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76 Cards in this Set
- Front
- Back
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Where is a peptic ulcer most commmon?
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the lower curvature of the stomach or the duodemum
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What causes peptic ulcers?
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Helicobacter pylori
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What factors excacerbate peptic ulcers?
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H. pylori, NSAIDS, Acid, Pepsin & smoking
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What helps decrease peptic ulcers?
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mucus, bicarbonate, blood flow & prostaglandins (stimulate secretion of mucus & promotes vasodilation)
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What type of bactieria is H, pylori?
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Gram Negative & can remain in gut for decades
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How do NSAIDS increase peptic ulcers?
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by inhibiting prostaglandins which help produce mucus that protects the stomach, & increase secreation of gastric acid
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How does gastric acid increase peptic ulcers?
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it directly activates pepsin which can injure unprotected cells of the gastric duodenl mucosa
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How does smoking increase peptic ulcers?
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delays ulcer healing, and increases risk or reoccurance
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What are the major classes of Anti-ulcer drugs
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1) Antibiotics 2) Antisecretory agents 3) Mucosal protectants 4) Antisecretory agents that enhance mucosal defenses 5) Antacids
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What 3 ways do drugs act to promote gastric healing?
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1) eradicate H.Pylori 2) reduce gastric acidity 3) enhance mucosal defenses
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How to treat a NSAIDs created ulcer?
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histamine2 receptor blocker & proton pump inhibitor
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What is best treatment for PUD?
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antibiotic along with an antisecretory agent
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Name antibiotics used to treat H.pylori
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Amoxicillian, bisuth, Biaxin, Flagyl, Tetracycline, Tinidazole
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Name Antisecretory Agents - H2 receptors
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Tagamet, Pepcid, Axid, Zantac
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What is mechinism of Action of H2 receptors?
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Supporession of acid secretion by blocking H2 recptors on parietal cells
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Name Antisecretory Agents - Proton Pump Inhibitors
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Nexium, Prevacid, Prilosec, Zegerid, Protonix, Aciphex, Gastrozephine
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What is mechanism of action for Proton pump inhibitors?
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Suppression of acid secretion by inhibing H+, K+-ATPase, the enzyme that makes gastric acid
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Name the Muscarinic Antagonists
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Carafate - (Sucralfate)
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What is mechanism of action for muscarinic antagonists?
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Forms a barrier over the ulcer crater that protects against acid and pepsin
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Name Antisecretory Agent that enhances mucosal defenses?
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Misoprostol (cytotec)
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How does Misoprostol work?
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Protects against NSAIDS- induced ulcers by stimulaing secretion of mucus and bicarb, maintaining submucosal bld flow & supressing secretion of gastric acid
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Name Antacids that work on PUD?
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Aluminum hydroxide, Calcium Carbonate, Magnesium hydroxide
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How do antacids work?
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React with gastric acid to form neutral salts
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How shoudl you alter diet to help decrease PUD?
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Eating 5-6 small meals a day helps reduce fluxuations in gastric pH & facilitate recovery
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How does pH effect pepsin?
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Stomach usualy 1.3 pH, if raises between 2-4.9 pH then pepsin production inceases. Need to administer doses of drugs to increase pH to over 5
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What 3 tests are available for H.pylori?
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breath test, blood test, stool test
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How to administer antibiotics for H.pylori?
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Need to administer together as may develope a resistance if used alone. Need at least 2 at a time and preferably 3 & need to add an antisecretory agent for 14 days
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What is first line antibiotic used for PUD?
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Amoxicillin
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Side effects of antibiotic regimen with H.pylori?
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nausea and diahrrhea common
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Histamine2, receptor Antagonists - H2RA - Cimetidine
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selective to H2 receptor - cannot help with allergies which comes from H1 receptors
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Cimitidine pharmocokenetics
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Take with meals to slow absorption and effets, crosses bld-brain barries and may see CNS effects, most is eliminated intact in urine. half-life is 2 hours, but increased in renal pts
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How to treat ulcers iwth cimitidine?
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4-6 weeks for duodonal ulcers, 8-12 weeks for gastric ulcers
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What is drug of choice for GERD?
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Cimetidine - helps feel better, but does not help heal
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What is drug of choice for OR procedures to decrease gastric acidity?
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Cimetidine
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Side effects of cimetidine
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low - gynomastia, reduced libido, impotence, CNS with elderly or renal impaired,
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What drugs do cimetidine interact with?
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inhibits hepatic metabolizing of warfarin phenytion, theophyline adn lidocaine
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Should cimetidine be administerd with antacids?
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No administer at least 1 hour apart
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What is the difference between Ranitidine(Zantac) and cimetidine (Tagamet)?
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Fewer side effects, more potent and fewer drug interactions
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Which is the drug of choice for Zollinger-Ellison symdrome?
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Raitidine - fewer side effects & greater potency
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Famotidine (Pepcid) does not bind to androgen receptors & does not inhibit hepatice drug-metabolizing durgs T or F
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True
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What is famotindine used for?
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treatment of gastric and duodenal ulcers & heart burn, acid indigestion and sour stomach - dosage 20-40 mg
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Nizatidine - Axid is like ranitidin and famotidine - increases risk of
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pneumonia as it increases gastric pH
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What do Proton Pump inhibitors do?
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suppressing secretion of gastric acid
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Are proton pump inhibitors different?
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Most are the same and prescribing based on cost and prescriber preference
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Omeprazole (Prilosec) is what type of drug?
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suppresant of acid secretion, better than H2RA drugs
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What is mechanism of action of Omeprazole?
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it is a prodrug and is converted to active state in parietal cells of stomach, and causes irreversible inhibition of proton pump - enzyme that produces gastric acid
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How long does it take to recover proton pumps to start making acid after stopping omeprazole?
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partial recovery 3-5 days, full recovery takes weeks
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How much drug of omeprazole reaches system?
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50% - metabolized in liver and excreted by kidneys, 1 hour plasma half life - effect last long after drug cleared from body d/t irreversible damage to proton pump
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How long should one take Omeprazole?
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made for short term therapy 4-8 weeks
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Therapeutic use of omeprazole
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duodenal ulcers, gastrci ulcers, erosive esophagitis, and GERD, long term therapy of hypersecretory condition(Zollinger-Ellison syndrome)
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Side Effects
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usually minimal with short term therapy, but can cause HA, diarrhea, N&V - long term theraphy increased risk of gastric CA & osteoporosis
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Drug interactions
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elevates gastric pH and decrease absorption of atazanavir (HIV drug) and 2 antifungal drugs ketoconazole and itraconazole
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What is the cause of GERD?
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inappropriate relaxation of lowe esophageal spinchter that normally prevents relfux of gastric acid - thus allowing gastric contents into esophagus
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What is the drug of choice for GERD?
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Proton pump inhibitors
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Non drug treatment for GERD
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lose weight, stop smoking, do not eat late at night, sleep with head of bed up, avoid alcohol
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Nexium is almost identical to Prilosec? T or F
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true -
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True or False. Sucralfate has no acid-neutralizing capacity adn does not decrease acid secretion
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True - it creates a protective barrier against acid and pepsin
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What is mechanism of action for sucralfate?
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when in acidic environment sucralfate changes into viscid and sticky gel that coats ulcer crater - can last up to 6 hours
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Where is sucralfate excreted?
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90% in feces - very little is absorbed systemically
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Side effects of sucralfate (carafate)
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constipation
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Interactions with other drugs
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May prevent absorption of other drugs - phenytion, theophylline, digoxin, warfarin & fluoroqunoline antibiotics - administer at least 2 hours apart
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What is misoprostol (cytotec) used for for GI?
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prevention of GI ulcers in people on long term therapy of NSAIDs
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What is mechanism of action of misoprostol?
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Help replace prostoglandins that NSAIDS destroy - prostaglandins help maintain protective mucus in GI
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Side effects of misoprostol?
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diarrhea and it is does related & abdominal pain, some women spotting and dysmenorrhea
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Misoprostol pregnancy category
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X - prostaglandins stimulate uternine contractions - women need to take preg test, be given oral and written warnings, begin therapy on 2nd day of period
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Antacids action
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alkaline compounds taht neutralize stomach acid used for GERD and PUD
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Antacid reduce pepsin activity how
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increasing pH above 5 & can stimulate prostagladins production helping mucosal wall
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Are antacid absorbed
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no
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How are antacids expressing in potency?
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Acid-neutralizing capacity -(ANC) Higher levels have more acid neutralizing capacity
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How do antacids help in PUD?
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need to promote healing and not just relieve pain - need to take on regular basis to do this. Take 7 times a day -1-3 hours after meal and at bedtime
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Adverse reactions with antacids
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constipation and diarrhea, some have a lot of sodium in them - do not use these with hypertensive patient
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What are the 4 groups of antacids?
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1) aluminum compounds 2) magnesium compounds 3) calcium compounds 4) sodium compounds
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Magnesium Hydroxide properties
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high ANC, rapid acting, long duration - makes it antacid of choice - Milk of magnesia - can cause diarrhea - careful in renal patients
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Aluminum hydroxide
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low ANC and slow acting, but has long effects - used in combination with magnesium hydroxide
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Calcium carbonate properties
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rapid acting, high ANC, long effects - can cause acid rebound and constipation
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Sodium Bicarb properties
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rapid onset and short lasting - not used for gastric acid upset
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