2.11 GI Pharm: GERD, Ulcers, Gastroparesis

Question 1

What is the general MOA of antacids or ionic salts?

Answer 1

Weak bases that react to gastric acid H+ to neutralize them

Question 2

Who should avoid using antacids?

Answer 2

People with renal insufficiency or drugs that need acidic environments like tetracyclines or FQ

Question 3

What kind of monitoring do you need to do with patients taking antacids?

Answer 3

Electrolyte imbalance and renal function

Question 4

What are antacids used to treat?

Answer 4

Mild GERD and occasional heartburn
NOT ulcers

Question 5

What antacids salt ADSE include diarrhea or hyper magnesia that can lead to renal insuffiency?

Answer 5

Magnesium salts

Question 6

What antacid slat can lead to hypercalcemia, alkalosis, or milk-alkali syndrome?

Answer 6

Calcium salt

Question 7

What antacid salt ADSE includes constipation, neurotoxicity, hypophosphatemia, and anemia in renal failure?

Answer 7

Aluminum salts

Question 8

What is the MOA of cimetidine, famotidine, ranitidine (“-idine”)?

Answer 8

H2 receptor antagonist (on parietal cells) reducing gastric acid secretion

Question 9

What are cimetidine specific ADSE?

Answer 9

Gynecomastia, galactorrhea, CYP450 interactions

Question 10

Although rare, what are the side effects of a competitive H2 receptor antagonist?

Answer 10

Headache, diarrhea, fatigue

Question 11

What are the contraindications for cimetidine, famotidine, ranitidine?

Answer 11

Pregnancy (cross placenta)

Question 12

What monitoring should you do for patients on H2 receptor antagonist?

Answer 12

Mental status (if IV) or drug interactions (cimetidine)

Question 13

What are the “-tidine” H2 receptor antagonists used to treat?

Answer 13

GERD, peptic ulcer, mild acid reflux

Question 14

What are the PPI drugs?

Answer 14

Omeprazole, lansoprazole, esomeprazole
“-prazoles”

Question 15

What is the MOA of “-prazoles”?

Answer 15

Irreversible inactivate H+/K+ ATPase parietal cells

Question 16

What is the specific ADME for PPIs?

Answer 16

Enteric coated activated in acidic environments
Take 1 hr before meal

Question 17

What ADSE should you consider for PPIs?

Answer 17

Diarrhea, headache, decreased B12 absorption, hypomagnesia, acid rebound, infection risk

Question 18

What should you avoid in patients taking omeprazole, lansoprazole, and esomeprazole?

Answer 18

Caution long term use (osteoporosis, hypomagnesia)
Avoid with CYP2C19 drugs (clopidogrel)

Question 19

What do you monitor with patients taking the “-prazoles”?

Answer 19

Magnesium levels and infection signs

Question 20

What do you use to treat GERD, peptic ulcers, H. Pylori infections, and NSAID-induced ulcers?

Answer 20

PPIs “-Prazole” drugs
Omeprazole, lansoprazole, esomeprazole

Question 21

What are some mucosal protective agents you can use?

Answer 21

Sucralfate, Bismuth, Misoprostol

Question 22

Sucralfate MOA?

Answer 22

Has aluminum that reduces pepsin access creating protective barrier on ulcers promoting healing

Question 23

What is used to treat GERD in pregnancy?

Answer 23

Sucralfate

Question 24

What is a Sucralfate ADSE?

Answer 24

Constipation (aluminum)

Question 25

Can cause black stool, darken the tongue?

Answer 25

Bismuth

Question 26

What are the contraindications for Bismuth?

Answer 26

Pregnancy and renal insufficiency

Question 27

What is the MOA or bismuth?

Answer 27

Enhances prostaglandin production, binds to ulcer craters, and antimicrobial effects to H. Pylori (salicylates)

Question 28

What is used to prevent NSAID ulcer damage?

Answer 28

Misoprostol

Question 29

Prostaglandin E1 analog that reduced acid secretion by decreasing cAMP?

Answer 29

Misoprostol

Question 30

Misoprostol ADSE and CONTRA?

Answer 30

Diarrhea + cramping NO to pregnancy

Question 31

What is the triple therapy for H. Pylori eradication?

Answer 31

Clarithromycin, amoxicillin, PPI

Question 32

What is the quadruple therapy for H. Pylori eradication?

Answer 32

Metronidazole, tetracycline, PPI, Bismuth

Question 33

Clarithromycin MOA?

Answer 33

Macrolide inhibiting bacterial 50S ribosome

Question 34

Amoxicillin MOA?

Answer 34

Penicillin derivative disrupting cell wall synthesis

Question 35

Metronidazole MOA?

Answer 35

DNA damage with free radicals (anaerobic bacteria)

Question 36

Tetracycline MOA?

Answer 36

Protein synthesis inhibitor bacterial 30S ribosome

Question 37

What is metroclopramide used for?

Answer 37

GERD, gastroparesis, antiemetic

Question 38

What are the ADSE for a prokinectic agent like metoclopramide?

Answer 38

CNS: restless, drowsy, extrapyramidal (tardive dyskinesia** with long term use)

Question 39

What is the MOA for metoclopramide?

Answer 39

D2 receptor antagonist with some 5-HT4 agonist activity (Increase GI motility and accelerate gastric emptying)

Question 40

Where does metoclopramide act?

Answer 40

Brain (CNS) - dopamine receptors It blocks the 5HT released from mucosal enterochromaffin cells