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Pharm II > Test 2 - Antiulcer Meds (Josh) > Flashcards

Test 2 - Antiulcer Meds (Josh) Flashcards

1
Q

Common stomach acid problems

A
  • GERD
  • Heartburn
  • Erosive espophagitis
  • Ulcers
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2
Q

What causes stomach acid problems?

A
  • helicobactor pylori (bacteria causes 60-75% of ulcers)
  • NSAIDs
  • Gastric Acid
  • Pepsin
  • Smoking
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3
Q

Does alcohol cause stomach acid problems?

A

no

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4
Q

Does spicy food cause stomach acid problems?

A

no

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5
Q

Does stress/anxiety cause stomach acid problems?

A

no

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6
Q

Antiulcer Medication Classes

A
  • Proton Pump Inhibitors (-prazole)
  • Histamine 2 blockers (-tidine)
  • Sucralfate
  • Antacids
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7
Q

Major Proton Pump inhibitors

A
  • OmePRAZOLE
  • EsomePRAZOLE
  • PantoPRAZOLE
  • LansoPRAZOLE
  • DexlansoPRAZOLE
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8
Q

Adverse effects of Proton Pump Inhibitors

A

very well tolerated

Acid rebound is a problem (can persist for several months)

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9
Q

How do you prevent Acid Rebound when discontinuing a proton pump inhibitor

A
  • taper off

- take an Antacid or H2 Blocker (-tidine)

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10
Q

What are some controversial adverse effects of proton pump inhibitors?

A
  • Pneumonia
  • Clostridium difficile
  • Nutritional deficits (vit. B12, Fe3+, Mg2+, Ca2+)
  • Osteoporosis/fractures
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11
Q

When should a proton pump inhibitor be taken?

A

before breakfast

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12
Q

Teaching regarding Proton Pump Inhibitors?

A

Take before breakfast

Don’t crush (delayed release)

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13
Q

Major Histamine-2 Blockers.

A

famoTIDINE

raniTIDINE

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14
Q

Adverse effects of H-2 Blockers

A
  • Tolerance
  • Rebound Effect
  • Confusion (if levels are too high)
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15
Q

Teaching regarding H-2 Blockers?

A

separate antacids (1 hour)

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16
Q

—– works by creating a protective barrier over the ulcer. (think pepto bismal commercial)

A

sucralfate

  • requires pH
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17
Q

—- work by raising stomach pH and require frequent dosing.

A

antacids

18
Q

—– lead to frequent electrolyte and pH changes.

A

antacids

19
Q

Which receptors do antacids work on?

A

none, they are receptorless drugs

20
Q

GERD means:

A

Gastro-esophogeal Reflex Disease

21
Q

In GERD and Erosive Esophagitis, what is the cause?

A

cardiac sphincter (upper stomach sphincter) fails and stomach acid backs up into esophagus (Barrett’s Esophagus)

22
Q

Which bacteria causes most ulcers?

A

helicobactor pylori

causes 60-75% of ulcers

23
Q

Is there any difference b/t esomeprazole and omeprazole?

A

no, they just changed the name to lengthen the patent and make $$

24
Q

MOA: Stomach Acid
Gastrin activates —— receptors and also causes —– cells to activate —— receptors. These actions cause —— to work, increasing stomach —- and decreasing stomach ——.

A 
CCK2
ECL Cells
Histamine 2
H+/K+ ATPase pump
increasing H+ (acid)
decreasing K+
25
Q

MOA: Proton Pump Inhibitors (-prazole)

Blocks the ———– pump, decreasing —– in the stomach, thereby lowering stomach —–.

A

H+/K+ ATPase pump
decreasing H+
lowering stomach acid

26
Q

Why is a -prazole drug better than a -tidine drug?

A
  • prazole blocks the H+/K+ ATPase pump (irreversably)

- tidine only blocks H2 receptors (CCK2 receptors can still be activated and pump can go on)

27
Q

Main adverse effect of -prazole (Proton Pump Inhibitor).

A

Acid Rebound (b/c we’ve been hitting brakes so hard)

28
Q

Main adverse effect of -prazole drugs is —– —–.

How is it managed?

A

Acid Rebound

Managed by:

  • tapering off (instead of cold turkey)
  • antacid or H2 blocker (-tidine)
29
Q

How long will the -prazole drug adverse effect of —– —— last?

A

Acid Rebound

can last for several months

30
Q

What are the controversial effects of -prazole drugs (Proton Pump Inhibitors)?

A
  • Pneumonia
  • Clostridium difficile (bacteria that causes really bad diarrhea)
  • Nutritional deficits
  • Osteoporosis/fractures

These are controversial b/c most patients on PPI are in ICU, and they already had these types of issues to begin with

31
Q

How often, and at what times, should a -prazole be taken?

A

Q day

Breakfast so that it is ready to act when the stomach gets first meal of the day

32
Q

Patient teaching about -prazole meds?

A
  • Don’t crush (they are delayed release)

- Once a day BEFORE breakfast (to maximize effect)

33
Q

Why do we want to take -prazole med before breakfast?

A

it takes 1-2 hours to reach peak effect and the drug can only block the H+/K+ ATPase pump when it’s pumping (ie: when there is food in the stomach)

34
Q

TOLERANCE is an issue w/ which antiulcer meds?

A

Histamine 2 Blockers (-tidine)

because body adjusts and just activates the CCK2 receptor more, eventually recovering to full stomach acid production

35
Q

REBOUND EFFECT is an issue w/ which antiulcer meds?

A
  • prazole (Proton Pump Inhibitors)
  • tidine (H2 Blockers)

Why? remember the BRAKES have been pressed and now they are removed and the body is responding overzealously

36
Q

How long should you separate a -tidine from an antacid?

A

~ 1 hr

antacids decrease absorption of -tidines, thus take -tidine an hour before gives it time to absorb

37
Q

Which med cannot be take with an antacid?

A

sucralfate

it won’t work if taken w/ an antacid b/c antacids raise pH and sucralfate requires a pH

38
Q

Which drug can only be given at a specific pH range?

A

sucralfate

requires pH

39
Q

What does sucralfate do and how long does it last?

A

puts a protective layer (like pepto bismol commercial) over an ulcer

lasts ~ 6 hrs

40
Q

Rolaids and Tums are examples of —– and they work by —– stomach pH.

A

Antacids

raising stomach pH

41
Q

—— are receptorless drugs that work by —— stomach ——-

A

Antacids

raising

pH

42
Q

—— can cause systemic —– in pH, which means what?

A

Antacids

systemic rise in pH

can eventually lead to metabolic alkalosis

Pharm II (37 decks)

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