Term
Aggressive Factors for PUD
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Definition
Aggressive Factors
Gastric acid, Pepsin, Bile acids, Helicobacter pylori, NSAIDs, Smoking, Steroids, Stress
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Term
| Protective Factors for pelvic ulcerative disease (PUD) |
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Definition
Protective Factors
Bicarbonate, Mucus, Mucosal blood flow, Prostaglandins
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Term
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Definition
Discontinue medications if possible that exacerbate condition
No smoking/ETOH
Avoid spicy/acid foods, black pepper, small frequent meals
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Term
| Treatment of PUD: Medications |
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Definition
H2 Blockers
Antisecretory and cytoprotective
Cytoprotective agents
Antacids
Antibiotics for H. Pylori
Treat stress
Antidepressants?
Surgery
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Term
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Definition
| sucralfate, bismuth compounds, prostaglandins |
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Term
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Definition
| antibiotics, bismuth compounds |
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Term
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Definition
| NaHCO3, CaCO3, Mg(OH)2, Al(OH)3 |
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Term
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Definition
| NaHCO3, CaCO3, Mg(OH)2, Al(OH)3 |
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Term
Acid secretion reducers:
-proton pump inhibitor:
-Muscarinic antagonist:
-H2 antagonist: |
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Definition
-proton pump inhibitor: omeprazole
-Muscarinic antagonist:prenzepine
-H2 antagonist: cimetidine, ranitine, famotidine, nizatidine |
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Term
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Definition
-H2 receptor blockers competitively inhibit histamine binding at H2 receptors
-No effect on H1 or H3 receptor-mediated actions
-Primary effect is on parietal cells of the stomach which produce acid in response to histamine
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Term
Mechanism of action of H2 antagonists:
-Block acid secretion stimulated by
-Single dose reduces 90% of |
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Definition
-Block acid secretion stimulated by
Histamine
Gastrin
Cholinomimetic drugs
Vagal stimulation
-Single dose reduces 90 % of
Basal
Food-stimulated
Nocturnal acid secretion
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Term
| Clinical Effects of H2 Antagonists |
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Definition
Relief symptoms
Promote healing
For short-term management active duodenal and gastric ulcers
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Term
| Adverse Effects of Cimetidine |
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Definition
CNS effects
-Slurred speech, delirium, confusion
Endocrine effects
-Binds to androgen receptors
Gynecomastia, reduced sperm count (males)
Galactorrhea (women)
-Inhibition of cyt p450 (1A2, 2C9, 2D6, 3A4)which increase effects of quinidine, phenytoin, warfarin, TCA
-hepatic blood flow
-Blood dyscrasias
Agranulocytosis
Aplastic anemia
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Term
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Definition
Weak bases, neutralize gastric acid
Reduce activity of pepsin (inactive at pH>4)
Reduce H. pylori colonization
Stimulate prostaglandins synthesis
Avoid other drugs within 1-2 hrs of adm
Should be given 1 to 3 hrs after meals and at bedtime
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Term
| Antacids decrease absorption of |
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Definition
| Digoxin, tetracycline, INH |
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Term
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Definition
Examples:
Sucralfate
Aluminum sucrose sulfate
Binds to necrotic ulcer tissue, forming barrier to acid and pepsin
Stimulates release of
Prostaglandin
Mucus
Bicarbonate
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Term
| Clinical effects of Sucralfate |
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Definition
Effective for long-term maintenance therapy
Prevent ulcer recurrence
Requires acid pH for activation
Should not be administered with H2 antagonists or antacids
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Term
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Definition
Misoprostol – analog of PGE1
Cytoprotective Agent
Inhibits gastric acid secretion
Stimulates secretion of mucus and bicarbonate
Effective for prevention of gastric ulcers induced by NSAIDs
Contraindicated in pregnancy
Can cause diarrhea
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Term
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Definition
Bismuth subsalicylate
cytoprotective agent
Antimicrobial activity
Inhibit activity of pepsin
Increase mucus secretion
Interacts with protein in necrotic mucosal tissue to coat and protect ulcer crater
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Term
Omeprazole, lansoprazole, esomeprazole
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Definition
Proton Pump Inhibitors
Prodrug, activated at acid pH
Irreversible inhibitor of H+-K+ ATPase proton pump of parietal cells
Effective for duodenal and gastric ulcers, GERD (short-term), Zollinger-Ellison syndrome (long-term)
Low toxicity
Large doses produce carcinoid tumors in rats
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Term
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Definition
Recommended for patients with PUD who are infected with Helicobacter pylori
Reduces rate of recurrence of ulcer
A two-week therapy with
-Bismuth + metronidazole + tetracycline or
-Clarithromycin + omeprazole
-Metronidazole or amoxicillin + clarithromycin + PPI (FDA recommendation)
A ten-day therapy with
Clarithromycin + ampicillin + omeprazole
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Term
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Definition
Poor esophageal clearance
Incompetent lower esophageal sphincter (LES)
Inappropriate transient relaxations
Abnormal basal pressure
Delayed gastric emptying
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Term
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Definition
Obesity
Smoking
Alcohol consumption
Diet (coffee, tea, chocolate, fatty foods, spicy foods)
Genetic
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Term
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Definition
Improve LES function
Increase esophageal clearance
Decrease volume and acidity of reflux
Protect esophageal mucosa
Two approaches
-“Step up”—from antacids, H2blockers, PPI
-“Step down” from PPI, H2 blockers, antacids
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Term
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Definition
Heartburn
Acid regurgitation
Difficulty in swallowing
Mouth filled with saliva
Chest pain
Sensation of object in throat
Asthma
Bronchitis
Hoarseness
Symptoms can lead to weight loss, vomiting of blood and anemia
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Term
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Definition
STAGE I – lifestyle modifications
STAGE II – pharmacotherapy
STAGE III – surgery
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Term
| Lifestyle Modifications include: |
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Definition
Elevation of the head of the bed
Cessation of cigarette smoking
Avoidance of foods that decrease LES pressure (coffee, tea, chocolate, fatty foods, onions, peppermint)
Avoidance of foods that cause topical injury to the mucosa (alcohol, spicy foods)
Avoidance of drugs that decrease LES pressure (theophylline, calcium channel blockers)
Avoidance of drugs that cause topical injury to the mucosa (quinidine, potassium chloride, NSAIDS
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Term
| Prokinetic agents used in the pharmacologic treatment of GERD |
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Definition
Prokinetic agents – metoclopramide, bethanechol)
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Term
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Definition
Increases LES pressure
Increases the force of esophageal peristalsis
Increases the rate of gastric emptying
Increases motility of the small intestine
Does not stimulate gastric acid secretion
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Term
| Metoclopramide uses and side effects |
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Definition
Therapeutic uses
GERD
Antiemetic (during cancer chemotherapy)
Gastric atony (gastroparesis)
Prevention of aspiration during surgery
Adverse effects
Sedation
Parkinsonism
Tardive dyskinesia
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Term
| Antiemetic Agents 5-HT3 Receptor Antagonists |
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Definition
5-HT3 Receptor Antagonists (ondansetron, granisetron)
Effective for chemotherapeutic agents, postoperative or postradiation induced vomiting
Not useful for motion sickness or nausea of vertigo
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Term
| Antiemetic Agents: Dopamine Antagonists |
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Definition
Dopamine Antagonists (droperidol, promethazine, prochlorperazine, metoclopramide)
Useful for chemotherapy-induced nausea and vomiting and postoperative nausea
Side effects include sedation, Parkinson syndrome
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Term
| Antiemetic Agents: 5HT3 Receptor Antagonists |
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Definition
5-HT3 Receptor Antagonists (ondansetron, granisetron)
Effective for chemotherapeutic agents, postoperative or postradiation induced vomiting
Not useful for motion sickness or nausea of vertigo
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Term
Antiemetic Agents: Anticholinergic Agents (scopolamine)
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Definition
Effective for nausea associated with motion sickness or vertigo
Administered via a transdermal patch
Side effects include dry mouth, blurred vision, drowsiness
Contraindicated in glaucoma and prostatic hypertrophy
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Term
Histamine H1 antagonists (cyclizine, diphenhydramine)
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Definition
Antiemetic Agents
Useful for nausea associated with motion sickness or vertigo
Side effect includes sedation
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Term
Benzodiazepines (lorazepam, diazepam)
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Definition
Antiemetic Agents
Administered prior to chemo- or radiotherapy to reduce anticipatory vomiting
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Term
Corticosteroids (dexamethazone, prednisolone)
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Definition
Corticosteroids (dexamethazone, prednisolone) for nausea and vomiting associated with chemotherapy
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Term
| Dronabinol (delta-9-tetrahydrocannabinol) |
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Definition
| used as an antiemetic agent and stimulates appetite. |
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