A.38. Drugs used in peptic ulcer diseases. pharmacotherapy of peptic ulcer diseases.

Question 1

what are Aluminum hydroxide and Magnesium oxide?

Answer 1

antacids

Question 2

what is the function of antacids

Answer 2

weak bases that neutralize the stomach acid by reacting with protons in the lumen of the gut

Question 3

where is Aluminum hydroxide and Magnesium hydroxide absorbed from?

Answer 3

poorly absorbed from the bowel

Question 4

how is aluminum hydroxide and Magnesium hydroxide given?

Answer 4

orally

Question 5

what are the side effects of aluminum hydroxide (Al[OH]₃)?

Answer 5

constipation

Question 6

what are the indications for giving Aluminum hydroxide and Magnesium hydroxide?

Answer 6

symptomatic relief of dyspepsia and heartburn

Question 7

what is Famotidine?

Answer 7

H₂-receptor antagonist

Question 8

how is famotidine and cimetidine given?

Answer 8

oral, parenteral

Question 9

what is the duration of action of famotidine?

Answer 9

12-24 hours

Question 10

are H₂-receptor antagonists (famotidine) inhibitors of cytochrome P450 enzymes?

Answer 10

yes

Question 11

what is the function of H₂-receptor antagonists?

Answer 11

competitive inhibitors of H₂-receptors–> indirect effect on proton pump activity –> ↓ gastric acid secretion (mainly nocturnal)

Question 12

which agents have a greater acid-suppressing effect- H₂-receptor antagonists or PPI’s?

Answer 12

PPI’s

Question 13

what are the indications for giving famotidine and PPI’s??

Answer 13

GERD
Peptic ulcer disease (PUD)
H.pylori associated ulcers 
NSAID'S induced ulcers 
Zollinger Ellison syndrome

Question 14

side effects of H₂-receptor antagonists

Answer 14

**famotidine has milder SE than cimetidine

GI distress
confusion, agitation (in elderly)
weak antiandrogenic effects (cimetidine)

Question 15

What is omeprazole or Pantoprazole?

Answer 15

proton pump inhibitors (PPI’s)

Question 16

what is the function of PPI’s?

Answer 16

irreversible, direct inhibitors of a proton pump (K⁺/H⁺ antiport) in gastric parietal cells

Question 17

what are the 1st line agents for reducing stomach acidity?

Answer 17

PPI’s

Question 18

how is omeprazole given?

Answer 18

orally

should be administered on an empty stomach

Question 19

how is pantoprazole given?

Answer 19

IV

Question 20

what is the T1/2 of PPI’s?

Answer 20

1-2 hours
the acid-suppressing effect lasts up to 24 hours
full acid-suppressing is reached within 3-4 days

Question 21

what effect does omeprazole have on Clopidogrel?

Answer 21

omeprazole is an inhibitor of cytochrome P450 enzymes

↓ the antiplatelet effect of clopidogrel

Question 22

what are the SE of PPI’s?

Answer 22

diarrhea, abdominal pain
headaches
↓ oral bioavailability of vitamin B12, iron, digoxin, and ketoconazole
↑ risk of respiratory and enteric infections
hypergastrinemia (ECL and parietal cells hyperplasia)

Question 23

how do PPI’s cause hypergastrinemia?

Answer 23

there’s a loss of negative feedback of H⁺ on D-cells

Question 24

what are Sucralfate and Misoprostol?

Answer 24

mucosal protective agents

Question 25

what is Sucralfate and what's it's function?

Answer 25

Aluminium sucrose sulphate 1. polymerizes on the GI luminal surfaces to form a protective gel-like coating of ulcer beds 2. enhances PGE synthesis 3. stimulates mucus and bicarbonate secretion 4. enhances mucosal defense and repair

Question 26

how are Sucralfate and Misoprostol given and how many times are they administered daily?

Answer 26

orally | 4 times daily

Question 27

what does sucralfate require for activation?

Answer 27

acidic pH | It's a prodrug

Question 28

what does sucralfate do?

Answer 28

improve healing after mucosal damage | prevent reoccurrence

Question 29

side effect of sucralfate

Answer 29

constipation

Question 30

what is Misoprostol

Answer 30

Prostaglandin (PGE₁) analogue

Question 31

what is the function of Misoprostol?

Answer 31

mucus and bicarbonate secretion ↑ HCl secretion ↓ mucosal vascularity and blood flow ↑

Question 32

when do we give Misoprostol?

Answer 32

NSAID'S induced ulcers (also prophylaxis)

Question 33

when is Misoprostol CI?

Answer 33

in pregnancy (abortifacient)

Question 34

a side effect of misoprostol

Answer 34

diarrhea

Question 35

misoprostol and Diclofenac are combined to treat..

Answer 35

arthritis pain, in patients with high-risk GI bleeding/ulceration

Question 36

what is the #1 triple therapy for H.pylori

Answer 36

'BMT regimen' Bismuth subsalicylate Metronidazole Tetracycline

Question 37

what is the #2 triple therapy for H.pylori

Answer 37

Ranitidine bismuth citrate Tetracycline clarithromycin or Metronidazole

Question 38

what is the #3 triple therapy for H.pylori

Answer 38

Omeprazole clarithromycin amoxicillin or metronidazole

Question 39

what is the Quadruple therapy for H.pylori

Answer 39

``` "BOMT" Bismuth subsalicylate Omeprazole Metronidazole Tetracycline ```