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GI 2 Exam 1 > Pharm - Antacids & Anti-Ulcer > Flashcards

Pharm - Antacids & Anti-Ulcer Flashcards

1
Q

What are the two main types of antacids?

A
  • low-systemic agents
  • high-systemic agents

(plus supplemental agent: simethicone)

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2
Q

what are the 3 classes of low-systemic agents?

A
  • aluminum salts (aluminum hydroxide)
  • calcium salts (calcium carbonate)
  • magnesium salts (magnesium hydroxide/carbonate/trisilicate)
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3
Q

what is the one class of high-systemic agents?

A

sodium bicarbonate

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4
Q

why is sodium bicarb not prescribed for anacid treatment anymore?

A

it is highly absorbed, leading to hypernatremia -> bad

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5
Q

what bind to H+ ions in the gastric lumen, that have already been released by parietal cells?

A

antacids

  • they do NOT decrease acid production or secretion!!
  • result in generation of common by-products (water, CO2, chloride salts)
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6
Q

what are the onset, DOA, and acid neutralizing capacity (ANC) of calcium and magnesium salts?

A

onset: rapid
DOA: long
ANC: Ca=very good, Mg=good

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7
Q

what supplemental compound decreases surface tension, aiding the expulsion of gas?

A

simethicone

- does NOT prevent gas, just makes it easier to expell

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8
Q

what are the two main side effects of aluminum salts?

A

constipation, hypophosphatemia

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9
Q

what are the two main side effects of magnesuim salts?

A

diarrhea, hypermagnesemia

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10
Q

what are the three main side effects of calcium salts?

A

constipation, hypercalcemia, hypophosphatemia

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11
Q

what are the three main side efffects of sodium bicarb?

A
  • gas/flatulence, hypernatremia, metabolic alkalosis -> now is used more to treat pts with pH imbalance (acidotic)
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12
Q

what are the two antacid combinations used to balance side effects?

A
  • Mg + Ca
  • Mg + Al

NOTE: if pt already has loose stool, don’t give Mg. same goes for constipation

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13
Q

what is the timing for antacid drugs?

A

take all 1-2 hours BEFORE other medications, OR 2-4 hours AFTER other meds

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14
Q

what are the 5 categories of anti-ulcer drugs?

A
  • H2 blockers
  • Proton pump inhibitors
  • Surface acting agents
  • PGE1 analogs
  • Bismuth compounds
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15
Q
  • cimetidine
  • ranitidine
  • famotidine
  • nizatidine
A

Histamine type-2 blockers

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16
Q

what is the MOA of H2 blockers?

A

they block the H2 receptor on the baso-lateral membrane of the parietal cells

  • relatively prompt relief of GERD symptoms
  • ulcer healing occurs 4-8 weeks, but NOT if caused by H.pylori

(gastrin binds CCK2r on ECL cell -> Hist released, binds H2r on parietal cell)

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17
Q

what are the adverse effects of H2 receptor blockers?

A

nausea, diarrhea, constipation, sometimes headache

RARE: cimetidine decreases testosterone binding to androgen receptor -> gynecomastia in men, galactorrhea in women

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18
Q

what two drugs are important examples of CYP450 inhibitors?

A

cimetidine and omeprazole

NOTE: ranitidine only has about 10% inhibition compared to cimetidine

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19
Q

what H2 blocker is contraindicated in pregnancy? what can be used instead?

A

ranitidine

- use famotidine instead

20
Q
  • omeprazole (po)
  • esomeprazole (po/iv*)
  • lansoprazole (po)
  • dexlansoprazole (po)
  • pantoprazole (po/iv*)
  • rabeprazole (po)
A

proton pump inhibitors (PPI’s)

21
Q

what is the MOA of PPI’s?

A

they bind sulfhydryl groups of H/K-ATPase on the lumen of parietal cells, inhibiting gastric acid secretion into the mucous layer

  • not as fast acting as H2 blockers, full symptom effects seen in a few-several days
  • ulcerations healed in 4-8 weeks, but NOT if caused by H.pylori*
22
Q

what are the adverse effects of PPI’s?

A

diarrhea, dyspepsia, nausea, headaches, generalized myalgia
- CDAD (C.diff assoc diarrhea) an additional concern, stop taking PPI immediately if pt gets foul-smelling watery diarrhea!

23
Q

what PPI is contraindicated in pregnancy? what can be used instead?

A

lansoprazole, also try to avoid omeprazole

- use pantoprazole instead

24
Q

sucralfate

A

sulfated polysaccharide

25
Q

what is the MOA of sucralfate?

A

bandaid!

  • interacts with stomach acid, creating a viscous, sticky polymer which adheres to epithelial cells around ulcer’s crater
  • forms protective barrier so more acid can’t irritate the ulcer further

NOTE: viscous blob will NOT adhere to normal epithelial tissue, so tx should be stopped once ulcer is healed

26
Q

what might sucralfate also stimulate?

A

local prostaglandin release, mucous production, and epidermal growth factor
- does not affect pH

27
Q

when is sucralfate indicated?

A

duodenal ulcers, but also off label for

  • aphthous ulcers (canker sores)
  • mucositis
  • radiation proctitis/ulcers
28
Q

what is the main adverse effect of sucralfate?

A

constipation -> added to Al(OH)3

29
Q

what is a relative contraindication of sucralfate?

A

severe renal failure (d/t aluminum)

NOTE: possible drug-drug interactions, so should be taken 2 hours after other meds like antacids

30
Q

what is the dosing regimen for sucralfate?

A

4 times daily

- take 2 hours after other medications, LOTs of drug interactions

31
Q

what is the MOA of misoprostol?

A
  • prostaglandin E1 analog, reduces gastric acid release from parietal cell negative effect
  • provides CYTOprotection (brand name is CYTOtec) by increasing mucosal defenses by making bicarb, mucous and increased blood flow positive effect
32
Q

what is the indication for misoprostol?

A

prevention of NSAID induced gastric ulceration in high risk patients

  • cervical ripening
  • post-partum hemorrhage (high dose given rectally)
33
Q

what are the two main contraindications of misoprostol?

A
  • pregnancy because it induces labor!

- IBD

34
Q

what are the adverse effects of misoprostol?

A

diarrhea, headache, dizziness

35
Q

what is the MOA of Bismuth compounds?

A

(Pepto-Bismol!) most well known for its antimicrobial properties, prevents microbial attachment to mucosa, possible inactivation of enterotoxins, disruption of bacterial wall

  • Rx: given in combination pack to treat H.pylori
  • OTC: used alone for reflux, bloating, gas
36
Q

what are the adverse effects of Bismuth compounds?

A

constipation, black/dark REGULARLY-formed stools

NOTE: if pt has black TARRY stool -> think GI bleed!

37
Q

what is the dosing regiment for Bismuth compounds?

A

take 2 hours after other medications, LOTs of drug interactions

38
Q

what are the absolute contraindications of Bismuth compounds?

A

GI bleeding, salicylate hypersensitivity

39
Q

what is the preferred treatment of H. pylori?

A
  • *COMBINATION THERAPY IS A MUST**

- at least 2 antibiotics and an acid reducer (PPI or H2 blocker) for 10-14 days**

40
Q

what can lead to false negatives on urease breath tests?

A

consuming Bismuth compounds within 4 weeks prior to performing test

41
Q

what is the triple therapy for H. pylori?

this is the GO-TO tx

A
  1. PPI
  2. clarithromycin
  3. either amoxicillin OR metronidazole (if allergic to amox)

*all 2x a day, for 14 days!

42
Q

what is the quadruple therapy for H. pylori?

A
  1. PPI**
  2. metronidazole
  3. tetracycline
  4. Bismuth subsalicylate

*PPI 2x a day, all others 4x a day for 10-14 days!

43
Q

what is the H. pylori treatment if pt has PCN allergy?

A

use metronidazole, NO amoxicillin

44
Q

what is the treatment for H. pylori with metronidazole resistance?

A

substitute tetracycline, consider quadruple therapy

NOTE: some communities have H. pylori resistance, can default to quad therapy

45
Q

**what should you consider in pregnant patient with PUD

A

if they don’t have H. pylori, consider short course of antacids or sucralfate

  • if moderate symptoms, consider ranitidine (H2 blocker)
  • if severe symptoms, consider lansoprazole (PPI)
46
Q

what should you consider if NSAID-at risk for pt with PUD?

A
  • if NSAID not required, consider acetaminophen and /C NSAID

- if NSAID required, consider COX-2 NSAID and/or consider PPI or misoprostol

GI 2 Exam 1 (22 decks)

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