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51 Cards in this Set

  • Front
  • Back
What are some symptoms of GI dysfunction?
- heart burn - abdominal pain - dyspepsia - nausea/vomiting - diarrhea/constipation - GI bleeding
What are the 3 phases of gastric acid secretion?
1. cephalic 2. gastric 3. intestinal
What are some pathological conditions of the GI tract that are improved by decreasing gastric acid and pepsin activity?
- GERD - esophagitis - gastric ulcer - duodenal ulcer - gastritis - zollinger-elison syndrome
What are factors associated with ulcer disease?
- erosive and protective factors - erosive (or aggresive factors) included HCl, pepsin, bile salts, H. pylori, drugs - protective factors include: rapid turnover of epithelial cells and prostaglandin synthesis (produced mucus and bicarbonate secretion)
How do pepsin and bile cause ulcer disease?
- pepsin and bile cause direct mucosal injury - pepsin is a protelytic enzyme that causes mucosal injury, especially if pH is less than 4
Give an example of how certain drugs can cause ulcer disease
- NSAIDs can cause ulcers by decreasing prostaglandin synthesis - prostaglandins have a protective function and help to neutralize acidity
What are some drugs that can cause GI mucosal injury?
- aspirin - bisphosphonates (fosamax) - chemo agents - ethanol - NSAIDs (naproxen, ibuprofen) - potassium supplementation
Why is potassium supplementation often enteric coated or time-released?
so that potassium with not be released in the stomach and cause GI upset
What are some complications of GERD?
- esophageal stricture - esophageal ulcer - erosive esophagitis - Barrett's esophagus - pulmonary aspiration (can cause aspiration pneumonia)
How could a patient with GERD present?
can present with: - heart burn - regurgitation - dysphagia - chest pain - hoarseness - asthma - dental erosions
How do proton pump inhibitors work?
- proton pump inhibitors work by inhibiting the release of H+ by the parietal cell - inhibit H+/K+ ATPase enzyme
How do Histamine 2-receptor antagonists (H2 Blockers) work?
- H2 receptor blockers prevent histamine from binding to the receptor site on the parietal cell and prevents activation of the parietal cell
How do you diagnose GERD?
- history and physical - barium studies - endoscopy
What are some recommended lifestyle modifcations for patients with GERD?
- change dietary habits - do not sleep directly after eating - elevate head of bed - stop smoking - lose weight
What is the mechanism of action for antacids and alginic acid?
- neutrilize stomach acid and deactivate pepsin - forms a viscous solution creating a more alkaline environment
What are some adverse drug events (ADEs) associated with antacids?
- diarrhea with magnesium antacids - constipation with aluminium - maalox and mylanta contain magnesium and aluminum - acid reboud
What are some drug interactions that occur with antacids?
- antacids can bind with other drugs and eliminate them through the feces - drugs like ferrous sulfate, digoxin, quinolones, isoniazid
You should avoid give sodium bicarbonate to patients with this condition
CHF, because sodium bicarbonate contains high levels of sodium
Which antacids can cause constipation?
aluminum hydroxide and calcium carbonate
With what patients should you avoid giving magnesium hydroxide?
- patients with chronic diarrhea or C. Dificil
Name 4 histamine 2 receptor antagonist (H2 blockers)
- cimetidine (tagamet) - famotidine (pepcid) - nizatidine (axid) - ranitidine (Zantac)
Patients with mild or moderate GERD are usually given these drugs
H2 blockers
What are 2 major drug interactions with cimedtidine?
- cimetidine can inhibit warfarin and phenytoin
What are some causes of higher doses of cimetidine?
- gynecomastia (enlargement of the breasts, especially in men) - mental confusion
Patients with moderate to severe GERD symptoms are given these drugs
proton pump inhibitors
What are some adverse drug events (ADEs) with proton pump inhibitors?
- GI disturbances - CNS disturbance - Gastric tumors - C. Dificil in patient on long-term PPI
What are some genetic or environmental factors that can increase the chance of development of peptic ulcer disease?
- first-degree relative having PUD - smoking - alcohol - diet
What is a leading cause of recurrent ulcers?
H. Pylori
What are some characteristics of H. Pylori?
- gram negative, spiral shaped, flagellated organism - penetrates and colonized gastric mucosa - acid sensitive - toxic to epithelial cells
What is an example of a non-invasive test to screen for H. Pylori?
- test for the presence of urease with a urea breath test
What does urease do?
- urease cleaves urea into bicarbonate and ammonium
What are some common agents used in the treatment for H. Pylori?
1. amoxicillin - type of penicillin 2. bismuth subsalicylate (Pepto Bismol) 3. Clarithromycin (Biaxin) - in the class called macrolytes 4. H2 Blockers 5. Lansoprazole (Prevacid) - PPI 6. Metornidazole (Flagyl) - antimicrobial agents 7. Omeprazole (prilosec) - PPI 8. Tetracyclin - can cause yellowing of the teeth, diarrhea 9. Ranitidine Bismuth Subscitrate - Pepto Bismol with Ranitidine (H2 blocker)
What is the best regiment for treating H. Pylori?
a regiment with 2 antibiotics
What is the 1st line treatment regiment of choice of treatment of H. Pylori?
- PPI, amocillin 1 gm, clarithromycin 500 mg (all twice daily for 7-14 days) - can substitute metronidazole 500 mg BID for amoxicillin with penicillin allergic patients
What is another option for 1st line treatment of H. Pylori?
- Bismuth Subscitrate 525 mg, metronidazle 500 mg, tetracycline 500 mg (all QID) with a PPI (BID) for 7-14 days - generally reserved for retreatment
What is the 1st line treatment for patient with macrolide allergy (allergic to clarithromycin)?
PPI, amoxicillin 1 gm, metronidazole 500 mg (all BID) for 14 days
What are 3 regiments that can be used as "rescue therapy"?
1. PPI, levofloxacin 250-500 mg, amoxicillin 1 gm (all BID for 14 days) 2. PPI, rifabutin 150 mg, amoxicillin 1 gm BID for 14 days - change rifabutin to rifampin with HIV patients 3. PPI twice daily plus amoxicillin 1 gm TID - not a good regiment since there is only one antibiotic
Give some examples of NSAIDs
- aspirin - naproxen - diclofenac - ibuprofen
How do NSAIDs cause ulcers?
NSAIDS inhibit prostaglandins which have a protective function in the GI
What is the treatment for NSAID ulcers?
- discontinue NSAIDs - check for presence of H. Pylori by endoscopy - use H2 blocker or PPI
How long is the treatment regiment with a gastric NSAID ulcer?
4-8 weeks
How long is the treatment regiment for a patient with a duodenal NSAID ulcer?
8-12 weeks
What drug is used in combination with a NSAID to increase prostaglandin?
Misoprostol (Misoprostol 200 mg and diclofenac 50 mg) in combination is called Arthrotec
Why are patients in the ICU given stess ulcer prophylaxis?
because 75% of ICU patients develop stress ulcers
What are risk factors for stress ulcers?
- coagulopathy (which can cause DIC) - head trauma - hepatic failure - mechanical ventrilation - major surgery - servere burns - organ failure
What are some agents used for stress ulcer prophylaxis?
- antacids (although they are not indicated in ICU setting) - H2 antagonist is the drug of choice
What are two H2 blockers that can be given for stress ulcer prophylaxis?
Ranitidine (Zantac) or Famotidine (Pepcid)
What are the dosages for ranitidine (zantac) and famotidine (pepcid) for stress ulcer prophylaxis when given IV? when given PO?
IV: Ranitidine 50 mg IV 8 hrs or Pepcid 20 mg IV Q 12 hrs PO: Ranitidine 150 mg PO BID or Pepcid 20 mg PO BID
What are some characteristics of sucralfate (carafate)?
- used for stress ulcer prophylaxis - coats the stomach lining to stop bleeding (acts like a bandaid) - only comes PO - can not be given with other drugs because it can bind with other drugs (needs to be given at least 2 hrs before given other medication)
What is the dosing for sucralfate (carafate)?
1 gm PO QID
Why can giving proton pump inhibitors in the ICU setting increase the risk for nosocomial infections?
- PPI decrease the acidity in the stomach which creates a medium that bacteria can grow