugs that are phenothiazines name is and what does it do?
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prochlorperazine
1.block dopamine receptors 2.effective against low or moderately emetogenic chemotherapeutic agents |
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antiemetic drugs that are phenothiazines adverse rxns?
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extrapyramidal sx
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antiemetic Drug that is a 5-HT3 serotonin-receptor blockers. name the two
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a. ondansetron
b. granisetron |
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when do you use 5-HT3 serotonin-receptor blockers?
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emesis assoc. with chemo
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5-HT3 serotonin-receptor blockers what is their duration of action?
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"Long"
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5-HT3 serotonin-receptor blockers... what do they actually blcok?
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Selectively block 5-HT3 receptors
a.visceral vagal afferent fibers in periphery b.chemoreceptor trigger zone in brain |
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antiemetic Substituted benzamides name it/ and its s/e and its sx
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1. metoclopramide
2. antidopaminergic side effects 3. extrapyramidal sx |
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antiemetic Butyrophenones do what and the drugs are?
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1.Block dopamine receptors
2.drugs a.droperidol b.domperidone |
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antiemetic Benzodiazepines name it/its beneficial effects and what its used to tx ?
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1.lorazepam
2.beneficial effects due to sedative, anxiolytic, amnesic properties 3.tx anticipatory vomiting |
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antiemetic corticosteriods name them? how are they sued? and s/e?
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1.mildly to moderately emetogenic chemo when used alone
a.dexamethasone b.methylprednisolone 2.most frequently used in combo when other agents 3.may cause insomnia, hyperglycemia in DM pts |
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antiemetic cannabinoids name them?
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1.marijuana derivatives
a.dronabinol 2.not first line |
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antiemetic drugs why are they combined?
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often combined to increase activity or decrease toxicity
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when does dexamathasone increase activity?
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dexamethasone inc. activity when given w/ high-dose metoclopramide (5-HT3 blocker)
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what combo reduces extrapyramidal rxn?
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diphenhydramine administered w/ high-dose metoclolpramide to reduce extrapyramidal rxn
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diarrhea definition
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Increased motility of GI tract and decreased absorption of fluid
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what are two antimotility agents
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1. diphenoxylate
2. loperamide |
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how do antimotility agents work?
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ii. Opioid-like actions on gut
iii. Inhibit ACh release and decrease peristalsis |
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bad s/e of anti motility drugs?
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may cause toxic mega colon
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adsorbents used for antidiarrheal agent name the three
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1. kaolin
2. pectin 3. methylcellulose |
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adsorbents work how?
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ii. adsorb intestinal toxins or microorganisms
iii. coat or protect intestinal mucosa |
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what is more effective antimotility drugs or adsorbents?
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anti-motility
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which NSAIDS are effective in controlling diarrhea
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ASA
Indomethasin |
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What helps travelers diarrhea
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bismuth subsalicylate
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what does a laxative do?
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Irritants or stimulants of gut
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which laxative irritating to the gut and increases peristalsis ?
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Casto oil
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which laxative stimulates colonic activity
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cascara
senna |
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what laxative is a potent stimulant of colon
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bisacodyl
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hydrophilic colloids are bulking agents which do what?
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form gels in large intestine causing water retention and intestinal distension therefore increase peristalsis
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name the hydrophilic colloids?
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methylcellulose
bran |
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what do saline cathatics do ( they are a bulking agent hint)
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are nonabsorbable salts that hold water in intestine by osmosis
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what is the name of the osmotic laxative?
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lactulose
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stool sofeners do what?
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become emulsified with stool causing a softer feces and ease of passage
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name the stool softeners (3 total)
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a. docusate sodium
b. mineral oil c. glycerin suppositories |
