Upper GI Drugs

Question 1

Name four strategies to treat Peptic Ulcer Disease

Answer 1

Decrease gastric acid production

Neutralize gastric acid

Increase Mucosal Defenses

Eradicate H pylori

Question 2

What is an ECL cell and what does it produce?

Answer 2

EnteroChromaffin- Like cell

Produces Histamine (H2)

Question 3

What three chemicals

cause parietal cells to produce gastric acid?

Answer 3

Gastrin (made in the G cell)

Histamine (made in the ECL cell)

Acetyl Choline (from nerve cells)

Question 4

How does negative feedback work in the stomach as pertains to gastric acid?

Answer 4

Gastric Acid in the antrum enters the D cell causing it to release Somatostatin (which “stops everything”) which enters the receptor on the G cell to stop Gastrin production.

Question 5

What are the three types of medications that reduce gastric acid secretion and which one is irreversible?

Answer 5

H2 Receptor Antagonists are reversible

Proton Pump Inhibitors are irreversible

PGE1 analog (misopristol)

Question 6

Which PUD treatment is “the perfect drug” and why?

Answer 6

PPIs because they only work where they are needed so there are no side effects and are 90-98% effective

Question 7

Which GI drugs should be taken before a meal and which should be taken after a meal? Why?

Answer 7

Antacids after a meal so they wil have some acid to neutralize.

Before a meal: PPIs (before breakfast) and Sucralfate (in order to pre-coat the stomach)

Question 8

What is the treatment coctail to eradicate H pylori?

Answer 8

PPI

Clarithromycin

Metronidazole or Amoxicillin

+/- bismuth subsalicylate

Question 9

Why do some antacids combine Mg(OH)2 and CaCO3?

Answer 9

To balance the side effects:

Mg(OH)2 –> diarrhea

CaCO3 –> constipation

Question 10

Your patient is a 65 year old female with HTN, adrenal insufficiency, kidney disease and heartburn. She asks if its okay to take Pepsid (Famotidine). What is your concern?

Answer 10

H2 antagonists have renal elimination so you need to change the dose accordingly.

Question 11

Your patient has occaisional severe heartburn at night. Which medication do you recommend and why?

Answer 11

H2 blockers/antagonists work best at night because that is when H2 is the primary inducer of acid (less ACh and Gastin)

Question 12

Your patient has early cirrhosis and GERD. What can you recommend to control the acid?

Answer 12

H2 blockers would be better than PPIs because PPIs have hepatic metabolism

Question 13

True or False: Long term use of PPIs increase the risk of pneumonia, infections and carcinoma.

Answer 13

False.

This is a concern, but has not been proven by evidence.

Question 14

PPIs have four proven adverse effects: two are common and two are rare. What are they?

Answer 14

Common:

Increased fracture risk & decreassed B12 absorption

(Due to changes in absorption of Ca++ and B12

in a less acidic environment)

Rare: Decreased Mg++ & increased risk of CKD

Question 15

Which medication is the first choice

to treat Zollinger Ellison Disease?

Answer 15

PPIs

Question 16

Your patient has Afib and is taking warfarin. He also needs an H2 receptor antagonist. Which do you chose and why?

Answer 16

Famotidine is better because is less of an CYP inhibitor than Cimetidine.

Question 17

Which drug is more potent? Cimetidine or Famotidine?

Answer 17

Famotidine is 20-50 times more potent

Question 18

You are doing your clinical rotation at Whitman Walker Clinic. You have a patient who is transgender and transitioning from male to female and needs an H2 blocker .

Which medication is the best choice?

Answer 18

Cimetidine: it has hormonal effects that cause gynocomastia and impotence in men, galactorrhea in women.

Question 19

Why is it contraindicated to take sucralfate simultaneously with an antacid?

Answer 19

Because it needs a low pH to work properly.

Question 20

You prescribed sucralfate to your patient who is taking many other medications. What do you need to explain to the patient?

Answer 20

Take the other medications first and wait two hours before taking the sucralfate. If you take the sucralfate first, you will not be able to absorb your other medications.

Question 21

You are on your pediatrics rotation seeing a 3 year old boy with gastric reflux.

What medication must you tell the parents to avoid?

Answer 21

Pepto Bismol (bismuth subsalicylate)

because when it reacts with stomach acid

it produces salicytic acid (aspirin)

which can cause Reyes Syndrome.

Question 22

Your 35 year old patient has a peptic ulcer and you advise her to take something to bind the ulcer to protect it. What do you recommend?

What is an added bonus to this medicaiton?

What odd side effect should you tell her about?

Answer 22

Bismuth Subsalicilate

Bonus: antimicrobial

Side Effect: blackens tongue and stool

Question 23

Most of the drugs on our list are aimed at reducing stomach acid. Which two also target the enzyme pepsin?

Answer 23

Sucralfate

Bismuth subsalicylate

Question 24

Your patient is 4 months pregnant and suffering from severe heartburn. Which heartburn medication must you avoid?

Answer 24

Misoprostol (PGE1 analog)

It can cause a miscarriage

(It causes uterine contractions

so it is used for abortions and to treat postpartum bleeding)

Question 25

What are the four main MOAs (methods of action)

of metaclopramide?

Answer 25

Increases ACh release in myenteric plexus

Increases smooth muscle response to ACh

Increases esophageal sphincter tone

Decreases pyloric sphincter tone (increasing gastric emptying)

Question 26

Which antiemetic needs to be given BEFORE chemo or surgery to prevent nausea and vomiting?

Answer 26

Odansetron (Zofran)

Question 27

Why is it not a good idea to give Metaclopramide long term?

Answer 27

It is a D2 receptor antagonist resulting in Parkinsonian symptpoms such as tardive dyskenesia

(Black box warning re irreversible muscle spasms)

Question 28

What is the MOA of Odansetron?

Answer 28

5HT3 antagonist

Question 29

What are the side effects of Odansetron?

Answer 29

Constipation

Headache

Question 30

What are the six targets/strategies to treat nausea/vomiting?

Answer 30

5-HT3 receptor antagonists

Central-acting dopamine receptor antagonists

H1 receptor antagonist

Muscarinic receptor antagonist

Neurokinin receptor antagonist

Cannabinoid receptor agonist