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Exam 3 > Drugs used to treat GERD PUD and Gastric Motility Disorders > Flashcards

Drugs used to treat GERD PUD and Gastric Motility Disorders Flashcards

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1
Q

Cimetidine, Ranitidine (Zantac), Famotidine (Pepcid), and Nizatidine are what class of drug?

A

H2 receptor antagonists

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2
Q

how do H2 receptor antagonists do their job?

A

they block histamine from binding to H2 receptor on parietal cells, resulting in reduced gastric acid secretion

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3
Q

Side effects of cimetidine

A

confusion, gynecomastia, infertility

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4
Q

Are H2 blockers safe in pregnancy?

A

Usually safe only if benefits outweigh the risks

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5
Q

What drugs do we have to renally adjust for?

A

H2 receptor antagonists

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6
Q

This drug class crosses the BBB, placenta, and is in breast milk

A

H2 receptor antagonists

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7
Q

How long does it take H2 receptor antagonist to peak?

A

1-3 hours

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8
Q

Which drugs may decrease the effects of ketoconazole, itraconazole, or alter serum levels of ferrous sulfate, diazepam?

A

H2: Ranitidine, Famotidine, Axid

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9
Q 
Name the drug class:
Omeprazole
Esomeprazole
Lansoprazole
Rabeprazole
Pantoprazole
A

Proton Pump Inhibitors

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10
Q

How to PPIs work?

A

they irreversibly bind the H+/K+ (ATPase) pump of the parietal cell, resulting in decreased acid secretion

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11
Q

Which drug results in the most potent gastric acid reduction?

A

PPIs

they heal ulcers more quickly than H2s

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12
Q

I usually take PPI 1POQD, but someone with what issues would take it BID?

A

ulcer

erosive espohagitis

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13
Q

PPIs work poorly in whom?

A

fasting patients
those taking other acid reducing agents

*they require an acididc environment for activity

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14
Q

When should I take my PPI?

A

30 minutes before a meal

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15
Q

Side effects from PPIs are rare, but what may I get?

A

diarrhea, Headache

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16
Q

Why shouldnt I stop taking my PPI abruptly?

A

it will increase gastrin levels by 400%, you gotta taper off to prevent dat acid spike

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17
Q

Who disrupts the mucosal defense layer?

A 
acid
pepsin
h pylori
aspirin
NSAIDS
corticosteroids
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18
Q

How do antacids work?

A

they neutralize gastric acid for a brief amount of time.
they enhance delivery of growth factors to injured muscosa AND
promote angiogenesis in injured mucosa.
Inhibit pepsin activity by binding bile acids
They also suppress H pyloi, but dont eradicate it

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19
Q

Name this drug class:
Calcium carbonate
magnesium hydroxide
aluminum hydroxide

A

Antacids

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20
Q

Adverse effects of calcium carbonate (antacid)

A

Milk-Alkali syndrome:
hypercalcemis
alkalosis
renal impariement

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21
Q

Adverse effects of magnesium Hydroxide (antacid)

A

Diarrhea

hypermagnesemia (in setting of renal failure)

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22
Q

Adverse effects of Aluminum Hydroxide

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A

constipation
NEVER GIVE TO RENAL FAILURE PTS:
(due to neurotoxicity, anemia, hypophosphatemia)

23
Q

What is sulcrafate (carafate) made out of?

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A

sulfate + aluminum

24
Q

Sulcrafate (Carafate) MOA

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A

forms ulcer-adherent complex that covers the ulcer and protects it

enhances growth factor and angiogenesis on injured tissue
suppresses H pylori

25
Sulcrafate (Carafate) Adverse effects
Constipation ALUMINUM TOXICITY in renal failure patients inhibits absoprtion of many other drugs
26
Since sulcrafate inhibits absoprtion of many other drugs, what should we do?
administer other drugs at least two hours before sulcrafate
27
Bismuth (pepto-bismol) MOA
suppresses H pylori increases secretions recruits macrophages to promote ulcer healing
28
ADE of pepto bismol
black/gray stools | monitor in renal failure
29
What is the result of giving bismuth with tetracyclines of uricosurics?
decreased effect
30
what is the result of giving bismuth with aspirin, warfarin, or in hypoglycemics?
increased toxicity
31
What do prostaglandin analogs do?
they improve muscoal blood flow, bicarb secretion, and dec acid secretion protect us from NSAID induced ulcers
32
What drug class is misoprostol (cytotec)?
synthetic prostaglandin analog
33
Why is misoprostol contraindicated in pregnancy?
produces uterine contrations that may endanger prgnancy
34
Misoprostol uses
NSAID induced gastric ulcers | but now PPIs are cheap and better
35
Antacids but you at a 6x increased risk of what?
c diff | infectious diarrhea
36
What is standard treatment for H. pylori?
PPI clarithromycin amoxicillin BID 2 wks
37
I have H. pylori but im allergic to penicillin and cant tolerate quadruple therapy
PPI clarithromycin metronidazole BID 2 wks
38
I have h pylori, im allergic to penicillin and ive failed a course of treatment
bismuth metronidazole tetracycline PPI
39
Who are NSAIDs?
aspirin, ibuprofen, naproxen, indomethacin
40
I need to take an NSAID. Use of what other drugs will put me at an increased risk for developing an ulcer?
glucocorticoids anticoagulants biphosphonates other NSAID/ASA
41
What is the rate of stomach contractions?
3 per minute
42
What is a gastroparesis diet?
small, frequent, low fat meals
43
What antiemetics are given for gastroparesis?
compazine, phenergan, tigan, zofram
44
How are prokinetic agents used for gastroparesis? (When and how do they help?)
Given 20-40 minutes before a meal to allow it to get into bloodstream they cause the stomach to contract more often and should help empty the stomach and reduce symptoms
45
Drug class: Erythromycin Metocloperamide Domperidone
prokinetic agents
46
Erythromycin MOA
antibiotic binds MOTILIN RECEPTORS in the stomach and small intestine, which stimulates contaction and improves emptying IV dose is better than PO
47
Erythromycin ADE
diarrhea N/V abdominal cramps
48
Issue with Eyrthromycin for gastroparesis
not FDA approved for it and tolerance over time
49
Domperidone MOA
blocks dopamine receptors to increase duration of antral and duodenal contractions and inhibit fundal relaxation anti-emetic also
50
Issue with domperidone
NOT IN US | CANADA ONLY
51
Side effects of Domperidone
allergic rash | abdominal cramps
52
Metocloperamide (Reglan) MOA
accelerates gastric emptying and intestinal transit Peripherally: cholinergic enhancement thru cholinesterase inhibition, anti-dopaminergic (d2) and directly on GI smooth muscle Centrally: anti-D2 and 5-HT3, so gives it some antiemetic propery
53
Metocloperamide ADE
restless, drowsy, tired, insomnia tardive dyskinesia at high doses

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