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1 STEP UW GI > AMBOSS pharm gastric > Flashcards

AMBOSS pharm gastric Flashcards

1
Q

H2 antihistamines? 4

A

Ranitidine
Famotidine
Nizatidine
Cimetidine

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2
Q

Location of H2 receptors?

A 
Gastric parietal cells (oxyntic cells)
Vascular smooth muscle
Neutrophils
Central nervous system
Heart
Uterus
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3
Q

Histamine effects on H2 receptors? 3

A

Increased gastric acid secretion

Positive inotropism and enhanced automaticity

Smooth muscle relaxation leading to vasodilatation

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4
Q

H2 antihistamines. revers or nonrevers?

A

REVERSIBLE

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5
Q

H2 antihistamines. What G protein?

A

Gs protein-coupled receptor

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6
Q

H2 antihistamines. effect on cAMP?

A

↓ adenylyl cyclase activity → ↓ cAMP levels –> ↓ protein kinase A activity → ↓ phosphorylation and activation of H+/K+ ATPase → ↓ gastric acid (H+) secretion

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7
Q

what H2 antihistamine has most side effects?

A

cimetidine

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8
Q

cimetidine Antiandrogenic effect (via release of prolactin)?

A

erectile dysfunction, gynecomastia, low libido in men

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9
Q

Cimetidine on CYP450?

A

Inhibition of cytochrome P450 (CYP2C19) → various drugs interactions, e.g., clopidogrel

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10
Q

Cimetidine due to cross of BBB?

A

Headaches, dizziness, confusion due to its ability to cross the blood-brain barrier

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11
Q

Cimetidine cross what apart from BBB?

A

placenta (but is considered safe)

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12
Q

Cimetidine on kidney?

A

Reduces renal creatinine excretion (along with ranitidine)

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13
Q

when to take H2 antihistamine (daytime)?

A

H2 blockers need to be taken before dinner.

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14
Q

H2 antihistamine indications?

A

Anaphylactic shock (together with H1 antihistamines)

Symptomatic treatment of peptic ulcers: reduce the production of hydrochloric acid (less effective than PPIs )

Gastroesophageal reflux disease (GERD)

Gastritis

Zollinger-Ellison syndrome

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15
Q

Relative contraindications of H2 antihistamine?

A

Pregnancy, since cimetidine is known to cross the placental barrier
Nursing mothers
Children

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16
Q

Proton pump inhibitors. drugs?

A 
Omeprazole 
Esomeprazole
Pantoprazole 
Lansoprazole, dexlansoprazole 
Rabeprazole
17
Q

Proton pump inhibitors. What drugs have the highest bioavailability and achieve the highest plasma levels?

A

Lansoprazole, dexlansoprazole

18
Q

Proton pump inhibitors. Most gastro-specific drug?

A

Pantoprazole

19
Q

Administration of PPI. Daytime?

A

1 Tablet/day taken in the morning on an empty stomach

20
Q

PPI. Reverse or nonrevers inhibition?

A

irreversible inhibition of H+/K+ATPase in parietal cells → increases stomach pH

21
Q

Degree of gastric acid supression by PPI?

A

Complete suppression of gastric acid secretion

22
Q

why PPI best before meal?

A

PPIs are given in an inactive form, which is activated and takes effect in an acidic environment (e.g., the canaliculi of the apical parietal cells). The lower the pH level is, the higher the enrichment of PPIs in the parietal cells (high specificity of PPIs). The highest levels of H+/K+ ATPase enzyme activity are reached in the parietal cell after a period of prolonged fasting. Therefore, administering PPIs before the first meal of the day achieves highest efficacy.

23
Q

PPI. GI complications?

……

↑ Risk of C. difficile infection

Reactive hypergastrinemia

↓ Absorption of iron and vitamin B12

↓ Absorption of calcium and magnesium → ↑ risk of osteoporosis in long-term use→ ↑ risk of fractures in elderly individuals

A

Nausea, diarrhea, abdominal pain, flatulence

24
Q

PPI. GI complications?

Nausea, diarrhea, abdominal pain, flatulence

…..

Reactive hypergastrinemia

↓ Absorption of iron and vitamin B12

↓ Absorption of calcium and magnesium → ↑ risk of osteoporosis in long-term use→ ↑ risk of fractures in elderly individuals

A

↑ Risk of C. difficile infection

25
Q

PPI. GI complications?

Nausea, diarrhea, abdominal pain, flatulence

↑ Risk of C. difficile infection

….

↓ Absorption of iron and vitamin B12

↓ Absorption of calcium and magnesium → ↑ risk of osteoporosis in long-term use→ ↑ risk of fractures in elderly individuals

A

Reactive hypergastrinemia

26
Q

PPI. GI complications?

Nausea, diarrhea, abdominal pain, flatulence

↑ Risk of C. difficile infection

Reactive hypergastrinemia

….

↓ Absorption of calcium and magnesium → ↑ risk of osteoporosis in long-term use→ ↑ risk of fractures in elderly individuals

A

↓ Absorption of iron and vitamin B12

27
Q

PPI. GI complications?

Nausea, diarrhea, abdominal pain, flatulence

↑ Risk of C. difficile infection

Reactive hypergastrinemia

↓ Absorption of iron and vitamin B12

…

A

↓ Absorption of calcium and magnesium → ↑ risk of osteoporosis in long-term use→ ↑ risk of fractures in elderly individuals

28
Q

Why PPI cause decr Ca absorption?

A

Because the gastric environment becomes less acidic, dietary calcium remains bound to oxalate, resulting in reduced absorption in the duodenum and jejunum.

29
Q

PPI neurological adverse?

A

Lightheadedness, headaches

Possibly increased risk of developing cognitive impairment/dementia

30
Q

PPI renal?

A

in rare cases, acute interstitial nephritis

31
Q

PPI on lungs?

A

↑ Risk of pneumonia;

Particularly in the 30 days after starting therapy; possibly due to aspiration of gastric content containing a larger number of bacteria than usual following suppression of gastric acid

32
Q

PPI indications.

A

Peptic ulcer disease (gastric and duodenal ulcers)

Prevention of stress ulcers

!Gastroesophageal reflux disease

Gastritis

Combination treatment in Helicobacter pylori eradication therapy

Zollinger-Ellison syndrome (gastrinoma)

Gastropathy caused by NSAIDs

Special indication: MALT lymphoma (stages I and II)

33
Q

PPI interactions enzyme?

A

CYP2C19-mediated

34
Q

Omeprazole and esomeprazole interactions. Clopidogrel?

A

↓ activation

35
Q

Omeprazole and esomeprazole interactions. Warfarin, phenprocoumon?

A

↓ clearance

36
Q

Omeprazole and esomeprazole interactions. Phenytoin, carbamazepine?

A

↑ clearance

37
Q

Omeprazole and esomeprazole interactions. Nifedipine?

A

↑ absorption, ↓ clearance

38
Q

Omeprazole and esomeprazole interactions. Diazepam?

A

↓ clearance

1 STEP UW GI (16 decks)

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