03.02 Drugs for Peptic Ulcer Disease Flashcards Preview

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Flashcards in 03.02 Drugs for Peptic Ulcer Disease Deck (43)
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1

Distal to the junction between antrum and acid secretory mucosa
High risk of malignancy
H. pylori, NSAID-induced
Gastric acid output normal or decreased
Burning or gnawing discomfort
Precipitated by food

Gastric ulcer

2

First portion of the duodenum (within 3 cm of pylorus)
Rare risk of malignancy
H. pylori, NSAIDS
High gastric acid secretion, low bicarbonate secretion
Burning or gnawing, awakens at night
90 minutes to 3 hours after a meal, relieved by antacids or food

Duodenal ulcer

3

Burning pain on epigastric region, often accompanied by a feeling of post-prandial fullness

Dyspepsia

4

Protective factors of GI mucosa

Bicarbonate
Gastric mucosa
Prostaglandins
Nitric oxide

5

Damaging factors of GI mucosa

Stress and trauma
NSAIDS
H. pylori
Caffeine
Acids
Skipping meals
Smoking, alcohol

6

Rebound acidity, diarrhea, constipation, metabolic alkalosis, abdominal distension, gas flatulence

Antacids

7

Dizziness, inhibition of CYP450, hormonal imbalances, Vit B12 supplementation

H2 receptor antagonists

8

CYP450 inhibition, rebound acidity, Vit B12 supplementation

PPI

9

Constipation, flatulence, dry mouth

Sulcralfate

10

Blackening of tongue and stool

Bismuth chelate

11

Empiric trial acid suppresion for ___ is the recommended line of therapy

4-8 weeks

12

If initial acid suppression fails after ___, it is reasonable to step up therapy

2-4 weeks

13

Most sensitive and specific approach for examining the upper GI tract
Direct visualization of the mucosa
Test for malignancy

Endoscopy

14

Other diagnostic procedures for peptic ulcer diseases

Barium studies
H. pylori detection (urease test)

15

Two types of antacids

Bicarbonates
Hydroxides

16

Acid neutralizer only
Rapidly neutralizing HCl and reducing pepsin activity
Stimulate mucosal prostaglandin production
Weak bases that react with H+ to form a salt and water
Fast onset, short duration

Antacids

17

Symptomatic relief of acid peptic disorders
Reduce the phosphorus levels among patients with renal insufficiency/failure
Ca2+ supplement for patients with osteoporosis or hypocalcemia

Antacids

18

Adverse effects of antacids

Metabolic alkalosis
Rebound acidity
Increased acid secretion due to negative feedback
Milk-alkali syndrome
Flatulence, abdominal distention, bloating or belching

19

CI in patients with cardiac or renal problems

Sodium bicarbonate

20

Increase acid secretion due to negative feedback

Calcium carbonate

21

Osmotic diarrhea
Hypermagnesemia
Flatulence

Mg(OH)2

22

Constipation
Usually combined with Mg(OH)2
Hypophosphatemia
Flatulence

Al(OH)3

23

Cimetidine, ranitidine, nizatidine, famotidine

H2 receptor antagonist

24

Technically an antihistamine
Block H2 receptors of the parietal cells via competitive inhibition
Reduces the direct-stimulatory effect of gastrin and acetylcholine
Suppress basal gastric acid secretion
Longer effect than antacids

H2 receptor antagonist

25

Indications of H2 receptor antagonists

Nocturnal acid secretion
Stress ulcers
NSAID-induced ulcers
GERD
Erosive esophagitis
Non-ulcer dyspepsia
First-line for bleeding from stress-related gastritis

26

Adverse effects of H2 receptor antagonists

Mental status changes among the elderly
Cross the placenta
Secreted into breast milk
Blood dyscrasias
Arrythmia

27

Prototype drug of H2 receptor antagonist
Rarely used because of its side effects (gynecomastia, galactorrhea, CNS effects)

Cimetidine

28

Commonly prescribed
Inhibit nocturnal gastric secretion
Known to prevent stress ulcers

Ranitidine

29

Ideal drug based on guidelines
Most potent acid inhibitory agents
Inhibits meal-stimulated acid secretion during the day as well as basal secretion overnight

PPI

30

Irreversibly inhibits proton pump
Rapid onset and duration
Prodrug that require activation in an acidic environment

PPI