Term
| Define Peptic Ulcer Disease |
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Definition
| a chronic recurrent condition defined as epigaztric pain that is associated with hyperacidity |
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Term
| What are Gastric Ulcers associated with? |
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Definition
Normal or Reduced Gastric acid output
Factors:
Altered mucosal resistance may |
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Term
| What are Duodenal Ulcers associated with? |
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Definition
High Gastric Acid output, especially at night
Factors:
Inadequate duodenal bicarbonate secretion and insufficient acid neutralization |
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Term
| What infection is PUD most associated with? |
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Definition
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Term
| What cancers is H. pylori associated with? |
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Definition
Adenocarcinoma of corpus and and antrum
MALT lymphoma |
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Term
| What are the 4 overall goals for treatment of Peptic Ulcer Disease? |
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Definition
Eradication of H. pylori
Relief of symptoms
Healing of ulcerations
Prevention of recurrence and complications |
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Term
| What is the Mechanism of action for Antacids? |
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Definition
weak bases that chmically neutralize acid.
By raising acid pH they prevent the transformation of pepsinogen to pepsin
(Goal to raise gastric pH >4) |
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Term
| What ingredient in antacid causes constipations? |
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Definition
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Term
| What ingredient in antacids cause diarrhea? |
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Definition
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Term
| What are the therapeutic uses of antacids? |
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Definition
Simple Dyspepsia
Adjuncts to primary therapy with H2 blockers or PPI |
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Term
| What is the dosing regimen for Antacids? |
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Definition
Prescrib according to neutralizing equivalents
1hr and 3hr after a meal and at Bedtime |
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Term
| What adverse effects do antacids have? |
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Definition
Can change absorption of other drugs
Do not take antacids within 1-2 hr of other drugs |
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Term
|
Definition
Cimetidine
Ranitidine
Famotidine
Nizatidine |
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Term
| Mechanism of action for H2 Antagonist? |
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Definition
H2 blockers competitively inhibit histamine-mediated acid secretion and also blunt the response to gastrin and Ach
Hight selective for H2 receptors
Inhibit Basal, food stimulated and nocturnal acid secretion
Reduce Volume and Concentraion of secretions |
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Term
| What is the order of relative potency for the H2 antagonist drugs from lowest to highest? |
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Definition
| Raniticine = Nizatidine < Famotidine |
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Term
| What drug interactions do the H2 antagonists have? |
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Definition
| May alter bioavailability of rate of absorption of certain drugs secondary to changes in gastric pH |
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Term
|
Definition
Omeprazole
Rabeprazole sodium |
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Term
| What is the pharmacological effect of Proton Pump inhibitors? |
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Definition
| Inhibit hydrogen ion pump responsible for secreting HCl into the gastric lumen |
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Term
| Which PPI is effective orally and has a long duration of action? |
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Definition
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Term
| What PPI is metabolized by the cytochrome P450 system to a much lower extent? |
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Definition
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Term
| What is the mechanism of action of the PPI? |
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Definition
| covalently modify sulfhydryl groups on proton pump, irreversibly inactivates H+ secretion |
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Term
| What is required for activation of the PPI? |
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Definition
acidic pH
Need to be ionized |
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Term
| Where are the H+K+ATPase pumps that PPIs are selctive for? |
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Definition
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Term
| What are the clinical uses of proton pump inhibitors? |
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Definition
Short-term treatment of active PUD
Managment of Zollinger-Ellison Syndrome
Refractory gastric, esophageal and duodenal ulcers
Management of GERD |
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Term
| T/F a Single daily dose of PPIs is safe and effective even for long term use. |
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Definition
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Term
|
Definition
Bismuth subsalicylate
Sucralfate
Misoprostol |
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Term
| What Cytoprotective agent Enhances secretion of mucus and HCO3 and inhibits H. Pylori? |
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Definition
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Term
| What is the mechanism of Bismuth subsalicylate? |
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Definition
| Chelates with proteins at the base of the ulcer crater and forms a protective barrier against acid and pepsin |
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Term
| What is an effective agent for the treatment of traveler's diarrhea in Mexico? |
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Definition
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Term
| What cytoprotective agent is the only agent that requires an acid pH for maximal activity? |
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Definition
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Term
| What is the mechanism of sucralfate? |
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Definition
| Forms sticky, viscous gel that adheres to gastric epithelial cells protecting them from acid and pepsin |
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Term
| What cytoprotective agent is usually substituted in chronically bedridden patients? Why? |
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Definition
Sucralfate
Works at acidic pH
special value in H2-blocker or PPI-induced pheumonia in bedridden patients
Alkalinization of stomach re-introduces harmful bacteria to the stomach |
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Term
| What cytoprotective agent is used for prevention of ulcers induced by NSAIDs? |
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Definition
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Term
| What is the mechanism of Misoprostol? |
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Definition
| Stimulates mucus and HCO3 production |
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Term
| What intolerable side effects does Misoprostol have? |
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Definition
Diarrhea - 40%
(stimulates uterus) |
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Term
| What cytoprotective agent is a slowly metabolized analog of PGE1? |
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Definition
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Term
| What is the typical treatment regimen for H. Pylori induced PUD? |
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Definition
PPI or H2 Blocker
Bismuth
1-2 antibiotics for 10-14 days |
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Term
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Definition
| conditions associated with involuntary regurgitation of gastric contents particularly at night or when the stomach is full |
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Term
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Definition
repeated transient relaxation of the LES
Incompetence of the LES
delayed gastric emptying
-> impaired resistance of the esophageal mucosa to injury which culminates in erosive esophagitis |
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Term
| What 2 conditions cause a reflux episode to occur? |
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Definition
1. Gastrointestinal contents must be ready to reflux
2. Anti-reflux mechanism at the LES is compromised |
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Term
| What are the 5 postural and dietary therapy steps to GERD? |
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Definition
1. Decrease gastric contents (size of meal)
2. Weight reduction
3. Bed elevation
4. Low fat diet
5. Avoid agents that decrease LES - coffee, peppermint |
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Term
| What classes of drugs are used in the treatment of GERD? |
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Definition
Prokinetic Drugs
Antisecretory Drugs |
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Term
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Definition
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Term
| What do the Prokinetic Drugs do for GERD? |
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Definition
Target physiology of GERD
Improve LES tone and competence
Enhance esophageal clearance
Improve delayed gastric emptying |
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Term
| What is the mechanism of action of Metochlopramide? |
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Definition
| Dopamine2 receptor blockers Within GI tract blockade of D2 receptors increases the local release of acetyl choline via 5HT4-R agonism |
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Term
| What is the main anti-reflux activity of the Prokinetic drugs? |
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Definition
| Enhanced gastric emptying |
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Term
| Side effects of Metochlopramide? |
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Definition
| Tardive Dyskinesia (central dopaminergic antagonism) |
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Term
| What are examples of Antisecretory Drugs used in Treatment of GERD? |
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Definition
| H2 receptor blockers Proton pump inhibitors |
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Term
| What are the Goals in treatment of IBD? |
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Definition
1. control inflammation
2. Reduce morbidity
3. Prevent complications
4. Maintain nutritional status |
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Term
| What drugs are used to control inflammation and immune reponse in IBD? |
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Definition
Prednisone
Other Glucocorticoids |
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Term
| What are the 5-aminoxalicylic acid derivatives, what are they used for? |
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Definition
Sulfasalazine
Dimer 5-ASA Mesalalamine
Local anti-inflammatory agents for IBD |
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Term
| What is an Immune suppressant antimetabolite used in IBD? |
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Definition
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Term
| What monoclonal ab to TNF-alpha is used in the treatment of IBD? |
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Definition
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Term
| When is Infliximab given for IBD? |
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Definition
| Crohn's diesease to mop up TNF-alpha which is thought to be an immunomodulatory cytokine |
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Term
| What is Infliximab generally given with? |
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Definition
immunosuppressive therapy
ie mercaptopurin |
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Term
| What drug used in IBD binds TNF-alpha and prevents it from interacting with receptor? |
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Definition
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Term
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Definition
| fusion protein containing ligand binding protein of TNF-alpha receptor linked to the Fc portion of human IgG1 |
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Term
| What is the etiology of Portal systemic Encephalopathy? |
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Definition
| Consequence of Liver Failure, increased blood ammonia levels |
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Term
|
Definition
Fecal Acidifier and Osmotic laxaitve effect
Acidification of the stool retards the nonionic diffusion of ammonia from colon to blood because NH3 is in the ammonium form which is non diffusable
Lactulose is not absorbed - semisynthetic disaccharide |
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Term
| What does distention of the stomach cause? |
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Definition
| Vagovagal reflex and ENS reflexes |
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Term
| What does the vagovagal reflect stimulate? |
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Definition
| Ach release and GRP release |
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Term
| What 3 things does Ach release cause in the Stomach? |
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Definition
(1) release of gastrin from G cells-> stimulates ECL cells and parietal cells-> release H+
(2)release His from ECL cells-> stimulate parietal cells-> release H+
(3) Direct stimulation of parietal cells-> release H+ |
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Term
|
Definition
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Term
| What does GRP release do? |
|
Definition
Stimulate G cells to release Gastrin->
stimulates parietal cells-> H+
Stimulates ECL cells-> Histamine-> stimulates parietal cells |
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Term
| What does the Cephalic phase cause? |
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Definition
| stimulates the vagovagal reflex |
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Term
| What 3 things stimulate G cells to release Gastrin? |
|
Definition
Ach
GRP
Peptides and Amino Acids (from digestion of proteins) |
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