Therapeutics Lecture 5 Part 2

Front 1

What are the non-pharmacological treatments?

Back 1

Review the following (M.O.F.A.S.A.M):

• Medication
• Obesity
• Fatty food
• Alcohol
• Smoking, coffee, chocolate
• Anxiety, depression, stress
• Meal patterns

Front 2

What do antacids do?

Back 2

'Neutralise' acid in the stomach

Front 3

What do antacids usually contain?

Back 3

Alumium, Magnesium or BOTH

Front 4

What else can antacids contain, but why is it unsuitable?

Back 4

Sodium bicarbonate, but it's unsuitable for regular use because of the high sodium content

Front 5

What do antacids provide?

Back 5

Immediate symptom relief

Front 6

How is the duration of antacids?

Back 6

It has a limited duration of action

Front 7

When should antacids be taken?

Back 7

After meals and before bedtime

Front 8

Can the administration of antacid be together with some drugs?

Back 8

NO

Front 9

What can aluminium based antacids cause?

Back 9

Constipation

Front 10

What can magnesium based antacids cause?

Back 10

Diarrhoea

Front 11

Name examples of antacids

Back 11

• Mucogel
  
• Maalox

Front 12

What can antacids that contain alginate do?

Back 12

Form a raft that 'floats' on the stomach contents to reduce reflux, and therefore protect the oesophageal mucosa

Front 13

Give examples of antacids that contain alginate

Back 13

• Gaviscon Adavnce
  
• Peptac
• Gastrocote

Front 14

What are histamine2 receptor antagonists?

Back 14

Structural analogues of histamine

Front 15

What do histamine2 receptor antagonists do?

Back 15

Block the histamine receptors in gastric parietal cells, and therefore prevent acid secretion

Front 16

Does HRA have any role in treating peptic ulcer disease?

Back 16

No, because it's less effective than proton pump inhibitors

Front 17

The main role of HRA is in what?

Back 17

Dyspepsia - because patients with mild symptoms may not need proton pump inhibitors

Front 18

Name examples of HRAs

Back 18

C.R.F.N-tidine:

• Cimetidine
• Ranitidine
• Famotidine
• Nizatidine

Front 19

HRAs have lower risk of side effects than what?

Back 19

Proton Pump Inhibitors

Front 20

What are the most COMMON side effects of HRAs?

Back 20

Diarrhoea and Headaches

Front 21

What occasional side effects have been reported for HRAs?

Back 21

Confusion and Rashes

Front 22

Which HRAs has the most drug interactions?

Back 22

Cimetidine

Front 23

Which HRAs is the most commonly prescribed?

Back 23

Ranitidine

Front 24

What do proton pump inhibitors do?

Back 24

Control gastric secretion by inhibiting proton pumps (H+,K+ -ATP ase) - the enzymes responsible for the final step in gastric secretion from parietal cells

Front 25

When carried in the blood stream, are PPIs active?

Back 25

They are inactive pro-drugs

Front 26

Which cell do PPIs get carried to?

Back 26

Parietal cells

Front 27

When are PPIs active?

Back 27

When they are under acidic conditions, they are converted into their active form

Front 28

How is the reversibility of PPI binding to proton pumps?

Back 28

Irreversible

Front 29

What should be noted about how different PPIs bind?

Back 29

Different PPIs bind to different sites on the proton pump

Front 30

Name proton pump inhibitors

Back 30

R.O.P.E.L-prazole:

• Omeprazole
• Lansoprazole
• Pantoprazole
• Rabeprazole
• Esomeprazole

Front 31

How many hours after administrations is the max plasma concentration reached for:

• Histamine Receptor Antagonists
• Proton Pump Inhibitors

Back 31

• HRAs: 1-3 hours
  
• PPIs: 2-3 hours

Front 32

Since PPIs irreversibly bind to the pumps, how is the duration of acid inhibition?

Back 32

It is a sustained duration, with a half life of approximately 48 hours

Front 33

When are PPIs most effective to be taken?

Back 33

30 minutes before meals

Front 34

What do PPIs only inhibit?

Back 34

ACTIVELY secreting proton pumps, because it only becomes active in acidic conditions

Front 35

PPIs get metabolised where?

Back 35

In the liver

Front 36

How is the safety of PPIs?

Back 36

It's relatively safe

Front 37

What are the most common side effects of PPIs?

Back 37

Diarrhoea and headache

Front 38

What has long term acid suppression been associated with?

Back 38

• Osteoporosis
  
• Pneumonia
• Clostridium difficile

*more studies needed to confirm this*

Front 39

What is eradication therapy in relation to dyspepsia?

Back 39

Eradication of H Pylori

Front 40

What is usually used to eradicate H pylori?

Back 40

Antibiotics and Ulcer healing drugs together

Front 41

What should be given in the first line of eradication therapy?

Back 41

PPI with amoxicillin and clarithromycin

Front 42

For patients allergic to penicillin, what can be done for them?

Back 42

Replace amoxicillin with metronidazole

Front 43

When choosing regimes for eradication, what should be a goal?

Back 43

Eradication rates of more than 80%

Front 44

What can enhance the efficacy of eradication?

Back 44

Lowering acidity levels

Front 45

What are the usual reasons for treatment failure by eradication therapy?

Back 45

N.A.R.I.U:

• Non-compliance
  
• ADRs
• Resistance to antibiotics
• Insufficient drug dosage
• Unapproved/ineffective treatment combos

Front 46

Surgical operations for dyspepsia used to be common, but now when are they ever used?

Back 46

In emergencies when bleeding peptic ulcers:

• Can't be controlled
• Cause perforation
• Cause obstruction