Drugs to treat PUD

Question 1

Stomach wall cells secrete ______ to produce protective layer coating the surface of cells.

They also recruit _______ to _______

Answer 1

Stomach wall cells secrete mucus to produce protective layer coating the surface of cells.

They also recruit bicarbonate to buffer acidity

Question 2

Prostaglandins promote:
1.
2.
3.

Answer 2

1. Mucus secretion
2. Bicarbonate secretion
3. Blood flow

Question 3

Can taking NSAIDs increase risk of damage to stomach?

Answer 3

yes

Question 4

Parietal cells release

Answer 4

H+

Question 5

Histamine activation of h2 receptors activates ______ to release H+

Answer 5

proton pumps

Question 6

Agents that reduce gastric acidity/ neutralise acids

Answer 6

• antacids
• H2 receptor antagonists
• PPIs

Question 7

Antacids: they do NOT ___________, rather they ________

Answer 7

they do NOT prevent gastric acid production, rather they reduce gastric acidity

Question 8

Rank most potent to least potent antacid

Answer 8

1. Most: Sodium bicarbonate
   Calcium carbonate
   Mg OH
   Al OH

Question 9

Liquid antacid or tablet is btr?

Answer 9

Liquid. Due to rate of dissolution

Question 10

Some antacid preps contain _______ as an anti-foaming agent (ease release of gas)

Answer 10

simethicone

Question 11

Adverse effects of antacids:

1. Na+
2. Ca++
3. Carbonates & bicarbonates:
4. Mg++
5. Al++

Answer 11

1. Na+: increase in Na in bloos and thus fluid retention, hypertension, CHF
2. Ca++: hypercalcemia, rebound acid secretion
3. Carbonates & bicarbonates: will produce CO2 gases which can lead to belging & flatulence
4. Mg++: osmotic diarrhoea
5. Al++: constipation

Question 12

MOA of H2-receptor antagonists

Answer 12

• competitive inhibitors of H2 receptors on parietal cells

- suppresses acid secretion by parietal cells

Question 13

Efficacy of H2-receptor antagonists
Effective at:
Not effective at:

Answer 13

Effective at: inhibiting nocturnal acid secretion (due to histamine)

Not effective at: blocking secretion associated with meals

Question 14

Rank most potent to least potent H2 receptor antagonist

Answer 14

Famotidine
Ranitidine
Cimetidine

Question 15

Adverse effects of ___________
headache
nausea
dry mouth

rare:
tachycardia
blood dyscrasia
blurred vision
musculoskeletal pain

Answer 15

famotidine & ranitidine

Question 16

Adverse effects of \_\_\_\_\_\_\_\_\_\_\_
headache
nausea
diarrhoea
constipation
fatigue
mental confusion in critically ill pts
men: gynaecomastia, impotence
women: galactorrhea

Answer 16

cimetidine

Question 17

Examples of PPIs

Answer 17

omeprazole

esomeprazole

Question 18

PPIs inhibit ________ in _____ cells

Answer 18

PPIs inhibit H+K+-ATPase (proton pumps) in parietal cells

Question 19

PPIs are reversible/irreversible

Answer 19

irreversible

Question 20

PPIs are ______ pro-drugs, hence _____ bioavailability; can/cannot absorb well

Answer 20

PPIs are inactive pro-drugs, hence good bioavailability; can absorb well

Question 21

PPIs are released and absorbed in _______

Answer 21

intestines

Question 22

PPIs are given during :

Answer 22

usually 1h before bfast; on empty stomach

Question 23

How many times of PPI is adminstered?

Answer 23

Once daily

Question 24

Adverse effects of \_\_\_\_\_\_\_\_\_\_\_
headache
nausea
diarrhoea
flatulence
dizziness
rash
constipation
long term: osteoporosis

other concerns (bot not proven): gastric cancer, pneumonia, Fe deficiency, vit. B12 deficiency

Answer 24

PPIs

Question 25

Agents that protect gastric mucous

Answer 25

- sulcrafate - bismuth compounds - misoprostol

Question 26

MOA of sucralfate

Answer 26

-vely charged sucrose sulphate binds postitively charged proteins at ulcer crater forming a viscous, tenacious gel that prevents further acid attack stimulates mucosal prostaglandin & bicarbonate secretion

Question 27

Sucralfate are given during :

Answer 27

usually 1h before bfast; on empty stomach

Question 28

Adverse effects of sucralfate

Answer 28

constipation | impairs absorption of other drugs

Question 29

Bismuth compounds stimulate ______ & ______ secretion. | They also has direct anti-microbial activity against ________.

Answer 29

stimulate mucus &. bicarbonate secretion against H.pylori

Question 30

Misoprostol is given how many times a day?

Answer 30

4 times daily

Question 31

Misoprostol is to prevent _____-induced peptic ulcers

Answer 31

NSAID

Question 32

MOA of Misoprostol - - low dose: - high dose:

Answer 32

- binds to PGE2 receptors - low dose: increases mucus & bicarbonate secretion,, enhances mucosal blood flow - high dose: decreases acid secretion

Question 33

``` Adverse effects of ___________ abdominal pain diarrhoea abortion (uterine contraction) bone pain & hyperostosis (excessive bone growth) ```

Answer 33

misoprotol

Question 34

Triple-therapy for H pylori eradication

Answer 34

clarithromycin + amoxicillin / metronidazole + PPI

Question 35

h pylori multiply best at pH

Answer 35

6-8 (alkaline)

Question 36

Antibiotics typically administered ____ a day.

Answer 36

2x a day

Question 37

Antibiotics are given during :

Answer 37

with or w/o food within 1 hr

Question 38

Do you need to complete the course of antibiotic?

Answer 38

YES

Question 39

Esomeprazole is better suited for pts with ____ than omeprazole.

Answer 39

NGT

Question 40

PPIs lower ___________ of antibiotics against H pylori

Answer 40

minimum inhibitory concentration (MIC) (aka make antibiotics more effective)

Question 41

PPI takes about _____ days to fully inhibit acid secretion

Answer 41

3-4 days