GI & Peptic 1

Question 1

What are the 3 Acid-Peptic Diseases?

Answer 1

• GERD
• Peptic ulcer (gastric & duodenal)
• Stress-related mucosal injury

Question 2

Over 90% of peptic ulcers are caused by what 2 things?

Answer 2

• Helicobacter pylori
• NSAIDs

Question 3

What induced this Peptic Ulcer?

• Chronic
• Site of damage: Duodenum
• Depend on Intragastric pH
• Sxs: epigastric pain
• Ulcer depth: superficial
• Less severe GI bleeding, single vessel

Answer 3

H. pylori

Question 4

What induced this Peptic Ulcer?

• Chronic
• Site of damage: Stomach
• Less dependent on Intragastric pH
• Asymptomatic
• Deep ulcer depth
• More severe GI bleeding, single vessel

Answer 4

NSAID

Question 5

What inuced this Peptic Ulcer?

• Acute
• Site of damage: Stomach
• Less dependent on Intragastric pH
• Asymptomatic
• Most superficial Ulcer depth
• GI bleeding is more severe (superficial mucosal capillaries)

Answer 5

SRMD

(stress related mucosal disease)

Question 6

What are the two MOAs of the two drug classes which treat ulcers?

Answer 6

1. agents that reduce intragastric acidity
2. agents that promote mucosal defense

Question 7

What medication is used for “Esophageal Clearance” to tx GERD?

Answer 7

Bethanechol

Question 8

What medication is used for “Gastric Emptying” for tx of GERD?

Answer 8

Metoclopramide

Question 9

Treatments for “Gastric Acid”

Answer 9

• H2 receptor antagonists
• Proton Pump Inhibitors (PPI)
• Omeprazole

Question 10

What are the 3 receptors in a Parietal Cell?

Answer 10

• Gastrin (CCK-B)
• Histamine (H2)
• Acetylcholine (muscarinic, M3)

Question 11

Acid Secretion

Which neurotransmitter is released from vagal postganglionic nerves?

Answer 11

Acetylcholine

Question 12

What are the 3 agents which reduce Intragastric Acidity?

Answer 12

• Antacids
• H2 receptor antagonists (H2 blockers)
• Proton Pump Inhibitors (PPI)

Question 13

Which Antacid?

• Reacts rapidly with HCL to produce carbon dioxide & sodium chloride
• Adverse effects:
  
  • CO2 gastric distention & belching
  • Unreacted alkali is readily absorbed, potentially causing metabolic alkalosis when given in high doses or to pts w/ renal insufficiency
• Sodium chloride absorption may exacerbate fluid retenion in pts w/ HF, HTN, & renal insufficiency

Answer 13

Sodium Bicarbonate

Question 14

What are 2 examples of Sodium Bicarbonate Antacids?

Answer 14

• Baking soda
• Alka seltzer

Question 15

Which Antacid?

• Less soluble & reacts more slowly w/ HCL to form carbon dioxide & calcium chloride
• Adverse effects:
  
  • belching or metabolic alkalosis
  • excessive doses of either sodium bicarb or calicum carbonate w/ calcium-containing products can lead to hypercalcemia, renal insufficiency, and metabolic alkalosis (milk alkali syndrome)

Answer 15

Calcium Carbonate

Question 16

What are 2 examples of Calcium Carbonate Antacid

Answer 16

• Tums
• Os-Cal

Question 17

Adverse Effects of which antacid?

• no gas is generated, belching does not occur
• metabolic alkalosis is also uncommon because of the
• osmotic diarrhea
• constipation

Answer 17

Magnesium hydroxide or Aluminum hydroxide

Question 18

Antacids should not be given within 2 hours of doses of what 4 medications?

Answer 18

• Tetracycline
• Fluoroquinolone
• Itraconazole
• Iron

Question 19

What are the names of the 4 H2-Receptor Antagonists (H2 Blockers)

Answer 19

• Cimetidine (Tagament)
• Ranitidine (Zantac)
• Famotidine (Pepcid)
• Nizatidine (Axid)

Question 20

Pharmacokinetics of which agent?

• Rapidly absorbed from the intestine
• 1st pass hepatic metabolism

Answer 20

H2-Receptor Antagonists (H2 blockers)

Question 21

Which 3 of the 4 H2 blockers have 1st pass hepatic metabolism?

Answer 21

• Cimetidine
• Ranitidine
• Famotidine

Question 22

MOA of what agent?

• Exhibit competitive inhibition at the parietal cell H2 receptors
• Suppress basal and meal stimulated acid secretion
• HIGHLY selective and do not affect H1 or H3 receptors

Answer 22

H2 Receptor Antagonists (H2 blockers)

Question 23

Which H2 blocker is most potent and which is least potent?

Answer 23

• Most potent: Famotidine
• Least potent: Cimetidine

Question 24

H2 Receptor Antagonists (H2 blockers)

• Prescription doses maintain greater than 50% acid inhibition for how many hours?
• OTC doses have a duration of acid inhibition of less than how many hours?

Answer 24

• Rx: 10 hours
• OTC: <6 hours

Question 25

**Adverse effects of which agent?** –extremely safe drugs –diarrhea, headache, fatigue, myalgias, constipation

Answer 25

H2 blockers

Question 26

**Adverse effects of which agents if given through IV?** –mental status changes •confusion, hallucinations, agitation

Answer 26

H2 Receptor Antagonists (H2 blockers)

Question 27

**Adverse effects of which agent?** •inhibits binding of dihydrotestosterone to androgen receptors –inhibits metabolism of estradiol, and increases serum prolactin levels

Answer 27

Cimetidine (H2 blocker)

Question 28

**Adverse effects of which agent?** –crosses the placenta •administered to pregnant women only if absolutely necessary –secreted into breast milk and may therefore affect nursing infants.

Answer 28

H2 blockers

Question 29

**Drug Interaction of which H2 blocker?** •Interferes (inhibitor) with several important hepatic cytochrome **P450 drug metabolism pathways**,

Answer 29

Cimetidine

Question 30

**Drug Interaction of which H2 blocker?** •binds 4–10 times less than cimetidine to cytochrome P450.

Answer 30

Ranitidine