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2.4.2. Clinical Pharmacology > Drugs for GORD > Flashcards

Drugs for GORD Flashcards

1
Q

Outline the pathology of GORD

A

Normal = squamous ep

Barrett’s oesophagus = columnar transformation of squamous ep

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2
Q

What is anti-reflux surgery?

A

Immobilize the lower oesophagus by wrapping the gastric fundus around the oesophagus

Fundic wrap

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3
Q

What are the defensive factors of the gastric mucosa?

A

Epithelial integrity

Cell replication and restitution

Mucous membrane barrier

Vascular supply

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4
Q

What factors can damage the gastric mucosa?

A

Acid

Helicobacter pylori

Drugs - NSAIDs

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5
Q

Describe the gastric barrier

A

Mucous barrier – pH 7

Gastric pits – allow for quick mobilisation of new cells

Extensive collateral network under the gastric mucosa of blood vessels

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6
Q

What are parietal [oxyntic] cells?

A

Produces acid

H2 antagonists = H2 receptors = lowers acid secretion

PPI = block all acid secretion

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7
Q

Outline the action of proton pump inhibitors (PPIs)

A

blocks H,K-ATPase in parietal cells = no acid secretion

Delayed as not all pumps active all of the time (proton pumps only active when you eat)

Max efficacy after 2-3 days

Restoration of acid secretion requires de novo synthesis

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8
Q

Discuss H2 receptor antagonist (H2RA)

A

block histamine receptors (H2) in parietal cells = lowers acid secretion

Short half life

Bd dosage = to achieve acid suppression

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9
Q

Briefly outline the neuro-endocrine regulation of digestion

A

CCK B = prod by enteroendocrine cells in the duodenum

ECL = in gastric mucosa, release histamine to aid acid secretion

Gastrin = stim parietal cells to prod acid

GRP = causes release of gastrin from G cells

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10
Q

What drugs are given to treat peptic disorders?

A

Antacids – anything that makes the environment more alkaline

Alginates – gaviscon, adhere to gastric mucosa protecting it from further insult

H2RA

PPI

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11
Q

Name some H2RA

A

Ranitidine

Nizatidine

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12
Q

Name some PPIs

A

Omeprazole

Lansoprazole

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13
Q

Outline the management for GORD symptom control

A

Symptom control

Healing of oesophagitis

Step up = lifestyle, antacids, alginates, H2RA, PPIs

Step down = PPIs, H2RA, antacids, alginates, lifestyle

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14
Q

How is peptic ulceration treated?

A

Stop NSAIDS – particularly if the indication for use isn’t that strong

H2RA/ PPI, 6/52

H pylori eradication

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15
Q

How are H pylori eradicated?

A

2 ABX – charithromycin, amoxycillin

Full acids blockade with PPI – lansoprazole

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16
Q

How can H pylori survive in the stomach?

A

Uses urease to break down uric acid to ammonia = alkaline

2.4.2. Clinical Pharmacology (27 decks)

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