PUD and GERD Flashcards Preview

Pharmacology Exam 2 > PUD and GERD > Flashcards

Flashcards in PUD and GERD Deck (47):
1

Why do NSAIDs increase risk of PUD?

1. Direct or topical irritation
2. inhibition of GI prostaglandin synthesis which is needed to maintain blood flow, stim bicarb and mucous production

2

Which two bisphosphonates can induce ulcerations?

Alendronate (Fosamax)
Risedronate (Actonel)

*take with a full glass of water and sit up

3

Which infection is strongly associated with PUD?

H.pylori

4

H.pylori - how does it damage the gut?

produces a large amount of urease --> catalyzes the breakdown of urea to alkaline ammonia and CO2

5

What is the only cancer you can cure by treating the causative organism?

gastric carcinoma or B-cell lymphoma r/t h.pylori

6

PUD - general approach to treatmen

1. stop smoking
2. take NSAIDs with food
3. stop or decrease NSAID dose
4. Meds: misoprostol, H2RA, PPI or PPI with hs H2RA
5. consider h.pylori

7

How long does treatment of PUD take?

6-8 weeks

8

Oral antacids - drugs

Amphojel, Maalox, Maalox HRF, Mylanta DS

9

What are oral antacids use for?

symptom relief

10

Oral antacids - ADE

diarrhea or constipation

11

Oral antacids - DDI and Why?

binds and prevents absorption or: levothyroxine, tetracyclines, iron, isoniazid, FQs

Why? binds with di valent and tri valent cations like Mg, Ca and Al

12

Which formula of oral antacids may be more effective?

chewable

13

What may be of concern in CHF patients regarding oral antacids?

Na+ content - depends on dose

14

*What medication provides a protective barrier in the esophagus against gastric contents…floats on surface of gastric contents but does not neutralize acid?

Gaviscon (antacid containing alginic acid)

used mostly for GERD

15

*What class are Ranitidine (Zantac), Famotidine (Pepcid) and Cimetidine (Tagamet) in?

Histamine Receptor Antagonist (H2RA)

16

*H2RA - MOA

reversibly inhibit H2 receptors on parietal cells (except famotidine which has some noncompetitive inhibition)

17

Of the H2RAs, which is probably "a little" better and why?

Famotidine (Pepcid) because longer t1/2 (12 hours)

18

Most H2RAs are BID dosing. Why do you give the 2nd dose at bedtime?

because nocturnal acid suppression is important for healing

19

H2RAs - ADE

thrombocytopenia (small risk), increased serum Cr and BMS

20

Which H2RA should be avoided in BMT patients?

Ranitidine (Zantac)
most likely to cause BMS

21

Which H2RA is used for prophylaxis of NSAID induced duodenal ulcers?

Famotidine (Pepcid)

22

How are most H2RAs cleared?

renal (adjust per CrCl)

23

*What class are Esomeprazole (Nexium), Lansoprazole (Prevacid), Panteprazole (Protonix) and Omeprazole (Prilosec)?

"prazoles" = PPI

24

*PPI - MOA

Prodrug that requires activation by acid. Irreversibly bind to H+/K+ ATPase pump on parietal cell and inhibits acid generation.

25

How long does it take to restore proton pumps after DC of PPI?

3-5 days

26

General dosing for PPI

qd

27

*How are most PPIs cleared?

hepatically
watch DDI…esp. CYP450

28

What are the long term safety concerns of PPI?

1. increased risk of fractures (b/c decreased Ca absorption)
2. possible hypomagnesemia
3. gastric carcinoid tumors from hypergastrinemia
4. pneumonia and enteric infections

29

Why is there an increased risk of pneumonia for the elderly on PPI?

Lower acid in the gut allows bacteria to grow and if aspirated, can cause pneumonia.

30

Why is there an increased risk of enteric infections on PPI?

Lower acid in the gut allows bacteria to grow (Salmonella, Shigella, Cholora)

31

*When is misoprostol (cytotec) used?

prophylaxis for PUD if on long term NSAID

32

Misoprostol (cytotec) - ADE

diarrhea and cramping

33

Misoprostol (cytotec) - pregnancy warning

avoid - can cause contractions

can be used to stimulate labor

34

*h.pylori triple therapy - PPI

PPI bid + clarithromycin 500 mg bid + AMX 1000 mg bid

80-90% eradication

35

at what pH does the gut heal?

>4

36

ACG guidelines for maintenance of GERD

PPIs

37

Which drug can be given to pregnant women with N/V or HA?

Reglan

38

In what condition is Reglan contraindicated in?

small bowel obstruction

39

How is Reglan eliminated?

renal (adjust per CrCl)

40

"functional GERD" - peak/onset

peaks at 4 months
usually gone by 12 months

41

GERD - non-pharmacological treatment (infants)

hypoallergenic formula trial
positioning (head up)
avoid caffeine, chocolate and spicy foods (breastfeeding)
weight control
avoid passive smoking

42

GERD - non-pharmacological treatments (adult)

IBW
modify diet
avoid ETOH and smoking
HOB up
avoid tight garments

43

Pharmacological options - GERD

1. oral antacids
2. H2RA
3. PPI
4. Prokinetic agents

44

Reglan - ADEs

drowsiness, diarrhea, dystonia, EPS

45

What pro kinetic drug can be used to treat GERD?

Reglan

46

*Risk factors -PUD

NSAIDS
h.pylori
steroids
anti-coagulants

47

Which pathway is DDI most likely with Prilosec (PPI)?

2C19