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

GERD and PUD Tx I Flashcards

1
Q

What are the Proton Pump Inhibitors

A 
dexlansoprazole
esomeprazole
lansoprazole
omeprazole
pantoprazole
rabeprazole
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2
Q

H2 receptor antagonists

A

cimetidine
famotidine
nizatidine
ranitidine

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3
Q

what are the antiacids

A

sodium bicarb
calcium carbonate
magnesium hydroxide/aluminum hydroxide

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4
Q

What agents provide mucosal protection

A

bismuth subcitrate
bismuth subsalicylate
misoprostol
sucralfate

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5
Q

What Antibiotics are used for Tx H.pylori

A

amoxicillin
clarithromycin
metronidazole
tetracycline

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6
Q

what NT increase acid secretion

A

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

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7
Q

When Ach and gastrin bind enterochromaffin like cells what happens

A

histamine is released

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8
Q

histamine acts where

A

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

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9
Q

which mediator Ach or gastrin has direct stimulation on parietal cells

A

Ach

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10
Q

What do antral D cells produce

A

somatostatin

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11
Q

what is the role of somatostatin

A

inhibits gastrin acid secretion

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12
Q

what stimulates release of somatostatin

A

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

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13
Q

How do Prostaglandins E2 and I2 affect proton pump

A

reduce cAMP and thus inhibit the proton pump

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14
Q

how do NSAIDS contribute to ulcers

A

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

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15
Q

what are various causes of GERD

A

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

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16
Q

Sx GERD

A

heartburn, regurg and chest pain

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17
Q

Atypical Sx GERD

A

dyspepsia, epigastric pain, nauseam bloating, belchins

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18
Q

What are the alarm Sx of GERD

A

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

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19
Q

What are lifestyle modifications for GERD

A 
weight loss
head of bed elevation
avoid meals 2-3 hr before bedtime
smoking cessation
cessation of foods that may aggravate reflux
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20
Q

what are Tx options for mild intermittent GERD

A

antacid or H@RA as needed

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21
Q

what are Tx for pharmacotherapy

A

NERD- antacid or H@RA

22
Q

what are Tx for erosive esophagitis

A

PPI for 8 weeks

23
Q

What is PUD

A

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

24
Q

causes of PUD

A

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

Year2 GI Exam I (18 decks)

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