Term
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Definition
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Term
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Definition
bicarbonate and mucus secretion prostaglandin formation |
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Term
__________ and ________ inhibit prostaglandin synthesis |
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Definition
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Term
Which COX-2 selective inhibitor has a lesser incidence of causing PUD? |
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Definition
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Term
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Definition
aspirin, NSAID use alcohol (in excess) smoking H. pylori infection |
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overall goals of therapeutic strategies |
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Definition
relief of symptoms healing of ulcers prevention of recurrence prevention of complications reduce aggressive factors increase protective factors |
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Definition
inhibit H+,K+,-ATPase proton pump by covalently binding to it |
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Term
PPIs _________ modify sulfhydryl groups on the proton pump which __________ inactivates H+ secretion. |
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Definition
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Term
Why does a PPI need to be taken 30-60 min before a meal? |
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Definition
works best on actively secreting pumps |
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Term
PPIs have a _________ mechanism. |
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Definition
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Term
Enteric coating--release of prodrug in intestine
at neutral pH of intestine, prodrug is chemically stable, lipid soluble, and devoid of inhibitory activity
neutral weak base absorbed and carried by blood stream to parietal cells in stomach, diffuse into secretory canaliculi, acid pH causes protonation and trapping of drug near proton pump |
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Definition
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Term
Which PPI may reduce the metabolism of phenytoin, warfarin, and diazepam? |
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Definition
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Definition
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Definition
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Definition
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dexlansoprazole (Kapidex, Dexilant) |
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Definition
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Definition
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Definition
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Definition
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Why are PPIs considered better drugs than H2 blockers? |
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Definition
H2 blocker significantly reduces the amount of acid throughout the day, but PPI keeps acid almost flat-lined. |
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Term
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Definition
duodenal and gastric ulcers GERD stress ulcers hypersecretory states preanesthetic to reduce the danger of aspiration pneumonitis |
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Term
Histamine activates ______________________ on parietal cells and stimulates ____________ activity and acid secretion into the lumen. |
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Definition
H2 subtype of receptor; H+,K+,-ATPase |
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Term
H2 blocker mechanism of action |
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Definition
competitively inhibits histamine-mediated acid secretion
blunts the response to gastrin and ACh |
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Term
Classic antihistamines, H1 blockers, do/do not inhibit acid secretion. |
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Definition
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Term
H2 blockers inhibit ______, _______, and ________ acid secretion. |
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Definition
basal; food-stimulated; nocturnal |
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Term
H2 blockers reduce both... |
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Definition
volume and H+ concentration of gastric secretions |
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Term
H2 blockers are equally ___________ but differ in ________. |
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Definition
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Term
Which H2 blocker inhibits the activity of CYP450? |
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Definition
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Term
If drug interactions need to be avoided, which H2 blocker should not be chosen? |
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Definition
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Term
standard treatment for PUD not associated with H. pylori |
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Definition
PPI--1 hr before first and second meal for 2 months
H2 blocker--at bedtime (if breakthrough symptoms)
reduce PPI to once daily until all symptoms are gone |
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Term
triple therapy for H. pylori |
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Definition
PPI (BID) clarithromycin (BID) (or metronidazole) amoxicillin (BID) (or metronidazole)
14 days |
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Term
quadruple therapy for H. pylori |
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Definition
PPI (BID) tetracycline (QID) metronidazole (TID/QID) pepto-bismol (QID)
14 days |
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Term
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Definition
Prevacid (lansoprazole) PPI clarythromycin amoxicillin
combo drug used to treat H. pylori |
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Term
advantages/disadvantages of quadruple therapy for H. pylori |
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Definition
less expensive, but compliance issues |
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Term
Why do you need to wait one week after stopping PPI to retest for H. pylori? |
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Definition
PPI can cause false positive on stool antigen test |
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Term
What should be done for a patient taking a PPI for GERD if they are planning on traveling out of the country? |
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Definition
cut the dose in half (one every other day) |
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Term
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Definition
simple dyspepsia adjuncts to primary therapy with PPIs or H2 blockers primary therapy in uncomplicated GERD |
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Term
antacid mechanism of action |
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Definition
weak bases that chemically neutralize acid
goal is to raise gastric pH above 4 |
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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major side effect of aluminum hydroxide |
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Definition
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Term
major side effect of magnesium hydroxide |
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Definition
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Term
Why are combinations of aluminum and magnesium hydroxides the most popular antacids? |
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Definition
combo minimizes disturbance of bowel motility |
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Term
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Definition
1 and 3 hrs after a meal and at bedtime |
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Term
adverse effects of antacids |
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Definition
changes in bowel motility alkalosis |
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Term
drug interactions with antacids |
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Definition
significant effects on the absorption of other drugs
do not take within 1-2 hrs of other drugs! |
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Term
What can occur with discontinuation of antacids? |
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Definition
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Term
mechanism of action for pepto-bismol |
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Definition
-enhances secretion of mucus and HCO3- -inhibits pepsin activity -chelates with proteins at the base of ulcers and forms a protective barrier against acid and pepsin -may inhibit H. pylori |
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Term
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Definition
effective adjunct for treatment and prophylaxis of duodenal and gastric ulcers, GERD, and diarrhea |
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Term
pepto-bismol side effects |
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Definition
black tarry stools blackened tongue (with long-term use) |
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Definition
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mechanism of action for 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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Definition
1 hr before meals and at bedtime promotes healing |
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Definition
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mechanism of action for misoprotol |
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Definition
slowly metabolized analog of PGE1 stimulates mucus and HCO3- production |
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Term
Misoprostol is primarily used for patients who must use ________. |
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Definition
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Term
Misoprostol causes _________ in 30% of patients. |
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Definition
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Term
misoprostol contraindications |
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Definition
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Term
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Definition
5-HT3 antagonist antiemetic |
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Term
5-HT3 antagonists are most effective when combined with... |
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Definition
corticosteroid therapy (short-term)--dexamethasone |
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Term
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Definition
neurokinin 1 receptor antagonist antiemetic |
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Term
primary use of aprepitant |
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Definition
combo with 5-HT3 antagonist and corticosteroid for prevention of chemotherapy induced nausea and vomiting |
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Definition
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Term
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Definition
D2 antagonist antiemetic and promotility agent |
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Term
Which D2 antagonist is also a weak 5-HT3 antagonist? |
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Definition
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Definition
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Term
dimenhydrinate (Dramamine) |
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Definition
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Definition
antimuscarinic agent patch for motion sickness |
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Definition
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Definition
chemotherapy-induced nausea and vomiting appetite stimulant |
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Term
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Definition
euphoria dysphoria sedation hallucinations |
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Term
indications for antiemetics |
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Definition
motion sickness and vertigo postoperative recovery pregnancy cancer chemotherapy migraine |
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Term
metoclopramide mechanism of action as promotility agent |
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Definition
increases esophageal peristalsis increases LES pressure promotes gastric emptying
no effect on small intestine or colon |
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Term
metoclopramide side effects |
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Definition
hyperprolactinemia anxiety depression tardive dyskinesia (typically limited to 2 week course) |
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Term
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Definition
macrolide antibiotic that promotes motility (acts on motilin receptor) |
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Term
Erythromycin is used for __________, but tolerance develops. |
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Definition
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Term
Why are macrolide antibiotics used in acute GI hemorrhage? |
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Definition
promote emptying of gastric blood before endoscopy |
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