Term
(Pathogenesis)
What are the four defensive factors associated with PUD? |
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Definition
-Mucus:protects cells from pepsin and acid
-Bicarbonate:Neutralizes h+ ions which penetrate mucous
-Blood flow:maintains mucousal integrity
-**Prostagladins:stimulate secretion of mucus and bicarbonate ions and promote vasodilation |
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Term
(Pathogenesis)
What are the five aggressive factors associated with PUD? |
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Definition
-Helicobacter Pylori:60-75% in ppl with PUD (MO: urea is converted to CO2 & NH4 by urease)
-NSAIDS: underlying cause for gastric and some duodenal ulcers
-Gastric Acid: activates pepsin(proteolytic enzyme)
-Pepsin
-Smoking:delays healing and increases recurrence |
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Term
| What are the three goals of PUD treatment? |
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Definition
1.Alleviate Symptoms
2.Promote Healing
3.Prevent Complications |
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Term
| What are the four classes of drugs used in PUD treatment? |
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Definition
1. Antibiotics
2.Antisecretory: histamine receptor antagonists and proton pump inhibitors
3.Mucosal Protectants
4.Antacids |
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Term
| In what ways do drugs promote ulcer healing? |
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Definition
1. Rid H.Pylori
2. Reduce Gastric acidity
3.Enhance mucosal defenses |
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Term
| What is the preferred treatment for a +60 pt with hx of ulcers, taking high-dose NSAIDs? |
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Definition
| Histamine2 receptor Antagonists & Proton Pump Inhibitors |
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Term
| What four tests are performed to detect H. Pylori? |
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Definition
1.Endoscopic Biopsy
2. Breath:urea + urease = CO2 by product
3.Serologic tests
4. Stool Tests |
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Term
|
Definition
-MO: topical to distrupt cell wall
-SE: black tongue and stool |
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Term
|
Definition
-MO:works w/in the cell to distrupt protein synthesis
-SE: taste distortion, GI upset
DOC Antibiotic H. Pylori induced PUD |
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Term
|
Definition
-MO:distrupts cell wall
-Works best at neutral pH
DOC H.Pylori induced PUD |
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Term
|
Definition
-MO:works w/in the cell to disrupt protein synthesis
-SE: discoloration of developing teeth
Contraindicated in pregnant, children < 6 yrs old AND photosensitivity |
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Term
|
Definition
-effective with sensitive strains
-40% are resistant
-SE:severe N&V when taken with alcohol |
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Term
| What are the characteristics of the antibiotic regimine? |
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Definition
- should include 2 antibiotics and 1 anti secretory
-14 days of therapy to eradicate |
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Term
| What is the DOC for gastric and duodenal ulcers and what is the MO? |
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Definition
Histamine-2 Receptor Antagonists
-MO: block receptors which stimule gastric acid secretion, reducing gastric juice and h+ ion concentration |
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Term
Cimetidine(Tagamet)
Uses?
SE?
Drug-Interactions? |
|
Definition
-Gastric and Duodenal ulcers
-GERD
-Zollinger-Ellison Syndrome
-SE: CNS(elderly with renal or hepatic impairment), Pneumonia(increased risk of colonization)
-Interactions: inhibits Cytochrome P450 enzymes |
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Term
|
Definition
-Similar to Cimetidine
-More potent, fewer SE & D-I's |
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Term
| Ranitidine Bismuth Citrate |
|
Definition
Only for duodenal associated with H. Pylori, walys with clarithromycin
-ranitidine supresses gastric secretions and bismuth kills h pylori |
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|
Term
| What h-2 blocker meds are similar to ranitidine? |
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Definition
| Nizatidine(Axid) & Famotidine(Pepcid) |
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|
Term
| What is the MO and indicated use of PPI's? |
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Definition
MO: irreversible inhibition of gastric acid generating enzyme
Indications: Gastric,Duodenal, and GERD |
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Term
|
Definition
-PO,before meals
-short term for ulcers and GERD
-Long term for hypersecretory conditions |
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Term
| Esomeprazole(Nexium), Lansoprazole(Prevacid), Pantoprazole (Protonix |
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Definition
- Esome: S-isomer of omeprazole
SIMILAR TO OMEPRAZOLE (PRILOSEC)
PPI's! |
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Term
|
Definition
-Similar to Omeprazole
-MO: REVERSIBLE inhibition of acid generating enzyme
-DI: increases digoxin levels by 20% |
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Term
| What are the three "other" Anti-ulcer Drugs? |
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Definition
| Misoprostol, Antacids, and Sucralfate |
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Term
|
Definition
-"other" anti-ulcer drug
-MO: promotes healing by creating protective barrier against acid and pepsin
-May alter other drug absorption |
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Term
|
Definition
-PO
-MO: supress gastric secretion, promote bicarbonate and mucus, maintain blood flow
-Indication: use for long-term NSAID induced ulcers
Contraindicated with Pregnancy |
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Term
|
Definition
Indications: PUD and GERD
-MO: raises pH ,symptom relief only
-SE: constipation and diarrhea, high Na concentration may exacerbate hypertension nad heart failure |
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Term
| What are the four major groups of antacids? |
|
Definition
1. Al
2. Mg **Constipation**
3. Ca
4. Na **hypertension/HF** |
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