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58 Cards in this Set
- Front
- Back
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What cells secrete pepsinogen?
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Chief cells
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What cells secrete acid?
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Parietal cells
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What stimulates the release of pepsin and histamine?
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Gastrin
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The activation of what substances lead to acid secretion?
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Acetylcholine
Histamine |
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What is the final step in acid secretion?
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H+ - K+ ATPase system
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What are the protective factors in the gut?
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Mucous barrier
Bicarbonate Blood flow Prostaglandins |
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What are the aggressive factors in the gut?
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Acid
Pepsin Bile salts |
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What are the 2 biggest risk factors for peptic ulcer disease?
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H. pylori infection
NSAIDs |
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Blood type O is a risk factor for what?
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Peptic ulcer disease
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Acute peptic ulcer disease is often due to what?
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Stress
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Gastric ulcers are most common in what population?
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Females over 60
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Duodenal ulcers are most common in what population?
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Males ages 30 - 50
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What is the MOA of antacids?
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Neutralize acid secretions
Inactivate pepsin and bile salts Increase lower esophageal sphincter tone |
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What are the drug interactions of antacids?
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Tetracyclines
Fluoroquinolones Antibiotics Keto- / itraconazole Warfarin |
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What are the substances usually found in antacids?
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Aluminum
Magnesium Calcium Simethicone |
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Maalox is a combination of what?
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Aluminum
Magnesium |
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Magnesium is often associated with what side effect?
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Diarrhea
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Aluminum is often associated with what side effect?
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Constipation
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What is the MOA of H2 receptor antagonists?
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Competitively and reversibly bind to H2 receptor on parietal cell
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How much do H2 receptor antagonists decrease gastric acid?
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70%
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What are the 4 H2 receptor antagonists?
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Cimetidine (Tagamet)
Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) |
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What H2 receptor antagonist can have an interaction with other drugs with CYP 450 3A4 metabolism?
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Cimetidine
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Gynecomastia is an adverse effect of what H2 receptor antagonist?
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Cimetidine
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What are the hematologic adverse effects of H2 receptor antagonists?
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Thrombocytopenia
Leukopenia Anemia |
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What is the MOA of PPIs?
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When activated by acidic conditions in the parietal cell, PPIs bind irreversibly to H+-K+ ATPase enzyme needed to pump H+ ions and acid secretions
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How much do PPIs inhibit the daily production of acid?
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Over 90%
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What are the available PPIs?
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Omeprazole (Prilosec, Zegerid)
Lansoprazole (Prevacid) Rabeprazole (AcipHex) Pantoprazole (Protonix) Esomeprazole (Nexium) Dexlansoprazole (Kapidex) |
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When are PPIs most efficacious?
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given 30 minutes prior to meal
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What are the adverse effects of PPIs?
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Nausea
Diarrhea Headache Associated with CAP and osteoporotic fractures |
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What is the MOA of Sucralfate (Carafate)?
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Aluminum hydroxide and sucrose sulfate dissolves in stomach acid, releases aluminum and forms a viscous gel - binds to ulcers, creating barrier to irritants
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What are the indications of Sucralfate (Carafate)?
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Maintenance and healing of GU and DU
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What are the adverse effects of Sucralfate (Carafate)?
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Constipation
Nausea Metallic taste |
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What is the MOA of Misoprostol (Cytotec)?
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Enhances protective mucosal defense by replenishing mucosal prostaglandins
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What is the indication for Misoprostol (Cytotec)?
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Prevention of NSAID-induced ulcers
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What are the adverse effects of Misoprostol (Cytotec)?
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Abdominal cramping and diarrhea
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What pregnancy category is Misoprostol (Cytotec)
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Category X
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What is the description of H.pylori?
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Spiral-shaped
Flagellated pH sensitive Gram-negative |
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What are the mechanisms of injury for H.pylori?
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Direct mechanisms
Altered immune/inflammatory response Hypergastrinemia |
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What does H.pylori produce that protects it from acid?
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Urease
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What is the therapy for h.pylori?
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2 antibiotics, 1 antisecretory agent
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What drugs are used in clarithromycin-based triple therapy for h.pylori?
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Clarithromycin
Amoxicillin (or metronidazole) PPI |
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What drugs are used in bismuth quadruple therapy?
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PPI
Bismuth subsalicylate Tetracycline Metronidazole |
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What is the MOA of bismuth subsalicylate?
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In presence of pH < 3.5, reacts with acid to form bismuth oxide and salicylic acid
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What is the action of bismuth subsalicylate against H. pylori?
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Disrupts H. pylori integrity and ability to adhere to epithelial surface
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What are the adverse effects of bismuth subsalicylate?
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Black stools
Black tongue |
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How do NSAIDs cause ulcers?
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Direct irritation
Systemic inhibition of GI mucosal prostaglandin synthesis (COX) |
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What are the ulcer prevention candidates for those who cannot discontinue NSAIDs?
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History of prior GI event
Advancing age (over 60 High dosage Concurrent corticosteroids Concurrent anticoagulants |
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What drugs are indicated for the prevention of NSAID-induced gastric ulcers?
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Misoprostol
PPI |
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What drugs are indicated for the prevention of NSAID-induced duodenal ulcers?
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Misoprostol
PPI H2RA |
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What are the contributing factors to GERD?
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Increased gastric acidity
Poor acid clearing Delayed gastric emptying Impaired LES tone Hiatal hernia |
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For symptoms of GERD occurring less than twice weekly, what is the treatment?
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Lifestyle modifications
Antacids OTC H2RAs |
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For persistent symptoms of GERD or mild esophagitis, what is the treatment?
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Increased H2RA dose or
Add prokinetic agent |
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For refractory or severe symptoms of GERD, what is the treatment?
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PPI
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What are medications that can affect the LES tone?
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Nitrates
Estrogen, oral contraceptives Theophylline Calcium channel blockers Benzodiazepines Anticholinergics Tricyclic antidepressants |
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What length of therapy is usually needed for healing of erosions?
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8 weeks
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What is the MOA of prokinetic agents?
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Promotes gastric emptying
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What is the MOA of Metoclopramide (Reglan)?
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Releases ACh from the myenteric plexus, causing GI smooth muscle contraction
Dopamine antagonist |
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What are the physiologic effects of Metoclopramide (Reglan)?
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Increases esophageal sphincter tone
Improved gastric tone/peristalsis Relaxes pyloric sphincter Augments duodenal peristalsis |
