Anti Ulcer drugs

Question 1

What are all the H2 Receptor Antagonists? and what are their suffix

Answer 1

Cimetidine
Famotidine
Nizatidine
Ranitidine

Question 2

what are all the Proton Pump Inhibitors and what are their suffix

Answer 2

Lansoprazole
Dexlansoprazole*
Omeprazole
Esomeprazole*
Pantoprazole
Rabeprazole

star means they are an Isomer

Question 3

What is the drug in the surface acting agent?

Answer 3

Sucralfate

Question 4

What is the drug in the PGE1 analog

Answer 4

Misoprostol

Question 5

What is the Bismuth Compound drug

Answer 5

Bismuth subsalicylate

Question 6

what are the adverse effects of histamine Type 2 blockers

Answer 6

Primarily GI-related

Some CNS-related

Question 7

What Rare side effect does Cimetidine have

Answer 7

Cimetidine decreases testosterone binding to androgen receptor (weak anti-androgen effects)
–Gynecomastiain men
–Galactorrheain women

Question 8

What Histamine Type two Blocker inhibit CYP450

Answer 8

Cimitidine

Question 9

What Histamine Type 2 Blocker is given in Pregnancy

Answer 9

ranitidine

Question 10

Mechanism of action of the PPIs

Answer 10

PPI’s covalently bind to sulfhydryl groups of H+/K+-ATPase at parietal cell secretory sites, thereby inhibiting gastric acid secretion by irreversibly inhibiting functioning ‘–ase’ pumps

inhibits pump-induced egress of gastric acid

Takes several days to create new steady-state of pump activity

Full symptom effects seen in a few-several days
longer than H2’s

•Inhibit 50%-90+% of acid
Depending on dose, frequency, duration

•Ulcerations healed in 4-8+ weeks*

Question 11

What is the major adverse effects of PPIs

Answer 11

GI-related

Additional Risk –CDAD
–Clostridium Difficile-Associated Diarrhea

CNS-related

Question 12

what PPI inhibits CYP450

Answer 12

Omeprazole

Question 13

What PPI is given in Pregnancy

Answer 13

lansoprazole most Common

or

Pantoprazole

Question 14

Mechanism of action of Sucralfate

Answer 14

Undergoes cross-linking from interaction with stomach acid, creating a viscous, sticky polymer which adheres to epithelial cells around ulcer’s crater

Prevents acid access to ulcer sites

•May also:
Stimulate local prostaglandin and mucous production and epidermal growth factor

Cytoprotection

Does not affect pH

Question 15

What are the indications of Sucralfate

Answer 15

Duodenal Ulcer

also:
Aphthous ulcers
Mucositis/Stomatitis
Radiation proctitis/ulcers (enema)
Bile reflux gastropathy

Question 16

What are the relative contraindications of Sucralfate

Answer 16

Severe renal failure die to the presence of Aluminum making it difficult to be excreted by the kidneys

Question 17

what are drug interactions pf Sucralfate

Answer 17

Possible; due to other drugs getting stuck in the barrier therefore, take 2-hours after other medications

Dosed QID for active ulcers so plan dosing other meds accordingly, if possible

also can cause constipation

Question 18

Mechanism of action for Misoprostol and when should it be given

Answer 18

A prostaglandin E1analog

Provides protective prostaglandin to gastric mucosa & reduces gastric acid release from parietal cell

Provides cytoprotectionby increasing mucosal defenses
–Stimulates bicarbonate and mucous production
–Increases mucosal blood flow

Standard doses reduce basal & nocturnal acid output (less than H2-antagonists and PPI’s)

given when NSAIDs must be given to a patient
-Primary Prophylaxis

Question 19

Off label uses of Misoprostol

Answer 19

With/Without mifepristone (pregnancy termination)

Alone for cervical ripening

Post-partum hemorrhaging (high dose)

Question 20

what are the two contradictions of Misoprostol

Answer 20

Pregnancy, unless needed for off label issues

IBD

Question 21

Mechanism of action pf Bismuth Compounds

Answer 21

PeptoBismol/Kaopectated

Originally developed as anti diarrheal agent

well known for its antimicrobial actions

Question 22

What is Bismuth Compounds used for

Answer 22

OTC: reflux hearburn, indigestion, and diarrhea

Rx used in combination with antibiotics and PPI for suppressant of H Pylori

Question 23

Adverse effects and Drug interactions of Bismuth Compounds

Answer 23

(dose related)
Constipation (anti-diarrheal actions)
Black/Dark (regularly-formed) stools

Drug Interactions:
Lots, take 2 hours after other medications

Question 24

Relative and absolute Contradictions of Bismuth Compounds

Answer 24

Relative Contraindications
Antiplatelets and anticoagulants
since Bismuth subsalicylate has aspirin modalities
Severe Renal failure

Absolute Contraindications
GI bleeding
Salicylate hypersensitivity

Question 25

How to approach the treatment of H.Pylori?

Answer 25

Combination therapy a must | -at least 2 antibiotics and an acid reducer (PPI or H2 blocker) for 10-14 days

Question 26

What is consisted in the typical triple therapy for H Pylori

Answer 26

``` Triple Therapy (14 days) All at B.I.D.dosing A PPI Clarithromycin Amoxicillin or Metronidazole ```

Question 27

what is consisted in the typical quadruple therapy?

Answer 27

``` Quadruple Therapy (10-14 days) PPI at B.I.D.,all others at Q.I.D.dosing A PPI Metronidazole Tetracycline Bismuth subsalicylate ```

Question 28

what happens if their is a failure of eradication with metronidazole containing triple therapy?

Answer 28

should be followed with a non-metronidazole containing quadruple therapy

Question 29

What to do in Clinical management of H Pylori if the patient is allergic to penicillen?

Answer 29

no amoxicillin | Substitute Metronidazole (consider Bismuth quad.)

Question 30

what to do in a CLinical management of H Pylori with Metronidazole resistance

Answer 30

Substitute Tetracycline | Consider Quadruple therapy (w/ Clarithromycin & Amoxicillin)

Question 31

what to do in a clinical management of H Pylori in a scenario with Clarithromycin resistance

Answer 31

Substitute either Amoxicillin or Tetracycline | Consider Bismuth quadruple therapy

Question 32

What to do if patient has Peptic Ulcer disease and presents without H. Pylori

Answer 32

Consider short course of antacids or Sucralfate (topical) –moderate symptoms, consider ranitidine –severe symptoms, consider lansoprazole