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Clinical Pharmacology and Therapeutics > Drugs Affecting Acid Secretion > Flashcards

Drugs Affecting Acid Secretion Flashcards

1
Q

What are we aiming to protect from when prescribing drugs that act on the stomach?

A

Helicobacter pylori
Acid
Drugs eg NSAIDs, Aspirin

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2
Q

What defensive factors in the stomach do we target?

A

Mucus barrier
Vascular Supply
Acid production (↓)
Epithelial Integrity

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3
Q

Which cells can be targetted to reduce acid production?

A

Parietal cells

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4
Q

What receptors in parietal cells can be targetted? (3)

A

H2 histamine receptors **
M3 ACh receptors
CCK B receptors for gastrin

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5
Q

Which is the most effective target for reducing acid secretion?

A

H2 histamine receptors

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6
Q

Where are proton pumps located?

A

Canalicular membrane

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7
Q

Which pump is targetted by PPIs?

A

H+-K+ ATPase exchanger

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8
Q

Are proton pumps always active?

A

NO

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9
Q

When do PPIs work?

A

When the pumps are active, i.e. take them before a meal

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10
Q

Whichis the most potent PPI?

A

Omeprazole

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11
Q

How quickly does omperazole work?

A

After 1 day

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12
Q

When, generally speaking, are PPIs at their most effective?

A

2-3 days after taking

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13
Q

How frequently should H2 antagonists be given? Why?

A

Twice a day as their t1/2 is short

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14
Q

What are 25% of gastric ulcers caused by?

A

NSAIDs/Aspirin

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15
Q

What are 75% of gastric ulcers caused by?

A

H. pylori

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16
Q

What are 96% of duodenal ulcers caused by?

A

H. pylori

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17
Q

What kind of scheme is used for treating peptic disorders?

A

A step up/down approach

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18
Q

What is the first step in treating peptic disorders?

A

Antacids

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19
Q

How do antacids work?

A

Bases within the antacids counteract the acid within the stomach to increase the pH

20
Q

Name some antacids

A

Alka-Seltzer
Milk of Magnesia
Pepto-Bismol
Tums

21
Q

What are the active ingredients in antacids?

A 
aluminium hydroxide
magnesium carbonate
magnesium trisilicate
magnesium hydroxide
calcium carbonate
sodium bicarbonate
22
Q

What is the second step in treating peptic disorders?

A

Alginates

23
Q

How do alginates work?

A

Adhere to exposed or inflammed mucosa

24
Q

Name an alginate

A

Gaviscon

25
Q

What is the third step in treating peptic disorders?

A

H2RAs (H2 receptors antagonists)

26
Q

Name some H2RAs

A

Cimetidine
Ranitidine
Nizatidine
Famotidine

27
Q

What is cimetidine metabolised by?

A

CYP450

28
Q

What is a specific ADR of cimetidine?

A

Gynaecomastia

29
Q

What is the main side effect of H2RAs?

A

Diarrhoea

30
Q

Are H2RAs generally safe and well tolerated?

A

Yes

31
Q

What is the fourth step in peptic disorder treatment?

A

PPIs

32
Q

Name some PPIs

A 
Omeprazole
Lansoprazole
Rabeprazole
Pantoprazole
Esomeprazole
33
Q

What are the most common ADRs of PPIs?

A

Diarrhoea

Colitis

34
Q

What is a potential complication of long term use of PPIs?

A

Upregulation of G cells

35
Q

What should be the very first step, before therpaeutic intervention, in treating GORD?

A

Lifestyle modification

36
Q

What lifestyle modifications should be advised in GORD?

A

Avoid heavy meals
Lose weight
Decrease chocolate and alcohol intake

37
Q

What is a complications of oesophagitis?

A

Barrets Oesophagus

38
Q

How is Barrets oesophagus treated?

A

Life-long PPI therapy

39
Q

What should be stopped if a patient has peptic ulcers?

A

NSAIDs

40
Q

What can be used for a temporary fix/symptom relief in peptic ulceration, and how long for?

A

H2RA or PPI for 6 weeks

41
Q

What is usually the cure of peptic ulcers?

A

Eradicating H. pylori

42
Q

How is H. pylori eradicated?

A

A 7 day, twice daily course of a PPI and 2 antibiotics

43
Q

Which antibiotics are used (without a penicillin allergy) to treat H. pylori?

A

Amoxacillin and either clarithromycin or metronidazole

44
Q

How is H. pylori treated in patients with a penicillin allergy?

A

PPI + clarithromycin + metronidazole (unless had clarithromycin exposure before)

45
Q

What is the issue with eradiaction of H. pylori?

A

It is a hard regime to stick to even for 7 days, so compliance is essential to encourage otherwise it will come back

Clinical Pharmacology and Therapeutics (26 decks)

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