GERD and PUD Tx I Flashcards Preview

Year2 GI Exam I > GERD and PUD Tx I > Flashcards

Flashcards in GERD and PUD Tx I Deck (50)
1

What are the Proton Pump Inhibitors

dexlansoprazole
esomeprazole
lansoprazole
omeprazole
pantoprazole
rabeprazole

2

H2 receptor antagonists

cimetidine
famotidine
nizatidine
ranitidine

3

what are the antiacids

sodium bicarb
calcium carbonate
magnesium hydroxide/aluminum hydroxide

4

What agents provide mucosal protection

bismuth subcitrate
bismuth subsalicylate
misoprostol
sucralfate

5

What Antibiotics are used for Tx H.pylori

amoxicillin
clarithromycin
metronidazole
tetracycline

6

what NT increase acid secretion

Ach and gastrin that increase cytosolic Ca causing acid secretion from H+/K ATPase pump

7

When Ach and gastrin bind enterochromaffin like cells what happens

histamine is released

8

histamine acts where

binds H2 R on parietal cells and activates proton pump via GPCR pathways

9

which mediator Ach or gastrin has direct stimulation on parietal cells

Ach

10

What do antral D cells produce

somatostatin

11

what is the role of somatostatin

inhibits gastrin acid secretion

12

what stimulates release of somatostatin

when gastric pH falls below 3 SSt is stimulated and it suppresses gastrin

13

How do Prostaglandins E2 and I2 affect proton pump

reduce cAMP and thus inhibit the proton pump

14

how do NSAIDS contribute to ulcers

block PG prduction causing more acid secretion, less mucus and bicarb and diminished blood flow

15

what are various causes of GERD

transient lower esophageal sphincter relaxation, reduced lower esophageal sphincter tone, delayed gastric emptying or hormonal changes due to pregnancy

16

Sx GERD

heartburn, regurg and chest pain

17

Atypical Sx GERD

dyspepsia, epigastric pain, nauseam bloating, belchins

18

What are the alarm Sx of GERD

bleeding, anemia, early satieity, unexplained weight loss, progressive dysphagia, recurrent vomiting, family Hx of GI cancer, previous esophagogastric malignancy

19

What are lifestyle modifications for GERD

weight loss
head of bed elevation
avoid meals 2-3 hr before bedtime
smoking cessation
cessation of foods that may aggravate reflux

20

what are Tx options for mild intermittent GERD

antacid or H@RA as needed

21

what are Tx for pharmacotherapy

NERD- antacid or H@RA

22

what are Tx for erosive esophagitis

PPI for 8 weeks

23

What is PUD

mucosal damage secondary to pepsin and gastric acid occuring in stomach or proximal duodenum

24

causes of PUD

H pyloric infection, chronic NSAID use, stress releated mucosal injury, Zollinger Ellison Syndrome

25

What are Sx of PUD

burning epigastric pain, pain after meals or on empty stomach, nocturnal pain relieved by food intake

26

What is Tx for duodenal ulcer

H2RA or PPI for 4 weeks

27

what is Tx for gastric ulcer

PPI for 8 weeks

28

what is Tx for H pylori eradication

has been shown to reduce risk of recurrence
antisecretory agent (PPI) and 2 antibiotics

29

MOA PPIs

inactive prodrugs that are lipophlic weak bases that diffuse readily across lipid membranes into acidified compartments from the alkaline intestinal lmen
when forms covalen disulfide bond with H/K ATPase becomes active and IRREVERSIBLY inactivates the enzyme

30

pharmacokinetics of PPIs making them really good drugs

short serum half lives but long duration of action at site

31

when should one take a PPI

on empty stomach at least 30 min before a meal

32

What are PPIs used to Tx

GERD, PUD and H pylori infections
NSAID ulcers, prevention of re-bleeding
stress related mucosal injury
zollinger ellison syndrome
heartburn OTC Tx

33

adverse effects of PPIs

diarrhea, HA and abdominal pain
increased risk of hospital and community acquired C difficile!!
decreased vit B12 absorption, increase risk hip fracture
increasesd risk nosocomial pneumonia
increased risk of enteric infections

34

drug interactions with PPIs

- decreased gastric pH change drug absorption like digoxin and itraconazole and atazanavir
-ompreazole may inhibit metabolis warfarin, dizepam, phenytoin and others
- could reduce clopidogrel activation reducing anti-platelet activity

35

what drugs should be switched from omeprazole if patients is on clopidogrel? why?

pantoprazole or rabeprazole

could decrease antiplatelet activity

36

What are the H2 R antagonists

cimetidine, famotidine, nizatidine and ranitidine

37

MOA H2RA

competitive inhibition at parietal cell H2 R
blocks histamine released form eCL cells by gastrin or vagal stimulation

38

what type of acid secretion do H2RA block

basal, so nocturnal acid secretion which relies on histamine instead of meal stimulated by Ach or gastrin

39

most important determinant of duodenal ulcer healing

control of nocturnal acid secretion

40

adverse effects of H2RA

diarrhea, HA fatigue, myalgia constipation
mental status changes
increased risk nosocomial pneumonia
bradycardia with rapid IV

41

adverse effect of cimetidine

gynecomastia or impotence in men and galactorrhea in women

42

drug drug interactions of H2RA

interferes with CYPs, especially cimetidine (theophylline, warfarin, phenytoin and lidocaine)
competes with creatinine and other drugs for renal tubular secretion
inhibit first pass metabolism of alcohol!!!

43

MOA antacids

weak bases that react with HCl to form a salt and water
neutralizes acid and reduces intragastric aciditiy

44

PK and effects of Na bicarb

reacts rapidly with HCl ro produce CO2 and NaCl
formation CO2 leads to distention and belching
NaCl absorption leading to fluid retention pose risk in HF and HTN paitents

45

PK and effects of Ca carbonate

reacts slowly with HCl for form CO2, CaCl2
may cause belching and metabolic alkalosis
hypercalcemia, renal insufficiency and metabolic alkalosis

46

PK and effects of Mg Hydroxide/ aluminum hydroxide

reacts slowly with HCl ro form MgCl2 or AlCl3 and H2O
no gas generated
Mg salts- osmotic diarrhea
Al salts- constipation

47

Uses for antacids

dyspepsia and intermittent heartburn

48

D-D interaction antacids

may bind and change absoprtion of other drugs
increase intragastric pH so that drug dissolution or solubility is altered
- do NOT gibe in 2 hours of tetracyclines and fluoroquinolones and Fe

49

final common pathway acid secretion

proton pump inhibitor

50

how long after taken of PPI drug will patient start secreting acid

3-4 days