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43 Cards in this Set
- Front
- Back
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What factors promote duodenal ulcers?
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Excess gastric acid
Inadequate bicarbonate secretion |
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What factors promote gastric ulcers?
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Excess enterotoxins
Inadequate mucus production |
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What are the ways to treat acid-peptic disease with drugs?
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Inhibit acid secretion
Neutralize the acid Protect the GI mucosa |
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How long does it take for an ulcer to heal? What is the relevance of this?
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8 weeks
People need to take their medications until they run out: the ulcer still is there even if pain isn't present. |
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What are some drugs that block acid secretion?
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PPIs
H2 blockers Antimuscarinics Prostaglandin derivatives |
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What are the prototypic PPIs?
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Esomeprazole
Lansoprazole -prazole THEY'RE THE BEST! |
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Where do the PPIs act?
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Parietal cell H/K ATPase
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What are the effects of the PPIs?
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Accelerate healing vs. placebo, H2s.
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How are PPIs delievered to the site of action?
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As prodrugs: they're not active until they reach the parietal cell
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What's the mechanism of the PPIs?
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Covalent binding to the H/K ATPase of actively secreting cells-->irreversible inhibition
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How long to the PPIs act at the parietal cell?
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16-24 hrs @ a pH of 4.
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What are indications for PPIs?
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GERD, DU, GU
Prevention of NSAID ulcers Zollinger-Ellison syndrome Treatment of heartburn Eradication of H. pylori |
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Why do people have their PPIs fail?
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They take the drug at the wrong time: they only inhibit the active pumps!
Take it right before a meal! |
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What are the most common acute side effects of PPIs?
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Mild diarrhea
Nausea Headache Gut pain |
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What are the long term side effects of PPIs?
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Profound decrease in H+ secretion-->increased gastrin-->mucosal effects
Rebound hypersecretion upon stopping the PPIs |
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What are the DDIs involving the PPIs?
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If drugs alter gastric pH, then you can have absorption altered
Decreases metabolic activation of clopidogrel |
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What are the prototypical H2 blockers?
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Ranitidine
Nizatidine Famotidine Cimetidine -tidine |
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What is the mechanism of the H2 blockers?
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Selective, competitive H2 blockade resulting in a modest decrease of acid secretion
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When do you have to adjust the dose of H2 blockers?
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Elderly
Renal dysfunction |
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What are the side effects of cimetidine?
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Gynecomastia
CNS: sensorium changes Inhibition of p450s THIS IS AVAILABLE OTC. |
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What are the antimuscarainic drugs that effect acid secretion?
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Atropine
Belladonna Pirenzepine |
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What is the effect of the antimuscarinics on acid secretion?
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Very little
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What are the indications for antimuscarainics in acid-related disease?
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Significant gut hypermotility
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How doe the antacids work?
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Slight increases in pH cause decrease in the proteolytic activity of the pepsins and causes lots O pain relief!
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What drugs relieve pain the fastest in acid-related disease?
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Antacids
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What is the effect of antacids on other drugs?
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Inhibit absorption by altering pH
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What are the main antacid drugs?
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AlOH
MgOH CaCO3 NaHCO3 |
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What are the side effects of aluminum salts?
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Constipating if used alone
Binds phosphate in the gut-->management of hyperphosphatemia Binding of proteolytic enzymes. |
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What happens with magnesium adminstration?
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Readily absorbed: hypermagnesemia
Laxative/cathartic effect if used alone (milk of magnesia) It can neutralize acids well! |
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What's the active ingredient in TUMS?
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CaCO3
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What are the side effects of CaCO3?
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Constipation
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What is the ability of CaCO3 to absorb acid?
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High!
But you do get reboud secretion |
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What are complications that can arise from taking NaHCO3?
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Hypervolemia due to ionic effects
Metabolic alkalosis from the HCO3 |
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How do you typically give the antacids?
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Combination
Maalox: magnesium and aluminum |
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How long do antacids effects act for?
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30 minutes (fasting)
2-3 hours 1 hr. after meals. |
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What are some prostaglandins given for acid-related disease?
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Misoprostol: PGE analog
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What are the effects of misoprostol?
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Antisecretory
Mucotropic Cytoprotective |
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What are the indications for misoprostol?
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Prophylaxis of NSAID induced ulcers
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What are the side effects of misoprostol?
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Pregnancy category X
It's used as an abortifacient |
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What are the effects of pepto-bismol (bismuth) on the GI tract?
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Antidiarrheal
Antibacterial |
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What are the side-effects of pepto-bismol?
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Blackens stool
Blackens tongue Reacts with a sulfur compound to make a black color |
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What compound in Pepto-Bismol causes it to be contraindicated in kids with viral illnesses?
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Salicyate salts
Risk of Ley's syndrome |
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What's the eradicative therapy for H. pylori?
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Peoto bismol
PPIs 2 microbials: metronidazole+amoxicillin/clarithromycin 8 weeks |
