PUD, GERD, IBD

Question 1

antacids

Answer 1

Mg-Al hydroxide (Maalox)
Mg-Al hydroxide/alginic acid
Calcium carbonate (Tums)

Question 2

MOA of antacids

Answer 2

neutralize gastric acid in stomach (aluminum causes constipation, magnesium causes diarrhea -opposing effect) (alginic acid prevents regurgitation)

Question 3

DDI of antacids

Answer 3

significant interaction in absorption of other drugs, do not take within 1-2 hours

Question 4

dose timing of antacids

Answer 4

1 & 3 hr after meal & @ bedtime

Question 5

H2 receptor antagonists used for PUD

Answer 5

cimetidine, ranitidine, nizatidine, famotidine

Question 6

MOA of H2 receptor antagonists & effects

Answer 6

MOA: bind and block H2 receptor and inhibit basal, food stimulated & nocturnal gastric acid secretion
effects: decrease volume & H+ concentration of gastric acid

Question 7

H2 receptor antagonists AE

Answer 7

infrequent and mild…

Question 8

rank the H2 antagonists in order of potency

Answer 8

Famotidine 20-50x > ranitidine/nizatidine 4-10x > cimetidine 1x

Question 9

which H2 antagonists inhibits CYP450

Answer 9

cimetidine

Question 10

PPI’s for PUD

Answer 10

omeprazole, esomeprazole, lansoprazole, rebeprazole

Question 11

MOA of PPI

Answer 11

enteric coating to get through stomach, absorbed to bloodstream and brought to parietal cells where acid protonates drug and traps near proton pump causing IRREVERSIBLE binding to H/K ATPase

Question 12

PPI AE

Answer 12

single dose is safe & effective for > 2 yrs

Question 13

PK of omeprazole & esomeprazole

Answer 13

effective orally, long duration & more powerful than H2 blockers

Question 14

PK of lansoprazole

Answer 14

similar to omeprazole but LESS effective in severe esophagitis

Question 15

PK of Rebeprazole

Answer 15

metabolized to much lower extent by CYP450

Question 16

4 uses for the PPIs

Answer 16

1. short term for active PUD
2. zollinger-ellison
3. refractory ulcers
4. GERD

Question 17

cytoprotective agents (2)

Answer 17

bismuth subsalicylate (pepto)
sucralfate

Question 18

MOA of bismuth subsalicylate

Answer 18

1. enhances secretion of mucous & HCO3-
2. inhibits pepsin activity
3. chelates proteins and forms barrier against acid
4. inhibits h pylori

Question 19

clinical use for pepto

Answer 19

1. adjuct tx for ulcers, GERD, diarrhea

2. traveler’s diarrhea

Question 20

sucralfate MOA

Answer 20

forms sticky, viscous gel that adheres to gastric epithelial cells protecting them from acid and pepsis

Question 21

PK for sucralfate

Answer 21

requires acidic pH for max activity

Question 22

clinical use of sucralfate

Answer 22

value in H2 blocker or PPI induced pneumonia because alkaline environment promotes bacteria

Question 23

antibiotics for H pylori eradication

Answer 23

clarithromycin, metronidazole, amoxicillin, ampicillin, furazolidine

Question 24

clarithromycin MOA

Answer 24

macrolide - inhibits protein synthesis

Question 25

metronidazole MOA

Answer 25

synthetic antibiotic active against obligate anaerobes

Question 26

penicillin class drugs used for h pylori

Answer 26

amoxicillin & ampicillin

Question 27

furazolidine MOA

Answer 27

nitrofuran antibacterial and antiprotozoal

Question 28

which antibiotic has the highest primary resistance to h pylori

Answer 28

metronidazole (43%) | clarithromycin (8%)

Question 29

general treatment regimen for h pylori

Answer 29

2 (abx) + 1 (ppi)

Question 30

dopamine receptor blocker to treat GERD?

Answer 30

metoclopramide

Question 31

metroclopromide MOA and effects

Answer 31

GI: block D2-R and increase Ach via 5HT4 - stimulates GI smooth muscle and increases amplitude of esophageal contractions, increase gastric emptying time and increase LES pressure

Question 32

BBW for metoclopramide

Answer 32

Tardive dyskinesia - so only give for 2 weeks

Question 33

what other non-pharm tx is there for GERD

Answer 33

1. dec gastric contents 2. dec size of meal 3. dec weight 4. dec fat in diet 5. bed elevation 6. avoid coffee & peppermint

Question 34

treatment goals for IBD (4)

Answer 34

1. control inflammation 2. reduce morbidity 3. prevent complications 4. maintain nutritional state

Question 35

sulfasalazine MOA

Answer 35

metabolized to 2 metabolites: 1. 5-aminosalicylic acid - anti-inflammatory 2. sulfapyridine - causes AE

Question 36

sulfasalazine AE

Answer 36

anemia, rash, impotence

Question 37

infliximab MOA

Answer 37

monoclonal ab that is a fusion against TNF-a

Question 38

etanercept MOA

Answer 38

fusion protein of TNFa receptor linked to Fc portion of human IgG1 - binds TNFa and prevents its interaction

Question 39

lactulose MOA

Answer 39

semisynthetic disaccharide and is a fecal acidifier (forms lactic, formic and acetic acid)

Question 40

lactulose AE

Answer 40

not absorbed so causes osmotic diarrhea

Question 41

lactulose PK

Answer 41

metabolized by enteric bacteria to its organic acid

Question 42

neomycin MOA

Answer 42

antibacterial given as an enema to reduce bacteria in colon

Question 43

2 drugs for tx of portal encephalopathy

Answer 43

lactulose, neomycin