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19 Cards in this Set
- Front
- Back
- 3rd side (hint)
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How do you define Non-Ulcer Dyspepsia (NUD) and how do you treat it?
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MCC upper GI complaints
>3 mo's dyspepsia with NO ulcers and NO IBS Tx: NO specific guidelines, whatever helps |
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What are the antacids? What is their MOA? What is their use?
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Sodium bicarb (alka-seltzer)
Calcium carbonate (tums!) MAGNESIUM salts ALUMINUM salts Neutralize gastric acid by forming salts, elevated pH inhibits pepsin (have to take AFTER meals to time with acid secretion!) PRN for BREAKTHROUGH sx's (bc freq dosing, chalky taste, ae) |
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What are the main AEs of the individual antacids?
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Sodium bicarb: systemic ALKALOSIS (inc Na, avoid in CHF/HTN/renal failure)
Calcium carbonate: HYPERcalcemia (avoid in renal failure, use with thiazides) Magnesium salts: DIARRHEA (MD) Aluminum salts: CONSTIPATION (AC) Use these together to balance!! |
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What are the drug interactions of the antacids? How can you avoid these?
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Chelation decreases abs of quinolones, tetracycline, bisphosphonates, levothyroxine
pH inc decreases abs of "azoles", digoxin, phenytoin, isoniazid TIME meds hours before or after |
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What are the Histamine2-Receptor Antagonists (H2RA)? What is their MOA?
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"tidine"
Cimetidine, Ranitidine, Famotidine, Nizatidine Competitively INHIBIT H2-R on parietal cells -> BLOCK basal and bolus ACID SECRETION |
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What are the AEs and drug interactions of H2RAs? What are their uses?
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Safe, well tolerated
pH inc decreases abs of "azoles" H. pylori: COMB with BISMUTH CITRATE + 2 ABX Acute tx for ulcers (more time for elderly and smokers) |
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Why does cimetidine (H2RA) suck? Don't use it.
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Highest CNS AE (crosses BBB)
Anti-androgenic effects (gynecomastia, impotence, dec sperm) P450 INHIBITOR: inc theophylline, phenytoin, warfarin, propanolol, diazepam.. |
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PPIs! Awesome! What are they and their MOA?
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"prazole" Omeprazole
IRREV bind PROTON PUMP (parietal cell H/K ATPase), most potent! Must cross parietal cell as inactive lipophilic form, activated by acid -- take BEFORE meals Use everywhere!! Comb with 2 ABX for H pylori |
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What are the 2 main AEs of PPIs?
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Inc risk of (aspiration) PNEUMONIA: upper GI microbes not killed by acid (caution: mechanical ventilation, elderly, immunocomp, COPD/asthma, PD)
Inc risk of FRACTURES: less Ca abs (take Ca and vit D, elderly take CALCIUM CITRATE) Also, HA, dizziness, diarrhea |
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What are the drug interactions of the PPIs and especially omeprazole?
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pH inc decreases abs of "azoles", Ca, Fe, digoxin, phenytoin, isoniazid..
Omeprazole INHIBITS p450: inc levels of diazepam, warfarin, digoxin, phenytoin |
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What is sucralfate and its MOA? What are its advantages and uses?
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CYTOPROTECTIVE agent: complex salt, Aluminum dissociates leaving anion (binds in mucosa and forms viscous adhesive protective barrier)
Adv: (minimal AE) so good for PREGNANCY (no pH change) so good for ASPIRATION PNEUMONIA RISK ONLY MONOtx (freq dosing) Binds to drugs: dec abs of phenytoin, digoxin, theophylline, wardarin, quinolones, tetracycline |
Aluminum in sucralfate: don't take in renal failure
Take on empty stomach, BEFORE meals bc want aluminum to bind to ulcer NOT food |
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What is bismuth subsalicylate and its MOA? What are its AEs? And its use??
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Pepto-bismol!! CYTOPROTECTIVE
Temp darkens stool, turns tongue black (okay) Has ASA, careful in kids (Reye's!) Mild abx effects: use for H PYLORI! |
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What is the tx for H pylori?
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At least 1 anti-sec + 2 Abx (triple tx)
Quad tx: PPI, BISMUTH, METRONIDAZOLE, TETRACYCLINE (after failure) Abx: Amoxicillin, Clarithromycin, Metronidazole, Tetracycline, (Levofloxacin) |
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What is misoprostol and its MOA? What are its AEs?
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PGE1 analog, replenish PG's
AEs: BAD! CI in PREGNANCY/CHILD-bearing age (uterine contractions, bleeding, abortions) N/D, abd discomfort, menstrual problems in females |
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What is the tx for NSAID-induced ulcers?
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PPIs DOC if NSAID continued, LARGE ulcer, GI BLEED
Misoprostol: prophylaxis (dosing worse and sig AEs) H2RAs, Sucralfate: small ulcers |
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What is the tx for stress ulcers? (Stress ulcers: impaired mechanisms when "stressed" - mech ventilation, CNS injury, burns, multi-organ failure, trauma, sepsis, coagulopathy)
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PPIs (Oral, IV)
H2RAs (IV good) Sucralfate: lower incidence aspiration pneumonia Antacids: rarely used, renal insuff bad (bc ions) |
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What is metoclopramide and its MOA? What are its AEs? When is it used?
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DA receptor antagonist, PROMOTILITY agent
Extrapyramidal sx's! AVOID in PD ONLY as ADJUNCT if motility problems |
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What is bethanecol and its MOA? What are its AEs/CIs? blaaah try not to use it.
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Stimulates cholinergic receptor: PROMOTILITY agent
Cholinergic AE CI in PUD, asthma/COPD |
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What is the regimen for mild/moderate/severe GERD?
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Mild: LM + antacids/H2RA
Moderate/Severe: LM + PPI!! |
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