Term
|
Definition
lesion in gastric/duodenal mucosa at site where mucosal epithelium is exposed to acid and pepsin
normal mucosa is protected by mucous and can withstand acid and pepsin attack but excess acid, intrinsic defect of barrier allows ulcers to form |
|
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Term
|
Definition
H. pylori
NSAID
stress related mucosa damage
zollinger ellison (inc gastric acid)
viral: CMV
cocaine: vascular insufficiency
radiation
chemo: hepatic artery insufficiency |
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Term
| explain how acid is releaed in the stomach |
|
Definition
neuron releases ACh which stimulates gastrin release from duodenal G cells.
gastrin stimulates parietal cell in the fundus release of HCl and intrinsic factor
histamine is released from mucosa mast cells via paracrine pathway and stimulates acid release
H/K ATPase on Chief cells secrete pepsinogen against gradient. acid converts pepsinogen to pepsin which digests |
|
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Term
| 3 things that protect us from acid |
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Definition
mucous: secreted from epithelial and mucous cells in stomach, contains bicarbonate
continous cell removal
prostaglandin F2 inhibits acid secretion |
|
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Term
| how does H. pylori cause damage |
|
Definition
colonizes acidic mucosa causing inflammatory gastritis, peptic ulcer, gastric lymphoma, adenocarcinoma
increases HCl secretion
decreases mucosa defenses |
|
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Term
| clinical signs of gastric or duodenal ulcer |
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Definition
| epigastric pain: burning, gnawing, aching |
|
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Term
| what persent of population is infected and what percent develops ulcers from H. pylori |
|
Definition
50% infected
15% get ulcers |
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Term
|
Definition
symptomatic clinical or histological alteration due to gastroesophageal refluc (retrograde acid into esophagus) due to decreased LES pressure
due to acid spending too much time in esophagus not too much acid
causes inflammation and erosive esophagitis |
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Term
| food causes of decreased LES pressure 10 |
|
Definition
carminatives (mints)
chocolate
fat
coffee
cola
tea
citris
tomato
onion
garlic |
|
|
Term
| hormone causes of decreased LES pressure 8 |
|
Definition
CCK
estrogen
gastric acid
gucagon progesterone
PGE
secretin
VIP |
|
|
Term
| drug causes of decreased LES pressure 15 |
|
Definition
anticholinergic
barbituates
BDZ
caffiene
CCB
dopamine
estrogen
EtOH
narcotics
nicotine
progesterone
throphylline
phentolamine
nitrates
isoproterenol |
|
|
Term
| causes of increased LES pressure 10 |
|
Definition
protein meal
gastric alkalinization
gastrin
PGE F2
prokinetics
endorphonium
methacoline
NE
pentagastrin
phenylperine |
|
|
Term
| what are the anatomical changes caused by all the things that change LES pressure allowing GERD 3 |
|
Definition
lower GE sphincter pressure due to...
spontaneous LES relaxations
transient increases in intra-abdominal pressure
atonic LES |
|
|
Term
| what are the 4 aggregating factors causing inflammation and erosive esophagitis |
|
Definition
gastric acid
pepsin
bile
pancreatic enzymes |
|
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Term
|
Definition
esophagitis
strictures
barretts esophagus
anemia |
|
|
Term
|
Definition
heartburn, may radiate to neck
hypersalivation
belching
regurgitation worse after fatty food, laying down, bending over |
|
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Term
|
Definition
nonallergic asthma
chronic cough
horseness
pharyngitis
CP like angina |
|
|
Term
|
Definition
1. remove stress, smoking, NSAIDS
2. remove H. pylori
3. NSAID ulcer treatment
4. relief of symptoms |
|
|
Term
|
Definition
1 PPI + 2 of theses (clathriomycin, amoxicillin, metronidazole, tetracycline)
3 antibiotics may cause better compliance, effectiveness, less resistance |
|
|
Term
| how do we treat NSAID ulcers |
|
Definition
H2 antagonist, PPI, or sucralfate
NSAID discontinuation
PPI causes better ulcer healing |
|
|
Term
| what can be used for PUD symptom relief 3 |
|
Definition
OTC H2 antagonist and antacids
RX PPI |
|
|
Term
| 5 steps in GERD treatment |
|
Definition
1. elevate head when sleeping, protein rich meals, stop smoking and drinking
2. OTC meds
3. perscription H2 antagonist
4. perscription PPI or high dose H2 antagonist
5. surery |
|
|
Term
| what OTC meds can be used for GERD 3 |
|
Definition
antacids
alginic acid
H2 antagonists |
|
|
Term
| how can GERD be prevented 2 |
|
Definition
PPI
ranitidine (only H2 antagonist for erosive esophagitis) |
|
|
Term
| which categories of drugs can be used for both PUD and GERD 3 |
|
Definition
H2 antagonists
PPI
Antacids |
|
|
Term
| which categories of drugs can be used only for PUD 2 |
|
Definition
prostaglandins
antimuscarinic |
|
|
Term
| which categories of drugs can be used olny for GERD 2 |
|
Definition
mucosal protective agents
promotility (prokinetic agents) |
|
|
Term
| 3 H2 receptor antagonists |
|
Definition
it rained on the cement as they family dined
raitidine
cimetidine
famotidine |
|
|
Term
|
Definition
ome es just being ome; lancing raspberries in a pan
omeprazole
esomeprazole
lansoprazole
rabeprazole
pantoprazole |
|
|
Term
| which antipsychotic isnt a PPI |
|
Definition
|
|
Term
| what drug is a prostaglandin |
|
Definition
i missed the prostate and it released prostaglandins
misoprostol |
|
|
Term
| which drug is a antimuscarinic that can be used in PUD |
|
Definition
that dic collected my acid
dicyclomine |
|
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Term
|
Definition
a glince of Al, Mg, Ca, Na, can fix the acid
aglinic acid
aluminum hydroxides
Magnesium hydroxides
calcium carbonates
sodium bicarbonates |
|
|
Term
| 2 mucosal protective agents |
|
Definition
collin bismith sure cared about the fate of his mucous
colloidal bismuth
sucralfate |
|
|
Term
| 1 promotility/prokinetic agent |
|
Definition
i got on the metro and the clomping made my GI turn
metoclopramine |
|
|
Term
| DOC for peptic ulcer and GERD |
|
Definition
|
|
Term
| which PUD/GERD drug promotes healing |
|
Definition
|
|
Term
| DOC for long term hypersecretion conditions (zollinger ellison) |
|
Definition
|
|
Term
| which PUD/GERD drug works on reflux esophagitis |
|
Definition
|
|
Term
| which PUD/GERD drug is also antimicrobial |
|
Definition
|
|
Term
| which PUD/GERD drug used for NSAID ulcer prevention |
|
Definition
|
|
Term
| which PUD/GERD drug used for NSAID ulcer treatment |
|
Definition
|
|
Term
| which PUD/GERD drug cannot be taken with antacids |
|
Definition
|
|
Term
| which PUD/GERD drug is also used in gastroparesis and as antiemetic |
|
Definition
|
|
Term
| MOA H2 receptor antagonist 4 |
|
Definition
blocking H2 in stomach inhibits acid, histamine (and thus HCl), and gastrin secretion
indirectly blocks M receptor and gastrin receptor due to role of histamine in their production |
|
|
Term
| H2 antagonist: administration and excretion |
|
Definition
oral
renal, excreted unchanged |
|
|
Term
|
Definition
| famotidine > ranitidine > cimetidine |
|
|
Term
|
Definition
DOC GERD and PUD
promote ulcer healing (need H. pylori tx or will reoccur) |
|
|
Term
|
Definition
limited H2 function in other tissues causes headache, dizziness, nausea
cimetidine is antiandrogenic (decreases production and blocks receptor) causing glyecomastia |
|
|
Term
| H2 antagonist: interactions 1 |
|
Definition
| cimetidine: P450 inhibitor which potentiates warfarin, diazepam, phenytoin, quinidine, carbamazepine, throphylline, imipramine |
|
|
Term
|
Definition
| H/K ATPase inhibitor inhibits gastri acid secretion by irreversibly inhibiting proton pump |
|
|
Term
| PPI: duration, administration |
|
Definition
oral delayed relase capsule: destoried by gastric acid without gelatin coated capsule which prevents release of drug until intestines which it is rapidly absorbed
actions are long lasting because their irreversible so once daily dosing |
|
|
Term
|
Definition
active ulcers
NSAID ulcers
reflux esophagatis
DOC zollinger ellison / hypersecretion |
|
|
Term
| PPI SE and interactions 5 |
|
Definition
omeprazole: P450 inhibitor increases warfarin, phenytoin, diazepam
3% get nausea, diarrhea, abdominal cholic
colpidogrel decreases drug effect |
|
|
Term
|
Definition
PGE E2 and I2 receptor agonist decreases cAMP and inhbits acid secretion
stimulates mucous and bicarb production |
|
|
Term
|
Definition
prevent NSAID (most selective, not most effective thats PPI)
peptic ulcer (less effective) |
|
|
Term
| misoprostol: pharmacokinetics |
|
Definition
| available in combo with diclofenac (NSAID) |
|
|
Term
|
Definition
diarrhea
abdominal cramps
abortion
premature birth
category X teratogenic birth defect |
|
|
Term
|
Definition
| adjunct to peptic ulcer treatment |
|
|
Term
|
Definition
| M blocker inhibits ACh stimulation of gastric acid secretion |
|
|
Term
|
Definition
| atropine like (Tachycardia, dry mouth, constipation, urine retention) |
|
|
Term
|
Definition
react with gastric acid to make water and salt
reduce pepsin activity by increasing pH
alginic acid: not as effective at neutralizing acid but protects esophageal mucosa |
|
|
Term
|
Definition
heal gastric ulcers
relieve GERD symptoms
AlOH slow relief
MgOH moderate relief
CaCO and NaHCO3 fast relief |
|
|
Term
|
Definition
| binds phosphate causing constipation |
|
|
Term
|
Definition
|
|
Term
|
Definition
systemic alkalosis - alkalinizes urine
liberate CO2 causing burps and farts |
|
|
Term
|
Definition
all have Na so important in HTN and CHF
affect absorption od drugs because they raise pH of stomach and bicarb alkalinizes urine
dont take other drugs +/-2h from antacid |
|
|
Term
|
Definition
requires acid for activation
complex of AlOH and sulfated sucrose binds positive charges in mucosa proteins
creates barrier impairing HCl diffusion and pepsin degradation
stimulates prostaglanding and bicarb release |
|
|
Term
|
Definition
| dont take with antacid, needs acid to activate |
|
|
Term
|
Definition
neutralize gastric acid
bind surface of stomach and create barrier
stimulate mucous and bicarb production
antibacterial on H. pylori |
|
|
Term
|
Definition
black tongue
black stool
increased bleeding time with bismuth subsalicylate (NSAID) |
|
|
Term
|
Definition
stimulate ACh release from enteric neurons increasing GI motility and LES pressure
blocks D2 receptors |
|
|
Term
|
Definition
adjunct to PPI and H2 block in GERD
gastroparesis
antiemetic |
|
|
Term
|
Definition
chronic use >12wk: tarditive dyskinesia
acute use: EPS/pseudo parkinsons |
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