GIT (Acid-Peptic Diseases) Flashcards
1
Q
Drugs used for peptic acid disease
A
Proton Pump Inhibitors
Antacids
Mucosal protective agents
H2 Blockers
Antibiotics
2
Q
Motility promoters
A
Motilin agonists, antidiarrheals, Dopamine antagonists, laxatives,
3
Q
Drugs for irritable bowel disease
A
Chloride Channel activators, antispasmodics, serotonin inhibitors
4
Q
Drugs for inflammatory bowel disease
A
Corticosteroids immunosuppresants, anti-tnf drugs, 5-asa drugs
5
Q
Other agents
A
Pancreatic lipase, Antidiarrheal ursodiol, laxatives
6
Q
antiemetics
A
neurkinin receptor, cannabinoids, corticosteroids, antimuscarinic, h1 blockers, d2 blockers, 5 ht3 blockers
7
Q
Acid– peptic disease includes:
A
Gastroesophageal Reflux
Peptic ulcer (gastric or duodenal)
Stress related injury
8
Q
Gastroesophageal Reflux refers to
A
Heart burn
9
Q
Heart burn occurs when acid rise to the
A
esophagus
10
Q
T/F: The location of HB and Angina are the same and
but the pain felt are different
A
T
11
Q
heat sensation rising
A
Heartburn
12
Q
suffocating/ crushing feeling
A
Angina
13
Q
The higher the stress, the ________(higher/lower) the secretion of
acid
A
higher
14
Q
Acid-Peptic Disease is the mucosal erosion or ulceration due to the caustic effect of ______, ______, and ______
A
acid, pepsin and bile
15
Q
Peptic ulcer may also be dueto the presence of
A
Helicobacter pyroli
16
Q
Prolong use of NSAIDs can lead to formation of ______
A
gastric
ulcer
17
Q
Simplest drug used in acid peptic disease
A
ANTACID
18
Q
ANTACIDs are ______ bases that react with the gastric HCl
A
weak bases
19
Q
Principal mechanism of Antacid
A
reduction of the intragastric
acidity
20
Q
For Antacids, a single dose of _______ mEq of antacid given _______ after meal
effectively neutralizes gastric acid for up to __________
A
156; 1 hour; 2 hours
21
Q
Antacids may affect the absorption of other medications by __________ or ________
A
binding
the drug or altering the intragastric pH
22
Q
Baking soda, Alka seltzer
A
SODIUM BICARBONATE
23
Q
SODIUM BICARBONATE produces
A
CO2 and NaCl
24
Q
In Sodium bicarbonate, unreacted alkali is readily absorbed which could lead to
_______________
A
metabolic alkalosis
25
exacerbate fluid retention
Sodium chloride
26
ADR of NaHCO3
○ Flatulence
○ Bloating
○ Belching
27
Tums
CaCO3
28
Less soluble and reacts slowly than sodium bicarbonate
CaCO3
29
CaCO3 forms
CaCl2 and CO2
30
Excessive dose of CaCO3 could lead to
hypercalcemia, renal
insufficiency and metabolic alkalosis
31
MgOH/AlOH reacts slowly to
HCl
32
Unabsorbed magnesium salt may cause
osmotic diarrhea
33
Unabsorbed aluminum salt
constipation
34
Commonly administered together to minimize impact on
bowel function
MgOH/AlOH
35
MgOH/AlOH is absorbed and excreted by the __________ thus should not be
taken in long term by patients with __________
kidney; renal insufficiency
36
-tidine drugs
HISTAMINE 2 RECEPTOR ANTAGONIST
37
Introduced in the 1970s
H2 antagonist
38
H2 antagonist drugs
Cimetidine, Ranitidine, Famotidine and Nizatidine
39
blocks histamine at the H2 receptor gastric parietal cells
H2 antagonist
40
H2 antagonists are rapidly absorbed from the
intestine
41
Mainstay drug in APD
H2 antagonist
42
Inhibits stomach acid production, especially at night
H2 antagonist
43
H2 antagonists that undergo first pass
hepatic resulting to a bioavailability of approximately 50%
Cimetidine, Ranitidine and Famotidine
44
H2 antagonist that has little first pass metabolism
Nizatidine
45
H2 antagonist is cleared bya combination of__________, __________, ____________
a combination of hepatic metabolism,
glomerular filtration and renal tubular secretion
46
H2 antagonist reduces acid secretion stimulated by histamine as well as ___________, and _________ agents by 2 mechanisms
gastrin and cholinomimetic
47
2 mechanisms involved in the reduction of acid secretion by H2 Antagonist
-Histamine release from ________ by ________ stimulation blocked from binding to the parietal cell H2 receptor
-____________of the parietal cell by gastrin or acetylcholine has a ____________ on acid secretion in the presence of H2 receptor blockade
-Histamine release from **ECL cells** by **gastrin or vagal stimulation** blocked from binding to the parietal cell H2 receptor
-**Direct stimulation** of the parietal cell by gastrin or acetylcholine has a **diminished effect** on acid secretion in the presence of H2 receptor blockade
48
When given in usual prescription doses, all inhibit 60 – 70
% of total 24-hour acid secretion.
H2 Antagonist
49
Clinical uses of H2 Antagonists
○ GERD
○ PUD
○ Non-ulcer dyspepsia
○ prevention of bleeding from stress-related gastritis
50
T/F: H2 Antagonists are extremely safe drugs
T
51
T/F: H2 Antagonists rarely causes ADR
T - Occur in less than 3%: diarrhea, headache, fatigue,
myalgias and constipation
52
this may increase
the risk of nosocomial pneumonia in critically ill patients
IV H2 blocker of PPI
53
All except _________ inhibit gastric first pass metabolism
of ethanol, especially in women
famotidine
54
Cimetidine inhibits binding of ____________ to androgen
receptor, inhibits metabolism of _________ and increase
___________ levels
dihydrotestosterone; estradiol; serum prolactin levels
55
Long term or high dose may cause impotence
Cimetidine
56
impotence in men
Gynecomastia
57
impotence in women
Galactorrhea
58
CIMETIDINE interferes with several important ________________________
drug metabolism pathway
hepatic cytochrome P450
59
Half-lives of drugs metabolized by the pathways may be
prolonged
CIMETIDINE
60
Compete with creatinine and certain drugs for renal
tubular secretion
CIMETIDINE
61
-prazole drugs
PROTON PUMP INHIBITOR (PPI)
62
PROTON PUMP INHIBITOR (PPI) DRUGS
Omepazole, Esomeprazole, Lansoprazole, Dexlansoprazole,
Rabeprazole and Pantoprazole
63
PPI is a substituted ___________ that resembles H2 antagonist
benzimidazole
64
to protect the acid labile prodrug
formulated for delayed release as acid resistant, enteric
coated capsule or tablet
Inactivate prodrug
65
T/F: PPI must be inactivated to protect the acid labile prodrug
formulated for delayed release as acid resistant, enteric
coated capsule or tablet
T
66
T/F: PPI drugs are mostly modified release
T
67
Lipophilic weak base (pKa 4 to 5), and after intestinal
absorption, diffuses readily across lipid membrane into
acidified compartment
PPI
68
Irreversibly inactivate the H+/K+ ATPase pump
PPI
69
Rapidly metabolized PPI may require ______________ to have an
effect
3 – 4 days
70
PPI must be administered with food or without food?
Without food
71
inhibits both fasting and meal stimulated secretion
because they block the final common pathway of acid
secretion
PPI
72
Preferred to use than H2 blockers
PPI
73
at Standard doses, inhibits 90 to 98% of 24-hour acid
secretion
PPI
74
Chronic treatment for hypergastrinemia
PPI
75
Minor reduction in _______
occur during proton pump inhibition
oral cyanocobalamin absorption
76
May cause Respiratory and enteric infection
PPI
77
T/F: Decreased gastric acidity may alter absorption of drug
which intragastric acidity affect drug bioavailability
T
78
All PPI are metabolized by
hepatic P450 cytochrome
79
T/F: Because of its short half-lives PPI interaction are rare
T
80
PPI that inhibits metabolism of warfarin,
diazepam and phenytoin
Omeprazole
81
PPI that decreases metabolism of diazepam
Esomeprazole
82
PPI that enhances clearance of theophylline
Lansoprazole
83
PPI that has no significant drug
interaction
Rabeprazole and Pantoprazole
84
important in
stimulating mucus and bicarbonate secretion and mucosal
blood flow
Mucosal prostaglandins
85
MUCOSAL PROTECTIVE AGENTs
Sucralfate
Misoprostol
Bismuth Compound
86
Salt of sucrose complexed to sulfurated aluminum
hydroxide
SUCRALFATE
87
In water or acidic solution, it forms a viscous, tenacious
paste that binds selectively to ulcer or erosion for up to 6
hours
SUCRALFATE
88
Is sucralfate soluble or poorly soluble
Poorly soluble molecule
89
binds to injured tissue in the stomach
Sucralfate
90
(Sucralfate) Negatively charged sucrose binds to the positively charged
protein in the base of ulcer or erosion, forming a ___________________ that resist further caustic damage and stimulates
mucosal prostaglandin and bicarbonate secretion
physical
barrier
91
Sucralfate must be taken _____ times daily
4 times daily
92
Prostaglandin E1 (PGE1) analogue
MISPROSTOL
93
Increased mucosal protection inhibit acid secretion
MISOPROSTOL
94
Oral administration is rapidly absorbed and metabolized to
free acid
MISOPROSTOL
95
Serum T1/2 : <30 minutes hence may be administered 3 – 4
times
MISOPROSTOL
96
Misoprostol is excreted in the
urine
97
T/F: Misoprostol has acid inhibitory and mucosal protective properties
T
98
Reduce ulcer in NSAID users
Misoprostol
99
Bismuth subsalicylate and Bismuth subcitrate potassium
BISMUTH COMPOUND
100
Coats ulcers and erosions, creating a protective layer
against acid and pepsin
BISMUTH COMPOUND
101
May also stimulate prostaglandin, mucus and bicarbonate
secretion
BISMUTH COMPOUND
102
Bismuth compound may also stimulate ______, _______, and __________ secretion
prostaglandin, mucus and bicarbonate
secretion
103
reduces stool frequency and liquidity in acute
infectious diarrhea, due to salicylate inhibition of
intestinal prostaglandin and chloride secretion
Bismuth subsalicylate
104
Bismuth subsalicylate reduces stool frequency and liquidity in acute
infectious diarrhea, due to ____________ inhibition of
intestinal _________ and _________ secretion
salicylate; prostaglandin and chloride
105
Bismuth subsalicylate reduces _________ and __________ in acute
infectious diarrhea, due to salicylate inhibition of
intestinal prostaglandin and chloride secretion
stool frequency and liquidity
106
Direct antimicrobial effec
BISMUTH COMPOUND
107
Causes a black tongue and black stool
BISMUTH COMPOUND
108
Widely used by patients for the nonspecific treatment of
dyspepsia and acute diarrhea
BISMUTH COMPOUND
109
Also used for the prevention of Traveller’s diarrhea
BISMUTH COMPOUND
110
Used in 4-drug regimen for the eradiacation of H. pylori
BISMUTH COMPOUND
111
4-drug regimen for the eradiacation of H. pylori:
○ PPI BID
■ Bismuth Subsalicylate (2 tab; _ mg)
■ Tetracycline( ________mg)
■ Metronidazole ( mg) times daily for
○ PPI BID
■ Bismuth Subcitrate mg
■ Metronidazole mg
■ Tetracycline mg, taken times daily for
days
○ PPI BID
■ Bismuth Subsalicylate (2 tab; **262** mg)
■ Tetracycline(**250** to **500** mg)
■ Metronidazole (**500** mg) **four** times daily for **10** **to**
**14** days
○ PPI BID
■ Bismuth Subcitrate **140** mg
■ Metronidazole **125** mg
■ Tetracycline **125** mg, taken **four** times daily for **10**
days
