PUD, GERD, and IBD Flashcards Preview

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Flashcards in PUD, GERD, and IBD Deck (20)
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1

Tx outline for PUD

1. Relief of symptoms
2. Healing of ulceration
3. Eradicate H. pylori to prevent recurrence

2

MOA antacids

NaHCO3+HCl=NaCl+CO2+H2O, goal is to raise pH >4

3

Ingredients in antacids

Aluminum OH--> constipation
Mg OH--> diarrhea
So, logically, a combination of the 2

4

Dosing and AE of antacids

1 and 3 hr after meal and before bedtime, dont take within 1-2 hrs of other drug, affects other drug absorption

5

MOA of H2 receptor antagonists

Competitive H2 receptor blockers, inhibit all phases of gastric secretion, reduce volume and H concentration of secretions, minimal side effects

6

What are the H2 receptor antagonists and how do they differ?

Cimetidine- least potent, inhibits CYP1A2, 2C19, 2D6, 3A4
ranitidine, nizatidine
Famotidine- most potent, take only once a day, reduces theophylline Cx

7

What are the most potent drugs reducing acid secretion?

PPI

8

MOA omeprazole

PPI, long duration

9

MOA lansoprazole

PPI, less effective in severe esophagitis

10

MOA of PPI

carried by blood to parietal cells and diffuse into secretory canaliculi, trapped by pH protonation due to acidity, bind COVALENTLY to enzyme- noncompetitive--> achlorhydria, new enzymes must be synthesized to overcome

11

What are the cytoprotective agents?

bismuth subsalicylate, sucralfate

12

MOA bismuth

enhances secretion of mucus and HCO3, inhibits pepsin activity, chelates with proteins to form protective barrier against acid and pepsin, inhibits H. pylori, absorbs etiological factors

13

MOA sucrasulfate

sticky viscous gel that adheres to gastric epithelial cells to protect them from acid and pepsin, only one requiring acid pH for max activity

14

When may you use either bismuth or sucrasulfate?

Bismuth: prevent traveler's diarrhea
Sucrasulfate: H2 or PPI-induced pneumonia in bedridden pt, any chronically bedridden pt

15

What antibiotics are used in the eradication of H. pylori? What are their MOA?

Clarithromycin: macrolide that inhibits protein synthesis
Amoxicillin: effective in G-
Metronidazole: effective against obligate anaerobes
Furazolidine: nitrofuran antibiotic and antiprotozoal

16

Tx regimen for H. pylori

Antibiotics given as multi-drug to prevent resistance. Biggest primary resistance problem is in metronidazole

17

How do you treat the component of GERD associated with GI contents ready to reflux?

Postural and diuretic therapy- lose weight, low fat diet, decrease size of meal, bed elevation

18

How do you treat the compromised LES portion of GERD?

use prokinetic, antisecretory drugs

19

MOA of metochlopramide

prokinetic used in GERD: D2 receptor blockers and weak 5-HT4 agonists--> stimulate GI smooth muscle, increase amplitude of esophageal contractions, accelerate gastric emptying, increase LES pressure

20

Metochlopramide AE

central dopaminergic antagonism- tardive dyskinesia, use short term!