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63 Cards in this Set

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What is PEPTIC ULCER DISEASE (PUD)?
Group of UPPER GI disorder w/ varing degrees of EROSION OF THE GUT WALL.
When do PEPTIC ULCERS develop?
When ther is an IMBALANCE btwn MUCOSAL DEFENSIVE factors & AGGRESSIVE factors.
Where does the MOST COMMON ULCERATION occur?
in the LESSER CURVATURE of the STOMACH & DUODENUM.
What are MOST CASES of Peptic Ulcer Disease caused from?
Infection w/ HELICOBACTER PYLORI.
What are the DEFENSIVE factors in the stomach?
MUCUS, BICARBONATE, BLOOD FLOW, PROSTAGLANDINS
What are the AGGRESSIVE factors that contribute to PUD?
HELICOBACTER PYLORI, NSAIDs, GASTRIC ACID, PEPSIN, SMOKING.
Where is the mucus secreted from? What does it form?
Secreted by cells of the GI MUCOSA to form a BARRIER
Where is the BICARBONATE secreted? Where does it go?
sECRETED BY epithelial cells OF THE stomach & duodenum. From the PANCREAS in to the DUODENUM.
Why is BLOOD FLOW important?
B/C it is ESSENTIAL FOR MUCOSAL INTEGRITY.
What is the function of the PROSTAGLANDINS?
Stimulate secretion of Mucus & Bicarb and promote VASODILATION & SUPPRESS GASTRIC ACID.
What do drugs for peptic ulcer disease used for?
Upper GI disorders, degrees of erosion of the gut wall.
How does a person get ulcers from H-PYLORI?
INGESTED, unaffected by acid, colonizes & remains for decades.
What is the MOST COMMON cause of Gastric & Duodenal ulcers?
HELICOBACTER PYLORI (H-PYLORI) which is a GRAM NEG. BACILLUS
D0 NSAIDS induce GASTRIC & DUODENAL ulcers?
YES
How does GASTRIC ACIDS contribute to Ulcers?
ACID injures MUCOSAL CELLS & ACTIVATES PEPSIN
What ais the name of the SYNDROME for HYPERSECRETION of acid to form ulcers?
ZOLLINGER-ELLISON SYNDROME
What is PEPSIN and how does it induce ulcers?
PROTEOLYTIC ENZYME present in GASTRIC JUICE that can injure Unprotected cells.
How does SMOKING effect Ulcers?
DELAYS ULCER HEALING & ^ RISK of RECURRENCE.
What are the GOALS of Drug Therapy for PUD?
ALLEVIATE SYMPTOMS
PROMOTE HEALING
PRVENT COMPLICATIONS
PREVENT RECURRENCES
What are the CLASSES of ANTIULCER drugs?
ANTIBIOTICS, ANTISECRETORY AGENTS, MUCOSAL PROTECTANTS, ANTACIDS
What do you test for H-pylori?
BREATH or SERUM test
What is the TREATMENT for H-PYLORI?
TWO ANTIBIOTICS-use with BISMUTH compounds(pepto) to COAT STOMACH
What do BISMUTH COMPOUNDS do to the H-PYLORI? Side Effects?
Disrupt Cell wall, INHIBIT UREASE activity & PREVENT H_PYLORI from ADHERING to GASTRIC SURFACE.**May COLOR TOUNGE or BLACKEN STOOL**
What do the antibiotics CLARITHROMYCIN & TETRACYCLINE do to H-PYLORI? Side effect of TETRACYCLINE?
INHIBIT PROTEIN SYNTHESES.
**STAINS TEETH, AVOID in PREGNANCY**
What does AMOXICILLIN do to H-PYLORI? Side Effects?
DISRUPTS CELL WALL. **DIARRHEA**
What should a pt taking METRONIDAZOLE AVOID?
PREGNANCY & ETOH
What 2 drugs are used for NSAID induced PUD?
NISOPROSTOL-for PROPHYLAXIS
OMEPRAZOLE-just as effective but better tolerated
How do you EVALUATE if medicine is working?
Monitor Relief of pain. Perform RADIOLOGIC/ENDOSCOPIC exam of Ulcer site. Test for H-PYLORI
What is the 1st choice TREATMENT of PUD?
HISTAMINE2(H2)-RECEPTOR ANTAGONISTS
Where are H2 cells found?
IN PARIETAL CELLS OF THE STOMACH
How does BLOCKING H2 RECEPTORS help PUD?
-REDUCES VOLUME & ACID CONCENTRATION (Hydrogen Ion Condcentration)
-SUPPRESSES BASAL ACID SECRETION
-REDUCES STIMULATION OF ACID SECRETION BY GASTRIN & ACETYLCHOLINE.
How is CIMETIDINE(tagamet) given?
PO, IM, IV
Where is CIMETIDINE (tagamet) MOTABOLISED? EXCRETED?
MOTABOLISED IN LIVER
EXCRETED IN URINE
What is important to remeber when giving CIMETIDINE (tagamet)?
FOOD DECREASES ABSORBTION.
CROSSES BBB
1HR BEFORE/AFTER ANACIDS
What are teh ADVERSE EFFECTS of CIMETIDINE (tagamet)
IMPOTENCE, REDUCED LIBIDO, Gynecomastia, in elderly-Renal/hepatic impaiment, CNS depression/excitation, confusion
With what drugs does CIMETIDINE(tagamet) interact with? How?
WARFARIN, DILANTIN, THEOPHYLINE-INCREASES EFFECTS
What is important to remember about RANITIDINE(zantac)?
MORE POTENT than cimetidine w/ fewer side effects & interactions, BLOCKS H2 RECEPTORS ON PARIETAL CELLS, FOOD has NO effect. WAIT 1hr before or after ANACIDS.
How is RANITIDINE (zantac) given?
PO, IM, IV
What is RANITIDINE BISMUTH CITRATE (TRITEC) a mix of?
PEPTO + RANITIDINE
What are the PROTON PUMP INHIBITORS?
OMEPRAZOLE(prilosec), ESOMEPRAZOLE(nexium), LANSOPRAZOLE(prevacid), RABEPRAZOLE(aciphex), PANTOPRAZOLE(protonix)
What is OMEPRAZOLE(prilosec) used for? Why?
SHORT TERM therapy of PUD **Long term showed possible CA**
How does OMEPRAZOLE(prilosec) work?
IRREVERSIBLY INHIBITS the ENZYME needed to produce stomach acid.
What is the 1/2 life of OMEPRAZOLE(prilosec)? What does it reduce?
2HRS.**REDUCES ACID PRODUCTION BY 97%**
What are the ADVERSE effects of OMEPRAZOLE(prilosec)?
HA, GI
How is OMEPRAZOLE(prilosec) administered?? Where does it dissolve?
PO**CAPS dissolve in STOMACH, GRANULES dissolve in DUODENUM
What DRUG INTERACTIONS does OMEPRAZOLE(prilosec) have? How?
ATAZANAVIR(anti-viral), KETOCONAZOLE(nizoral), ITRACONAZOLE(sporonox) **OMEPRAZOLE(prilosec) REDUCES ABSORBTION of these drugs.
When should you take LANSOPRAZOLE(previcid)?
BEFORE BREAKFAST
What is SUCRALFATE(carafate) used for?
PROTCTIVE BARRIER AGAINST PEPSIN & ACID
How does SUCRALFATE(carafate) work?
forms a STICKY GEL that ADHERES to ULCER
When should you take SUCRALFATE(carafate)? How is it eliminated?
1HR BEFORE MEAL. **STOOL**
What are the ADVERSE effects of SUCRALFATE(carafate)? DRUG INTERACTIONS?
CONSTIPATION **ANTACIDS interfere with effectiveness take 30MIN APART
What is MISOPROSTOL(cytotec) used for?
ONLY for PREVENTION of gastric ulcers caused by NSAID use.
How does MISOPROSTOL(cytotec) work?
ANALOG OF PROSTAGLANDIN E1 (helper), misoprostol seres as a replacement of prostaglandins.
What are the ADVERSE effects of MISOPROSTOL(cytotec) use?
DIARRHEA
DYSMENNORHEA
Who is MISOPROSTOL(cytotec) cautioned in? What MUST you take with it?
NO PREGNANCY/CHILD BEARING YEARS**BIRTHCONTROL**
What is an ANTACID? What is it used for?
ALKALINE COMPOUNDS used to NEUTRALIZE STOMAC ACID. **PUD, Gastroesophageal reflux disease**
What are the THERAPUTIC uses of ANTACIDS?
PUD, Give BEFORE anesthesia to PREVENT aspiration pneumonitis, PROPHYLACTICALLY used to prevent STRESS ULCERS
ADVERSE effects of ANTACIDS?
CONSTIPATION d/t aluminum hydroxide or DIARRHEA d/t mg hydroxide. HTN/heart failure d/t Na.
What are the 4 groups of ANTACIDS?
1. ALUMINUM COMPOUNDS
2. MG COMPOUNDS
3. Ca COMPOUNDS
4. Ns COMPOUNDS
What is important to remember in MG Compounds?
RAPID/LONG ACTING, gives DIARRHEA, AVOID in pts. with potential INTESTINAL prob., Used as LAXITIVE
What is important to remember about ALUMINUM HYDROXIDE?
SLOW/LONG ACTING, ALOT OF Na, give you CONSTIPATION, ABSORBS tetracyclines, warfarin, dig-may cause HYPOPHOSPHATEMIA
What is important to remember about Ca CARBONATE?
RAPID/LONG ACTING, gives you ACID REBOUND/CONSTIPATION/ ERUCTATION & FLATULENCE
What is important to remember about Na BICARB?
UNFIT FOR ULCER TREATMENT. RAPID/SLOW ACTING. ^ INTRAABDOMINAL PRESSURE: ABSORPTION OF Na, EXASTERBATES HTN/Heart FAILURE, get SYSTEMIC ALKALOSIS