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