antacid and ulcer drugs

Question 1

Low systemic antacids

Answer 1

• Aluminum
• Calcium
• Magnesium

Question 2

High systemic antacids

Answer 2

-sodium salts

Question 3

the one supplemental antacid agent

Answer 3

simethicone

Question 4

Do antacids reduce acid production and secretion?

Answer 4

NOOOO

Question 5

What are the two antacids that have rapid onset and long duration of action and have good acid neutralizing capacity

Answer 5

• calcium

- Magnesium

Question 6

MOA of simethicone antacid

Answer 6

• surfactant: decreases surface tension

- Aids in expulsion of gas (PRO FART)

Question 7

Adverse effect of Aluminum antacid

Answer 7

constipation

Question 8

adverse effect of magnesium antacid

Answer 8

Diarrhea (stool-softening/laxative-like activity)

Question 9

adverse effect of calcium antacid

Answer 9

constipation

Question 10

Adverse effect of sodium antacid

Answer 10

• Gas/Flatulence (“bicarb. burp)

- be cautious with HTN .. . hypernatremia

Question 11

Drug interactions with antacids

Answer 11

TONS!!!!!!!!!!

Question 12

Advice on when to take antacids

Answer 12

*****take all antacids 1-2 hours before other medications OR 2-4 hours after other meds

Question 13

What are the 5 CATEGORIES of anti-ulcer agents

Answer 13

• H2 receptor antagonist
• Proton Pump inhibitor
• Surface Acting Agents
• PGE1 analog
• Bismuth compounds

Question 14

H2 receptor antagonists have what ending

Answer 14

Tidine

Question 15

Proton pump inhibitors have what ending

Answer 15

Prazole

Question 16

If you give enough H2 antagonist, can you completely shut down acid production?

Answer 16

NO, multiple paths lead to acid production

Question 17

Onset of action with H2 antagonist

Answer 17

.5-2 hours

Question 18

How long until ulcer healing occurs after H2 antagonist given

Answer 18

4-8 weeks

Question 19

Adverse effects of H2 antagonist

Answer 19

relatively mild and infrequent . . . GI related or CNS like drowsiness or headache

Question 20

Adverse effect of Cimetidine with Long term, high dosage

Answer 20

• gynecomastia in men

- Galactorrhea in women

Question 21

Drug interaction of cimetidine

Answer 21

PROTOTYPICAL inhibitor of CYP450 isoenzymes

Question 22

which H2 antagonist would you use in pregnancy

Answer 22

Ranitidine

Question 23

Proton pump inhibitor MOA

Answer 23

covalently bind to sulfhydryl groups of H+/K+ ATPase at parietal cell secretory sites, thereby inhibiting gastric acid secretion by IRREVERSIBLY inhbiting ase pumps

Question 24

time takes for PPIs to start working

Answer 24

several days

Question 25

when given a PPI, how long does it take ulcers to heal

Answer 25

4-8 weeks

Question 26

Adverse effect of PPI

Answer 26

CDAD | -Clostridium Difficile Associated Diarrhea

Question 27

Drug interactions for Omeprazole

Answer 27

PROTOTYPICAL CYP450 inhibitor

Question 28

which PPI do you use for pregnancy

Answer 28

Iansoprazole

Question 29

What is the anti ulcer drug that is a sulfated polysaccharide that creates a viscous, sticky polymer which adhere to epithelial cells around ulcers crater to prevent acid access in ulcer site

Answer 29

Sucralfate

Question 30

Does sucralfate affect pH

Answer 30

no

Question 31

adverse effect of sucralfate

Answer 31

constipation

Question 32

dosing for sucralfate that makes it difficult

Answer 32

4 times a day and avoid with other meds

Question 33

Misoprostol is an analog to what

Answer 33

prostaglandin E1

Question 34

What type of protection does misoprostol provide

Answer 34

Cytoprotection by increasing mucosal defenses

Question 35

Indication for misoprostal use

Answer 35

NSAID-induced gastric ulceration

Question 36

Contraindication for misoprostal

Answer 36

Pregnancy

Question 37

MOA of Bismuth compounds (pepto-Bismol)

Answer 37

anti- diarrheal and antimicrobial

Question 38

Bismuth compounds are used with what in treatment of H. pylori

Answer 38

antibiotics

Question 39

Adverse affects of Bismuth compounds

Answer 39

Black/Dark stools

Question 40

Drug interactions with Bismuth compounds

Answer 40

Lots, take 2 hours after other meds

Question 41

Absolute contraindication for Bismuth

Answer 41

- GI bleeding | - Salicylate hypersensitivity

Question 42

Treatment for H. pylori . .generally

Answer 42

Combination . . AT LEAST 2 antibiotics and an acid reducer (PPI or H2 blocker

Question 43

Time frame and number of drugs for H. pylori treatment

Answer 43

- 10-14 days | - Triple drug therapy

Question 44

normal triple drug therapy for H. pylori

Answer 44

- PPI - Clarithromycin - either amoxicillin OR metronidazole

Question 45

Quadruple therapy for H. pylori

Answer 45

- PPI (or H2 blocker) - Metronidazole OR Clarithromycin - Amoxicillin OR Tetracycline - Bismuth Subsalicylate

Question 46

When is tetracycline useful in quadruple therapy for H. pylori

Answer 46

amoxicillin allergy and metronidazole resistance

Question 47

Expain the time frame for continuation of PPI or H2 blocker after the 10-14 day combo therapy for H. pylori

Answer 47

consider for several weeks after for complete healing of ulcers

Question 48

H. pylori therapy with PCN allergy

Answer 48

substitute metronidazole for amoxicillin

Question 49

H. pylori therapy with metronidazole resistance

Answer 49

- substitute tetracycline | - consider quadruple therapy

Question 50

H. pylori with clarithromycin resistance

Answer 50

- substitute either amoxicillin or tetracycline | - consider quadruple therapy

Question 51

treatment of Pregnant patient with ulcer but without H. pylori

Answer 51

- short course of antacids or sucralfate - if moderate consider ranitidine - if severe consider Iansoprazole

Question 52

If patient has an ulcer and on NSAIDs

Answer 52

- if it ISN'T required consider switching to Acetaminophen | - If NSAIDS are required then Misoprostol