Chapter 46: Peptic Ulcer Disease Flashcards Preview

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Flashcards in Chapter 46: Peptic Ulcer Disease Deck (23)
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1

How do H2 receptor antagonists work?

Reversible and competitive inhibition of H2 receptors on parietal cells...prevents histamine from binding

2

What do H2 receptor antagonists end in?

TIDINES

3

Cimetidine inhibits cytochrome P450 mediated metabolism and thus interferes with __ metabolism

Hepatic

4

Which H2 receptor antagonist would you avoid in pregnant or breast feeding patients?

Cimetidine

5

What is the drug of choice for pregnant patient with peptic ulcer disease?

Ranitidine, famotidine, nizatidine

(any TIDINE except cimetidine) (NOT PPIs)

6

Which H2 receptor antagonist would you give via IV to treat hypersecretory conditions? Or to treat patients who cannot tolerate oral med?

Ranitidine

"after you RAN, you needed an IV"

7

What is the therapy of choice for H. pylori or NSAID derived ulcers?

PPIs "PRAZOLES"

8

What is the MOA of PPIs?

Irreversibly inhibits H/K ATPase on parietal cells...stops production of HCl (~18 hours)

9

What is a compensatory physiologic secretory effect that PPIs may have on the stomach?

May cause compensatory large increase in gastrin

10

What are some serious/common adverse effects of PPIs? Don't use with what drug?

Can interfere with the antiplatelet effects of Clopidogrel

Increased risk of bone fracture
(remember our case patient with two broken hips?)

11

What are some weirdo effects associated with H2 antagonists?

Gynecomastia, galactorrhea, loss of libido

12

Which are more expensive, H2 antagonists or PPIs?

PPIs are way more $$$$$$

13

Do you use IV or oral PPIs?

Oral always unless serious/severe case...then pantoprazole can be given IV form

14

Antacids neutralize gastric acid. List 4 antacids

Aluminum hydroxide
Magnesium hydroxide
Sodium bicarbonate
Calcium carbonate

15

Which antacid can also be used in the treatment of osteoporosis?

Calcium carbonate

16

Which antacid can also be used in the treatment of uric acid renal stones or diarrhea?

Sodium bicarbonate

17

The multidrug regimen used to treat H. pylori includes which coating agent?

colloidal bismuth

bismuth impedes the growth of the organism

18

Sucralfate MOA?

coat gastric mucosa with protective layer

19

Misoprostol MOA and clinical application?

Prostaglandin - used to tx of NSAID induced ulcers --> replaces the mucosalprotective effects of PGE2

20

Misoprostol used with what drug has abortifactant effects?

mifepristine

21

What side effect of misoprostol interferes with patient adherence?

stomach cramps

22

Dicylomine MOA and clinical application?

Inhibits Ach binding to parietal cells
Used in irritable bowel disease and peptic ulcer disease
Rarely used because not as effective as H2 blockers or PPIs

23

H. pylori triple therapy =?

PPI, amoxicillin, clarithromycin